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Attia GM, Alharbi OA, Aljohani RM. The Impact of Irregular Menstruation on Health: A Review of the Literature. Cureus 2023; 15:e49146. [PMID: 38130524 PMCID: PMC10733621 DOI: 10.7759/cureus.49146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Women are considered to have an irregular menstrual cycle if their cycle length is less than 21 days or more than 35 days, accompanied by less or very severe blood flow. The prevalence of menstrual cycle irregularities varies across countries. Irregular periods can occur due to changes in the body's levels of estrogen and progesterone hormones, which disrupt the normal pattern of the period. Menstrual irregularity has been found to be associated with various diseases and medical conditions, such as metabolic syndrome, coronary heart disease, type 2 diabetes mellitus, and rheumatoid arthritis. Anemia, osteoporosis, psychological problems, impaired quality of life, and infertility have also been recorded. Moreover, a significant correlation between irregular periods and the risk of developing pregnancy-related hypertensive disorders, as well as an increased risk of adverse obstetric and neonatal outcomes, has been proven. Therefore, irregular menstruation is considered an important health indicator among women. Physical, mental, social, psychological, and reproductive problems are often associated with menstrual irregularities. Thus, evaluating the factors associated with irregular menstruation is necessary to determine appropriate preventive and treatment strategies and to decrease the associated health problems. The aim of this review was to define normal and irregular menstruation, their types, and prevalence, to recognize the risk factors and causes of irregular menstruation, and to understand their impact on women's health.
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Affiliation(s)
- Ghalia M Attia
- Medical Histology and Cell Biology, Mansoura University, Mansoura, EGY
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2
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DiVall SA. Practical considerations for diagnosis and treatment of polycystic ovary syndrome in adolescence - distilling guidelines into clinical practice. Curr Opin Pediatr 2023; 35:494-499. [PMID: 37097290 DOI: 10.1097/mop.0000000000001255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
PURPOSE OF REVIEW The diagnostic criteria for polycystic ovary syndrome (PCOS) in adults may overdiagnose PCOS in adolescents. Since 2015, three guidelines have developed adolescent-specific diagnostic criteria and treatment recommendations. In this review, we compare and contrast the recommendations to assist in the practical application to clinical practice. RECENT FINDINGS The guidelines agree that hyperandrogenism with menstrual irregularity be diagnostic criteria for PCOS in adolescents yet have slight differences in how to diagnose hyperandrogenism and in the definition of menstrual irregularity. The diagnostic option of 'at risk for PCOS' is recommended for those girls presenting with criteria within 3 years of menarche or with hyperandrogenism without menstrual irregularity, with re-assessment later in adolescence. Lifestyle changes is first line treatment. Treatment with combined oral contraceptives or metformin is suggested, using patient characteristics and preferences to guide decision-making. SUMMARY PCOS is associated with long term reproductive and metabolic complications and will present during adolescence. Yet, diagnostic features may overlap with normal adolescent physiology. The recent guidelines strove to develop criteria to accurately identify girls with PCOS allowing early surveillance and treatment yet avoid overdiagnosis of normal adolescents.
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Affiliation(s)
- Sara A DiVall
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
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3
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Peña AS, Codner E, Witchel S. Criteria for Diagnosis of Polycystic Ovary Syndrome during Adolescence: Literature Review. Diagnostics (Basel) 2022; 12:diagnostics12081931. [PMID: 36010282 PMCID: PMC9406411 DOI: 10.3390/diagnostics12081931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/11/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine conditions in women. PCOS may be more challenging to diagnose during adolescence due to an overlap with the physiological events of puberty, which are part of the diagnostic criteria in adult women. This review focuses on the evidence available in relation to PCOS diagnostic criteria for adolescents. Adolescent PCOS should be diagnosed using two main criteria irregular -menstrual cycles (relative to number of years post-menarche) and hyperandrogenism (clinical and/or biochemical); after excluding other conditions that mimic PCOS. Accurate definitions of the two main criteria will decrease challenges/controversies with the diagnosis and provide timely diagnosis during adolescence to establish early management. Despite the attempts to create accurate diagnostic criteria and definitions, this review highlights the limited research in this area, especially in the follow up of adolescents presenting with one diagnostic feature that are called “at risk of PCOS”. Studies in adolescents continue to use the Rotterdam diagnostic criteria that uses pelvic ultrasound. This is inappropriate, because previous and emerging data that show many healthy adolescents have polycystic ovarian morphology in the early years post-menarche. In the future, anti-Müllerian hormone levels might help support PCOS diagnosis if adolescents meet two main criteria.
