Menstrual disturbances in puberty

Low Body Fat Percentage and Menstrual Cycle Disorders in Female Elite Adolescent Dancers

Introduction: The menstrual cycle is an important indicator of health in female athletes. Female elite adolescent dancers are expected to control their weight while also training intensely, which can lead to menstrual disorders. This study aimed to investigate the relationship between body composition and menstrual status in female elite adolescent dancers. Methods: In total, 131 female elite adolescent dancers (age: 15.9 ± 1.5 years) were enrolled in this study. We measured the height, weight, and body fat percentage (BFP) for each participant and calculated their body mass index (BMI). We gathered information on individual menstruation patterns and the participants' menstrual cycles over the previous year using recall methods. We then compared the differences between dancers with menstrual cycle disorders and those without. Primary amenorrhea was defined as menarche occurring after the age of 15, while secondary amenorrhe was defined as experiencing fewer than 5 or no menstrual periods for at least 3 of the previous 12 months. We conducted a reliability test using the same questionnaire 2 weeks later. Statistical significance was defined as P < .05, and we calculated the effect sizes (d) and 95% confidence intervals (95% CI). Results: The average BMI and BFP were 22.6 ± 3.0% and 19.4 ± 2.2 kg/m2, respectively. Low BFP and low BMI were observed in 51 (38.6%) and 47 (35.6%) participants, respectively. Primary amenorrhea in 3 participants (2.3%) and 29 (22.1%) reported experiencing secondary amenorrhea; they had lower BFP than the dancers who did not experience amenorrhea (P = .041, 95% CI, -2.51 to -0.05). Conclusion: Female elite adolescent dancers in China may have lower BFP and menstrual problems. Given that lower BFP may contribute to the occurrence of menstruation disorders, it is essential to pay an attention to both BFP and the menstruation status in female elite adolescent dancers.

Incidence of menstrual cycle abnormalities and polycystic ovary syndrome in female Japanese patients with type 1 diabetes mellitus. The role of androgens

Type 1 diabetes mellitus (T1DM) adversely affects gonadal function. This study aimed to define the characteristics and factors associated with menstrual cycle abnormalities and polycystic ovary syndrome (PCOS) in Japanese patients with T1DM. Our study enrolled 157 patients, including 55 with oligomenorrhea (prolonged menstrual cycle) and 102 without oligomenorrhea. LH/FSH ratio (p = 0.04) and total testosterone levels (p = 0.03) were significantly higher in the oligomenorrhea group than in the non-oligomenorrhea group. No significant differences were found between the two groups regarding age at menarche, age at T1DM diagnosis, treatment, glycated hemoglobin, or total daily insulin dose. Of the 55 patients in the oligomenorrhea group, 27 were diagnosed with PCOS based on the Rotterdam criteria. We concluded that female patients with T1DM, as well as abnormal menstrual cycles and hyperandrogenism, may suffer from undiagnosed PCOS and should be referred to a gynecologist for full assessment, diagnosis, and treatment.

Population Pharmacodynamic Models of Risperidone on PANSS Total Scores and Prolactin Levels in Schizophrenia

Currently, research predominantly focuses on evaluating clinical effects at specific time points while neglecting underlying patterns within the treatment process. This study aims to analyze the dynamic alterations in PANSS total scores and prolactin levels in patients with schizophrenia treated with risperidone, along with the influencing covariates. Using data from an 8-week randomized, double-blind, multicenter clinical trial, a population pharmacodynamic model was established for the PANSS total scores of and prolactin levels in patients treated with risperidone. The base model employed was the Emax model. Covariate selection was conducted using a stepwise forward inclusion and backward elimination approach. A total of 144 patients were included in this analysis, with 807 PANSS total scores and 531 prolactin concentration values. The PANSS total scores of the patients treated with risperidone decreased over time, fitting a proportionally parameterized sigmoid Emax model with covariates including baseline score, course of the disease, gender, plasma calcium ions, and lactate dehydrogenase levels. The increase in prolactin levels conformed to the ordinary Emax model, with covariates encompassing course of the disease, gender, weight, red blood cell count, and triglyceride levels. The impacts of the baseline scores and the course of the disease on the reduction of the PANSS scores, as well as the influence of gender on the elevation of prolactin levels, each exceeded 20%. This study provides valuable quantitative data regarding PANSS total scores and prolactin levels among patients undergoing risperidone treatment across various physiological conditions.

Factors associated with adolescent pregnancy in Maharashtra, India: a mixed-methods study

