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Li X, Yang J, Blockeel C, Lin M, Tian X, Wu H, Cao Y, Deng L, Zhou X, Xie J, Hu Y, Chen X. Association of severity of menstrual dysfunction with cardiometabolic risk markers among women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 2024; 103:1606-1614. [PMID: 38715377 PMCID: PMC11266638 DOI: 10.1111/aogs.14863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/23/2024] [Accepted: 04/13/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) is associated with a wide range of unfavorable cardiometabolic risk factors, including obesity, hypertension, insulin resistance, impaired glucose metabolism, dyslipidemia, and metabolic syndrome. Compared with women with regular menstrual cycles, women with a history of irregular menstrual periods have an increased unfavorable cardiometabolic risk. Recently, the association between the severity of oligomenorrhea and hyperinsulinemia and insulin resistance has been demonstrated. However, evidence linking the severity of menstrual cyclicity with cardiometabolic risk in PCOS women is scarce. MATERIAL AND METHODS This work was a prospective cross-sectional study. A total of 154 women diagnosed with PCOS by the Rotterdam criteria were recruited from July 2021 to September 2022. PCOS women with eumenorrheic (eumeno group), oligomenorrhea (oligo group), and amenorrhea (ameno group) underwent history and physical examination, gonadal steroid hormone measurement, lipid profile, oral glucose tolerance test, and homeostasis model assessment of insulin resistance. RESULTS A trend toward an increase in unfavorable cardiometabolic risk markers including obesity, hypertension, prevalence of insulin resistance, prediabetes, dyslipidemia, and metabolic syndrome was observed in the ameno group (n = 57) as compared with the eumeno (n = 24) or oligo group (n = 73). A higher prevalence of insulin resistance (odds ratio [OR]: 3.02; 95% confidence interval [CI]: 1.03-8.81) and prediabetes (OR: 3.94; 95% CI: 1.01-15.40) was observed in the ameno group than in the eumeno group, and a higher proportion of dyslipidemia (OR: 2.44; 95% CI: 1.16-5.15) was observed in the ameno group than in the oligo group in the binary logistic regression analysis after adjusting for confounding factors. CONCLUSIONS PCOS women with amenorrhea show a higher prevalence of insulin resistance, prediabetes, and dyslipidemia compared with those with oligomenorrhea or eumenorrhea. The severity of menstrual dysfunction could be used as a readily obtainable marker for the identification of PCOS women at greatest risk of cardiometabolic diseases.
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Affiliation(s)
- Xuelan Li
- Reproductive Medicine CenterShunde Hospital of Southern Medical University (The First People's Hospital of Shunde)FoshanGuangdongChina
| | - Jie Yang
- Reproductive Medicine CenterShunde Hospital of Southern Medical University (The First People's Hospital of Shunde)FoshanGuangdongChina
| | - Christophe Blockeel
- Brussels, IVF, center for Reproductive MedicineUniversitair Ziekenhuis Brussel, Vrije Universiteit BrusselBrusselsBelgium
| | - Min Lin
- Reproductive Medicine CenterShunde Hospital of Southern Medical University (The First People's Hospital of Shunde)FoshanGuangdongChina
| | - Xiaoyan Tian
- Reproductive Medicine CenterShunde Hospital of Southern Medical University (The First People's Hospital of Shunde)FoshanGuangdongChina
| | - Haocun Wu
- Department of Clinical LaboratoryShunde Hospital of Southern Medical University (The First People's Hospital of Shunde)FoshanGuangdongChina
| | - Yaqi Cao
- College of ScienceMinzu University of ChinaBeijingChina
| | - Ling Deng
- Reproductive Medicine CenterShunde Hospital of Southern Medical University (The First People's Hospital of Shunde)FoshanGuangdongChina
| | - Xianli Zhou
- Reproductive Medicine CenterShunde Hospital of Southern Medical University (The First People's Hospital of Shunde)FoshanGuangdongChina
| | - Jinying Xie
- College of ScienceMinzu University of ChinaBeijingChina
| | - Yunzhao Hu
- Department of CardiologyShunde Hospital of Southern Medical University (The First People's Hospital of Shunde)FoshanGuangdongChina
| | - Xin Chen
- Reproductive Medicine CenterShunde Hospital of Southern Medical University (The First People's Hospital of Shunde)FoshanGuangdongChina
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Karim B, Jergel A, Bai S, Bradley K, Arconada Alvarez SJ, Gilmore AK, Greenleaf M, Kottke MJ, Parsell M, Patterson S, Sotos-Prieto M, Zeichner E, Gooding HC. Incorporating Cardiovascular Risk Assessment into Adolescent Reproductive Health and Primary Care Visits. J Pediatr Adolesc Gynecol 2024; 37:426-432. [PMID: 38599564 PMCID: PMC11260258 DOI: 10.1016/j.jpag.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/04/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024]
Abstract
STUDY OBJECTIVE This study aimed to evaluate the usability and feasibility of incorporating a cardiovascular risk assessment tool into adolescent reproductive health and primary care visits. DESIGN, SETTING, AND PARTICIPANTS We recruited 60 young women ages 13-21 years to complete the HerHeart web-tool in 2 adolescent clinics in Atlanta, GA. MAIN OUTCOME MEASURES Participants rated the tool's usability via the Website Analysis and Measurement Inventory (WAMMI, range 0-95) and their perceived 10-year and lifetime risk of cardiovascular disease (CVD) on a visual analog scale (range 0-10). Participants' perceived risk, blood pressure, and body mass index were measured at baseline and 3 months after enrollment. Health care providers (HCP, n = 5) completed the WAMMI to determine the usability and feasibility of incorporating the HerHeart tool into clinical practice. RESULTS Adolescent participants and HCPs rated the tool's usability highly on the WAMMI with a median of 79 (interquartile range [IQR] 65, 84) and 76 (IQR 71, 84). At the baseline visit, participants' median perceived 10-year risk of a heart attack was 1 (IQR 0, 3), and perceived lifetime risk was 2 (IQR 0, 4). Immediately after engaging with the tool, participants' median perceived 10-year risk was 2 (IQR 1, 4.3), and perceived lifetime risk was 3 (IQR 1.8, 6). Thirty-one participants chose to set a behavior change goal, and 12 participants returned for follow-up. Clinical metrics were similar at the baseline and follow-up visits. CONCLUSION HerHeart is acceptable to young women and demonstrates potential for changing risk perception and improving health habits to reduce risk of CVD. Future research should focus on improving retention in studies to promote cardiovascular health within reproductive health clinics.
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Affiliation(s)
- Brianna Karim
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Andrew Jergel
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Shasha Bai
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Kolbi Bradley
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Santiago J Arconada Alvarez
- Georgia Clinical and Translational Science Alliance, Emory University, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
| | - Amanda K Gilmore
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Morgan Greenleaf
- Georgia Clinical and Translational Science Alliance, Emory University, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
| | - Melissa J Kottke
- Jane Fonda Center, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Maren Parsell
- Georgia Clinical and Translational Science Alliance, Emory University, Atlanta, Georgia; Emory Healthcare, Emory University, Atlanta, Georgia
| | - Sierra Patterson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Holly C Gooding
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
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Xie JW, Guo YF, Wang M, Tong ML, Zhu XZ, Lin LR. Syphilis susceptibility factors atlas: A wide-angled Mendelian randomization study. Prev Med 2024; 185:108033. [PMID: 38851401 DOI: 10.1016/j.ypmed.2024.108033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE The pathogenic mechanisms of syphilis and the host defense mechanisms against syphilis remain poorly understood. Exploration of the susceptibility factors of syphilis may provide crucial clues for unraveling its underlying mechanisms. METHODS A two-sample Mendelian Randomization framework was utilized, and the inverse-variance weighted method was used as the main analysis. All data was sourced from Genome-wide association studies datasets from 2015 to 2022 in Europe, and all participants were of European descent. Only summary-level statistics were used. Sensitivity analyses were conducted to evaluate the heterogeneity and pleiotropy of the datasets. RESULTS Our study established 18 exposure factors (12 risk factors and 6 protective factors) for syphilis susceptibility. Twelve factors encompassing body mass index, waist circumference, darker natural skin, cooked vegetable intake, processed meat intake, diabetes mellitus, glucose regulation disorders, gout, autoimmune diseases, rheumatoid arthritis, diverticulitis, and longer menstrual cycles were found to increase susceptibility to syphilis. In contrast, 6 factors including easier skin tanning, blonde natural hair color, irritability, higher neuroticism scores, extended sleep duration, and delayed age at first sexual intercourse were connected to a reduced risk of syphilis infection (all P < 0.05). CONCLUSIONS This study identified 18 influencing factors of syphilis susceptibility. These findings offered novel insights for further probing into the underlying pathogenic mechanisms of syphilis and underscored the importance of multifaceted prevention strategies against syphilis.
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Affiliation(s)
- Jia-Wen Xie
- Center of Clinical Laboratory, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University, Xiamen, China; Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Yin-Feng Guo
- Center of Clinical Laboratory, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University, Xiamen, China; Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Mao Wang
- Center of Clinical Laboratory, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University, Xiamen, China; Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Man-Li Tong
- Center of Clinical Laboratory, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University, Xiamen, China; Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Xiao-Zhen Zhu
- Center of Clinical Laboratory, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University, Xiamen, China; Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Li-Rong Lin
- Center of Clinical Laboratory, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University, Xiamen, China; Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China.
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Yin S, Yang Y, Wang Q, Guo W, He Q, Yuan L, Si K. Association between Abortion and All-Cause and Cause-Specific Premature Mortality: A Prospective Cohort Study from the UK Biobank. HEALTH DATA SCIENCE 2024; 4:0147. [PMID: 39011272 PMCID: PMC11246836 DOI: 10.34133/hds.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/13/2024] [Indexed: 07/17/2024]
Abstract
Background: Concerns have been raised about the increasing prevalence of both spontaneous and induced abortions worldwide, yet their effect on premature mortality remains poorly understood. We aimed to examine the associations between abortion and all-cause and cause-specific premature mortality, and the potential effect modification by maternal characteristics. Methods: Women aged 39 to 71 years at baseline (2006 to 2010) with prior pregnancies were derived from the UK Biobank and categorized as no abortion history, spontaneous abortion alone, induced abortion alone, and both spontaneous and induced abortions. All-cause and cause-specific mortality were ascertained through linkage to death certificate data, with premature death defined as occurring before the age of 70. Results: Of the 225,049 ever gravid women, 43,418 (19.3%) reported spontaneous abortion alone, 27,135 (12.1%) reported induced abortion alone, and 10,448 (4.6%) reported both spontaneous and induced abortions. During a median of 14.4 years of follow-up, 5,353 deaths were recorded, including 3,314 cancer-related and 1,444 cardiovascular deaths. Compared with no abortion history, spontaneous abortion alone was associated with an increased risk of all-cause premature mortality (adjusted hazard ratio [aHR] 1.10, 95% confidence interval [CI] 1.02 to 1.17), and induced abortion alone was associated with increased risks of all-cause (aHR 1.12, 95% CI 1.04 to 1.22) and cardiovascular mortality (aHR 1.27, 95% CI 1.09 to 1.48). The aHRs for all-cause and cardiovascular mortality were higher for recurrent abortions, whether spontaneous or induced (P trend < 0.05). The increased risk of all-cause mortality associated with induced abortion was higher in women with hypertensive disorders of pregnancy than in those without (40% vs. 9%, P interaction = 0.045). Conclusions: Either spontaneous or induced abortion alone was associated with an increased risk of premature mortality, with induced abortion alone particularly linked to cardiovascular death. Future studies are encouraged to explore the underlying mechanisms.
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Affiliation(s)
- Shaohua Yin
- Department of Medical Engineering,
Peking University Third Hospital, Beijing, China
| | - Yingying Yang
- Clinical Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine,
Tongji University, Shanghai, China
| | - Qin Wang
- Department of Health Management,
Naval Medical University, Shanghai, China
| | - Wei Guo
- Department of Military Health Statistics,
Naval Medical University, Shanghai, China
| | - Qian He
- Department of Military Health Statistics,
Naval Medical University, Shanghai, China
| | - Lei Yuan
- Department of Health Management,
Naval Medical University, Shanghai, China
| | - Keyi Si
- Department of Environmental Health, School of Public Health,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Dubey P, Reddy S, Singh V, Yousif A, Dwivedi AK. Association of heavy menstrual bleeding with cardiovascular disease in US female hospitalizations. BMC Med 2024; 22:208. [PMID: 38783294 PMCID: PMC11119710 DOI: 10.1186/s12916-024-03426-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Heavy menstrual bleeding (HMB) is a common menstrual disorder associated with multiple risk factors of cardiovascular disease (CVD) in women. In addition, HMB is often present with irregular menstruation (IM) which is a risk factor for CVD outcomes. However, the relationship between HMB and CVD outcomes is unexplored in the presence or absence of IM. We determined the association of HMB with multiple CVD outcomes using a nationally representative sample of female hospitalizations in the US. METHODS All hospitalizations of females with HMB diagnosis and normal menstrual cycles from ages of 18 to 70 years were extracted from the National Inpatient Sample Database, 2017. The HMB was defined using the International Classification of Diseases (ICD)-10 for excessive and frequent menstruation bleeding and included any current or history of HMB diagnosis. Outcomes including major adverse cardiovascular events (MACE), coronary heart disease (CHD), stroke, heart failure (HF), atrial fibrillation (AF) or arrhythmia, myocardial infarction (MI), and diabetes (DM) were defined using ICD-10 codes. Adjusted logistic regression and prosperity scores-matched logistic regression analyses were conducted to summarize adjusted associations with an odds ratio (OR) and a 95% confidence interval (CI). RESULTS Among 2,430,851 hospitalizations, HMB was observed in 7762 (0.68%) females with age ≤ 40 years and 11,164 (0.86%) females with age > 40 years. Among hospitalizations with age ≤ 40 years, HMB was significantly associated with increased odds of CVD outcomes including MACE (OR = 1.61; 95% CI: 1.25, 2.08), CHD (OR = 1.72; 95% CI: 1.10, 2.71), stroke (OR = 1.95; 95% CI: 1.12, 3.40), HF (OR = 1.53; 95% CI: 1.15, 2.03), and AF/arrhythmia (OR = 1.84; 95% CI: 1.34, 2.54). These associations were confirmed in multiple sensitivity analyses. In contrast, HMB was not robustly associated with CVD events among hospitalizations of women with age > 40 years. HMB without IM was strongly associated with DM, HF, AF, and MACE outcomes while HMB with IM was strongly associated with CHD and AF outcomes in hospitalizations of young women. CONCLUSIONS HMB is associated with CVD events among US hospitalizations of young women. A routine investigation and screening of menstrual disorders, especially HMB, is useful for CVD risk stratification and management in young women.