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Affiliation(s)
- Alexia S. Peña
- Discipline of Paediatrics, The University of Adelaide Robinson Research Institute, 72 King William Road, Adelaide, SA 5006, Australia
- Endocrinology and Diabetes Department, Women’s and Children’s Hospital, 72 King William Road, Adelaide, SA 5006, Australia
- Correspondence: ; Tel.: +61-881618134
| | - Ethel Codner
- Institute of Child and Maternal Research, School of Medicine, University of Chile, Santiago 836-0160, Chile
| | - Selma Witchel
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15224, USA
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4
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Wojcik M, Amer S, Jayaprakasan K. The prevalence of hyperprolactinaemia in subfertile ovulatory women and its impact on fertility treatment outcome. J OBSTET GYNAECOL 2022; 42:2349-2353. [PMID: 35473513 DOI: 10.1080/01443615.2022.2049727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Subtle hyperprolactinaemia is not an uncommon finding in ovulatory subfertile women. The objective of this study is to evaluate the prevalence of hyperprolactinaemia in subfertile ovulatory and oligo-anovulatory women, and to determine if hyperprolactinaemia influences fertility treatment outcome. All women (n = 1010) who attended the fertility clinic of a UK tertiary hospital during 2015-2019 were included. Out of 804 eligible women analysed, 575 women (71.5%) were ovulatory and 229 (28.5%) were oligo-anovulatory. Prevalence of hyperprolactinaemia was higher in the ovulatory group than in the oligo-anovulatory group (26.8% vs. 14.4%; OR: 2.2; 95% confidence interval (CI): 1.4-3.2). On sub-group analysis, the prevalence of mild, moderate and severe hyperprolactinaemia was 23.0%, 3.7% and 0.2% in ovulatory women and 11.8%, 1.7% and 0.9% in oligo-anovulatory women. Mild hyperprolactinaemia was found to be more prevalent in the ovulatory group (OR: 2.2; 95%CI: 1.4-3.5). Ongoing pregnancy/livebirth rates were similar between hyperprolactinaemic and normoprolactinaemic women (42.8% vs. 46.7%). Hyperprolactinaemia did not have an impact on ongoing pregnancy/livebirth rates in both ovulatory and oligo-anovulatory women (OR:0.8; 95%CI: 0.5-1.1; OR: 1.2; 95%CI: 0.6-2.5, respectively). Hyperprolactinaemia is prevalent among ovulatory women, although most had mildly raised clinically insignificant levels. Elevated prolactin levels in ovulatory women do not seem to impact on pregnancy outcome. Impact StatementWhat is already known on this subject? Prolactin has been linked to ovulation and fertility. Prolactin testing is not generally recommended for subfertile women with regular menstrual cycles, which is a surrogate marker of ovulation. However, some clinicians, particularly in the general practice, still perform prolactin test as part of baseline endocrine profile.What do the results of this study add? Prevalence of hyperprolactinaemia in subfertile ovulatory women was 26.8% (154/575), of which 86% (132/154) were mild. Further, the livebirth/ongoing pregnancy rates were similar between hyperprolactinaemic and normoprolactinaemic women. Prolactin being a sensitive hormone, responsive to even minimal stress and its high levels not influencing clinical pregnancy outcome, prolactin measurement is not needed in women having regular menstrual cycles.What are the implications of these findings for clinical practice and/or further research? Hyperprolactinaemia was not uncommon in ovulatory women, although most had mildly elevated levels. Hyperprolactinaemia did not have any impact on fertility treatment outcome. Serum prolactin should not be tested in ovulating women, as mild elevations are commonly present and have no clinical significance.
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Affiliation(s)
- Maria Wojcik
- School of Medicine, University of Nottingham, Derby and Nottingham, UK
| | - Saad Amer
- School of Medicine, University of Nottingham, Derby and Nottingham, UK.,Gynaecology, Derby Fertility Unit, Royal Derby Hospital, Derby, UK
| | - Kanna Jayaprakasan
- School of Medicine, University of Nottingham, Derby and Nottingham, UK.,Gynaecology, Derby Fertility Unit, Royal Derby Hospital, Derby, UK
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5
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Joham AE, Peña AS. Polycystic Ovary Syndrome in Adolescence. Semin Reprod Med 2022; 40:e1-e8. [PMID: 36096151 DOI: 10.1055/s-0042-1757138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common, complex, and chronic condition that presents many diagnostic and management challenges for managing clinicians. PCOS diagnosis in adolescents presents a particular challenge for treating clinicians due to the overlap of diagnostic features with normal physiological changes during adolescence. Adolescent diagnostic criteria include well-defined menstrual irregularity according to time postmenarche and hyperandrogenism, but does not require the use of pelvic ultrasound. Adolescents with only one criterion should be considered at risk of PCOS and be followed up around transition to adult care. While PCOS was traditionally considered to be a reproductive disorder, PCOS is now recognized to have major metabolic and cardiovascular health consequences and psychological sequelae that can be present from adolescence. Management of PCOS includes healthy lifestyle, metformin, combined oral contraceptive pill, and/or antiandrogens according to symptoms of concern even in adolescents at risk of PCOS.