Reducing the adolescent birth rate is paramount in achieving the health-related Sustainable Development Goals, given that pregnancy and childbirth are the leading cause of mortality among young women aged 15-19. This study aimed to explore predictors of adolescent pregnancy among girls aged 13-18 years in Maharashtra, India, during the COVID-19 pandemic. Using a mixed-methods approach, primary data were gathered from two regions in Maharashtra between February and April 2022. Quantitative data from face-to-face interviews with 3049 adolescent girls assessed various household, social, and behavioural factors, as well as the socioeconomic and health impacts of COVID-19. Qualitative data from seven in-depth interviews were analysed thematically. The findings reveal that girls from low socioeconomic backgrounds face a higher likelihood of adolescent pregnancy. Multivariable analysis identified several factors associated with increased risk, including older age, being married, having more sexual partners, and experiencing COVID-19-related economic vulnerability. On the other hand, rural residence, secondary and higher secondary education of the participants, and higher maternal education were associated with a decreased likelihood of adolescent pregnancy. In the sub-sample of 565 partnered girls, partner's emotional abuse also correlated with higher rates of adolescent pregnancy. Thematic analysis of qualitative data identified four potential pathways leading to adolescent pregnancy: economic hardships and early marriage; personal safety, social norms, and early marriage; social expectations; and lack of knowledge on contraceptives. The findings underscore the significance of social position and behavioural factors and the impact of external shocks like the COVID-19 pandemic in predicting adolescent pregnancy in Maharashtra, India.Plain Language Summary: Adolescent pregnancy is an important health issue for young girls. In South Asia, one out of every five adolescent girls becomes a mother before turning 18, and in India, around 9% of girls aged 15-19 get pregnant yearly. This study focused on understanding the factors associated with adolescent pregnancy in Maharashtra, India, especially after the COVID-19 pandemic. We collected information from both urban and rural areas in Maharashtra. A total of 3049 adolescent girls participated in a survey, and seven girls participated in detailed interviews. Our analysis showed that factors like older age, being married, having multiple sexual partners, and experiencing economic difficulties due to COVID-19 increased the chances of adolescent pregnancy. On the other hand, living in rural areas, higher education for both the girls and their mothers reduced the likelihood of adolescent pregnancy. Qualitative analysis revealed that economic challenges, concerns about safety and societal norms, early marriage, societal expectations, and lack of knowledge about contraceptives could contribute to adolescent pregnancy in Maharashtra.

Menstrual characteristics and dysmenorrhea among Palestinian adolescent refugee camp dwellers in the West Bank and Jordan: a cross-sectional study

BACKGROUND

Women and girls experience menstruation throughout their reproductive years. Normal adolescent menstrual cycles gauge current and future reproductive health. Dysmenorrhea (painful menstruation) is the most prevalent menstrual disturbance in adolescents that can be debilitating. This study examines the menstrual characteristics of adolescent girls living in Palestinian refugee camps in the West Bank of the Israeli-occupied Palestinian territory and Jordan, including estimates of dysmenorrhea levels and associated factors.

METHODS

A household survey of 15 to 18-year-old adolescent girls was conducted. Trained field workers collected data on general menstrual characteristics and dysmenorrhea level using Working ability, Location, Intensity, Days of pain Dysmenorrhea scale (WaLIDD), in addition to demographic, socio-economic, and health characteristics. The link between dysmenorrhea and other participant characteristics was assessed using a multiple linear regression model. Additionally, data on how adolescent girls cope with their menstrual pain was collected.

RESULTS

2737 girls participated in the study. Mean age was 16.8 ± 1.1 years. Mean age-at-menarche was 13.1 ± 1.2; mean bleeding duration was 5.3 ± 1.5 days, and mean cycle length was 28.1 ± 6.2 days. Around 6% of participating girls reported heavy menstrual bleeding. High dysmenorrhea levels were reported (96%), with 41% reporting severe symptoms. Higher dysmenorrhea levels were associated with older age, earlier age-at-menarche, longer bleeding durations, heavier menstrual flow, skipping breakfast regularly, and limited physical activity patterns. Eighty nine percent used non-pharmacological approaches to ease menstrual pain and 25% used medications.

CONCLUSION

The study indicates regular menstrual patterns in terms of length, duration, and intensity of bleeding and a slightly higher age-at-menarche than the global average. However, an alarmingly high prevalence of dysmenorrhea among participants was found that tends to vary with different population characteristics, some of which are modifiable and can be targeted for better menstrual health.This research emphasizes the need for integrated efforts to assist adolescents with menstrual challenges such as dysmenorrhea and irregular periods to achieve informed recommendations and effective actions.

Relationship between depressive symptoms and self-reported menstrual irregularities during adolescence: evidence from UDAYA, 2016

Background

The study examined the prevalence of self-reported menstrual irregularities during adolescence and explored the association of depressive symptoms with self-reported menstrual irregularities in adolescents in two major states of Uttar Pradesh and Bihar in India.

Methods

This study is based on the data obtained from the first round of the "Understanding the lives of adolescents and young adults" (UDAYA, 2016) survey. The effective sample size for the study was 12,707 adolescent girls aged 10–19 years. A bivariate analysis with chi-square test was conducted to determine the self-reported menstrual irregularity by predictor variables. Multivariable logistic regression models were employed to examine the associations between self-reported menstrual irregularity, depressive symptoms and other explanatory variables.

Results

A proportion of 11.22% of adolescent girls reported menstrual irregularity and 11.40% of the participants had mild depressive symptoms. Adolescent girls with mild (AOR: 2.15, CI: 1.85–2.51), moderate (AOR: 2.64, CI: 2.03–3.42) and severe depressive symptoms (AOR: 2.99, CI: 2.19–4.10) were more likely to have menstrual irregularity as compared to those who had minimal depressive symptoms. Physically active adolescent girls were less likely to report menstrual irregularity (AOR: 0.82, CI: 0.73–0.93) than physically inactive girls. Adolescent girls who used piece of cloth for menstrual hygiene practices (AOR: 1.17; CI: 1.02–1.35) and those who used either napkin or cloth or other materials (AOR: 1.32; CI: 1.14–1.54) had higher likelihood of menstrual irregularity as compared to those who used only sanitary napkins.

