Amenorrhoea and other menstrual symptoms in student nurses

Menstrual Distress and Sex-Role Attributes

The relationship between severity of menstrual distress, measured by the Moos Menstrual Distress Questionnaire, and sex-role attributes, measured by the Bem Sex-Role Inventory, was examined for a group of 103 undergraduate women. Data were compared for women using and not using oral contraceptives and for women from different religious groups. Because trait anxiety, as measured by a 28-item short form adapted from the Taylor Manifest Anxiety Scale, was significantly correlated with menstrual distress, first-order correlations between distress and sex-role attributes partialled out anxiety scores. Although none of the sex-role attributes was significantly related to distress for the entire group or for the group of women using the pill, a significant positive relationship between masculinity and menstrual distress was noted for the group of women not using the pill. The pattern of results suggested that although sex role attributes and anxiety are related to reports of menstrual distress for Catholic women, only anxiety is associated with distress for Jewish women, and neither sex-role attributes nor anxiety is correlated with distress for Protestant women.

The etiology of some menstrual disorders: a gynecological and psychiatric issue

Some menstrual disorders with distinct gynecological character such as amenorrhea or menometrorrhagia (MMR) may have psychogenic etiology. On the other hand, in menstrual psychosis (MP), a distinctly psychiatric disorder, the etiology is not necessarily psychogenic, but rather is hormonal-biological. We present 4 cases, one each of primary and secondary amenorrhea, MMR, and MP, respectively. In the first 3 cases (2 amenorrhea and 1 MMR), we found psychogenic factors: an insult to feminine development after rape (case 1) or marriage problems (cases 2 and 3). In the case of a recurrent MP, no relevant psychological etiology was found. Furthermore, some of the patient's relatives had menstrual or peripartum psychiatric disorders. Menstrual disorders' etiology can be psychogenic or hormonal. The correct etiology is the guide for the adequate therapeutic way: psychotherapy based in psychogenic disorders and neuroleptic or antiovulatory drugs in those of biological etiology.

Menstrual irregularity and menstrual symptoms

The authors examined whether women with irregular cycles showed more symptoms of menstrual distress than women with regular cycles. One hundred fourteen college women prospectively recorded the dates of 6 to 8 menstrual cycles and replied to a menstrual-symptoms questionnaire. The researchers cross-classified regularity and irregularity, by the women's self-definitions (questionnaire data) and by objective criteria (based on the respondents' prospective recordings of their menstrual data). The results showed that women with irregular cycles experienced twice as many menstrual symptoms as women with regular cycles. The use of a more valid criterion for menstrual irregularity revealed that women with irregular cycles suffered more menstrual distress than did women with regular cycles.

Menstrual and premenstrual issues in female military cadets: a unique population with significant concerns

CONTEXT

There is a strong need to determine what effect, if any, menstruation has on the performance of duty as a Cadet at the United States Military Academy (USMA) at West Point, and to determine what impact, if any, the USMA environment has on the menstrual cycle.

STUDY OBJECTIVES

To study menstrual function and premenstrual symptoms in a structured, rigorous military environment; determine the perceived impact of menstrual and premenstrual symptoms on academic, physical, and military activities; and evaluate the difficulties inherent to menstruation in a military setting.

DESIGN, SETTING, AND PARTICIPANTS

A survey about high school menstrual and premenstrual function, and the Premenstrual Assessment Form (PAF), were completed by all 158 freshman female Cadets in July 1991. In May 1992, 83 participants completed a survey assessing menstrual and premenstrual symptoms, including interference with activities during the year.

MAIN OUTCOME MEASURES

Menstrual regularity, premenstrual symptoms, interference with activities.

RESULTS

Participants reported menstrual patterns and premenstrual symptoms in high school similar to other females their age. Most (62%) predicted a change in menstruation at the USMA, half were worried that physical symptoms would interfere with activities, one-fourth were worried that premenstrual symptoms would interfere with activities, and one-fourth were worried that obtaining and changing menstrual materials would interfere with activities. Almost all respondents (91%) reported changes in menstruation during the year, most commonly less regular, less frequent, shorter, lighter, and less crampy periods. Menstrual and premenstrual symptoms interfered with physical activities (66.2%, 61.4% respectively) more so than academic (50.6%, 45.7% respectively) or military activities (39.8%, 47.0% respectively). Female Cadets described significant difficulties with changing (62.6%), obtaining (51.8%), and disposing of (38.5%) menstrual materials.

CONCLUSIONS

The data demonstrate major changes in menstrual function in over 90% of female Cadets; a significant perceived impact of menstrual and premenstrual symptoms on academic, physical, and military activities; and difficulties in obtaining, changing, and disposing of menstrual materials in a military setting. These findings have implications for females in the military, as well as for young women generally.