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Affiliation(s)
- Anju E Joham
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Diabetes and Vascular Medicine, Monash Health, Melbourne, Australia
| | - Alexia S Peña
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Department of Endocrinology and Diabetes, Women's and Children's Hospital, North Adelaide, South Australia, Australia
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6
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Saei Ghare Naz M, Farahmand M, Dashti S, Ramezani Tehrani F. Factors Affecting Menstrual Cycle Developmental Trajectory in Adolescents: A Narrative Review. Int J Endocrinol Metab 2022; 20:e120438. [PMID: 35432553 PMCID: PMC8994833 DOI: 10.5812/ijem.120438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
CONTEXT The time interval between the age at menarche and regulation of menstrual cycles (menstrual cycle developmental trajectory) is considered an indicator of the function of the reproductive system later in life. This study aimed to summarize the factors affecting this trajectory. EVIDENCE ACQUISITION A comprehensive literature search in PubMed, Scopus, Google Scholar, and Web of Science was performed to identify studies investigating factors influencing the regularity of the menstrual cycle in adolescents. RESULTS The interval between menarche and the onset of the regular menstrual cycle in adolescent girls may vary from several months to several years. Several factors, including genetic, race/ethnicity, intrauterine situation, social factors, geographical factors, lifestyle, and chronic diseases, are considered the predisposing factors for the trajectory. CONCLUSIONS Age at menarche and the onset of regular menstrual cycles are directly and indirectly influenced by several genetic, environmental, and lifestyle factors. Understanding these factors may improve our practice in managing irregular menstrual cycles that commonly happen in the first years after menarche.
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Affiliation(s)
- Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Farahmand
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sareh Dashti
- Department of Midwifery, Faculty of Nursing and Midwifery, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Tanton C, Nakuya K, Kansiime C, Hytti L, Torondel B, Francis SC, Namirembe P, Nakalema S, Nalugya R, Musoke SN, Neema S, Ross DA, Bonell C, Seeley J, Weiss HA. Menstrual characteristics, menstrual anxiety and school attendance among adolescents in Uganda: a longitudinal study. BMC Womens Health 2021; 21:410. [PMID: 34895210 PMCID: PMC8665501 DOI: 10.1186/s12905-021-01544-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/18/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Qualitative data show negative impacts of menstruation on health and education in many settings, but there are few longitudinal quantitative studies of the impact of menstruation. We analyse associations with menstrual anxiety and school attendance in a study of Ugandan secondary school students. METHODS Data were from a longitudinal pilot study of a menstrual health intervention (MENISCUS), conducted in two secondary schools in Entebbe sub-district, Uganda. Self-completed menstrual-related data, including menstrual anxiety, were collected from 232 participants pre- and post-intervention. A sub-cohort of 100 randomly-selected post-menarcheal girls were asked to self-complete daily diaries during 10 months of follow-up, with data on menstrual flow, pain, and school attendance. We used multivariable logistic regression to estimate associations with menstrual anxiety among all girls at baseline, and random-effects logistic regression to estimate associations of menstrual characteristics with school non-attendance for 3 months pre-intervention in the sub-cohort, adjusting for within-girl clustering. RESULTS Overall, 130/222 (58.6%) of menstruating girls reported being anxious about their next period. Menstrual anxiety was higher in those not living with their mother (adjusted odds ratio (OR) = 1.91; 95% confidence interval (CI) 1.01-3.60), believing menstrual myths (aOR = 1.83; 0.95-3.50 for not agreeing that it is healthy for a girl to run, dance or cycle during her period; aOR = 1.97; 1.04-3.73 for agreeing that when a girl has her period she is unclean), lower menstrual confidence (aOR = 2.49; 1.33-4.65 for avoiding physical activity during her period; aOR = 1.68; 0.89-3.17 for not feeling comfortable to talk to other girls about her period; aOR = 2.89; 1.28-6.54 for agreeing that boys/girls tease them about their periods; and aOR = 2.27; 1.21-4.27 for worrying about being teased during her period). Those with lower knowledge about menstruation were less likely to report anxiety (aOR = 0.44; 0.23-0.84). During the pre-intervention period of the sub-cohort, school non-attendance was associated with menstrual pain, with 21.7% of girls missing school on days when they reported pain vs. 8.3% on days when no pain was reported (aOR = 3.82; 1.66-8.77). CONCLUSIONS Menstruation causes substantial anxiety in Ugandan schoolgirls, and menstrual pain is associated with missing school on period-days. Menstrual health interventions should address socio-cultural aspects of menstruation to reduce anxiety, and provide education on pain management strategies to support school attendance.