Conclusion

A significant association of depressive symptoms with self-reported menstrual irregularity among adolescent girls was observed. Therefore, while treating females with irregular menstrual cycles, clinicians may need to pay greater attention to thir mental health peoblems.

Prevalence of oligomenorrhea among women of childbearing age in China: A large community-based study

OBJECTIVE

To investigate the prevalence and the related characteristics of oligomenorrhea among women within childbearing age in China.

STUDY DESIGN

A large-scale community-based investigation was conducted from 2013 to 2015. A total of 12,964 women aged 18-49 years from 9 provinces/municipalities in China were recruited for healthcare screening in local community health centers. Outcome measures include clinical history, ultrasonographic exam, and hormonal and metabolic parameters.

RESULTS

Among women within childbearing age in China, the prevalence of oligomenorrhea was 12.2% (1,579/12,964). Both sociodemographic factors and medical history were significantly associated with oligomenorrhea (P < 0.05). In such women, the prevalence of obesity, acne, seborrhea, acanthosis, larger ovarian size, and polycystic ovarian morphology was higher when compared with normal women; the prevalence of anti-Mullerian hormone, total testosterone, and androstenedione (P < 0.05) was higher as well. The infertility rates of all women were higher in the oligomenorrhea group (17.2%, 272⁄1,579) than in the non-oligomenorrhea group (9.0%, 1,024⁄11,385), and among women without contraception, for the oligomenorrhea group, the infertility rate was 32.5% (128⁄394), and for the non-oligomenorrhea group, 17.9% (400⁄2,240). In the oligomenorrhea group, 57.4% (156/272) of the women underwent treatments for infertility, which was higher than the non-oligomenorrhea group 36.1% (370/1,024).

CONCLUSIONS

Obesity, acne, seborrhea, acanthosis, larger ovarian size, and polycystic ovarian morphology were significantly associated with oligomenorrhea. The increase of anti-Mullerian hormone, total testosterone, and androstenedione level was also demonstrated in the oligomenorrhea group. Higher prevalence of infertility and medical treatment rate was observed in women with oligomenorrhea.

Menstrual History-Taking at Annual Well Visits for Adolescent Girls

STUDY OBJECTIVE

To determine the rates at which primary care providers elicit menstrual histories from adolescent girls at well visits.

DESIGN

Retrospective chart review.

SETTING

The departments of Pediatrics, Adolescent Medicine, and Family Medicine of Cooper University Healthcare from January 1, 2010 to June 1, 2016.

PARTICIPANTS

Women aged 12-21 years who were seen for a well visit in the described setting.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

We searched physician well visit notes for documentation of the following aspects of menstrual history: menarche, last menstrual period, usual length of cycle, and the presence or absence of associated symptoms (such as pain and cramps). The presence or absence of each aspect was recorded in a binary fashion in a deidentified data set.

RESULTS

A total of 954 unique charts were analyzed: 415 from Adolescent Medicine, 289 from Family Medicine, and 250 from General Pediatrics at Cooper University Healthcare. Adolescent Medicine was 6.44 times more likely to take a complete menstrual history than Family Medicine (P < .0001) and 5.80 times more likely than Pediatrics (P < .0001). There was no statistical difference between Pediatrics and Family Medicine (odds ratio, 0.55; P = .3150).

CONCLUSION

Menstrual history-taking is often incomplete and can vary between departments, even within the same institution. These results indicate opportunities to raise awareness about the importance of a complete menstrual history and to develop quality improvement initiatives to increase documentation of the complete menstrual history.

Venous Thromboembolism in Female Adolescents: Patient Characteristics

STUDY OBJECTIVE

Our goal was to describe the period prevalence of venous thromboembolism (VTE) and characterize adolescent female patients diagnosed with VTE by describing their age, race, and number of comorbidities. Female adolescents with estrogen exposure were of particular interest because estrogen-containing contraceptives increase the risk of VTE.

DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS

We queried the Pediatric Health Information System database for International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification codes to identify female patients aged 12-18 years diagnosed with a VTE or pulmonary embolism from April 2006 to March 2016 in the United States. Patient demographic characteristics and comorbidities were also analyzed. We divided our study population into two five-year groups and calculated the change in period prevalence of VTE between those groups.

MAIN OUTCOME MEASURES

Primary diagnosis of VTE in the extremities, or pulmonary embolism.

RESULTS

The period prevalence of VTE increased from 2.3 female adolescents per 10,000 hospitalized children (group 1) to 3.3 per 10,000 (group 2), representing a statistically significant increase of 0.010% (P < .001). Caucasian and black individuals were most commonly affected. The number of girls affected increased steadily from ages 12 to 16 years and a large percentage (59.6%) had four or more comorbidities. In patients (n = 32) with estrogen exposure, more than 96% had one or more comorbidity in addition to estrogen exposure.