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Affiliation(s)
- Pallavi Dubey
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Sireesha Reddy
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Vishwajeet Singh
- Biostatistics and Epidemiology Consulting Lab, Office of Research, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Abdelrehman Yousif
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Alok Kumar Dwivedi
- Biostatistics and Epidemiology Consulting Lab, Office of Research, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
- Division of Biostatistics & Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
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Cunningham AC, Pal L, Wickham AP, Prentice C, Goddard FGB, Klepchukova A, Zhaunova L. Chronicling menstrual cycle patterns across the reproductive lifespan with real-world data. Sci Rep 2024; 14:10172. [PMID: 38702411 PMCID: PMC11068910 DOI: 10.1038/s41598-024-60373-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024] Open
Abstract
The intricate hormonal and physiological changes of the menstrual cycle can influence health on a daily basis. Although prior studies have helped improve our understanding of the menstrual cycle, they often lack diversity in the populations included, sample size, and the span of reproductive and life stages. This paper aims to describe the dynamic differences in menstrual cycle characteristics and associated symptoms by age in a large global cohort of period-tracking application users. This work aims to contribute to our knowledge and understanding of female physiology at varying stages of reproductive aging. This cohort study included self-reported menstrual cycle and symptom information in a sample of Flo application users aged 18-55. Cycle and period length and their variability, and frequency of menstrual cycle symptom logs are described by the age of the user. Based on data logged by over 19 million global users of the Flo app, the length of the menstrual cycle and period show clear age-associated patterns. With higher age, cycles tend to get shorter (Cycle length: D ¯ = 1.85 days, Cohen's D = 0.59) and more variable (Cycle length SD: D ¯ = 0.42 days, Cohen's D = 0.09), until close to the chronological age (40-44) suggesting menopausal transition, when both cycles and periods become longer (Cycle length: D ¯ = 0.86 days, t = 48.85, Cohen's D = 0.26; Period length: D ¯ = 0.08, t = 15.6, Cohen's D = 0.07) and more variable (Cycle length SD: D ¯ = 2.80 days, t = 111.43, d = 0.51; Period length SD: D ¯ = 0.23 days, t = 67.81, Cohen's D = 0.31). The proportion of individuals with irregular cycles was highest in participants aged 51-55 (44.7%), and lowest in the 36-40 age group (28.3%). The spectrum of common menstrual cycle-related symptoms also varies with age. The frequency of logging of cramps and acne is lower in older participants, while logs of headache, backache, stress, and insomnia are higher in older users. Other symptoms show different patterns, such as breast tenderness and fatigue peaking between the ages of 20-40, or mood swings being most frequently logged in the youngest and oldest users. The menstrual cycle and related symptoms are not static throughout the lifespan. Understanding these age-related differences in cycle characteristics and symptoms is essential in understanding how best to care for and improve the daily experience for menstruators across the reproductive life span.
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Affiliation(s)
- Adam C Cunningham
- Flo Health UK Limited, 27 Old Gloucester Street, London, WC1N 3AX, UK.
| | - Lubna Pal
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Aidan P Wickham
- Flo Health UK Limited, 27 Old Gloucester Street, London, WC1N 3AX, UK
| | - Carley Prentice
- Flo Health UK Limited, 27 Old Gloucester Street, London, WC1N 3AX, UK
| | | | - Anna Klepchukova
- Flo Health UK Limited, 27 Old Gloucester Street, London, WC1N 3AX, UK
| | - Liudmila Zhaunova
- Flo Health UK Limited, 27 Old Gloucester Street, London, WC1N 3AX, UK
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Miao H, Yang H, Yin M, Wang Y, Fang Y, Yang M, Zou J, Zhang W, Zhang L, Liu C, Wang Y, Wang Z, Yu Y, Wei D. Menstrual abnormalities effects on clinical features and in vitro fertilization pregnancy outcomes in women with polycystic ovarian syndrome. AJOG GLOBAL REPORTS 2024; 4:100332. [PMID: 38584798 PMCID: PMC10997835 DOI: 10.1016/j.xagr.2024.100332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND The diagnostic criteria and phenotypes in polycystic ovary syndrome are heterogeneous. Currently, it is unclear how to assess a patient's prognosis based on the onset time of menstruation disturbance. Evidence on this topic is scarce and has mainly focused on menstrual patterns. OBJECTIVE This study aimed to assess the association between the onset time of menstrual disturbance and clinical features and in vitro fertilization pregnancy outcomes in patients with polycystic ovary syndrome. STUDY DESIGN Our study was a secondary analysis of data collected as part of a randomized controlled trial conducted to compare live birth rates between fresh embryo transfer and frozen embryo transfer in 1508 individuals with polycystic ovary syndrome. Here, 1500 participants were classified into 2 groups according to the onset time of menstrual disturbance: immediately after menarche (early group) and after at least 1 year of regular menstruation (late group). We compared the prepregnancy clinical features, variables of ovarian stimulation, pregnancy outcomes after the initial cycle of embryo transfer, and perinatal and neonatal complications in the 2 groups. RESULTS Compared with the late group, the early group had more antral follicles (32.00 [range, 27.25-39.50] vs 28.00 [range, 24.00-36.00]; P<.001), an elevated level of antimüllerian hormone (7.02 ng/mL [range, 3.60-11.47] vs 5.66 ng/mL [range, 3.65-8.92]; P=.024), a higher level of baseline luteinizing hormone (10.01±5.93 vs 8.51±5.53 IU/l; P<.001) and luteinizing hormone-to-follicle-stimulating hormone ratio (1.51 [range, 1.00-2.32] vs 1.45 [range, 0.92-2.13]; P<.001), lower levels of fasting glucose (5.47 mmol/L [range, 5.11-5.73] vs 5.50 mmol/L [range, 5.17-5.76]; P<.001), and insulin at 2 hours after 75-g oral glucose tolerance test (56.85 µU/mL [range, 34.63-94.54] vs 59.82 µU/mL [range, 33.56-94.67]; P=.027), a higher level of high-density lipoprotein (1.26 mmol/L [range, 1.04-1.37] vs 1.21 mmol/L [range, 1.07-1.45]; P=.006). During in vitro fertilization, the early group had a higher level of peak estradiol (4596.50 pg/mL [range, 2639.25-6321.00] vs 3954.00 pg/mL [range, 2378.75-6113.50]; P=.013), and luteinizing hormone (2.52 IU/L [range, 1.40-4.21] vs 1.93 IU/L [range, 0.91-3.32]; P=.010) on the day of human chorionic gonadotropin trigger. There was no statistically significant difference observed in the number of oocytes and embryos, the rates of pregnancy and live birth, and the risks of obstetrical and neonatal between the 2 groups. CONCLUSION An early onset of menstrual disturbance in patients with polycystic ovary syndrome may be associated with slightly more severe reproductive features and slightly milder metabolic features. Nonetheless, the outcomes of in vitro fertilization and the initial cycle of embryo transfer were comparable between the 2 groups.
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Affiliation(s)
- Haozhe Miao
- Center for Reproductive Medicine, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Medical Integration and Practice Center, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, and Wei)
| | - Huiming Yang
- Center for Reproductive Medicine, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Medical Integration and Practice Center, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, and Wei)
| | - Mengfei Yin
- Center for Reproductive Medicine, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Medical Integration and Practice Center, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, and Wei)
| | - Yixuan Wang
- Center for Reproductive Medicine, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Medical Integration and Practice Center, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, and Wei)
| | - Yuan Fang
- Center for Reproductive Medicine, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Medical Integration and Practice Center, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, and Wei)
| | - Min Yang
- Center for Reproductive Medicine, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Medical Integration and Practice Center, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, and Wei)
| | - Jialin Zou
- Center for Reproductive Medicine, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Medical Integration and Practice Center, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, and Wei)
| | - Wenwen Zhang
- Center for Reproductive Medicine, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Medical Integration and Practice Center, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, and Wei)
| | - Lingling Zhang
- Center for Reproductive Medicine, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Medical Integration and Practice Center, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, and Wei)
| | - Chendan Liu
- Center for Reproductive Medicine, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Medical Integration and Practice Center, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, and Wei)
| | - Yue Wang
- Center for Reproductive Medicine, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Medical Integration and Practice Center, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, and Wei)
| | - Ze Wang
- Center for Reproductive Medicine, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
| | - Yunhai Yu
- Department of Obstetrics and Gynecology, Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (Dr Yu)
| | - Daimin Wei
- Center for Reproductive Medicine, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, Z Wang, and Wei)
- Medical Integration and Practice Center, Shandong University, Jinan, China (Drs Miao, H Yang, Yin, Yi Wang, Fang, M Yang, Zou, W Zhang, L Zhang, Liu, Yu Wang, and Wei)
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Wang Z, Jukic AMZ, Baird DD, Wilcox AJ, Li H, Curry CL, Fischer-Colbrie T, Onnela JP, Williams MA, Hauser R, Coull BA, Mahalingaiah S. Irregular Cycles, Ovulatory Disorders, and Cardiometabolic Conditions in a US-Based Digital Cohort. JAMA Netw Open 2024; 7:e249657. [PMID: 38700861 PMCID: PMC11069087 DOI: 10.1001/jamanetworkopen.2024.9657] [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] [Received: 10/31/2023] [Accepted: 03/05/2024] [Indexed: 05/06/2024] Open
Abstract
Importance Polycystic ovary syndrome (PCOS), characterized by irregular menstrual cycles and hyperandrogenism, is a common ovulatory disorder. Having an irregular cycle is a potential marker for cardiometabolic conditions, but data are limited on whether the associations differ by PCOS status or potential interventions. Objective To evaluate the association of PCOS, time to regularity since menarche (adolescence), and irregular cycles (adulthood) with cardiometabolic conditions. Design, Setting, and Participants This cross-sectional study used a large, US-based digital cohort of users of the Apple Research application on their iPhone. Eligibility criteria were having ever menstruated, living in the US, being at age of consent of at least 18 years (or 19 years in Alabama and Nebraska or 21 years in Puerto Rico), and being able to communicate in English. Participants were enrolled between November 14, 2019, and December 13, 2022, and completed relevant surveys. Exposures Self-reported PCOS diagnosis, prolonged time to regularity (not spontaneously establishing regularity within 5 years of menarche), and irregular cycles. Main Outcomes and Measures The primary outcome was self-reported cardiometabolic conditions, including obesity, prediabetes, type 1 and 2 diabetes, high cholesterol, hypertension, metabolic syndrome, arrhythmia, congestive heart failure, coronary artery disease, heart attack, heart valve disease, stroke, transient ischemic attack (TIA), deep vein thrombosis, and pulmonary embolism measured using descriptive statistics and logistic regression to estimate prevalence odds ratios (PORs) and 95% CIs. Effect modification by lifestyle factors was also estimated. Results The study sample (N = 60 789) had a mean (SD) age of 34.5 (11.1) years, with 12.3% having PCOS and 26.3% having prolonged time to regularity. Among a subset of 25 399 participants who completed the hormonal symptoms survey, 25.6% reported irregular cycles. In covariate-adjusted logistic regression models, PCOS was associated with a higher prevalence of all metabolic and several cardiovascular conditions, eg, arrhythmia (POR, 1.37; 95% CI, 1.20-1.55), coronary artery disease (POR, 2.92; 95% CI, 1.95-4.29), heart attack (POR, 1.79; 95% CI, 1.23-2.54), and stroke (POR, 1.66; 95% CI, 1.21-2.24). Among participants without PCOS, prolonged time to regularity was associated with type 2 diabetes (POR, 1.24; 95% CI, 1.05-1.46), hypertension (POR, 1.09; 95% CI, 1.01-1.19), arrhythmia (POR, 1.20; 95% CI, 1.06-1.35), and TIA (POR, 1.33; 95% CI, 1.01-1.73), and having irregular cycles was associated with type 2 diabetes (POR, 1.36; 95% CI, 1.08-1.69), high cholesterol (POR, 1.17; 95% CI, 1.05-1.30), arrhythmia (POR, 1.21; 95% CI, 1.02-1.43), and TIA (POR, 1.56; 95% CI, 1.06-2.26). Some of these associations were modified by high vs low body mass index or low vs high physical activity. Conclusions and Relevance These findings suggest that PCOS and irregular cycles may be independent markers for cardiometabolic conditions. Early screening and intervention among individuals with irregular menstrual cycles may be beneficial.
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Affiliation(s)
- Zifan Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anne Marie Z. Jukic
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, North Carolina
| | - Donna D. Baird
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, North Carolina
| | - Allen J. Wilcox
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, North Carolina
| | - Huichu Li
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | | | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Brent A. Coull
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shruthi Mahalingaiah
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Zhang M, Wen T, Wang D. The association between COVID-19 and infertility: Mendelian randomization analysis. Medicine (Baltimore) 2024; 103:e37346. [PMID: 38457599 PMCID: PMC10919494 DOI: 10.1097/md.0000000000037346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/25/2023] [Accepted: 02/02/2024] [Indexed: 03/10/2024] Open
Abstract
Since December 2019, COVID-19 has triggered a global pandemic. The association of COVID-19 with the long-term reproductive situation of women and males is not clear. Thus, our aim was to assess the causal association between COVID-19 and infertility using Mendelian randomization (MR) analysis based on the OpenGWAS database. Two-sample MR analysis was conducted using one genome-wide association study (GWAS) on COVID-19 and infertility in individuals of European ancestry. The summary data of genetic variation come from the GWAS in European populations. We applied several MR methods, including MR Egger, weighted median, inverse variance weighted, simple mode, weighted mode, to test causal relationships. After observing the statistical analysis results of MR, we conducted sensitivity analysis to test robustness. After gene prediction, it was found that there was no clear causal relationship between COVID-19 and male infertility in MR analysis [OR 0.4702 (95% CI, 0.1569-1.4093), P = .178]. Moreover, COVID-19 was not associated with female infertility [OR 0.9981 (95% CI, 0.763-1.544), P = .646]. Sensitivity analysis showed that the MR results were robust [level pleiotropy, male: (MR-Egger, intercept = 0.1967434; se = 0.1186876; P = .2392406); female: (MR-Egger, intercept = -0.05902506; se = 0.05362049; P = .3211367)]. To further validate the impact of COVID-19 on infertility, we added a covariate (sex hormone binding global levels, abortion) to the MR analysis, which is a multivariate MR analysis. According to univariate and multivariate MR analyses, the evidence does not support that COVID-19 is a causal risk factor for infertility in European population. This information can provide information for doctors in reproductive centers when managing infertility patients.