Severity of osteopenia in estrogen-deficient women with anorexia nervosa and hypothalamic amenorrhea

Reduced bone density is observed in over half of women with anorexia nervosa (AN), in whom the risk of fracture is significantly increased even at a young age. It is unknown to what extent low bone density in AN differs from other conditions of premenopausal osteoporosis and is related to estrogen deficiency and/or other factors, such as nutritional status. We therefore investigated bone loss in nutritionally replete and nutritionally deplete amenorrheic women by comparing patients with AN (n = 30) to age-matched subjects with hypothalamic amenorrhea (HA; n = 19) in whom duration of amenorrhea, prior estrogen use, and age of menarche were comparable. Healthy, age-matched, eumenorrheic women were studied as a control group (NL; n = 30). Weight and nutritionally dependent factors including (body mass index, 20.7 +/- 0.3 vs. 16.7 +/- 0.3 kg/m2; P < 0.0001), insulin-like growth factor I (270 +/- 18 vs. 203 +/- 17 ng/mL; P < 0.01), percent body fat (26% vs. 19%; P < 0.0001), and lean body mass (38.7 +/- 1.1 vs. 34.3 +/- 0.8, P < 0.01) were significantly different between the HA and AN groups, respectively. The bone densities of the anterior-posterior (AP) spine, total hip, and total body measured by dual energy x-ray absortiometry were reduced in both amenorrheic groups compared to those in control subjects, but were significantly lower in women with AN than in those with HA. The t scores for AP spine and hip were -1.80 +/- 0.15 (AN), -0.80 +/- 0.22 (HA), and 0.28 +/- 0.19 SD (NL) for the AP spine and -1.62 +/- 0.17 (AN), -0.51 +/- 0.21 (HA), and 0.25 +/- 0.16 (NL) for the total hip, respectively (P < 0.01 for all comparisons). Among the amenorrheic subjects, duration of amenorrhea, age of menarche, and N-telopeptide were inversely correlated with bone density at all sites, whereas body mass index, insulin-like growth factor I, lean body mass, and fat intake were positively correlated with bone density at all sites measured. In multivariate regression analyses, bone density was most significantly related to lean body mass (P = 0.05 and P = 0.03 for the spine and hip, respectively), but not to the duration of amenorrhea or other indexes of estrogen status among patients with AN. In contrast, bone density of the lumbar spine was significantly related to weight and duration of amenorrhea among patients with HA. These data demonstrate that the severity of osteopenia in AN is greater than that in patients with HA and is critically dependent upon nutritional factors in addition to the degree or duration of estrogen deficiency itself. Lean body mass, independent of the duration or severity of estrogen deficiency, is an important predictor of bone loss among women with AN.

Late adolescent outcome of early onset anorexia nervosa

Forty-three young female patients admitted consecutively to hospital with anorexia nervosa (AN) were re-evaluated in late adolescence an average of 4.3 years following initial presentation. Follow-up interviews were conducted individually by a paediatrician and a psychiatrist on 32 of the original 43 patients (mean age 18.3 years) with outcome assessed by multidimensional physical, menstrual, eating behaviour, psychosocial and global outcome criteria. Physical outcome, as assessed by validated indices of body adiposity, was within the normal range (3-97th percentiles) in 94% of the 32 patients seen at follow-up, although only 56% reported regular cyclical menstrual function. Good physical outcome, however, was not necessarily predictive of successful adjustment in other areas. Eating behaviour was unequivocally normal in only 25% of patients, with a majority still dieting, binging or vomiting with meals, Psychosocial adjustment was satisfactory in the majority of cases but varied widely. Univariate and multivariate statistical analysis identified higher premorbid and admission body mass index (BMI) percentiles, a family history of obesity and shorter duration of illness on admission as significant prognostic indicators of favourable physical outcome. Although girls who develop AN in early adolescence are generally thought to have a favourable long-term prognosis, health professionals need to be aware that these patients form a heterogeneous group and may have considerable ongoing physiologic and psychologic disturbance despite normalization of body mass.

Secondary amenorrhea: two kinds of psychogenic disorder--a case report

A brief review of the limited sources in the literature on secondary amenorrhea indicates that this symptom may, in many cases, be psychogenic in origin. The disorder in such instances is often short term, spontaneously reversible, and occurs as a reaction to stress or a traumatic event. Most of these women are basically healthy, psychologically speaking. In some cases, however, this menstrual disturbance may continue for months or longer. In such instances, one may expect to find a neurotic conflict related to feminine identity as the cause. The therapeutic approach in these two alternative forms of secondary psychogenic amenorrhea (SPA) will differ; hence, it is essential that the gynecologist and psychiatrist distinguish between them. A case illustration is presented, describing in detail the treatment of a women with longstanding SPA which resolved with dynamically-oriented psychotherapy.