CONCLUSION

Pediatric health care providers should be aware that the period prevalence of VTEs in female adolescents is increasing. Those with a history of estrogen exposure rarely develop VTEs from estrogen alone and they typically have multiple comorbidities.

Menstrual Characteristics and Related Problems in 9- to 18-Year-Old Turkish School Girls

STUDY OBJECTIVE

To determine the cross-sectional characteristics of menstruating girls, dysmenorrhea, and the frequencies of related problems.

DESIGN

Descriptive, cross-sectional study.

SETTING

Randomly selected primary, junior, and high schools in the city center of Kayseri.

PARTICIPANTS

Two thousand female adolescents of ages between 9 and 18 years.

MAIN OUTCOME MEASURES

We used a questionnaire addressing the epidemiological characteristics of menstruation, such as age at menarche, duration of menstrual intervals, average days of bleeding, and any menstrual problems and their frequencies.

RESULTS

This study consists of a sufficient number of participants from all age groups. Of the participant (n = 2000) girls, 63.7% (n = 1274) had started menstruating. The mean age at menarche was 12.74 (±1.03) years. With a prevalence of 84.8% (n = 1080), dysmenorrhea was the most prevalent menstrual problem and the average pain score was 5.87 (±2.45). Of the menstruating girls, 34% (n = 439) used painkillers, the most commonly used was acetaminophen; during their period the prevalence of nonmedical methods to relieve pain was 35.2%; the rate of seeking medical help for dysmenorrhea was 9.3% (n = 119). In menstruating participants, 90.8% discussed their menstrual problems with their mothers. The rate of school absenteeism in menstruating girls was 15.9% in general and 18% in those with dysmenorrhea.

CONCLUSION

Problems related to menstruation are common in adolescents and these problems affect their social life. In adolescent girls, the most common menstrual problem is dysmenorrhea and it affects school performance and attendance. Girls with menstrual problems showed a low rate of seeking medical help.

Prevalence and associated factors of dysmenorrhea among secondary and preparatory school students in Debremarkos town, North-West Ethiopia

BACKGROUND

Dysmenorrhea is one of the most common gynecologic disorders and a frequently observed cause of anxiety and discomfort among female adolescents. Its prevalence varies between 16% and 91% in women of reproductive age. Its population statistics are too scant in Ethiopia. This study was aimed to determine the prevalence and associated factors of dysmenorrhea among secondary and preparatory school students in Debremarkos town, 2016.

METHODS

Institutional based cross-sectional study was employed from Sept.26 to Oct.17, 2016 among secondary and preparatory school students in Debremarkos town. Self-administered questionnaire was used to collect data from 539 individuals selected by simple random sampling technique. Data were checked, coded and entered into Epi-data version 3.1 and exported to SPSS version 20 for analysis. Univariate, bivariate and multivariable analysis were carried out. Binary logistic regression model was computed and P value < 0.05 was considered as significant. All ethical procedures were considered.

RESULTS

The prevalence of dysmenorrhea was 69.3%. Age, AOR (95% CI) =1.38(1.15, 1.65), family history of dysmenorrhea, AOR (95% CI) = 9.79(4.99, 19.20), physical activity, AOR (95% CI) =0.39(0.13, 0.82), sugar intake, AOR (95% CI) =2.94 (1.54, 5.61), early menarche AOR (95% CI) =4.10(1.21,13.09), late menarche AOR (95% CI) =0.50 (0.27, 0.91), heavy menstrual periods AOR (95% CI) =2.91(1.59, 5.35) and sexual intercourse AOR (95% CI) =0.24 (0.10.0.55) had statistically significant association with the occurrence of dysmenorrhea.

CONCLUSIONS

Age, positive family history of dysmenorrhea, physical activity, excessive sugar intake, early menarche, late menarche, sexual intercourse and heavy menstrual periods had a statistically significant association with the occurrence of dysmenorrhea.

Assessment of the menstrual cycle, eating disorders and self-esteem of Polish adolescents

INTRODUCTION

Eating disorders are an important factor in menstrual cycle disorders in girls. Moreover, low self-esteem among adolescent girls may be a risk factor for eating disorders. The aim of the study was to assess the menstrual cycle, eating habits and self-esteem of Polish adolescents.

METHODS

The study was conducted from January 2014 to March 2015 and included 623 girls, aged 15-19, from randomly selected junior high schools in Silesia, Poland, in which their menstrual cycle, risk of eating disorders and self-esteem were evaluated. A five-part questionnaire was used to assess basic demographic data, lifestyle and physical activity, gynecological history, as well as Rosenberg Self-Esteem Scale (SES) and Eating Attitude Test (EAT-26).

RESULTS

Irregular menstrual cycles were observed in 236 (37.88%) girls; 5.20% presented secondary amenorrhea. Based on the EAT-26 test, 101 (16.21%) girls were indicated being at risk for an eating disorder. Low self-esteem was observed in 340 (54.57%) study girls on the base of SES.

DISCUSSION

Girls with irregular menses had higher scores on the EAT-26 test in subscales: EAT-overall score, EAT-diet and EAT-bulimia, while lower scores on the SES. In our study, we did not observe a significant relationship between exercise intensity, body mass, BMI and menstrual cycle regularity. Low self-esteem among adolescent girls may be a risk factor for eating disorders which could interrupt the menstrual cycle.