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Affiliation(s)
- Clare Tanton
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Kevin Nakuya
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Catherine Kansiime
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Belen Torondel
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanna C Francis
- MRC International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Prossy Namirembe
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Ruth Nalugya
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Stella Neema
- College of Humanities and Social Science, Makerere University, Kampala, Uganda
| | - David A Ross
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Bonell
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Janet Seeley
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Helen A Weiss
- MRC International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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8
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Grant AD, Wilbrecht L, Kriegsfeld LJ. Adolescent Development of Biological Rhythms in Female Rats: Estradiol Dependence and Effects of Combined Contraceptives. Front Physiol 2021; 12:752363. [PMID: 35615288 PMCID: PMC9126190 DOI: 10.3389/fphys.2021.752363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/11/2021] [Indexed: 01/23/2023] Open
Abstract
Adolescence is a period of continuous development, including the maturation of endogenous rhythms across systems and timescales. Although, these dynamic changes are well-recognized, their continuous structure and hormonal dependence have not been systematically characterized. Given the well-established link between core body temperature (CBT) and reproductive hormones in adults, we hypothesized that high-resolution CBT can be applied to passively monitor pubertal development and disruption with high fidelity. To examine this possibility, we used signal processing to investigate the trajectory of CBT rhythms at the within-day (ultradian), daily (circadian), and ovulatory timescales, their dependence on estradiol (E2), and the effects of hormonal contraceptives. Puberty onset was marked by a rise in fecal estradiol (fE2), followed by an elevation in CBT and circadian power. This time period marked the commencement of 4-day rhythmicity in fE2, CBT, and ultradian power marking the onset of the estrous cycle. The rise in circadian amplitude was accelerated by E2 treatment, indicating a role for this hormone in rhythmic development. Contraceptive administration in later adolescence reduced CBT and circadian power and resulted in disruption to 4-day cycles that persisted after discontinuation. Our data reveal with precise temporal resolution how biological rhythms change across adolescence and demonstrate a role for E2 in the emergence and preservation of multiscale rhythmicity. These findings also demonstrate how hormones delivered exogenously in a non-rhythmic pattern can disrupt rhythmic development. These data lay the groundwork for a future in which temperature metrics provide an inexpensive, convenient method for monitoring pubertal maturation and support the development of hormone therapies that better mimic and support human chronobiology.
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Affiliation(s)
- Azure D. Grant
- The Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
| | - Linda Wilbrecht
- The Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Lance J. Kriegsfeld
- The Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
- Department of Integrative Biology, University of California, Berkeley, Berkeley, CA, United States
- Graduate Group in Endocrinology, University of California, Berkeley, Berkeley, CA, United States
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9
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Kiconco S, Teede HJ, Azziz R, Norman RJ, Joham AE. The Need to Reassess the Diagnosis of Polycystic Ovary Syndrome (PCOS): A Review of Diagnostic Recommendations from the International Evidence-Based Guideline for the Assessment and Management of PCOS. Semin Reprod Med 2021; 39:71-77. [PMID: 34404096 DOI: 10.1055/s-0041-1735259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder that is associated with negative metabolic, reproductive, endocrine, and psychological consequences among women of reproductive age. The diagnosis of PCOS remains challenging due to limited and conflicting evidence regarding definitions for each of the diagnostic features. This review of the recommended PCOS assessment criteria from the international evidence-based guideline highlights the crucial need to reassess, redefine, and optimize the diagnosis of PCOS. Notably, normal values and cut-offs need to be defined for each diagnostic feature across the lifespan and diverse ethnic groups. Understanding how these features cluster together and relate to short- and long-term health outcomes in PCOS is also vital. Ultimately, greater knowledge of the natural history of PCOS is needed through well-characterized, community-based longitudinal studies, which will inform future PCOS diagnosis guidelines and optimize women's health in reproductive life.