Current perspectives on the eating disorders: I. History, psychological and biological aspects

An ongoing, major effort in psychiatry throughout the 1980s has been the study of anorexia and bulimia. In spite of ample effort on the part of researchers and clinicians, the etiology of these disorders remains elusive. Because of the multiple biological, sociocultural, and psychological forces involved and the early genesis of the disorder, an understanding of the eating disorders is tantamount to an appreciation of the developmental process itself. Part I of this paper presents a historical view of the eating disorders and reviews recent progress in classification criteria, epidemiology, biology, psychology, developmental, and analytic theory. Part II will focus on treatment, outcome, and research priorities.

Low profiles of salivary progesterone among college undergraduate women

High incidences of amenorrhea and oligomenorrhea are often found among late adolescent, college-aged women. We studied menstrual profiles of salivary progesterone in 17 undergraduate women (average age 20.2 years) who were experiencing regular menstrual cycles, and compared the results with similar data obtained from older women, both recreational runners (30.7 years) and nonexercising controls (29.3 years), to see whether this late adolescent population showed evidence of compromised luteal function not manifested by menstrual irregularity. The profiles obtained from the undergraduates and the older women were similar in shape but different in level. The undergraduate profiles were significantly lower than the controls (average progesterone level during the luteal phase, 154 +/- 14 versus 287 +/- 30 pmol/L; peak progesterone level, 352 +/- 35 versus 655 +/- 46 pmol/L; mean +/- SE, p less than 0.01), and remained at a significantly elevated level for fewer days (1.3 +/- 0.4 versus 4.5 +/- 0.6 days, p less than 0.01). The undergraduates were more comparable in all measures to the older women runners; however, reported exercise and weight differences did not account for the low levels in the undergraduates. We suggest that the low progesterone levels in the undergraduates reflect an extended process of ovarian maturation that does not culminate until the mid to late twenties.

Ovulatory disturbances. Causative factors among Japanese student nurses in a dormitory

The incidence of ovulatory disturbances in student nurses living in a restricted circumstance was evaluated by observing a basal body temperature (BBT) chart recorded for three to nine months by all of the student nurses in our medical college. The students were 18-21 years of age and were all living in a school dormitory. One hundred of the 154 students (64.9%) were anovulators during the school term. However, 40 of the anovulators showed ovulatory cycles with biphasic BBT patterns during their spring and/or summer holidays. The subjects' living conditions were investigated by questionnaire. Age of menarche, sport activity, self-perceived physical and mental work load, and native region did not appear to be related to their ovulatory disturbances. Weight-height-derived indices indicated that the anovulators had a tendency to corpulence as compared to the regular ovulators. Serum luteinizing hormone, follicle stimulating hormone, and prolactin levels of the anovulators were not significantly different from the regular ovulators.

Menstrual dysfunction in cystic fibrosis

Several factors potentially involved in the menstrual dysfunction of some females with cystic fibrosis were analyzed by a retrospective chart review. The mean age of menarche for the cystic fibrosis patients was 14.4 years, compared to 12.9 years for American females (p less than 0.001). At last evaluation, comparison of the mean figures for amenorrheic patients and for menarchal cystic fibrosis patients reveals statistically significant differences in the age of diagnosis, weight-height index, weight, height, percent of body fat, weight percentile, and height percentile. The highest correlative was weight (r = 0.59). Of our cystic fibrosis patients who were menarchal, 95% had a weight greater than 82 pounds, whereas 75% of those who were amenorrheic weighed less than 82 pounds. Menstrual irregularities, sexual activity, and contraceptive use among these patients also is discussed.

Prevalence of oligomenorrhea and amenorrhea in a college population

Menstrual disorders in college students have been reported as higher than in the general population. Several reasons, among them calorie-restricted diets, strenuous exercise, and college-related stress, have been attributed to this increased prevalence. During the period November, 1979, to January, 1980, 991 of 1,420 college students completed questionnaires which inquired about their menstrual history. The prevalence of oligomenorrhea in this group was 11.3% and that of amenorrhea was 2.6%. Significant factors associated with oligomenorrhea or amenorrhea in this group were weight loss (greater than 20 pounds) and jogging. In most women with oligomenorrhea or amenorrhea, menstrual irregularity was present prior to college entry. With the use of self-administered questionnaires, we could not identify any specific college stress to account for the presence of menstrual abnormalities in a college population.

Menstrual disorders in college students

During the period January, 1978 to June, 1979, a total of 900 college students was seen in a university student health center. Among these, 14.6% (131/900) had menstrual disorders. Oligomenorrhea or secondary amenorrhea, the chief complaint in 72.5% (95/131) students, accounted for 10.6% (95/900) of the total population. When a selected group of students with oligomenorrhea/amenorrhea was investigated, most had elevated levels of luteinizing hormone (LH) and normal/low levels of follicle-stimulating hormone (FSH) suggestive of polycystic ovary syndrome (PCO). The significance of these findings in the development of oligomenorrhea/amenorrhea and PCO under stress is discussed.