The association between mental health problems and menstrual cycle irregularity among adolescent Korean girls

BACKGROUND

Menstrual cycle irregularity is common among adolescents and can induce mental health problems such as stress, depression, and suicidal ideation. We examined the association between mental health problems and menstrual cycle irregularity among adolescent Korean girls.

METHODS

This population-based cross-sectional study was on 808 female adolescents (12-18 years of age) participating in the 2010-2012 Korean National Health and Nutrition Examination Survey. Psychological stress, depressive mood, suicidal ideations, suicide attempts, and psychological counseling were assessed through questionnaires and surveys, and hierarchical multivariable logistic regression analysis was performed.

RESULTS

The risk of menstrual cycle irregularity tended to increase, as the number of mental health problems increased (P for trend=0.016). High stress levels, depressive mood, and psychological counseling were associated with increased risks of menstrual cycle irregularity (odd ratio [95% confidence interval]=1.88 [1.1-3.21], 2.01 [1.01-4.03], and 2.92 [1.16-7.34], respectively) even after adjusting for age, body mass index, alcohol consumption, smoking status, physical activity, hemoglobin level, monthly household income, weight loss attempts, age at menarche, and sleep duration. Suicidal ideation was not significantly associated with menstrual cycle irregularity.

LIMITATIONS

Menstrual irregularity was evaluated based solely on subjects' self-reports, which are subject to their subjective perceptions and appraisal. Cross-sectional design and retrospective data could not draw causal relationship.

CONCLUSIONS

Positive associations were observed between mental health problems and menstrual cycle irregularity among adolescent Korean girls. More attention should be paid towards mental health, to improve menstrual cycle regularity and help prevent related chronic diseases later in life.

Prevalence of headache and its interference in the activities of daily living in female adolescent students

OBJECTIVE:

To describe the prevalence of headache and its interference in the activities of daily living (ADL) in female adolescent students.

METHODS:

This descriptive cross-sectional study enrolled 228 female adolescents from a public school in the city of Petrolina, Pernambuco, Northeast Brazil, aged ten to 19 years. A self-administered structured questionnaire about socio-demographic characteristics, occurrence of headache and its characteristics was employed. Headaches were classified according to the International Headache Society criteria. The chi-square test was used to verify possible associations, being significant p<0.05.

RESULTS:

After the exclusion of 24 questionnaires that did not met the inclusion criteria, 204 questionnaires were analyzed. The mean age of the adolescents was 14.0±1.4 years. The prevalence of headache was 87.7%. Of the adolescents with headache, 0.5% presented migraine without pure menstrual aura; 6.7%, migraine without aura related to menstruation; 1.6%, non-menstrual migraine without aura; 11.7%, tension-type headache and 79.3%, other headaches. Significant associations were found between pain intensity and the following variables: absenteeism (p=0.001); interference in ADL (p<0.001); medication use (p<0.001); age (p=0.045) and seek for medical care (p<0.022).

CONCLUSIONS:

The prevalence of headache in female adolescents observed in this study was high, with a negative impact in ADL and school attendance.

Comparing the Effects of Agnugol and Metformin on Oligomenorrhea in Patients with Polycystic Ovary Syndrome: A Randomized Clinical Trial

INTRODUCTION

Polycystic Ovarian Syndrome (PCOS) is the most common endocrinopathy and cause of oligomenorrhea in women.

AIM

The present study was conducted with the aim to compare the effect of Agnugol and Metformin drugs on oligomenorrhea in patients with PCOS.

MATERIALS AND METHODS

This study was a clinical trial on 120 women with PCOS and had oligomenorrhea, referring to a gynaecology clinic Fatemieh, Hamadan city, Iran, 2015. Women were randomly divided into 2 groups using permutation blocks (getting the medications Agnugol and Metformin) and were treated with drugs Agnugol and Metformin for 3 months. Data collection included demographic questionnaire and check list was designed and completed before and at the end of interventions, by both groups. To analyse the data, descriptive statistics, chi-square tests, t-test, ANOVA with repeated measures was used.

RESULTS

The mean and SD of age was 39.45±4.60 for women taking Agnugol and 38.466±0.84 for those taking Metformin. Based on the results between the subjects, the two groups were not significantly different in terms of menstruation length, cycle intervals, or the number of pads, meaning that the two drugs had similar effects on menstrual cycle regulation, menstruation length and the number of pads. More side effects were reported in the group using Metformin.

CONCLUSION

Agnugol and Metformin drugs in the treatment of oligomenorrhea patients with PCOS have the same effect. Since Metformin is a chemical drug with side effects, Agnugol can be presented as its herbal alternative to treat oligomenorrhea.

Gynecological Problems of Adolescent Girls Attending Outpatient Department at Tertiary Care Center with Evaluation of Cases of Puberty Menorrhagia Requiring Hospitalization

ABSTRACT

Adolescence is a period of enormous physical and psychological change for young girls. Many adolescents with menstrual disturbances never present to their family doctor or gynecologist. Embarrassment about discussing menstruation, fear of disease, and ignorance about services available may lead to delayed presentation or consultation with doctor.