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Affiliation(s)
- Mei Zhang
- Department of Reproduction Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
- Department of Obstetrics and Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
| | - Tingyuan Wen
- Department of Reproduction Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
- Department of Obstetrics and Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
| | - Dejing Wang
- Department of Reproduction Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
- Department of Obstetrics and Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
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10
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Doğan E, Uncu B, Duman R. Comparison of menstrual cycle irregularities among young women based on coronavirus disease 2019 infection status: a cross-sectional study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20230801. [PMID: 38451576 PMCID: PMC10913787 DOI: 10.1590/1806-9282.20230801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 10/22/2023] [Indexed: 03/08/2024]
Abstract
OBJECTIVE The coronavirus disease 2019 pandemic that has emerged recently has significantly affected and continues to affect our lives. The Severe Acute Respiratory Syndrome Coronavirus 2 virus has significant effects on women's health due to gender-related physiological differences. The aim of this study was to compare the menstrual cycle status of young women according to their status of having had coronavirus disease 2019. METHODS This descriptive cross-sectional study was conducted with 220 young women aged between 18 and 25 years who received at least one dose of coronavirus disease 2019 vaccine. The study data were collected as a survey on the online platform. RESULTS The descriptive characteristics of young women who had had and had not had coronavirus disease 2019 were distributed homogeneously between the groups (p>0.05). Furthermore, there was no statistical difference in terms of menstrual cycle patterns (p>0.05). The mean scores from the Premenstrual Syndrome Scale and its subscales and the mean scores from the COVID Stress Scale and its subscales were similar in both groups, and no statistically significant difference was identified (p>0.05). CONCLUSION Although menstrual cycle irregularities due to coronavirus disease 2019 have been reported, these effects are usually observed during the pandemic. A decrease in stress and anxiety with the end of the pandemic may explain the return of the menstrual cycle to normal.
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Affiliation(s)
- Elif Doğan
- Istanbul University-Cerrahpasa, Faculty of Health Science, Department of Midwifery – İstanbul, Turkey
| | - Betül Uncu
- Istanbul University-Cerrahpasa, Faculty of Health Science, Department of Midwifery – İstanbul, Turkey
| | - Rukiye Duman
- Istanbul University-Cerrahpasa, Faculty of Health Science, Department of Midwifery – İstanbul, Turkey
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Lai S, Jin Q, Wang D, Li T, Wang X. Effects of menstrual disorders and dysmenorrhea on cardiovascular disease: a Mendelian randomization study. Front Endocrinol (Lausanne) 2024; 15:1302312. [PMID: 38375191 PMCID: PMC10875084 DOI: 10.3389/fendo.2024.1302312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Background Observational studies have demonstrated associations between menstrual disorders, dysmenorrhea, and cardiovascular disease (CVD). However, it remains unclear whether these associations are causal. This study is to investigate whether menstrual disorders and dysmenorrhea causally affect the risk of CVD. Methods The summary data for menstrual disorders (excessive menstruation and irregular menses) and dysmenorrhea were obtained from FinnGen study, summary data for CVD were obtained from UK Biobank and meta-analysis. The inverse-variance-weighted method was mainly used in the Mendelian randomization for causality analysis. Sensitivity analyses were performed by several methods under different model assumptions. Results Genetic liability to excessive menstruation was associated with higher risk of atrial fibrillation (odds ratio (OR), 1.078 [95% confidence interval (CI), 1.015-1.145]; P=0.014), but a lower risk of hypertension (OR, 0.994 [95% CI: 0.989-0.999]; P=0.016). Irregular menses was associated with higher risk of atrial fibrillation (OR, 1.095 [95% CI: 1.015-1.182]; P=0.02), hypertension (OR, 1.007 [95% CI: 1.000-1.013]; P=0.047), myocardial infarction (OR, 1.172 [95% CI: 1.060-1.295]; P=0.02), ischemic heart disease, (OR, 1.005 [95% CI: 1.000-1.010]; P=0.037) and coronary heart disease (OR, 1.004 [95% CI: 1.001-1.008]; P=0.026). Dysmenorrhea was associated with higher risk of atrial fibrillation (OR, 1.052 [95% CI: 1.014-1.092]; P=0.008) and Ischemic stroke (cardioembolic) (OR, 1.122 [95% CI: 1.002-1.257]; P=0.046). After Benjamini-Hochberg correction, irregular menses was associated with higher risk of myocardial infarction. Conclusion We confirmed a causal relationship of excessive menstruation, irregular menses and dysmenorrhea on cardiovascular outcomes independent of sex hormone levels, with an emphasis on the link between irregular menses and myocardial infarction. These clinical features can be utilized as markers to identify women at higher risk of developing CVD in the future, recommending early clinical intervention of menstrual diseases.
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Affiliation(s)
- Sijia Lai
- Institute of Cardiovascular Disease, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qiubai Jin
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dayang Wang
- Institute of Cardiovascular Disease, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tianli Li
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Xian Wang
- Institute of Cardiovascular Disease, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Stuenkel CA. Reproductive milestones across the lifespan and cardiovascular disease risk in women. Climacteric 2024; 27:5-15. [PMID: 37769699 DOI: 10.1080/13697137.2023.2259793] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/12/2023] [Indexed: 10/03/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death for women across the developed and developing world. Beyond traditional cardiovascular risk factors, a number of reproductive milestones have been recognized. The goal of this White Paper, issued by the International Menopause Society in conjunction with World Menopause Day 2023, is to highlight female reproductive milestones in terms of potential cardiovascular risk and to review recommendations for minimizing that risk. The primary milestones discussed relate to menstrual cyclicity, adverse pregnancy outcomes, breast cancer treatments and menopause. Each of these categories has a number of permutations that have been shown in observational studies to be associated with increased cardiovascular risks. In current clinical care, recognition of these reproductive milestones has been encouraged so patients can be informed and motivated to engage in primary prevention of CVD early in their life course rather than retrospectively later in life. Options for specifically targeted care with specialist teams are designed to enhance success with risk identification, screening and possible detection of CVD and, optimally, primary or secondary prevention of CVD. Promoting cardiovascular health of women has far-reaching effects for themselves, their families and their progeny. It is time to make women's cardiovascular health a priority.
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Affiliation(s)
- C A Stuenkel
- Department of Medicine, Division of Endocrinology and Metabolism, UC San Diego School of Medicine, La Jolla, CA, USA
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13
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Kumar N, Gangane N, Mohapatra I, Rukadikar C, Sharmila V, Pushpalatha K, Eerike M, Santhoshi G, Samantaray SR, Seth S, Trigunait P, Reddy NJ, Patel S, Rani S, Mishra R, Negi K. Effect of COVID-19 Vaccination on Menstrual Cycle Patterns of Reproductive-age Women: A Multi-centric Observational Study. Curr Drug Res Rev 2024; 16:237-248. [PMID: 37291775 DOI: 10.2174/2589977515666230608140606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023]
Abstract
AIM The study was conducted to know the impact of COVID-19 vaccination on menstrual cycle patterns and pre- and post-menstrual symptoms in women aged 18-45 years. BACKGROUND COVID-19 vaccination was introduced to combat the dreadful impacts of human coronavirus infection. The two indigenously developed COVID-19 vaccines approved for use in India are COVISHIELD and COVAXIN. OBJECTIVES To investigate the effects of COVID-19 vaccination on the menstrual cycle, pre- and post-menstrual symptoms and to establish the correlation with the type of vaccine received. METHODS Multi-centric observational study conducted in six institutes of national importance in different states of India over one year. A total of 5709 female participants fulfilling inclusion criteria were enrolled. Data about the impact of vaccines (COVISHIELD and COVAXIN) and prior COVID-19 infection on the menstrual cycle and its associated symptoms were obtained using all participants' online and offline interviews. RESULTS Of 5709 participants, 78.2% received COVISHIELD and 21.8% COVAXIN. Of the total 5709 participants, 333 (5.8%) developed post-vaccination menstrual disturbances, with 32.7% having frequent cycles, 63.7% prolonged cycles, and 3.6% inter-menstrual bleeding. A total of 301 participants noticed changes in the amount of bleeding, with 50.2% excessive, 48.8% scanty, and 0.99% amenorrhea followed by heavy bleeding. Furthermore, the irregularities of the menstrual cycle (p = 0.011) and length (0.001) were significantly higher in the COVAXIN group (7.2%) as compared to the COVISHIELD (5.3%) group. A total of 721 participants complained of newly developed/worsening pre- and post-menstrual symptoms. These symptoms were significantly higher in the COVISHIELD group (p = 0.031), with generalized weakness and body pains as the main complaints (p = 0.001). No significant difference was observed in the incidence of COVID-19 infection with these vaccines. No significant associations were observed when comparing menstrual abnormalities among those with COVID-19 infection (p > 0.05). CONCLUSION COVISHIELD and COVAXIN vaccines were associated with menstrual cycle disturbances and pre-and post-menstrual symptoms in a small proportion of participants, with 94.7% having no change in the amount of bleeding during menstruation post-vaccination. The menstrual irregularities observed were significantly higher with the COVAXIN vaccine. Others: Further, long-term studies are required to confirm that the impact of COVID-19 vaccination on the menstrual cycle may be short-lasting, with no severe effects on women's menstrual health.
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Affiliation(s)
- Naina Kumar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Neha Gangane
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Ipsita Mohapatra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Charushila Rukadikar
- Department of Physiology, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Vijayan Sharmila
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - K Pushpalatha
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Madhavi Eerike
- Department of Pharmacology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - G Santhoshi
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Subha Ranjan Samantaray
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Shikha Seth
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Pragati Trigunait
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - Nanditha Jangam Reddy
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - Shweta Patel
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Sandhya Rani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Roopanshi Mishra
- Department of Physiology, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Kamlesh Negi
- Department of Physiology, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
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14
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Wang YX, Mitsunami M, Manson JE, Gaskins AJ, Rich-Edwards JW, Wang L, Zhang C, Chavarro JE. Association of Gestational Diabetes With Subsequent Long-Term Risk of Mortality. JAMA Intern Med 2023; 183:1204-1213. [PMID: 37695588 PMCID: PMC10495928 DOI: 10.1001/jamainternmed.2023.4401] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/14/2023] [Indexed: 09/12/2023]
Abstract
Importance Gestational diabetes has been associated with numerous chronic diseases. However, few studies have examined the association of gestational diabetes with long-term mortality risk. Objective To investigate the associations between gestational diabetes and long-term risks of total and cause-specific mortality. Design, Setting, and Participants This cohort study analyzed participants of the Nurses' Health Study II who were followed for 30 years (1989-2019). Participants included US female nurses aged 25 to 42 years who reported at least 1 pregnancy (≥6 months) at 18 years or older across their reproductive life span. Data were analyzed from May 1, 2022, to May 25, 2023. Exposure Gestational diabetes across the reproductive life span. Main Outcomes and Measures Hazard ratios (HRs with 95% CIs) for total and cause-specific mortality were estimated by Cox proportional hazards regression models. Results A total of 91 426 parous participants were included, with a mean (SD) age of 34.9 (4.7) years and a body mass index of 24.1 (4.7) at baseline. During a follow-up period of 2 609 753 person-years, 3937 deaths were documented, including 255 deaths from cardiovascular disease and 1397 from cancer. Participants with a history of gestational diabetes had a higher crude mortality rate than those without a history of gestational diabetes (1.74 vs 1.49 per 1000 person-years; absolute difference = 0.25 per 1000 person-years). The corresponding HR for total mortality was 1.28 (95% CI, 1.13-1.44), which did not materially change after additional adjustment for potential confounders and lifestyle factors during the reproductive life span (HR, 1.25; 95% CI, 1.11-1.41). The association persisted regardless of the subsequent development of type 2 diabetes and was more robust among participants who adopted less healthy lifestyles; experienced gestational diabetes in 2 or more pregnancies (HR, 1.48; 95% CI, 0.99-2.19); had gestational diabetes both in the initial and subsequent pregnancies (HR, 1.71; 95% CI, 1.11-2.63); and concurrently reported hypertensive disorders in pregnancy (HR, 1.80; 95% CI, 1.21-2.67), preterm birth (HR, 2.46; 95% CI, 1.66-3.64), or low birth weight (HR, 2.11; 95% CI, 1.21-3.68). Cause-specific mortality analyses revealed that gestational diabetes was directly associated with the risk of mortality due to cardiovascular disease (HR, 1.59; 95% CI, 1.03-2.47). Additionally, gestational diabetes was inversely associated with cancer mortality (HR, 0.76; 95% CI, 0.59-0.98); however, it was only evident among participants who later developed type 2 diabetes. Conclusions and Relevance Results of this cohort study suggest that participants who reported a history of gestational diabetes exhibited a small but elevated risk of subsequent mortality over 30 years. The findings emphasize the importance of considering gestational diabetes as a critical factor in later-life mortality risk.
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Affiliation(s)
- Yi-Xin Wang
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Makiko Mitsunami
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - JoAnn E. Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Audrey J. Gaskins
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Janet W. Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Liang Wang
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas
| | - Cuilin Zhang
- Global Center for Asian Women’s Health and Bia-Echo Asia Centre for Reproductive Longevity and Equality, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Sun Y, Wang YX, Qian D, Mustieles V, Zhang Y, Messerlian C. Blood Trihalomethane Concentrations and Osteoarthritis among U.S. Population Aged over 50 Years. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:16166-16175. [PMID: 37852642 DOI: 10.1021/acs.est.3c01495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Exposure to trihalomethanes (THMs) has been associated with inflammation and oxidative stress, which are implicated in osteoarthritis. However, the association of THM exposure with osteoarthritis is unknown. Therefore, we pooled seven independent National Health and Nutrition Examination Survey cycles (1999-2012) among participants aged over 50 years who had quantified blood concentrations of chloroform (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM), and bromoform (TBM). Among 4,077 adults aged over 50 years, 781 (21.3%) reported osteoarthritis. Logistic regression models showed increased odds of osteoarthritis across the categories of blood BDCM, DBCM, and brominated THM (Br-THM, which was the sum of BDCM, DBCM, and TBM) concentrations [odds ratios = 1.46 (95% CI 1.09-1.94), 1.53 (95% CI 1.15-2.04), and 1.35 (95% CI 0.97-1.88), respectively], comparing highest versus lowest exposure categories (quartiles or tertiles). Additionally, we found positive dose-response relationships between blood BDCM, DBCM, and Br-THM concentrations and serum markers of oxidative stress (i.e., gamma-glutamyltransferase). In summary, blood Br-THM concentrations were associated with elevated serum levels of gamma-glutamyltransferase as well as an increased risk of osteoarthritis among U.S. adults aged over 50 years. However, more prospective population studies are needed to verify these findings and explore the underlying mechanisms.