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Affiliation(s)
- Sylvia Kiconco
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Department of Diabetes and Vascular Medicine, Monash Health, Victoria, Australia
| | - Ricardo Azziz
- American Society for Reproductive Medicine, Birmingham, Alabama.,Department of Obstetrics and Gynaecology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Health Policy, Management, and Behaviour; University at Albany School of Public Health, SUNY, Rensselaer, New York
| | - Robert J Norman
- Department of Obstetrics and Gynaecology, Robinson Research Institute, University of Adelaide, South Australia, Australia
| | - Anju E Joham
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Department of Diabetes and Vascular Medicine, Monash Health, Victoria, Australia
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10
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Perspectives on the International Recommendations for the Diagnosis and Treatment of Polycystic Ovary Syndrome in Adolescence. J Pediatr Adolesc Gynecol 2020; 33:445-447. [PMID: 32615268 DOI: 10.1016/j.jpag.2020.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/22/2020] [Indexed: 01/24/2023]
Abstract
Recommendations have been provided for the diagnosis and therapy of polycystic ovary syndrome in adolescence from 3 international expert conferences 2015-2018. Despite agreement about essentials, differences among details of these recommendations have engendered confusion. This commentary provides perspective about the agreements and disagreements among these recommendations and how these recommendations relate to other guidance. It concludes with practice suggestions that align with these recommendations.
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11
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Polycystic ovary syndrome (PCOS) and adolescence: How can we manage it? Eur J Obstet Gynecol Reprod Biol 2020; 250:235-240. [PMID: 32497923 DOI: 10.1016/j.ejogrb.2020.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 11/21/2022]
Abstract
Polycystic Ovary Syndrome is a very complex syndrome, with typical hormonal and metabolic features. In adolescent girls, this condition shows particular characteristics which are in common with adult sign and symptoms, often making the diagnosis difficult. On the other side, treatment strategy aims to manage the different aspects of this syndrome, and is generally based on lifestyle/diet modifications possibly associated with use of estroprogestins, anti-androgens and insulin-sensitizing agents. In this article, we will briefly review both diagnosis and clinical approach to polycystic ovary syndrome in adolescence which still remain a matter of debate in view of the peculiar hormonal milieu of that critical period.
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12
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Peña AS, Witchel SF, Hoeger KM, Oberfield SE, Vogiatzi MG, Misso M, Garad R, Dabadghao P, Teede H. Adolescent polycystic ovary syndrome according to the international evidence-based guideline. BMC Med 2020; 18:72. [PMID: 32204714 PMCID: PMC7092491 DOI: 10.1186/s12916-020-01516-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/11/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Diagnosing polycystic ovary syndrome (PCOS) during adolescence is challenging because features of normal pubertal development overlap with adult diagnostic criteria. The international evidence-based PCOS Guideline aimed to promote accurate and timely diagnosis, to optimise consistent care, and to improve health outcomes for adolescents and women with PCOS. METHODS International healthcare professionals, evidence synthesis teams and consumers informed the priorities, reviewed published data and synthesised the recommendations for the Guideline. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied to appraise the evidence quality and the feasibility, acceptability, cost, implementation and strength of the recommendations. RESULTS This paper focuses on the specific adolescent PCOS Guideline recommendations. Specific criteria to improve diagnostic accuracy and avoid over diagnosis include: (1) irregular menstrual cycles defined according to years post-menarche; > 90 days for any one cycle (> 1 year post-menarche), cycles< 21 or > 45 days (> 1 to < 3 years post-menarche); cycles < 21 or > 35 days (> 3 years post-menarche) and primary amenorrhea by age 15 or > 3 years post-thelarche. Irregular menstrual cycles (< 1 year post-menarche) represent normal pubertal transition. (2) Hyperandrogenism defined as hirsutism, severe acne and/or biochemical hyperandrogenaemia confirmed using validated high-quality assays. (3) Pelvic ultrasound not recommended for diagnosis of PCOS within 8 years post menarche. (4) Anti-Müllerian hormone levels not recommended for PCOS diagnosis; and (5) exclusion of other disorders that mimic PCOS. For adolescents who have features of PCOS but do not meet diagnostic criteria an 'at risk' label can be considered with appropriate symptomatic treatment and regular re-evaluations. Menstrual cycle re-evaluation can occur over 3 years post menarche and where only menstrual irregularity or hyperandrogenism are present initially, evaluation with ultrasound can occur after 8 years post menarche. Screening for anxiety and depression is required and assessment of eating disorders warrants consideration. Available data endorse the benefits of healthy lifestyle interventions to prevent excess weight gain and should be recommended. For symptom management, the combined oral contraceptive pill and/or metformin may be beneficial. CONCLUSIONS Extensive international engagement accompanied by rigorous processes honed both diagnostic criteria and treatment recommendations for PCOS during adolescence.