AIMS AND OBJECTIVE

To evaluate the different gynecological problems in adolescent girls attending outpatient department.To evaluate the prevalence of severe anemia requiring indoor admission in adolescent girls with puberty menorrhagia.To assess the etiologies of puberty menorrhagia.

RESULT

There were a total of 655 adolescent girls attending the gynecology OPD during the study period. Menstrual complaints (84.88 %) were the commonest indication for OPD consultation among adolescent girls. 17 girls required hospitalization; all of them needed blood transfusion due to significant severe anemia resulting from puberty menorrhagia. 14 (82.35 %) had anovulatory DUB, while 2 (11.76 %) had coagulation disorders, and one (5.88 %) had hypothyroidism.

CONCLUSION

Adolescent girls with menorrhagia need to be evaluated thoroughly earlier rather than later so that effective management can be started and severe anemia with its consequences can be avoided. Adolescent health education and group discussion is needed to create awareness regarding adolscent gynecological problems; it should be conducted regularly in schools and colleges.

The investigation of children and adolescents with abnormalities of pubertal timing

Concerns with pubertal development are common and can cause considerable distress to patients and their carers. Many presentations reflect normal variations of pubertal timing and primarily require reassurance, although patients may opt for interventions. Other presentations need active management to avoid significant adverse effects on growth and psychosocial development. All should undergo careful assessment, particularly as some children or adolescents presenting with abnormalities in pubertal timing may have serious pathology which requires urgent investigations and treatment. This review describes the appropriate investigations and their interpretation for young people presenting with disorders in pubertal timing.

Patients' auto report of regularity of their menstrual cycles. Medical history is very reliable to predict ovulation. A cross-sectional study

OBJECTIVE

Infertility of ovulatory cause can account for a quarter of infertility etiologies and one of the questions in the patients' clinical history is about their self-perception of the regularity of their menstrual cycles. The aim of this study was to assess whether the information on menstrual regularity is consistent with the assessment of the presence or absence of ovulation.

METHODS

Cross-sectional study. The inclusion criteria were: patients with infertility for at least one year, complete examination and ovulation monitoring, aged between 18 and 38 years completed. The patients were divided into two paired groups: those who reported regular menstrual cycles and those who reported irregular cycles. In the ultrasonographic monitoring of ovulation we separated those who ovulated from those who did not ovulate, and applied the Fischer's test.

RESULTS

Among the 199 patients who reported having regular menstrual cycles, 113 had proven ovulation upon ultrasound monitoring and 86 patients did not ovulate. Among the 29 patients who reported irregular cycles, 24 did not ovulated at the cycle monitoring. The Fisher's exact test was applied and the p-value found was significant.

CONCLUSION

The story of the patient in the clinical interview about the presence of regular or irregular menstruation correlates with the presence or absence of ovulation, it should be taken into consideration in the reasoning regarding the infertility etiology. This report would be important to guide the patient's ovulatory regularity diagnosis.

Menstrual Cycle and the Prevalence of Premenstrual Syndrome/Premenstrual Dysphoric Disorder in Adolescent Athletes

STUDY OBJECTIVE

The purpose of this study was to assess the menstrual cycle, menstrual disorders and premenstrual syndrome/premenstrual dysphoric disorder (PMS/PMDD) in girls and young women participating in competitive sports. The impact of PMS/PMDD symptoms on the quality of life was also analyzed.

DESIGN

The prospective study encompassed 125 girls and young women with the aim to determine the presence of menstrual disorders and the prevalence of PMS/PMDD.

PARTICIPANTS

The studied group was composed of 75 female athletes aged 16 to 22 years. The control group included 50 healthy girls and young women who did not practice competitive sports.

SETTING

The studied athletes and the controls prospectively evaluated their 2 consecutive menstrual cycles by using a questionnaire.

INTERVENTIONS

The research tools were a purpose-built questionnaire, a daily log of PMS symptoms according to the American College of Obstetricians and Gynecologists' guidelines, and a daily log of PMDD symptoms based on the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria.

MAIN OUTCOME MEASURES

To determine the impact of competitive sports on the menstrual cycle, menstrual disorders, and the prevalence of PMS/PMDD in girls and young women.

RESULTS

Intensive physical exercise delayed menarche. PMDD was diagnosed in 8% and PMS in 42.4% of all respondents. The prevalence of PMDD did not differ significantly between the groups (9.33% versus 6.00%). PMS was significantly more frequent among athletes than among controls (49.33% versus 32%, P = .045). The prevalence of PMS correlated significantly with mean age (P = .00001) and age at menarche (P = .03) in athletes. PMS was more frequent in older athletes and in girls with older age at menarche.

CONCLUSION

Competitive sports, older mean age, older age at menarche, length of sporting career, and intensity of training are conducive to PMS. The prevalence of PMS increases with the duration and intensification of competitive exercises.