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Affiliation(s)
- Yang Sun
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Yi-Xin Wang
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Dongyang Qian
- Department of Orthopedics, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510515, China
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts 02115, United States
| | - Vicente Mustieles
- Instituto de Investigación Biosanitaria Ibs GRANADA, 18012 Granada, Spain
- Center for Biomedical Research (CIBM), University of Granada, 18010 Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Yu Zhang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Carmen Messerlian
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
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Ollila MM, Arffman RK, Kaikkonen K, Morin-Papunen L, Junttila J, Piltonen TT. High-sensitivity troponin-T levels and associated health conditions in 3146 women aged 46. Ann Med 2023; 55:2264340. [PMID: 37795692 PMCID: PMC10557532 DOI: 10.1080/07853890.2023.2264340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/24/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE The aim of the study was to investigate are there associations between common female sex-specific health conditions (oligo/amenorrhea, hyperandrogenism, menopause and polycystic ovary syndrome [PCOS]) and high-sensitivity troponin-T (hs-TnT) levels. METHODS Cross-sectional and longitudinal analyses of a general population-based prospective cohort study were performed. The hs-TnT levels of 3146 women aged 46 were measured using an Elecsys® Troponin T high-sensitivity assay. Median hs-TnT levels and 25 and 75 percentiles of the cases and controls were compared. Also, a logistic regression analysis using a binary outcome - undetectable hs-TnT (< 3.0 ng/L) versus detectable hs-TnT (≥ 3.0 ng/L) - was performed. RESULTS Women with oligo/amenorrhea at age 31 had significantly higher hs-TnT levels at age 46 than women without oligo/amenorrhea (4.06 [3.59; 4.86] vs 3.98 [3.44; 4.71] ng/L, p = .042). Menopausal women had significantly higher hs-TnT levels than premenopausal women (4.15 [3.54; 4.91] vs 3.95 [3.45; 4.68] ng/L, p = .012) at age 46. Women with PCOS or hyperandrogenism had comparable hs-TnT levels with their controls. In the adjusted logistic regression analysis, oligo/amenorrhea (odds ratio [OR] = 1.52 [0.90-2.57]), hyperandrogenism (OR = 1.20 [0.75-1.92]), PCOS (OR = 1.51 [0.81-2.84]) and menopause (OR = 1.05 [0.63-1.74]) were not significantly associated with detectable hs-TnT. CONCLUSIONS This study was the first to investigate how oligo/amenorrhea, hyperandrogenism, PCOS and menopause are associated with hs-TnT. Although women with oligo/amenorrhea and menopause had higher hs-TnT levels than women without these conditions, the difference was small. Larger studies are required to better understand the effects of oligo/amenorrhea on cardiovascular health.
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Affiliation(s)
- Meri-Maija Ollila
- Department of Obstetrics and Gynaecology, Medical Research Center Oulu, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Riikka K. Arffman
- Department of Obstetrics and Gynaecology, Medical Research Center Oulu, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Kari Kaikkonen
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynaecology, Medical Research Center Oulu, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Terhi T. Piltonen
- Department of Obstetrics and Gynaecology, Medical Research Center Oulu, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
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17
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Chang DH, Dumanski SM, Brennand EA, Ruzycki SM, Ramage K, Gantar T, Shah S, Ahmed SB. Female Reproductive Health and Contraception Use in CKD: An International Mixed-Methods Study. Kidney Med 2023; 5:100713. [PMID: 37719717 PMCID: PMC10502408 DOI: 10.1016/j.xkme.2023.100713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Rationale & Objective Female reproductive health is recognized as a predictor of morbidity, mortality, and quality of life, although data in the setting of chronic kidney disease (CKD) are limited. Study Design A mixed-methods study was employed. Phase 1 was an anonymous, internet-based survey. Phase 2 was semistructured interviews offered to all respondents upon survey completion. Setting & Participants The survey was disseminated internationally from October 4, 2021, to January 7, 2022, to individuals aged 18-50 years with both a uterus and CKD diagnosis. Outcomes Menstrual health and contraceptive use by CKD stage (dialysis, nondialysis CKD, and transplant). Analytical Approach Survey data were analyzed using descriptive statistics. Interview data were analyzed using the framework method of analysis. Results Of 152 respondents, 98 (mean age 33 ± 0.7 years; n = 20 dialysis, n = 59 nondialysis CKD, n = 19 transplant) satisfied the inclusion criteria, representing 3 continents. The most common causes of CKD among survey respondents were hereditary causes in dialysis (n = 6, 30%) and glomerulonephritis in nondialysis CKD (n = 22, 37%) and transplant (n = 6, 32%). The majority reported heavy menstrual bleeding (n = 12, 86% dialysis; n = 46, 94% nondialysis CKD; n = 14, 100% transplant). Less than half of participants were consistently able to afford period products. Condoms were the most common contraceptive reported. Most participants reported no contraceptive use (n = 10, 50% dialysis; n = 37, 63% nondialysis CKD; n = 7, 37% transplant), primarily because of "fear". Interviews (n = 6) revealed a perception of a relationship between kidney function and menstrual health, concerns about contraceptive use, and a desire for greater multidisciplinary care to improve kidney and reproductive health. Limitations Self-reported outcomes, need for internet access and a device. Conclusions Abnormal menstruation and period poverty (ie, inability to afford period products and the socioeconomic consequences of menstruation) were common, and contraceptive use was low among female individuals with CKD, highlighting an important gap in the sex-specific care of this population. Plain-Language Summary Chronic kidney disease (CKD) in female individuals is accompanied by menstrual disorders and low contraceptive use. However, most data are limited to the dialysis and transplant populations. Therefore, this mixed-methods study aimed to describe self-assessed menstruation and contraceptive use across all stages of CKD. People aged 18-50 years with a uterus and CKD diagnosis were invited to participate in an online survey shared internationally as well as an optional telephone interview. Abnormal menstruation and period poverty (ie, inability to afford period products and the socioeconomic consequences of menstruation) were common, and contraceptive use was low among female individuals with CKD, highlighting an important gap in the sex-specific care of this population.
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Affiliation(s)
- Danica H. Chang
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Sandra M. Dumanski
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- Alberta Kidney Disease Network, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Erin A. Brennand
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Shannon M. Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Kaylee Ramage
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Taryn Gantar
- Kidney Health Strategic Clinical Network, Alberta, Canada
| | - Silvi Shah
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Sofia B. Ahmed
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- Alberta Kidney Disease Network, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
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Matsuura Y, Tran NH, Yasui T. The Changes in Menstrual and Menstrual-Related Symptoms among Japanese Female University Students: A Prospective Cohort Study from Three Months to Nine Months after Admission. Healthcare (Basel) 2023; 11:2557. [PMID: 37761754 PMCID: PMC10531057 DOI: 10.3390/healthcare11182557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Menstrual and menstrual-related symptoms can significantly impact an individual's physical and psychological health. Understanding how these symptoms evolve over time is crucial to provide appropriate support and healthcare services to young women. This study aimed to investigate changes in menstrual and menstrual-related symptoms among first-year female university students. A prospective longitudinal design was used to compare the symptom profiles between two time points (three and nine months after admission). Out of 100 female university students, 30 responses were analyzed. Data on menstrual and menstrual-related symptoms were collected using standardized questionnaires focusing on menstrual status and the Menstrual Distress Questionnaire (MDQ); no notable changes occurred between the time points. Approximately half reported having irregular menstruation during the three time periods. Among the sub-scales, premenstrual "impaired concentration" showed a tendency to be lower, whereas menstrual "water retention" tended to be higher in timepoint 2 compared to timepoint 1. "Distractible" was found to be significantly lower in timepoint 2 compared to timepoint 1. There was a significant association between a sleep duration of <7 h and worsened MDQ scores. These findings may underscore the importance of providing comprehensive lifestyle and menstrual education to new university students, along with access to appropriate medical care.
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Affiliation(s)
- Yukie Matsuura
- Department of Reproductive and Menopausal Medicine, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Nam Hoang Tran
- Research Center for Higher Education, Tokushima University, Tokushima 770-8502, Japan
| | - Toshiyuki Yasui
- Department of Reproductive and Menopausal Medicine, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
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19
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Jung HN, Suh D, Jeong WC, Ryu J, Kim YM, Yoon S, Kim H. Associations of chronotype and insomnia with menstrual problems in newly employed nurses at university hospitals in the Republic of Korea. Ann Occup Environ Med 2023; 35:e30. [PMID: 37701482 PMCID: PMC10493377 DOI: 10.35371/aoem.2023.35.e30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/06/2023] [Accepted: 06/30/2023] [Indexed: 09/14/2023] Open
Abstract
Background Dysmenorrhea and menstrual cycle changes occur in women working shifts. Circadian rhythm disruption and sleep disturbances associated with shift work leads to health problems. We identified chronotypes and the occurrence of insomnia among newly employed university hospital nurses and investigated the association of these factors with menstrual problems. Methods We conducted pre-placement health examinations for shift workers using self-reported questionnaires between 2018 and 2020. A total of 463 nurses were included in the study. Sociodemographic data, shift work experience, and information on insomnia were collected from health examination data. In addition, details regarding chronotype, dysmenorrhea, irregular and abnormal menstrual cycles, amenorrhea, and contraceptive use were obtained from the questionnaire. Multiple logistic regression analysis was performed to study the association between chronotype, insomnia, and menstrual problems after controlling for age, body mass index, contraceptive use, amenorrhea, and prior shift work. Results The prevalence rates of dysmenorrhea, irregular menstrual cycles, and longer menstrual cycles were 23.8%, 14.9%, and 4.1%, respectively. The risk of dysmenorrhea increased in the evening-type (odds ratio [OR]: 3.209; 95% confidence interval [CI]: 1.685-6.113) and those with insomnia (OR: 1.871; 95% CI: 1.074-3.261). Additionally, the risk of an irregular menstrual cycle (OR: 2.698; 95% CI: 1.167-6.237) increased in the evening-type, and the risk of a longer menstrual cycle (OR: 4.008; 95% CI: 1.354-11.864) increased in individuals with insomnia. Conclusions Our findings suggest that dysmenorrhea is promoted in the evening-type and insomnia individuals. There may be an increased risk of irregular menstrual cycles among evening-type nurses and an increased risk of longer menstrual cycles among those with insomnia. Therefore, factors such as evening-type and insomnia should be considered for the prevention of menstrual problems in women performing shift work.
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Affiliation(s)
- Han-Na Jung
- Department of Occupational and Environmental Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Dongwhan Suh
- Department of Occupational and Environmental Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Woo Chul Jeong
- Department of Occupational and Environmental Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Jia Ryu
- Department of Occupational and Environmental Medicine, Catholic Kwandong University International St. Mary’s Hospital, Incheon, Korea
| | - Yu-Mi Kim
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, Korea
- School of Public Health, Hanyang University, Seoul, Korea
| | - Seohyun Yoon
- Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyunjoo Kim
- Department of Occupational and Environmental Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
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20
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Kazzi B, Shankar B, Elder-Odame P, Tokgözoğlu LS, Sierra-Galan LM, Michos ED. A Woman's Heart: Improving Uptake and Awareness of Cardiovascular Screening for Middle-Aged Populations. Int J Womens Health 2023; 15:1171-1183. [PMID: 37520181 PMCID: PMC10377626 DOI: 10.2147/ijwh.s328441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
Mid-life, the years leading up to and following the menopause transition, in women is accompanied by a change in cardiometabolic risk factors, including increases in body weight, changes in body composition, a more insulin-resistant state, and a shift towards a more atherogenic dyslipidemia pattern. Cardiovascular disease (CVD) risk assessment should be performed continually throughout the lifespan, as risk is not stagnant and can change throughout the life course. However, mid-life is a particularly important time for a woman to be evaluated for CVD risk so that appropriate preventive strategies can be implemented. Along with assessing traditional risk factors, ascertainment of a reproductive history is an integral part of a comprehensive CVD risk assessment to recognize unique female-specific or female-predominant factors that modify a woman's risk. When there is uncertainty about CVD risk and the net benefit of preventive pharmacotherapy interventions (such as statins), measuring a coronary artery calcium score can help further refine risk and guide shared decision-making. Additionally, there should be heightened sensitivity around identifying signs and symptoms of ischemic heart disease in women, as these may present differently than in men. Ischemia from coronary microvascular disease and/or vasospasm may be present even without obstructive coronary artery disease and is associated with a heightened risk for major cardiovascular events and reduced quality of life. Therefore, correctly identifying CVD in women and implementing preventive and treatment therapies is paramount. Unfortunately, women are underrepresented in cardiovascular clinical trials, and more data are needed about how to best incorporate novel and emerging risk factors into CVD risk assessment. This review outlines an approach to CVD screening and risk assessment in women using several methods, focusing on the middle-aged population.
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Affiliation(s)
- Brigitte Kazzi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bairavi Shankar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Petal Elder-Odame
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lale S Tokgözoğlu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Lilia M Sierra-Galan
- Cardiology Department of the Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Erin D Michos
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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21
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Wang YX, Varraso R, Dumas O, Stuart JJ, Florio A, Wang L, Rich-Edwards JW, Camargo CA, Chavarro JE. Hypertensive disorders of pregnancy and risk of asthma and chronic obstructive pulmonary disease: a prospective cohort study. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100540. [PMID: 37457814 PMCID: PMC10338286 DOI: 10.1016/j.lana.2023.100540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023]
Abstract
Background Hypertensive disorders of pregnancy (HDPs) have been associated with respiratory dysfunction during pregnancy and postpartum. In this study, we explored the associations between HDPs (gestational hypertension and preeclampsia) and the risk of incident asthma and chronic obstructive pulmonary disease (COPD) during adulthood and the potential mediating role of chronic hypertension. Methods We included parous nurses in the Nurses' Health Study II reporting a pregnancy lasting no less than 6 months. The associations between HDPs and asthma and COPD were estimated using Cox proportional hazards models with adjustment for confounders. Findings We included 73,807 nurses [92.5% (68,246 of 73,807) White] in asthma analyses and 79,843 [92.4% (73,746 of 79,843) White] in COPD analyses, whose mean (SD, range) age, at baseline, were both 34.8 (4.7, 25.0-44.0) years. During 24 years of follow-up, we identified 2663 incident cases of asthma and 537 COPD. Compared with nurses without HDPs, nurses reporting HDPs had an increased HR for incident asthma and COPD of 1.22 (95% CI 1.10-1.36) and 1.39 (95% CI 1.11-1.74), respectively. The risk of asthma was similar when gestational hypertension and preeclampsia were assessed separately [HR = 1.25 (95% CI 1.08-1.43) and 1.24 (95% CI 1.11-1.38), respectively]. However, only nurses with preeclampsia had a higher risk of COPD (HR = 1.41, 95% CI 1.11-1.78). Mediation analyses estimated that chronic hypertension explained 18.6% (95% CI 8.9-35.0%) and 10.7% (95% CI 2.9-32.4%) of the associations between HDPs and asthma and COPD, respectively. Interpretation HDPs may serve as useful markers of increased susceptibility to chronic respiratory diseases during adulthood. Funding The National Institutes of Health grants.