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Affiliation(s)
- Alexia S Peña
- Discipline of Paediatrics, The University of Adelaide Robinson Research Institute and Endocrine Department, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA, 5006, Australia.
| | - Selma F Witchel
- Department of Pediatrics, Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathleen M Hoeger
- Department of OBGYN, University of Rochester Medical Center, Rochester, NY, USA
| | - Sharon E Oberfield
- Division of Pediatric Endocrinology, Columbia University Irving Medical Center, New York, NY, USA
| | - Maria G Vogiatzi
- Division of Endocrinology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Philadelphia, Philadelphia, PA, USA
| | - Marie Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Melbourne, VIC, Australia
| | - Rhonda Garad
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Melbourne, VIC, Australia
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Melbourne, VIC, Australia
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Louwers YV, Laven JS. Characteristics of polycystic ovary syndrome throughout life. Ther Adv Reprod Health 2020; 14:2633494120911038. [PMID: 32518918 PMCID: PMC7254582 DOI: 10.1177/2633494120911038] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 02/06/2023] Open
Abstract
Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age. It is a complex disease in which genetic, endocrine, environmental, and behavioral factors are intertwined, giving rise to a heterogeneous phenotype with reproductive, metabolic, and psychological characteristics. Polycystic ovary syndrome affects women’s health and their quality of life across the life course. During different life stages, the polycystic ovary syndrome phenotype can change, which requires a personalized diagnostic approach and treatment. Polycystic ovary syndrome is a major cause of anovulatory infertility; this disorder is also associated with hirsutism and acne. Diagnosing polycystic ovary syndrome during adolescence is challenging because the polycystic ovary syndrome criteria include normal physiological events that occur during puberty. With increasing age, the syndrome evolves from a reproductive disease to a more metabolic disorder. Along with metabolic disturbances, including insulin resistance and abnormalities of energy expenditure, polycystic ovary syndrome is recognized as a major risk factor for the development of type 2 diabetes and cardiovascular disease in later life. Moreover, there is evidence for familial clustering of endocrine and metabolic features of polycystic ovary syndrome. Environmental factors such as diet and obesity appear to contribute to the phenotype. Treatment should be tailored to the specific concerns and needs of the individual patient and involves restoring fertility, treatment of the metabolic complaints, treatment of androgen excess, and providing endometrial protection. The complexity of the disorder, and the impact on quality of life, requires a timely diagnosis, screening for complications, and management strategies for the long-term health issues associated with polycystic ovary syndrome. The syndrome remains underdiagnosed, and women experience significant delays to diagnosis.
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Affiliation(s)
| | - Joop S.E. Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Huang YX, Xu DQ, Yue SJ, Chen YY, Tao HJ, Fu RJ, Xing LM, Wang T, Ma YL, Wang BA, Tang YP, Duan JA. Deciphering the Active Compounds and Mechanisms of Qixuehe Capsule on Qi Stagnation and Blood Stasis Syndrome: A Network Pharmacology Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:5053914. [PMID: 32190085 PMCID: PMC7063220 DOI: 10.1155/2020/5053914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/18/2020] [Accepted: 01/25/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Qixuehe capsule (QXH), a Chinese patent medicine, has been demonstrated to be effective in the treatment of menstrual disorders. In traditional Chinese medicine (TCM) theory, qi stagnation and blood stasis syndrome (QS-BSS) is the main syndrome type of menstrual disorders. However, the pharmacodynamic effect of QXH in treating QS-BSS is not clear, and the main active compounds and underlying mechanisms remain unknown. METHODS A rat model of QS-BSS was established to evaluate the pharmacodynamic effect of QXH. Thereafter, a network pharmacology approach was performed to decipher the active compounds and underlying mechanisms of QXH. RESULTS QXH could significantly reduce the rising whole blood viscosity (WBV) and plasma viscosity (PV) but also normalize prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen (FIB) content in QS-BSS rats. Based on partial least-squares-discriminant analysis (PLS-DA), the low-dose QXH-intervened (QXH-L) and the high-dose QXH-intervened (QXH-H) groups seemed the most effective by calculating the relative distance to normality. Through network pharmacology, QXH may improve hemorheological abnormality mainly via 185 compounds-51 targets-28 pathways, whereas 184 compounds-68 targets-28 pathways were associated with QXH in improving coagulopathy. Subsequently, 25 active compounds of QXH were verified by UPLC-Q/TOF-MS. Furthermore, 174 active compounds of QXH were shared in improving hemorheological abnormality and coagulopathy in QS-BSS, each of which can act on multiple targets to be mainly involved in complement and coagulation cascades, leukocyte transendothelial migration, PPAR signaling pathway, VEGF signaling pathway, and arachidonic acid metabolism. The attribution of active compounds indicated that Angelicae Sinensis Radix (DG), Paeoniae Radix Rubra (CS), Carthami Flos (HH), Persicae Semen (TR), and Corydalis Rhizoma (YHS) were the vital herbs of QXH in treating QS-BSS. CONCLUSION QXH can improve the hemorheology abnormality and coagulopathy of QS-BSS, which may result from the synergy of multiple compounds, targets, and pathways.