Menstrual pain and quality of life in women with primary dysmenorrhea: Rationale, design, and interventions of a randomized controlled trial of effects of a treadmill-based exercise intervention

Dysmenorrhea in the absence of pelvic abnormality is termed primary dysmenorrhea (PD). The health burden and social and economic costs of PD are high as it is reported to be the leading cause of recurrent absenteeism from school or work in adolescent girls and young adults. The belief that exercise works for relieving symptoms in women with PD is based on anecdotal evidence and non-experimental studies. There is very limited evidence from randomized controlled trials (RCTs) to support the use of exercise to reduce the intensity of menstrual pain. The objective of this study is to evaluate the effectiveness of exercise to reduce intensity of pain and improve quality of life in women with PD. We describe the study design of a single-blind (assessor), prospective, two-arm RCT, and the participant characteristics of the 70 women recruited in the age-group 18 to 43 years. The primary outcome of the study is pain intensity. The secondary outcomes of the study are quality of life, functional limitation, sleep, global improvement with treatment, and protocol adherence. The outcomes assessments are done at first menstrual period (baseline, Week 0), 2nd menstrual period (Week 4) and at two additional time points (Week 16 and Week 28) during the trial. The results of the study will provide physiotherapists, medical practitioners, and researchers as well as the women who have PD with new insights, knowledge, and evidence about the use of exercise to manage pain in women with PD.

Menstrual cycle alterations during adolescence: early expression of metabolic syndrome and polycystic ovary syndrome

STUDY OBJECTIVE

To assess the importance of the menstrual pattern as a marker for clinical and laboratory alterations related to metabolic syndrome (MS) and polycystic ovary syndrome (PCOS) among Brazilian adolescents.

DESIGN

A cross-sectional study.

SETTING

Endocrine Gynecology Outpatient Clinic of the Adolescent Health Studies Center (NESA) at the Pedro Ernesto University Hospital.

PARTICIPANTS

59 girls (12-19 years old) were classified by their menstrual cycles as regular (n = 23) and irregular (n = 36).

INTERVENTION

None.

MAIN OUTCOME MEASURES

Biochemical collections were made of peripheral blood after fasting for 12 hours, and the oral glucose tolerance test with 75 g of anhydrous glucose.

RESULTS

PCOS, MS, and the criteria for MS were significantly more frequent (P < .05) in the subgroup with irregular menstruation. Adolescents with irregular cycles presented a significant increase in waist circumference, glycemia 2 hours after oral glucose overload (2 h), fasting and 2-h insulin, HOMA-IR, and triglycerides. In contrast, the glucose/insulin ratio, quantitative insulin-sensitivity check index, and HDL serum levels were significantly lower among patients with irregular menstruation, compared to those with regular cycles. In the logistic regression, we noted that insulin 2 h ≥ 75 μIU/mL (r = 1.90; P = .018), waist circumference > 95 cm (r = 2.21; P = .006) and diagnosis of PCOS (r = 1.93; P = .023) were significantly correlated to irregular cycles.

CONCLUSIONS

We concluded that close observation of menstrual cycle patterns is an important tool for identifying adolescents at higher risk of developing PCOS and MS.

Toxicological assessment of drugs that affect the endocrine system in puberty-related disorders

INTRODUCTION

Toxicologists must ensure that clinical risk-to-benefit analysis should be made both for genders and age groups, with any treatment. Puberty concerns physiological changes leading to organism's maturation. Pubertal growth disorders are increasing in last decades: besides causing physical and psychological distress, they may signal underlying endocrine-metabolic abnormalities with serious health consequences later on. Therapeutic approaches for some health conditions in childhood and adolescence are considered.

AREAS COVERED

The authors discuss how some diseases and treatments can impact pubertal growth. The authors look at particular immunological disorders such as asthma and how both the disease and treatment affects pubertal growth. They also discuss how the provision of available data can help to assess the dose-response of the drug, in these cases, and minimize the chance of side effects. The authors also discuss pediatric inflammatory bowel disease and how both the disease and treatment can mitigate the growth delay. Last, but not least, the authors discuss how the effects of the drugs used in the treatment of psychiatric disorders may accentuate endocrine issues in juvenile patients. Hyperprolactinemia induction by some antipsychotics is highlighted as an example.

EXPERT OPINION

Appropriate risk-benefit analysis of drugs prescribed during childhood and adolescence and intended to be used in the long term is required. Furthermore, future treatment strategies and safer compounds development should be supported by the knowledge of mechanisms underlying adverse side effects in pubertal growth and development.

Menstruation disturbances: prevalence, characteristics, and effects on the activities of daily living among adolescent girls from Brazil

STUDY OBJECTIVE

To determine the prevalence, characteristics and effects on the activities of daily living of menstruation disturbances among adolescent girls.

DESIGN

Descriptive, cross-sectional study.

SETTING

A public school in the city of Petrolina, Brazil.

PARTICIPANTS

218 female adolescents of ages between 12 and 17 years.

MAIN OUTCOME MEASURE

We used a structured questionnaire addressing the socio-demographic and menstrual characteristics of the adolescents. The intensity of menstrual pain and its effect on the activities of daily living were measured using an 11-point numeric rating scale.

RESULTS

The mean age of adolescent girls was 13.7 ± 1.5 years. The menstrual cycles of 67% were regular, while 33% were irregular. Dysmenorrhea had a prevalence of 73%, and school absenteeism was observed among 31% of the adolescents. In addition, 66% of the participants considered that dysmenorrhea affected their activities of daily living. Associations were found between the intensity of pain and the variables: school absenteeism; affected activities of daily living; need to use medications; and between affected activities of daily living and school absenteeism (P < .05).