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Affiliation(s)
- Yi-Xin Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Raphaëlle Varraso
- Université Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94907, Villejuif, France
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94907, Villejuif, France
| | - Jennifer J. Stuart
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Florio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Liang Wang
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Janet W. Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Carlos A. Camargo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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22
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Li H, Gibson EA, Jukic AMZ, Baird DD, Wilcox AJ, Curry CL, Fischer-Colbrie T, Onnela JP, Williams MA, Hauser R, Coull BA, Mahalingaiah S. Menstrual cycle length variation by demographic characteristics from the Apple Women's Health Study. NPJ Digit Med 2023; 6:100. [PMID: 37248288 DOI: 10.1038/s41746-023-00848-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/19/2023] [Indexed: 05/31/2023] Open
Abstract
Menstrual characteristics are important signs of women's health. Here we examine the variation of menstrual cycle length by age, ethnicity, and body weight using 165,668 cycles from 12,608 participants in the US using mobile menstrual tracking apps. After adjusting for all covariates, mean menstrual cycle length is shorter with older age across all age groups until age 50 and then became longer for those age 50 and older. Menstrual cycles are on average 1.6 (95%CI: 1.2, 2.0) days longer for Asian and 0.7 (95%CI: 0.4, 1.0) days longer for Hispanic participants compared to white non-Hispanic participants. Participants with BMI ≥ 40 kg/m2 have 1.5 (95%CI: 1.2, 1.8) days longer cycles compared to those with BMI between 18.5 and 25 kg/m2. Cycle variability is the lowest among participants aged 35-39 but are considerably higher by 46% (95%CI: 43%, 48%) and 45% (95%CI: 41%, 49%) among those aged under 20 and between 45-49. Cycle variability increase by 200% (95%CI: 191%, 210%) among those aged above 50 compared to those in the 35-39 age group. Compared to white participants, those who are Asian and Hispanic have larger cycle variability. Participants with obesity also have higher cycle variability. Here we confirm previous observations of changes in menstrual cycle pattern with age across reproductive life span and report new evidence on the differences of menstrual variation by ethnicity and obesity status. Future studies should explore the underlying determinants of the variation in menstrual characteristics.
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Affiliation(s)
- Huichu Li
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, 02115, MA, USA
| | - Elizabeth A Gibson
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, 02115, MA, USA
| | - Anne Marie Z Jukic
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, 27709, NC, USA
| | - Donna D Baird
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, 27709, NC, USA
| | - Allen J Wilcox
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, 27709, NC, USA
| | | | | | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, 02115, MA, USA
| | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, 02115, MA, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, 02115, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, 02115, MA, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, 02115, MA, USA
| | - Shruthi Mahalingaiah
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, 02115, MA, USA.
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23
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Wang YX, Sun Y, Missmer SA, Rexrode KM, Roberts AL, Chavarro JE, Rich-Edwards JW. Association of early life physical and sexual abuse with premature mortality among female nurses: prospective cohort study. BMJ 2023; 381:e073613. [PMID: 37137504 PMCID: PMC10155244 DOI: 10.1136/bmj-2022-073613] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To explore associations between early life physical and sexual abuse and subsequent risk of premature mortality (death before age 70 years). DESIGN Prospective cohort study. SETTING The Nurses' Health Study II (2001-19). PARTICIPANTS 67 726 female nurses aged 37-54 years when completing a violence victimization questionnaire in 2001. MAIN OUTCOME MEASURES Hazard ratios and 95% confidence intervals for total and cause specific premature mortality by childhood or adolescent physical and sexual abuse, estimated by multivariable Cox proportional hazard models. RESULTS 2410 premature deaths were identified over 18 years of follow-up. Nurses who experienced severe physical abuse or forced sexual activity in childhood and adolescence had a higher crude premature mortality rate than nurses without such abuse in childhood or adolescence (3.15 v 1.83 and 4.00 v 1.90 per 1000 person years, respectively). The corresponding age adjusted hazard ratios for premature deaths were 1.65 (95% confidence interval 1.45 to 1.87) and 2.04 (1.71 to 2.44), respectively, which were materially unchanged after further adjusting for personal characteristics and early life socioeconomic status (1.53, 1.35 to 1.74, and 1.80, 1.50 to 2.15, respectively). Cause specific analyses indicated that severe physical abuse was associated with a greater risk of mortality due to external causes of injury and poisoning (multivariable adjusted hazard ratio 2.81, 95% confidence interval 1.62 to 4.89), suicide (3.05, 1.41 to 6.60), and diseases of the digestive system (2.40, 1.01 to 5.68). Forced sexual activity as a child and adolescent was associated with greater risk of mortality due to cardiovascular disease (2.48, 1.37 to 4.46), external injury or poisoning (3.25, 1.53 to 6.91), suicide (4.30, 1.74 to 10.61), respiratory disease (3.74, 1.40 to 9.99), and diseases of the digestive system (4.83, 1.77 to 13.21). The association of sexual abuse with premature mortality was stronger among women who smoked or had higher levels of anxiety during adulthood. Smoking, low physical activity, anxiety, and depression each explained 3.9-22.4% of the association between early life abuse and premature mortality. CONCLUSION Early life physical and sexual abuse could be associated with a greater risk of adult premature mortality.
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Affiliation(s)
- Yi-Xin Wang
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Yang Sun
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Stacey A Missmer
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Kathryn M Rexrode
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea L Roberts
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Jorge E Chavarro
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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24
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Sun W, Xia L, Ji C, Wei Q, Zhang J, He S, Wang X, Shen X, Zhang X, Li C. Relationship between covid-pandemic anxiety and sleep disorder with menstrual disorders among female medical workers. BMC Womens Health 2023; 23:210. [PMID: 37118730 PMCID: PMC10147349 DOI: 10.1186/s12905-023-02314-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/29/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND It has been more than 2 years since the 2019 novel coronavirus disease (COVID-19) pandemic destabilized the world, adversely affecting not only physical health, but also mental health. During this time, frontline medical workers were at a greater health risk, especially female medical workers. Changes or abnormalities in the menstrual cycle-an important indicator of women's health-may jeopardize female reproductive functioning. Considering that emotional health and sleep status may be related to the menstrual cycle, this study aimed to investigate the association between menstrual cycle changes, anxiety, sleep dysfunction, and other factors among female medical workers during the COVID-19 pandemic. METHODS A cross-sectional survey was conducted by distributing online questionnaires to female medical workers in China from February to May 2022. The study included 160 women aged 18-45 years old. The questionnaires covered data related to the participants' sociodemographic characteristics, medical and reproductive history, and lifestyle. The Rating Scale for Clinical Manifestations of Menopathy (SCMM), Self-Rating Anxiety Scale (SAS), and Sleep Dysfunction Rating Scale (SDRS) were utilized. Data were analyzed using chi-square tests, t-tests, and linear regression analysis. RESULTS A total of 160 female medical staff were randomly selected in this research, of whom seven scored less than 3 points, 85 scored 3-11 points, and 68 scored more than 11 points on the total score of the SCMM. Compared to pre-pandemic scores, scores of dizziness and tinnitus were significantly higher during the COVID-19 pandemic. Scores corresponding to the following clinical symptoms were also higher during the pandemic: Menopathy, including hypaphrodisia, dim complexion, abnormal urination, languidness, dim menstruation, thin menstruation, dysmenorrhea, and empty or saggy lower abdomen (p < 0.05). However, pre-pandemic scores of vaginal bleeding quantity were significantly higher than those found during the COVID-19 pandemic (p < 0.05). Scores of vaginal bleeding quantity were significantly lower in cabin hospitals than other types of hospitals, and a similar finding was observed for vaginal bleeding duration (all p < 0.05). Moreover, the findings of the univariable and multivariable linear regression analysis revealed a link between consistent exercise, the underlying illness, the SDRS score, the SAS score, and the total score of SCMM (p < 0.05). CONCLUSIONS In this study, we found that menstruation in female medical workers was affected by the COVID-19 pandemic. Furthermore, regular exercise and good physical condition were protective factors, while anxiety and insomnia were risk factors for menstrual abnormalities.
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Affiliation(s)
- Wenxi Sun
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China
| | - Liping Xia
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China
| | - Caifang Ji
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China
| | - Qianqian Wei
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China
| | - Jun Zhang
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China
| | - Sidi He
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China
| | - Xuqin Wang
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China
| | - Xueqin Shen
- The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, 215100, Jiangsu Province, China
| | - Xiaobin Zhang
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China.
| | - Chuanwei Li
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China.
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25
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Temkin SM, Barr E, Moore H, Caviston JP, Regensteiner JG, Clayton JA. Chronic conditions in women: the development of a National Institutes of health framework. BMC Womens Health 2023; 23:162. [PMID: 37024841 PMCID: PMC10077654 DOI: 10.1186/s12905-023-02319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
Rising rates of chronic conditions were cited as one of the key public health concerns in the Fiscal Year (FY) 2021 U.S. Senate and House of Representatives appropriations bills, where a review of current National Institutes of Health (NIH) portfolios relevant to research on women's health was requested. Chronic conditions were last defined by the US Department of Health and Human Services (HHS) in 2010. However, existing definitions of chronic conditions do not incorporate sex or gender considerations. Sex and gender influence health, yet significant knowledge gaps exist in the evidence-base for prevention, diagnosis, and treatment of chronic diseases amongst women. The presentation, prevalence, and long-term effects of chronic conditions and multimorbidity differs in women from men. A clinical framework was developed to adequately assess the NIH investment in research related to chronic conditions in women. The public health needs and NIH investment related to conditions included in the framework were measured. By available measures, research within the NIH has not mapped to the burden of chronic conditions among women. Clinical research questions and endpoints centered around women can be developed and implemented; clinical trials networks with expanded or extended eligibility criteria can be created; and data science could be used to extrapolate the effects of overlapping or multiple morbidities on the health of women. Aligning NIH research priorities to address the specific needs of women with chronic diseases is critical to addressing women's health needs from a life course perspective.
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Affiliation(s)
- Sarah M Temkin
- Office of Research On Women's Health, National Institutes of Health, Bethesda, MD, USA.
| | - Elizabeth Barr
- Office of Research On Women's Health, National Institutes of Health, Bethesda, MD, USA
| | - Holly Moore
- National Institute On Drug Abuse National Institutes of Health, Bethesda, MD, USA
| | - Juliane P Caviston
- Office of Research On Women's Health, National Institutes of Health, Bethesda, MD, USA
| | - Judith G Regensteiner
- Department of Medicine, Ludeman Family Center for Women's Health Research, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Janine A Clayton
- Office of Research On Women's Health, National Institutes of Health, Bethesda, MD, USA
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26
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Ghandour R, Hammoudeh W, Stigum H, Giacaman R, Fjeld H, Holmboe-Ottesen G. Menstrual characteristics and dysmenorrhea among Palestinian adolescent refugee camp dwellers in the West Bank and Jordan: a cross-sectional study. Arch Public Health 2023; 81:47. [PMID: 36998019 PMCID: PMC10061948 DOI: 10.1186/s13690-023-01059-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 03/10/2023] [Indexed: 04/01/2023] Open
Abstract
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.
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Affiliation(s)
- Rula Ghandour
- grid.22532.340000 0004 0575 2412Institute of Community and Public Health, Birzeit University, Said Khoury Building for Development Studies, Birzeit, P.O.Box 14, occupied Palestinian territory
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Weeam Hammoudeh
- grid.22532.340000 0004 0575 2412Institute of Community and Public Health, Birzeit University, Said Khoury Building for Development Studies, Birzeit, P.O.Box 14, occupied Palestinian territory
| | - Hein Stigum
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Rita Giacaman
- grid.22532.340000 0004 0575 2412Institute of Community and Public Health, Birzeit University, Said Khoury Building for Development Studies, Birzeit, P.O.Box 14, occupied Palestinian territory
| | - Heidi Fjeld
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Gerd Holmboe-Ottesen
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
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27
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Okoth K, Smith WP, Thomas GN, Nirantharakumar K, Adderley NJ. The association between menstrual cycle characteristics and cardiometabolic outcomes in later life: a retrospective matched cohort study of 704,743 women from the UK. BMC Med 2023; 21:104. [PMID: 36941638 PMCID: PMC10029324 DOI: 10.1186/s12916-023-02794-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 02/17/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Female reproductive factors are gaining prominence as factors that enhance cardiovascular disease (CVD) risk; nonetheless, menstrual cycle characteristics are under-recognized as a factor associated with CVD. Additionally, there is limited data from the UK pertaining to menstrual cycle characteristics and CVD risk. METHODS A UK retrospective cohort study (1995-2021) using data from a nationwide database (The Health Improvement Network). Women aged 18-40 years at index date were included. 252,325 women with history of abnormal menstruation were matched with up to two controls. Two exposures were examined: regularity and frequency of menstrual cycles; participants were assigned accordingly to one of two separate cohorts. The primary outcome was composite cardiovascular disease (CVD). Secondary outcomes were ischemic heart disease (IHD), cerebrovascular disease, heart failure (HF), hypertension, and type 2 diabetes mellitus (T2DM). Cox proportional hazards regression models were used to derive adjusted hazard ratios (aHR) of cardiometabolic outcomes in women in the exposed groups compared matched controls. RESULTS During 26 years of follow-up, 20,605 cardiometabolic events occurred in 704,743 patients. Compared to women with regular menstrual cycles, the aHRs (95% CI) for cardiometabolic outcomes in women with irregular menstrual cycles were as follows: composite CVD 1.08 (95% CI 1.00-1.19), IHD 1.18 (1.01-1.37), cerebrovascular disease 1.04 (0.92-1.17), HF 1.30 (1.02-1.65), hypertension 1.07 (1.03-1.11), T2DM 1.37 (1.29-1.45). The aHR comparing frequent or infrequent menstrual cycles to menstrual cycles of normal frequency were as follows: composite CVD 1.24 (1.02-1.52), IHD 1.13 (0.81-1.57), cerebrovascular disease 1.43 (1.10-1.87), HF 0.99 (0.57-1.75), hypertension 1.31 (1.21-1.43), T2DM 1.74 (1.52-1.98). CONCLUSIONS History of either menstrual cycle irregularity or frequent or infrequent cycles were associated with an increased risk of cardiometabolic outcomes in later life. Menstrual history may be a useful tool in identifying women eligible for periodic assessment of their cardiometabolic health.