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Affiliation(s)
- Yu-Xi Huang
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an 712046, China
- Oxford Chinese Medicine Research Centre, University of Oxford, Oxford, UK
| | - Ding-Qiao Xu
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an 712046, China
| | - Shi-Jun Yue
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an 712046, China
| | - Yan-Yan Chen
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an 712046, China
| | - Hui-Juan Tao
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Rui-jia Fu
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an 712046, China
| | - Li-Ming Xing
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an 712046, China
| | - Taiyi Wang
- Oxford Chinese Medicine Research Centre, University of Oxford, Oxford, UK
| | - Yu-ling Ma
- Oxford Chinese Medicine Research Centre, University of Oxford, Oxford, UK
| | - Bao-An Wang
- Shaanxi Momentum Qixuehe Pharmaceutical Co., Ltd., Xi'an 712000, China
| | - Yu-Ping Tang
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an 712046, China
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Jin-Ao Duan
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
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15
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Witchel SF, Oberfield SE, Peña AS. Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls. J Endocr Soc 2019; 3:1545-1573. [PMID: 31384717 PMCID: PMC6676075 DOI: 10.1210/js.2019-00078] [Citation(s) in RCA: 214] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/30/2019] [Indexed: 02/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by hyperandrogenism and chronic anovulation. Depending on diagnostic criteria, 6% to 20% of reproductive aged women are affected. Symptoms of PCOS arise during the early pubertal years. Both normal female pubertal development and PCOS are characterized by irregular menstrual cycles, anovulation, and acne. Owing to the complicated interwoven pathophysiology, discerning the inciting causes is challenging. Most available clinical data communicate findings and outcomes in adult women. Whereas the Rotterdam criteria are accepted for adult women, different diagnostic criteria for PCOS in adolescent girls have been delineated. Diagnostic features for adolescent girls are menstrual irregularity, clinical hyperandrogenism, and/or hyperandrogenemia. Pelvic ultrasound findings are not needed for the diagnosis of PCOS in adolescent girls. Even before definitive diagnosis of PCOS, adolescents with clinical signs of androgen excess and oligomenorrhea/amenorrhea, features of PCOS, can be regarded as being “at risk for PCOS.” Management of both those at risk for PCOS and those with a confirmed PCOS diagnosis includes education, healthy lifestyle interventions, and therapeutic interventions targeting their symptoms. Interventions can include metformin, combined oral contraceptive pills, spironolactone, and local treatments for hirsutism and acne. In addition to ascertaining for associated comorbidities, management should also include regular follow-up visits and planned transition to adult care providers. Comprehensive knowledge regarding the pathogenesis of PCOS will enable earlier identification of girls with high propensity to develop PCOS. Timely implementation of individualized therapeutic interventions will improve overall management of PCOS during adolescence, prevent associated comorbidities, and improve quality of life.