CONCLUSIONS

Among the menstrual disturbances observed dysmenorrhea stood out due to its high prevalence among adolescents with a negative effect on adolescents' activities of daily living. Early diagnosis and knowledge about menstrual disturbances are essential because in addition to reiterating the importance of implementing health education actions, they also help to choose appropriate treatments, thus minimizing the negative effects of these disturbances on the lives of adolescents.

Gynecologic concerns in pubertal females with blood disorders

PURPOSE OF REVIEW

The incidence and prevalence of blood disorders varies depending on the underlying etiology, age, ethnicity, family history, and presence of comorbid medical conditions. Gynecologic problems occurring around puberty may cause stress to families and patients, as well as management challenges to providers.

RECENT FINDINGS

Management strategies in the setting of bleeding disorders include hormonal and non-hormonal options to address problems occurring around puberty. Management strategies in the setting of clotting disorders allow providers to address common problems occurring in adolescence, while minimizing risk of venous thromboembolism.

SUMMARY

Preparedness is important at this time of life, not only to prevent unwanted gynecologic complications or hospitalizations related to specific blood conditions, but also to identify problems related to reproductive care that may be exacerbated or complicated by an underlying blood disorder.

Abnormal uterine bleeding and dysfunctional uterine bleeding in pediatric and adolescent gynecology

Abnormal uterine bleeding (AUB), which is defined as excessively heavy, prolonged and/or frequent bleeding of uterine origin, is a frequent cause of visits to the Emergency Department and/or health care provider. While there are many etiologies of AUB, the one most likely among otherwise healthy adolescents is dysfunctional uterine bleeding (DUB), which is characterizing any AUB when all possible underlying pathologic causes have been previously excluded. The most common cause of DUB in adolescence is anovulation, which is very frequent in the first 2-3 post-menarchal years and is associated with immaturity of the hypothalamic - pituitary - ovarian axis. Management of AUB is based on the underlying etiology and the severity of the bleeding and primary goals are prevention of complications, such as anemia and reestablishment of regular cyclical bleeding, while the management of DUB can in part be directed by the amount of flow, the degree of associated anemia, as well as patient and family comfort with different treatment modalities. Treatment options for DUB are: combined oral contraceptives (COCs), progestogens, non steroidal anti inflammatory drugs (NSAIDs), tranexamic acid (anti-fibrinolytic), GnRH analogues, Danazol and Levonorgestrel releasing intra uterine system (LNG IUS).

Long-term followup of adolescent and young adult females with hypergonadotropic hypogonadism

The condition characterized by elevated gonadotrophins (gonadotropins elevated into the menopausal range), low sex steroids, and menstrual disorders was previously termed Premature Ovarian Failure (POF). However, over the last two years an effort has been made by many authors to have the term Primary Ovarian Insufficiency (POI) exclusively applied. Irrespective of the term, the condition concerns adolescent and young adult women under 40 years who experience cessation of menstruation for more than 3 cycles (whereas these women in the past had a rhythmic menstrual cycle) or amenorrhea for 4-6 months against the background of a previously disturbed menstrual cycle. Determining the cause of POI is difficult, and it is even harder to deal with problems arising from the paucity of estrogen as well as to draw up the plan for long-term monitoring of these patients. This paper presents long-term therapeutic management strategies concerning emotional health, hormone replacement therapy, maintenance of bone health, family planning, other associated disorders as well as possible research options for the future.

Age, puberty, body dissatisfaction, and physical activity decline in adolescents. Results of the German Health Interview and Examination Survey (KiGGS)

Background

Physical activity (PA) shows a marked decline during adolescence. Some studies have pointed to pubertal status or timing as possible PA determinants in this age group. Furthermore, it was supposed that the impact of pubertal changes on PA might be mediated by psychological variables like body dissatisfaction (BDS).

Methods

The 11- to 17-year-old subsample of the German Health Interview and Examination Survey (KiGGS) was used (n = 6 813; 51.3% male, response rate = 66.6%). Through sex-specific sequential multinomial logistic regressions we analysed the univariate and independent associations of chronological age, absolute pubertal status, relative pubertal timing, and BDS with the frequency of PA.

Results

Chronological age showed a significantly negative association with PA in both sexes, independent of puberty. The odds of inactivity in contrast to nearly daily PA increased about 70% in boys and 35% in girls for each year of age, respectively. Adjusted for age and other possible confounders, inactivity was significantly less likely for boys in late pubertal stages (OR = 0.27, 95% CI = 0.09-0.78). The risk of inactivity was more than doubled in boys maturing earlier than peers in terms of relative pubertal timing (OR = 2.20, 95% CI = 1.36-3.56). No clear significant puberty effects were found in girls, but the inactivity was more likely for those with irregular menstruation (OR = 1.71, 95% CI = 1.06-2.75). BDS also contributed to the prediction of PA in both sexes. It partially mediated puberty effects in boys but not in girls.

Conclusions

Overall, chronological age was a far more important predictor of PA in German adolescents than absolute pubertal status or relative pubertal timing. Further possible explanatory variables like sociocultural influences, social support or increasing time requirements for education should be analysed in conjunction with chronological age in future studies.