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Affiliation(s)
- Kelvin Okoth
- Institute of Applied Health Research, IOEM Building, University of Birmingham, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - William Parry Smith
- Institute of Applied Health Research, IOEM Building, University of Birmingham, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - G Neil Thomas
- Institute of Applied Health Research, IOEM Building, University of Birmingham, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, IOEM Building, University of Birmingham, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
| | - Nicola J Adderley
- Institute of Applied Health Research, IOEM Building, University of Birmingham, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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28
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Farland LV, Wang Y, Gaskins AJ, Rich‐Edwards JW, Wang S, Magnus MC, Chavarro JE, Rexrode KM, Missmer SA. Infertility and Risk of Cardiovascular Disease: A Prospective Cohort Study. J Am Heart Assoc 2023; 12:e027755. [PMID: 36847044 PMCID: PMC10111453 DOI: 10.1161/jaha.122.027755] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/17/2023] [Indexed: 03/01/2023]
Abstract
Background Certain symptoms associated with infertility are associated with cardiovascular disease, including menstrual cycle irregularity, early menopause, and obesity; however, few studies have investigated the association between infertility and cardiovascular disease risk. Methods and Results Participants in the NHSII (Nurses' Health Study II) who reported infertility (12 months of trying to conceive without success, including women who subsequently conceived) or who were gravid, with no infertility were followed from 1989 until 2017 for development of incident, physician-diagnosed coronary heart disease (CHD) (myocardial infarction, coronary artery bypass grafting, angioplasty, stent) and stroke. Time-varying Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% CIs and were adjusted a priori for potential confounding variables. Among 103 729 participants, 27.6% reported having ever experienced infertility. Compared with gravid women who had not reported infertility, women with a history of infertility had greater risk of CHD (HR, 1.13 [95% CI, 1.01-1.26]) but not stroke (HR, 0.91 [95% CI, 0.77-1.07]). The association between history of infertility and CHD was strongest among women who reported infertility at an earlier age (HR for infertility first reported at ≤25 years, 1.26 [95% CI, 1.09-1.46]; HR at 26-30 years, 1.08 [95% CI, 0.93-1.25]; HR at >30 years, 0.91 [95% CI, 0.70-1.19]). When we investigated specific infertility diagnoses, elevated risk of CHD was observed among women whose infertility was attributed to an ovulatory disorder (HR, 1.28 [95% CI, 1.05-1.55]) or endometriosis (HR, 1.42 [95% CI, 1.09-1.85]). Conclusions Women with infertility may be at an increased risk of CHD. Risk differed by age at first infertility diagnosis and was restricted to ovulatory- and endometriosis-related infertility.
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Affiliation(s)
- Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonAZ
- Department of Obstetrics and Gynecology, College of Medicine‐TucsonUniversity of ArizonaTucsonAZ
| | - Yi‐Xin Wang
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMA
| | - Audrey J. Gaskins
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Janet W. Rich‐Edwards
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Division of Women’s Health, Department of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Siwen Wang
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMA
| | | | - Jorge E. Chavarro
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Kathryn M. Rexrode
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Division of Women’s Health, Department of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Stacey A. Missmer
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Department of Obstetrics and Gynecology and Reproductive Biology, College of Human MedicineMichigan State UniversityGrand RapidsMI
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29
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Chang DH, Dumanski SM, Ahmed SB. Female sex-specific considerations to improve rigor and reproducibility in cardiovascular research. Am J Physiol Heart Circ Physiol 2023; 324:H279-H287. [PMID: 36563011 DOI: 10.1152/ajpheart.00462.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cardiovascular disease is the leading cause of death in women. Despite recognition of sex-specific differences in cardiovascular health, females are underrepresented across all aspects of cardiovascular research, playing a key role in reducing rigor and reproducibility in cardiovascular research and contributing to these poorer health outcomes. Therefore, we propose a framework to capture factors associated with the female sex at the preclinical, recruitment, data collection, and data analysis stages. In preclinical cardiovascular research, female experimental models are commonly excluded despite similar variability in findings compared with males. To reduce this sex bias, the inclusion of female models and the incorporation of sex as a biological variable are critical to improve reproducibility and inform clinical research and care. Although funding agencies have mandated the inclusion of women in clinical trials, greater efforts are needed to achieve optimal participation-to-prevalence ratio to increase the generalizability of results to real-world settings. Female participants face more stringent exclusion criteria in research compared with males owing to sex-specific factors. However, their routine exclusion from cardiovascular research is not only unethical but limits generalizability and applicability to clinical practice. Identifying sex assigned at birth, collecting information on female sex-specific and -predominant factors associated with cardiovascular health and risk, and stratifying data by sex, including adverse events, are essential to ensure reproducibility and relevance of findings to target populations. Increasing female representation and the incorporation of female sex-specific cardiovascular risk factors in cardiovascular research will not only lead to enhanced rigor and reproducibility but improved cardiovascular health for all.
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Affiliation(s)
- Danica H Chang
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sandra M Dumanski
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Kidney Disease Network, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Kidney Disease Network, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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30
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Henyoh AMS, Allodji RS, de Vathaire F, Boutron-Ruault MC, Journy NMY, Tran TVT. Multi-Morbidity and Risk of Breast Cancer among Women in the UK Biobank Cohort. Cancers (Basel) 2023; 15:cancers15041165. [PMID: 36831509 PMCID: PMC9953793 DOI: 10.3390/cancers15041165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
(Multi-)Morbidity shares common biological mechanisms or risk factors with breast cancer. This study aimed to investigate the association between the number of morbidities and patterns of morbidity and the risk of female breast cancer. Among 239,436 women (40-69 years) enrolled in the UK Biobank cohort who had no cancer history at baseline, we identified 35 self-reported chronic diseases at baseline. We assigned individuals into morbidity patterns using agglomerative hierarchical clustering analysis. We fitted Cox models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for breast cancer risk. In total, 58.4% of women had at least one morbidity, and the prevalence of multi-morbidity was 25.8%. During a median 7-year follow-up, there was no association between breast cancer risk (5326 cases) and either the number of morbidities or the identified clinically relevant morbidity patterns: no-predominant morbidity (reference), psychiatric morbidities (HR = 1.04, 95%CI 0.94-1.16), respiratory/immunological morbidities (HR = 0.98, 95%CI 0.90-1.07), cardiovascular/metabolic morbidities (HR = 0.93, 95%CI 0.81-1.06), and unspecific morbidities (HR = 0.98, 95%CI 0.89-1.07), overall. Among women younger than 50 years of age only, however, there was a significant association with psychiatric morbidity patterns compared to the no-predominant morbidity pattern (HR = 1.25, 95%CI 1.02-1.52). The other associations did not vary when stratifying by age at baseline and adherence to mammography recommendations. In conclusion, multi-morbidity was not a key factor to help identify patients at an increased risk of breast cancer.
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Affiliation(s)
- Afi Mawulawoe Sylvie Henyoh
- Radiation Epidemiology Group, Center for Research in Epidemiology and Population Health, INSERM U1018, Paris Sud-Paris Saclay University, Gustave Roussy, 94800 Villejuif, France
- Correspondence: (A.M.S.H.); (T.-V.-T.T.)
| | - Rodrigue S. Allodji
- Radiation Epidemiology Group, Center for Research in Epidemiology and Population Health, INSERM U1018, Paris Sud-Paris Saclay University, Gustave Roussy, 94800 Villejuif, France
| | - Florent de Vathaire
- Radiation Epidemiology Group, Center for Research in Epidemiology and Population Health, INSERM U1018, Paris Sud-Paris Saclay University, Gustave Roussy, 94800 Villejuif, France
| | - Marie-Christine Boutron-Ruault
- Health across Generations Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Paris Sud-Paris Saclay University, Gustave Roussy, 94800 Villejuif, France
| | - Neige M. Y. Journy
- Radiation Epidemiology Group, Center for Research in Epidemiology and Population Health, INSERM U1018, Paris Sud-Paris Saclay University, Gustave Roussy, 94800 Villejuif, France
| | - Thi-Van-Trinh Tran
- Radiation Epidemiology Group, Center for Research in Epidemiology and Population Health, INSERM U1018, Paris Sud-Paris Saclay University, Gustave Roussy, 94800 Villejuif, France
- Correspondence: (A.M.S.H.); (T.-V.-T.T.)
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31
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Zhang CY, Li H, Zhang S, Suharwardy S, Chaturvedi U, Fischer-Colbrie T, Maratta LA, Onnela JP, Coull BA, Hauser R, Williams MA, Baird DD, Jukic AMZ, Mahalingaiah S, Curry CL. Abnormal uterine bleeding patterns determined through menstrual tracking among participants in the Apple Women's Health Study. Am J Obstet Gynecol 2023; 228:213.e1-213.e22. [PMID: 36414993 PMCID: PMC9877138 DOI: 10.1016/j.ajog.2022.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/07/2022] [Accepted: 10/23/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Use of menstrual tracking data to understand abnormal bleeding patterns has been limited because of lack of incorporation of key demographic and health characteristics and confirmation of menstrual tracking accuracy. OBJECTIVE This study aimed to identify abnormal uterine bleeding patterns and their prevalence and confirm existing and expected associations between abnormal uterine bleeding patterns, demographics, and medical conditions. STUDY DESIGN Apple Women's Health Study participants from November 2019 through July 2021 who contributed menstrual tracking data and did not report pregnancy, lactation, use of hormones, or menopause were included in the analysis. Four abnormal uterine bleeding patterns were evaluated: irregular menses, infrequent menses, prolonged menses, and irregular intermenstrual bleeding (spotting). Monthly tracking confirmation using survey responses was used to exclude inaccurate or incomplete digital records. We investigated the prevalence of abnormal uterine bleeding stratified by demographic characteristics and used logistic regression to evaluate the relationship of abnormal uterine bleeding to a number of self-reported medical conditions. RESULTS There were 18,875 participants who met inclusion criteria, with a mean age of 33 (standard deviation, 8.2) years, mean body mass index of 29.3 (standard deviation, 8.0), and with 68.9% (95% confidence interval, 68.2-69.5) identifying as White, non-Hispanic. Abnormal uterine bleeding was found in 16.4% of participants (n=3103; 95% confidence interval, 15.9-17.0) after accurate tracking was confirmed; 2.9% had irregular menses (95% confidence interval, 2.7-3.1), 8.4% had infrequent menses (95% confidence interval, 8.0-8.8), 2.3% had prolonged menses (95% confidence interval, 2.1-2.5), and 6.1% had spotting (95% confidence interval, 5.7-6.4). Black participants had 33% higher prevalence (prevalence ratio, 1.33; 95% confidence interval, 1.09-1.61) of infrequent menses compared with White, non-Hispanic participants after controlling for age and body mass index. The prevalence of infrequent menses was increased in class 1, 2, and 3 obesity (class 1: body mass index, 30-34.9; prevalence ratio, 1.31; 95% confidence interval, 1.13-1.52; class 2: body mass index, 35-39.9; prevalence ratio, 1.25; 95% confidence interval, 1.05-1.49; class 3: body mass index, >40; prevalence ratio, 1.51; 95% confidence interval, 1.21-1.88) after controlling for age and race/ethnicity. Those with class 3 obesity had 18% higher prevalence of abnormal uterine bleeding compared with healthy-weight participants (prevalence ratio, 1.18; 95% confidence interval, 1.02-1.38). Participants with polycystic ovary syndrome had 19% higher prevalence of abnormal uterine bleeding compared with participants without this condition (prevalence ratio, 1.19; 95% confidence interval, 1.08-1.31). Participants with hyperthyroidism (prevalence ratio, 1.34; 95% confidence interval, 1.13-1.59) and hypothyroidism (prevalence ratio, 1.17; 95% confidence interval, 1.05-1.31) had a higher prevalence of abnormal uterine bleeding, as did those reporting endometriosis (prevalence ratio, 1.28; 95% confidence interval, 1.12-1.45), cervical dysplasia (prevalence ratio, 1.20; 95% confidence interval, 1.03-1.39), and fibroids (prevalence ratio, 1.14; 95% confidence interval, 1.00-1.30). CONCLUSION In this cohort, abnormal uterine bleeding was present in 16.4% of those with confirmed menstrual tracking. Black or obese participants had increased prevalence of abnormal uterine bleeding. Participants reporting conditions such as polycystic ovary syndrome, thyroid disease, endometriosis, and cervical dysplasia had a higher prevalence of abnormal uterine bleeding.
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Affiliation(s)
| | - Huichu Li
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | | | - Sanaa Suharwardy
- Health, Apple Inc, Cupertino, CA; Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | | | | | | | - Jukka-Pekka Onnela
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Brent A Coull
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Russ Hauser
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | | | - Donna D Baird
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Anne Marie Z Jukic
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
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Vidafar P, Spitschan M. Light on Shedding: A Review of Sex and Menstrual Cycle Differences in the Physiological Effects of Light in Humans. J Biol Rhythms 2023; 38:15-33. [PMID: 36367137 PMCID: PMC9902977 DOI: 10.1177/07487304221126785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The human circadian system responds to light as low as 30 photopic lux. Furthermore, recent evidence shows that there are huge individual differences in light sensitivity, which may help to explain why some people are more susceptible to sleep and circadian disruption than others. The biological mechanisms underlying the differences in light sensitivity remain largely unknown. A key variable of interest in understanding these individual differences in light sensitivity is biological sex. It is possible that in humans, males and females differ in their sensitivity to light, but the evidence is inconclusive. This is in part due to the historic exclusion of women in biomedical research. Hormonal fluctuations across the menstrual cycle in women has often been cited as a confound by researchers. Attitudes, however, are changing with funding and publication agencies advocating for more inclusive research frameworks and mandating that women and minorities participate in scientific research studies. In this article, we distill the existing knowledge regarding the relationship between light and the menstrual cycle. There is some evidence of a relationship between light and the menstrual cycle, but the nature of this relationship seems dependent on the timing of the light source (sunlight, moonlight, and electric light at night). Light sensitivity may be influenced by biological sex and menstrual phase but there might not be any effect at all. To better understand the relationship between light, the circadian system, and the menstrual cycle, future research needs to be designed thoughtfully, conducted rigorously, and reported transparently.
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Affiliation(s)
- Parisa Vidafar
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
- Translational Sensory and Circadian Neuroscience, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Manuel Spitschan
- Translational Sensory and Circadian Neuroscience, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- TUM Institute for Advanced Study, Technical University of Munich, Garching, Germany
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Zehravi M, Maqbool M, Ara I. Teenage menstrual dysfunction: an overview. Int J Adolesc Med Health 2023; 35:15-19. [PMID: 36117242 DOI: 10.1515/ijamh-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 07/12/2022] [Indexed: 11/15/2022]
Abstract
When a girl experiences her first period, she starts a new phase of her life and becomes biologically capable of becoming a mother and giving birth to a child. Girls' hypothalamus-pituitary-ovary axis reaches "axial maturity" during puberty, when they are between the ages of 8 and 13 years old. Secondary biological features, including as growth, body-shape changes in females, breast growth, hair growth on the vulva, and hair growth on the axillary pits, are often observed during this era. The first menstruation, or menarche, is also commonly observed during this time. During the menstrual cycle, a woman's ability to conceive and give birth is at the core of her reproductive life.