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Affiliation(s)
- Selma Feldman Witchel
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sharon E Oberfield
- Division of Pediatric Endocrinology, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Alexia S Peña
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia
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Gunn HM, Tsai MC, McRae A, Steinbeck KS. Menstrual Patterns in the First Gynecological Year: A Systematic Review. J Pediatr Adolesc Gynecol 2018; 31:557-565.e6. [PMID: 30064002 DOI: 10.1016/j.jpag.2018.07.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/13/2018] [Accepted: 07/22/2018] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVE Understanding what constitutes a normal menstrual cycle during the first gynecological year (GY1) is a common concern of adolescents and clinicians. However, limited high-quality evidence exists. We aimed to summarize published literature regarding menstrual and ovulatory patterns in GY1. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Electronic databases (MEDLINE, Pre-MEDLINE, Embase, Web of Science, CINAHL, Cochrane Library) were systematically searched from database inception to 2018. Eligible studies described menstrual cycles, symptoms, or validated ovulatory data in healthy adolescents in GY1. Two authors independently screened studies, extracted data, and assessed methodological quality. RESULTS Twenty-two studies involving more than 2000 adolescents were included. Thirteen recorded menstrual cycle and/or symptom data and 14 measured ovulation. Mean cycle length ranged from 32 to 61 days and decreased throughout GY1. Mean menses length was 4.9 to 5.4 days. Frequent menstrual bleeding was reported in up to 23% of participants, infrequent menstrual bleeding in up to one-third, and "irregular menstrual bleeding" in up to 43%. Dysmenorrhea was reported by 30%-89% of participants. Prevalence of ovulatory cycles identified using luteal phase serum or salivary progesterone or urinary pregnanediol was 0 to 45% and increased throughout GY1. However, all used definitions that would be considered subovulatory in clinical practice. CONCLUSION Menstrual and ovulatory patterns in GY1 are diverse and differ from those of adults. A transitional phase of menstrual and ovulatory immaturity is common. However, ovulation, irregular cycles, and dysmenorrhea are not uncommon. As such, safe sexual practice should be advocated and prompt medical management should be accessible.
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Affiliation(s)
- Harriet Mary Gunn
- Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, New South Wales, Australia; Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia; UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
| | - Meng-Che Tsai
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Paediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Alexandra McRae
- Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, New South Wales, Australia; Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Katharine S Steinbeck
- Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, New South Wales, Australia; Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
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17
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Peña AS, Metz M. What is adolescent polycystic ovary syndrome? J Paediatr Child Health 2018; 54:351-355. [PMID: 29280221 DOI: 10.1111/jpc.13821] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/29/2017] [Accepted: 10/17/2017] [Indexed: 12/28/2022]
Abstract
The diagnostic criteria for adolescent polycystic ovary syndrome (PCOS) has been derived from adult criteria, which makes diagnosis challenging as criteria include normal physiological events that occur during puberty such as acne, hirsutism, menstrual irregularities, high androgen levels and polycystic ovarian morphology on pelvic ultrasound. The only criteria that applies from the adult criteria is exclusion of other conditions that mimic PCOS. Clinical findings consistent with hyperandrogenaemia during adolescence include inflammatory acne, hirsutism, alopecia and/or menstrual irregularities, which are severe and present 2 years after menarche. The measurement of androgen levels during adolescence should take into account age, puberty, type of androgen measured, assay used and diurnal rhythm. Multiple measurements are useful to demonstrate hyperandrogenaemia. The combination, severity and persistence of the hyperandrogenic symptoms and hyperandrogenaemia in girls 2 years or more post-menarche support the diagnosis of adolescent PCOS. Adolescent girls with these findings should be followed up into adulthood.
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Affiliation(s)
- Alexia S Peña
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Department of Endocrinology and Diabetes, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Michael Metz
- SA Pathology, Women's and Children's Hospital, Adelaide, South Australia, Australia
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Reynolds GD, Roth KC. The Development of Attentional Biases for Faces in Infancy: A Developmental Systems Perspective. Front Psychol 2018; 9:222. [PMID: 29541043 PMCID: PMC5835799 DOI: 10.3389/fpsyg.2018.00222] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 02/09/2018] [Indexed: 11/16/2022] Open
Abstract
We present an integrative review of research and theory on major factors involved in the early development of attentional biases to faces. Research utilizing behavioral, eye-tracking, and neuroscience measures with infant participants as well as comparative research with animal subjects are reviewed. We begin with coverage of research demonstrating the presence of an attentional bias for faces shortly after birth, such as newborn infants' visual preference for face-like over non-face stimuli. The role of experience and the process of perceptual narrowing in face processing are examined as infants begin to demonstrate enhanced behavioral and neural responsiveness to mother over stranger, female over male, own- over other-race, and native over non-native faces. Next, we cover research on developmental change in infants' neural responsiveness to faces in multimodal contexts, such as audiovisual speech. We also explore the potential influence of arousal and attention on early perceptual preferences for faces. Lastly, the potential influence of the development of attention systems in the brain on social-cognitive processing is discussed. In conclusion, we interpret the findings under the framework of Developmental Systems Theory, emphasizing the combined and distributed influence of several factors, both internal (e.g., arousal, neural development) and external (e.g., early social experience) to the developing child, in the emergence of attentional biases that lead to enhanced responsiveness and processing of faces commonly encountered in the native environment.
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Affiliation(s)
- Greg D. Reynolds
- Developmental Cognitive Neuroscience Laboratory, Department of Psychology, University of Tennessee, Knoxville, TN, United States
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