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Affiliation(s)
- Mehrukh Zehravi
- Department of Clinical Pharmacy Girls Section, Prince Sattam Bin Abdul Aziz University, Alkharj, Saudia Arabia
| | - Mudasir Maqbool
- Department of Pharmaceutical Sciences, University Of Kashmir, Srinagar, Jammu and Kashmir, India
| | - Irfat Ara
- Regional Research Institute of Unani Medicine, Srinagar, Jammu and Kashmir, India
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34
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Wang S, Rexrode KM, Florio AA, Rich-Edwards JW, Chavarro JE. Maternal Mortality in the United States: Trends and Opportunities for Prevention. Annu Rev Med 2023; 74:199-216. [PMID: 36706746 DOI: 10.1146/annurev-med-042921-123851] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Maternal mortality is unusually high in the United States compared to other wealthy nations and is characterized by major disparities in race/ethnicity, geography, and socioeconomic factors. Similar to other developed nations, the United States has seen a shift in the underlying causes of pregnancy-related death, with a relative increase in mortality resulting from diseases of the cardiovascular system and preexisting medical conditions. Improved continuity of care aimed at identifying reproductive-age women with preexisting conditions that may heighten the risk of maternal death, preconception management of risk factors for major adverse pregnancy outcomes, and primary care visits within the first year after delivery may offer opportunities to address gaps in medical care contributing to the unacceptable rates of maternal mortality in the United States.
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Affiliation(s)
- Siwen Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA;
| | - Kathryn M Rexrode
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea A Florio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA;
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA; .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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35
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Ravi S, Valtonen M, Ihalainen JK, Holopainen E, Kosola S, Heinonen S, Waller B, Kujala UM, Parkkari J. Eating behaviours, menstrual history and the athletic career: a retrospective survey from adolescence to adulthood in female endurance athletes. BMJ Open Sport Exerc Med 2023; 9:e001489. [PMID: 36896365 PMCID: PMC9990674 DOI: 10.1136/bmjsem-2022-001489] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 03/11/2023] Open
Abstract
Aim To evaluate differences in menstrual and pubertal history and trends in eating behaviours among women with and without a competitive sports background. Additionally, we investigated if menstrual history and eating behaviours are associated with sports career-related factors. Methods This retrospective study was conducted on 100 women with a competitive endurance sports background and their age-matched, gender-matched and municipality-matched controls (n=98). Data were collected using a questionnaire using previously validated instruments. Generalised estimating equations were used to calculate associations of menstrual history and eating behaviours with outcome variables (career length, participation level, injury-related harms and career termination due to injury). Results Athletes reported higher rates of delayed puberty and menstrual dysfunction than controls. No differences between the groups were observed in the Eating Disorder Examination Questionnaire short form (EDE-QS) scores at any age. Previous disordered eating (DE) was associated with current DE in both groups. Among athletes, higher EDE-QS scores during the sports career were associated with a shorter career (B=-0.15, 95% CI -0.26 to -0.05). Secondary amenorrhoea was associated with lower participation level (OR 0.51, 95% CI 0.27 to 0.95), injury-related harms during the career (OR 4.00, 95% CI 1.88 to 8.48) and career termination due to injury (OR 1.89, 95% CI 1.02 to 3.51). Conclusion The findings indicate that DE behaviours and menstrual dysfunction, specifically secondary amenorrhoea, have a disadvantageous relationship with a sports career in women competing in endurance sports. DE during the sports career is associated with DE after the career.
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Affiliation(s)
- Suvi Ravi
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Maarit Valtonen
- KIHU Research Institute for Olympic Sports, Jyväskylä, Finland
| | - Johanna K Ihalainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Elina Holopainen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Silja Kosola
- Pediatric Research Center, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Saara Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Ben Waller
- Sports Science Department, Reykjavik University, Reykjavik, Iceland.,Institute of Rehabilitation, Jyväskylä University of Applied Sciences, Jyväskylä, Finland
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jari Parkkari
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Antero J, Golovkine S, Niffoi L, Meignié A, Chassard T, Delarochelambert Q, Duclos M, Maitre C, Maciejewski H, Diry A, Toussaint JF. Menstrual cycle and hormonal contraceptive phases' effect on elite rowers' training, performance and wellness. Front Physiol 2023; 14:1110526. [PMID: 36875020 PMCID: PMC9981658 DOI: 10.3389/fphys.2023.1110526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/02/2023] [Indexed: 02/19/2023] Open
Abstract
Objectives: To investigate the effect of menstrual cycle (MC) and hormonal contraception (HC) phases in elite rowers training, performance and wellness monitoring. Methods: Twelve French elite rowers were follow-up for 4,2 cycles on average in their final preparation for the Olympics and Paralympics Games in Tokyo 2021 through an on-site longitudinal study based on repeated measures. Daily self-reported evaluation using Likert rating scales of wellness (sleep quality, fitness, mood, injuries' pain), menstrual symptoms and training parameters (perceived exertion and self-assessment of performance) were collected (n = 1,281) in parallel to a coach evaluation of rowers' performance (n = 136), blinded to theirs MC and HC phases. Salivary samples of estradiol and progesterone were collected in each cycle to help to classify the MC into 6 phases and HC into 2-3 phases depending on the pills' hormone concentration. A chi-square test normalized by each rower was used to compare the upper quintile scores of each studied variable across phases. A Bayesian ordinal logistic regression was applied to model the rowers' self-reported performance. Results: Rowers with a natural cycle, n = 6 ( + 1 amenorrhea) evaluate their performance and wellness with significant higher score indices at the middle of their cycle. Top assessments are rarer at the premenstrual and menses phases, when they more frequently experience menstrual symptoms which are negatively correlated with their performance. The HC rowers, n = 5, also better evaluate their performance when taking the pills and more frequently experience menstrual symptoms during the pill withdrawal. The athletes self-reported performance is correlated with their coach's evaluation. Conclusion: It seems important to integrate MC and HC data in the wellness and training monitoring of female athletes since these parameters vary across hormonal phases affecting training perception of both athlete and coach.
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Affiliation(s)
- Juliana Antero
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Steven Golovkine
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Louis Niffoi
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Alice Meignié
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Tom Chassard
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Quentin Delarochelambert
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Martine Duclos
- Department of Sport Medicine and Functional Exploration, University Hospital CHU G. Montpied, INRAE, UNH, CRNH Auvergne, Clermont Auvergne University, Clermont-Ferrand, France
| | - Carole Maitre
- Medical Department at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | | | - Allison Diry
- French Rowing Federation, Nogent-sur-Marne, France
| | - Jean-François Toussaint
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France.,URP 7329, Université Paris Cité, Paris, France.,Center for Investigation in Sport Medicine, CIMS Hôtel-Dieu, Assistance Publique-Hopitaux de Paris, Paris, France
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37
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Ma SS, Yin WJ, Wang P, Wang HX, Zhang L, Jiang XM, Zhang Y, Tao R, Ge JF, Zhu P. Previous pregnancy loss and gestational cardiovascular health: A prospective cohort of nulliparous women. Front Public Health 2023; 11:1071706. [PMID: 37113178 PMCID: PMC10127104 DOI: 10.3389/fpubh.2023.1071706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/10/2023] [Indexed: 04/29/2023] Open
Abstract
Objectives To estimate the association of previous pregnancy loss with subsequent cardiovascular health during gestation and to examine the role of high-sensitivity C reactive protein (hs-CRP) in the association. Methods A total of 2,778 nulliparous pregnant women were recruited between March 2015 and November 2020 in Hefei city, China. Their cardiovascular health (CVH) including prepregnancy body mass index (BMI), blood pressure, total cholesterol, fasting plasma glucose, and smoke status were recorded at 24-28 weeks' gestation, as well as their reproductive history. Multivariate linear and logistic regression were performed to examine the association of pregnancy loss with cardiovascular health. And the role of hs-CRP between pregnancy loss and CVH was assessed by the mediation analysis. Results Compared with women who have no pregnancy loss, women with a history of spontaneous or induced abortions had higher BMI (β, 0.72, 95% CI, 0.50 to 0.94) and fasting plasma glucose (β, 0.04, 95% CI, 0.01 to 0.07), and had lower total CVH scores after adjusting for confounders (β, -0.09, 95% CI, -0.18 to -0.01). CVH scores were most significantly decreased among women with 3 or more induced abortions (β, -0.26, 95% CI, -0.49, -0.02). The contribution of pregnancy loss to poorer gestational CVH mediated by increased hs-CRP levels was 23.17%. Conclusion Previous pregnancy loss was associated with poorer cardiovascular health during gestation, which may be mediated by their gestational inflammatory status. Exposure to miscarriage alone was not a significant predictor of poorer CVH.
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Affiliation(s)
- Shuang-shuang Ma
- Department of Sleep Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People's Hospital, Hefei, China
- Anhui Mental Health Center, Hefei, Anhui, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Wan-jun Yin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Peng Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Hai-xia Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Lei Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Xiao-min Jiang
- Department of Obstetrics and Gynecology, Anhui Women and Child Health Care Hospital, Hefei, Anhui, China
| | - Ying Zhang
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ruixue Tao
- Department of Obstetrics and Gynecology, Hefei First People's Hospital, Hefei, Anhui, China
| | - Jin-fang Ge
- School of Pharmacy, Anhui Medical University, Hefei, Anhui, China
- *Correspondence: Jin-fang Ge,
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China
- Peng Zhu,
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Fowler CI, Koo HP, Richmond AD, Creel D, Asman K. U.S. Women's Knowledge of Reproductive Biology. Womens Health Issues 2023; 33:54-66. [PMID: 35868957 DOI: 10.1016/j.whi.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/19/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Having accurate knowledge of reproductive biology can help women to improve their general, sexual, and reproductive health and assert their sexual and reproductive rights. METHODS This cross-sectional study examined knowledge of three topics (age-related fertility decline, egg supply, fertile period) among a national probability sample of 1,779 nonsterilized, English-speaking women (aged 18-29 years) in the U.S. general population. Using bivariate and multivariable regressions, we assessed associations between knowledge of these topics and individual characteristics. RESULTS Most respondents were unmarried (63%), childless (78%), and intended to have children (65%); 51% did not know whether they would have difficulty conceiving, and 44% had discussed fertility-related topics with a health care provider. More respondents knew the age of marked fertility decline (62%) than the fertile period (59%) or that ovaries do not continuously produce new eggs (45%); 22% knew all three topics, and 13% knew none. In multivariable analysis, knowledge was positively associated (p < .001) with education, income, and having regular periods. Black and Asian respondents and those for whom religion was very important were less likely (all p values < .01) than White and nonreligious respondents to know all three topics. Knowledge was unrelated to relationship status, parity, childbearing intentions, receipt of fertility-related counseling or services, self-perceived infertility risk, or health status; the relationship with Hispanic ethnicity approached but did not reach significance (p = .08). CONCLUSIONS Young U.S. women have incomplete knowledge of aspects of their reproductive biology; these knowledge gaps could increase their risk of adverse health and reproductive outcomes. Policy-, provider-, and client-level interventions are warranted to address these knowledge gaps.
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Affiliation(s)
| | - Helen P Koo
- Independent Consultant, Durham, North Carolina
| | - Alicia D Richmond
- Office of Population Affairs, U.S. Department of Health and Human Services, Washington, District of Columbia
| | - Darryl Creel
- RTI International, Washington, District of Columbia
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Mínguez-Alarcón L, Hammer KC, Williams PL, Souter I, Ford JB, Rexrode KM, Hauser R, Chavarro JE. Self-reported history of comorbidities and markers of ovarian reserve among subfertile women. J Assist Reprod Genet 2022; 39:2719-2728. [PMID: 36322231 PMCID: PMC9790841 DOI: 10.1007/s10815-022-02643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To investigate whether history of comorbidities is associated with markers of ovarian reserve among subfertile women. METHODS This observational study includes 645 women seeking fertility care at the Massachusetts General Hospital who enrolled in the Environment and Reproductive Health (EARTH) study (2005-2019). Women completed a comprehensive questionnaire including medical diagnosis of comorbidities. Ovarian reserve markers including antral follicle count (AFC), assessed by transvaginal ultrasound, and circulating serum levels of day 3 FSH and AMH, are assessed by immunoassays. We fit linear regression models to evaluate the association between history of comorbidities and markers of ovarian reserve while adjusting for confounders. RESULTS Self-reported history of hypertension, cancer, and neurological disorders was negatively associated with AFC in unadjusted models and in adjusted models for age, smoking, physical activity, comorbidity count, and BMI. Adjusted mean AFC (95% CI) was lower among women with history of hypertension, compared to women with no self-reported history of hypertension (11.5 vs 15.6, p value 0.0001). In contrast, day 3 FSH levels were positively related to history of eating disorders in both unadjusted and adjusted models (10.8 vs. 7.43 IU/L, p value ≤ 0.0001). Self-reported history of other comorbidities was unrelated to AFC, day 3 FSH, and AMH levels. CONCLUSIONS History of hypertension, cancer, and neurological disorders was negatively associated with AFC, and eating disorders were positively related to day 3 FSH levels. The prevention of common comorbidities among women in reproductive age may help increase women's fertility given the declining birth rates and increasing use of assisted reproductive technologies in the past years.
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Affiliation(s)
- Lidia Mínguez-Alarcón
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, Boston, MA, USA.
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA.
| | - Karissa C Hammer
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paige L Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Irene Souter
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer B Ford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA
| | - Kathryn M Rexrode
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, MA, Boston, USA
| | - Jorge E Chavarro
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Sasaki N, Akiyama H, Kawakami N, Nishi D. Preconception menstrual cycle disorder and antenatal depression: a cross-sectional study with prerecorded information. J Psychosom Obstet Gynaecol 2022; 43:411-418. [PMID: 34882063 DOI: 10.1080/0167482x.2021.2010699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the association between pre-pregnancy menstrual cycle characteristics (i.e. cycle-length variability and cycle length) and antenatal depression. METHODS This study retrieved the data from the baseline survey of the randomized controlled trial with pregnant women at 16-20 weeks gestation who used a pregnancy tracking app. The antenatal depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 16-20 weeks gestation, and the cutoff point of 10/11 was adopted. Pre-conceptional menstrual cycle information was obtained via a prerecorded period tracking app. Cycle-length variability was defined as the average difference in the lengths between cycles, dichotomized into regular (≤6 days) and irregular (>6 days). Cycle length was coded as a categorical variable: <25 days, 25-26 days, 27-29 days (regular), 30-31 days, 32-33 days, and 34+ days. The associations of cycle disorders with EPDS scores were examined using regression analysis and a multiple logistic regression model adjusted for covariates. RESULTS The total of 3473 participants were analyzed in this study. Irregular cycle variability (>6 days) was significantly associated with high EPDS scores (adjusted: standardized beta = 0.049, p = 0.003) and with high cutoff EPDS scores (over 11) (adjusted OR = 1.40 [1.02-1.94], p = 0.038) but not with cycle length. CONCLUSION Irregular menstrual cycle before pregnancy was associated with depression during pregnancy. The health of the menstrual cycle during preconception needs to be further explored to promote healthy maternal mental health.
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Affiliation(s)
- Natsu Sasaki
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Hiroto Akiyama
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
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Rytz CL, Kochaksaraei GS, Skeith L, Ronksley PE, Dumanski SM, Robert M, Ahmed SB. Menstrual Abnormalities and Reproductive Lifespan in Females with CKD: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol 2022; 17:1742-1753. [PMID: 36418040 PMCID: PMC9718020 DOI: 10.2215/cjn.07100622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/16/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Menstrual abnormalities and shortened reproductive lifespan are associated with shorter life expectancy and higher cardiovascular and osteoporosis risk in the general population, although the magnitude of these reproductive factor irregularities in females with CKD is unclear. This systematic review and meta-analysis aimed to summarize the current knowledge regarding menstrual abnormalities and reproductive lifespan among females with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A comprehensive bibliographic search (MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature [CINAHL]) was completed from database inception to February 2022 to identify all original articles reporting on females of reproductive age with nondialysis-dependent/nonkidney transplant CKD, dialysis-dependent CKD, or kidney transplantation and menstruation patterns, age of menarche, and/or menopause. Data extraction and study quality assessment were completed in duplicate. Random effects meta-analyses were used to derive pooled proportions estimates. RESULTS Forty-six studies were identified, and 35 were meta-analyzed, stratified by KRT modality and reported outcome. Menstrual abnormalities were present in 19%-47% of patients on hemodialysis and 75% of patients on peritoneal dialysis. Kidney transplantation was associated with a 7%-30% decrease in menstrual abnormalities. Reproductive lifespan was 32 years (95% confidence interval, 30 to 34 years). Although significant heterogeneity was present, study quality ranged from fair to good, and no evidence of publication bias was noted. CONCLUSIONS Menstrual abnormalities and shorter reproductive lifespan are common in females with CKD, although kidney transplantation may improve menstrual health.
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Affiliation(s)
- Chantal L. Rytz
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Leslie Skeith
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
- Alberta Kidney Disease Network, Calgary, Alberta, Canada
| | - Paul E. Ronksley
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
- Alberta Kidney Disease Network, Calgary, Alberta, Canada
| | - Sandra M. Dumanski
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
- Alberta Kidney Disease Network, Calgary, Alberta, Canada
| | - Magali Robert
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Sofia B. Ahmed
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
- Alberta Kidney Disease Network, Calgary, Alberta, Canada
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The effect of COVID-19 vaccination on the menstrual pattern and mental health of the medical students: A mixed-methods study from a low and middle-income country. PLoS One 2022; 17:e0277288. [DOI: 10.1371/journal.pone.0277288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
Objective
To assess the effect of COVID-19 vaccination on menstrual patterns and mental health of medical students and to explore the students’ perspective regarding this effect.
Materials and methods
This mixed-method study was conducted on the medical and dental students of the private and public sector institutions of Peshawar from September 2021 to March 2022. A Menstrual symptom questionnaire (MSQ) and hospital anxiety and depression scale (HADS) were used. This was followed by qualitative interviews with the students who faced problems in their menstruation after the COVID-19 vaccination.
Results
A total of 953 students were included, with a mean age of 20.67±1. 56 years. More than half (n = 512, 53.7%) experienced menstrual cycle abnormalities post-vaccination. The majority having disturbances in their menstrual cycle had significantly higher levels of anxiety (p = 0.000). Results on the menstrual symptom questionnaire, anxiety, and depression subtype of HADS showed a negative and statistically significant relationship with changes after COVID-19 vaccination (p<0.05). In the qualitative interviews, 10 (58.8%) students each had problems with frequency and flow, followed by 7 (41.2%) students, who had dysmenorrhea. Seven (41.2%) consulted a gynecologist for management. The majority (n = 14, 82.4%) stated that these issues had an adverse impact on their mental health and almost half (n = 8, 47.1%) suggested consulting a gynecologist while facing such situations.
Conclusion
This study showed the impact of the COVID-19 vaccine on women`s menstrual patterns and subsequent mental health status. Although the majority of the students experienced menstrual cycle abnormalities and subsequent mental health adversities post COVID-19 vaccination but these were temporary and self-limiting and were attributed to the psychological impact of the vaccination. Therefore, it is imperative to alert health care professionals about possible side effects and prior counseling is expected to play an important role in this context.
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Crosstalk between Extracellular Matrix Stiffness and ROS Drives Endometrial Repair via the HIF-1α/YAP Axis during Menstruation. Cells 2022; 11:cells11193162. [PMID: 36231126 PMCID: PMC9562179 DOI: 10.3390/cells11193162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/17/2022] Open
Abstract
Although the menstrual cycle driven by sex steroid hormones is an uncomplicated physiological process, it is important for female health, fertility and regenerative biology. However, our understanding of this unique type of tissue homeostasis remains unclear. Here, we examined the biological effects of mechanical force by evaluating the changing trend of extracellular matrix (ECM) stiffness, and the results suggested that ECM stiffness was reduced and that breaking of mechanotransduction delayed endometrium repair in a mouse model of simulated menses. We constructed an ECM stiffness interference model in vitro to explain the mechanical force conduction mechanism during endometrial regeneration. We discovered that ECM stiffness increased the expression and nuclear transfer of YAP, which improved the creation of a microenvironment, in a manner that induced proliferation and angiogenesis for endometrial repair by activating YAP. In addition, we observed that physiological endometrial hypoxia occurs during the menstrual cycle and that the expression of HIF-1α was increased. Mechanistically, in addition to the classical F-actin/YAP pathway, we also found that the ROS/HIF-1α/YAP axis was involved in the transmission of mechanical signals. This study provides novel insights into the essential menstrual cycle and presents an effective, nonhormonal treatment for menstrual disorders.
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Zhang B, Yu X, Liu J, Liu J, Liu P. COVID-19 vaccine and menstrual conditions in female: data analysis of the Vaccine Adverse Event Reporting System (VAERS). BMC Womens Health 2022; 22:403. [PMID: 36195902 PMCID: PMC9532224 DOI: 10.1186/s12905-022-01934-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In reports of adverse reactions following vaccination with the coronavirus disease 2019(COVID-19) vaccines, there have been fewer reports of concern for menstrual disorders in female. OBJECTIVE Our study employed Vaccine Adverse Event Reporting System (VAERS) to investigate and analyze the relationship between COVID-19 Vaccines and menstrual disorders in female. METHODS We collected reports of menstrual disorders in VAERS from July 2, 1990 to November 12, 2021, and performed a stratified analysis. The potential relationship between COVID-19 vaccine and reports of menstrual disorders was evaluated using the Reporting Odds Ratio (ROR) method. RESULTS A total of 14,431 reports of menstrual disorders were included in the study, and 13,118 were associated with COVID-19 vaccine. The ROR was 7.83 (95% confidence interval [95%CI]: 7.39-8.28). The most commonly reported event was Menstruation irregular (4998 reports), and a higher percentage of female aged 30-49 years reported menstrual disorders (42.55%) after exposure to COVID-19 Vaccines. Both for all reports of menstrual disorders (ROR = 5.82; 95%CI: 4.93-6.95) and excluding reports of unknown age (ROR = 13.02; 95%CI: 10.89-15.56),suggest that female age may be associated with menstrual disorders after vaccination with the COVID-19 Vaccines. CONCLUSION There is a potential safety signal when the COVID-19 vaccine is administered to young adult female (30-49 years old), resulting in menstrual disorders in. However, due to the well-known limitations of spontaneous reporting data, it is challenging to explicity classify menstrual disorders as an adverse event of the COVID-19 Vaccines, and reports of adverse reactions to COVID-19 Vaccines in this age group should continue to be tracked.
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Affiliation(s)
- Bing Zhang
- First School of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China
| | - Xiao Yu
- Department of Gynecology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250000, Shandong, China
| | - Jinxing Liu
- Department of Gynecology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250000, Shandong, China
| | - Jinbao Liu
- Department of Orthopedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250000, Shandong, China.
| | - Pengfei Liu
- Department of Reproduction and Genetics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250000, Shandong, China.
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Wang YX, Stuart JJ, Rich-Edwards JW, Missmer SA, Rexrode KM, Farland LV, Mukamal KJ, Nelson SM, Solomon CG, Fraser A, Chavarro JE. Menstrual Cycle Regularity and Length Across the Reproductive Lifespan and Risk of Cardiovascular Disease. JAMA Netw Open 2022; 5:e2238513. [PMID: 36282498 PMCID: PMC9597395 DOI: 10.1001/jamanetworkopen.2022.38513] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/08/2022] [Indexed: 12/02/2022] Open
Abstract
Importance Menstrual cycle characteristics may be associated with an increased risk of cardiovascular disease (CVD). However, existing studies are limited, and few have explored the mediating role of established CVD risk factors. Objective To explore the associations of menstrual cycle characteristics across the reproductive lifespan with the risk of CVD and to what extent these associations were mediated by hypercholesterolemia, chronic hypertension, and type 2 diabetes. Design, Setting, and Participants This cohort study prospectively followed Nurses' Health Study II participants between 1993 and 2017 who reported menstrual cycle regularity and length for ages 14 to 17 years and 18 to 22 years at enrollment in 1989 and updated current cycle characteristics in 1993 (at ages 29 to 46 years). Data analysis was performed from October 1, 2019, to January 1, 2022. Exposures Menstrual cycle regularity and length across the reproductive lifespan. Main Outcomes and Measures Incident CVD events of interest, including fatal and nonfatal coronary heart disease (CHD; myocardial infarction [MI] or coronary revascularization) and stroke. Results A total of 80 630 Nurses' Health Study II participants were included in the analysis, with a mean (SD) age of 37.7 (4.6) years and body mass index of 25.1 (5.6) at baseline. Over 24 years of prospective follow-up, 1816 women developed their first CVD event. Multivariable Cox proportional hazards models showed that, compared with women reporting very regular cycles at the same ages, women who had irregular cycles or no periods at ages 14 to 17, 18 to 22, or 29 to 46 years had hazard ratios for CVD of 1.15 (95% CI, 0.99-1.34), 1.36 (95% CI, 1.06-1.75), and 1.40 (95% CI, 1.14-1.71), respectively. Similarly, compared with women reporting a cycle length of 26 to 31 days, women reporting a cycle length 40 days or more or a cycle too irregular to estimate from ages 18 to 22 or 29 to 46 years had hazard ratios for CVD of 1.44 (95% CI, 1.13-1.84) and 1.30 (95% CI, 1.09-1.57), respectively. Mediation analyses showed that subsequent development of hypercholesteremia, chronic hypertension, and type 2 diabetes only explained 5.4% to 13.5% of the observed associations. Conclusions and Relevance In this cohort study, both irregular and long menstrual cycles were associated with increased rates of CVD, which persisted even after accounting for subsequently established CVD risk factors.
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Affiliation(s)
- Yi-Xin Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jennifer J. Stuart
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Janet W. Rich-Edwards
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Stacey A. Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids
| | - Kathryn M. Rexrode
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | - Kenneth J. Mukamal
- Division of General Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Scott M. Nelson
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Caren G. Solomon
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Abigail Fraser
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Michos ED, Honigberg MC. Sex-Specific Factors Associated With Atrial Fibrillation in Women-Rhythm of Reproductive Health. JAMA Netw Open 2022; 5:e2229723. [PMID: 36048446 DOI: 10.1001/jamanetworkopen.2022.29723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael C Honigberg
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston
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Song S, Choi H, Pang Y, Kim O, Park HY. Factors associated with regularity and length of menstrual cycle: Korea Nurses’ Health Study. BMC Womens Health 2022; 22:361. [PMID: 36050702 PMCID: PMC9438137 DOI: 10.1186/s12905-022-01947-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Menstrual cycle characteristics are linked to reproductive function and long-term health outcomes. This study aimed to evaluate menstrual cycle patterns, characterized by regularity and length, and associated factors among women in the Korea Nurses’ Health Study. Methods A total of 9335 premenopausal women aged 22–45 years were included in this cross-sectional study. Regularity and length of menstrual cycles were self-reported, and their associations with reproductive, lifestyle, and occupational factors were examined using binomial and multinomial logistic regression models. Adjusted least-square means of menstrual distress, depressive symptoms, stress, fatigue, anxiety, and sleep problems were estimated according to menstrual cycle characteristics using generalized linear models. Results Twenty-one percent of nurses reported having irregular menstrual cycles (variability > 7 days). Ten percent, 64%, and 26% had menstrual cycle length of < 26, 26–31, and 32–50 days, respectively. Variability and length of cycles decreased with age and increased with age at menarche. Parous women showed low tendency of irregular cycles. Women with body mass index (BMI) > 25 kg/m2 had higher odds of irregular (odds ratio [OR] 1.68; 95% confidence interval [CI] 1.40–2.03) and long cycles (OR 1.31; 95% CI 1.08–1.58) than those with BMI 18.5– < 23 kg/m2. Irregular cycles were less common in women performing vigorous physical activity, but more common in those with prolonged standing or frequent heavy lifting at work. Frequent rotating night shift was associated with irregular cycles among nulliparous women. Levels of menstrual and premenstrual distress, depressive symptoms, perceived stress, physical and mental fatigue, anxiety, and sleep problems were higher in women with irregular cycles than in those with regular cycles (p < 0.001, each). Conclusions The study suggests that irregular and long menstrual cycles are associated with reproductive, lifestyle, and occupational factors; also with menstrual distress and perceived health status. Our findings contribute to a better understanding of potential risk factors for menstrual dysfunction, and thus, may help improve women’s health. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01947-z.
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Nazir M, Asghar S, Rathore MA, Shahzad A, Shahid A, Ashraf Khan A, Malik A, Fakhar T, Kausar H, Malik J. Menstrual abnormalities after COVID-19 vaccines: A systematic review. VACUNAS 2022; 23:S77-S87. [PMID: 35873308 PMCID: PMC9294036 DOI: 10.1016/j.vacun.2022.07.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/02/2022] [Indexed: 01/09/2023]
Abstract
The objective of this systematic review is to give a comprehensive interpretation of menstrual cycle changes after the COVID-19 vaccination. Additionally, it is imperative to assess reports of menstrual changes following vaccination to dispel concerns that COVID-19 vaccines hinder the likelihood of pregnancy in the long run. A literature review was conducted using digital databases to systematically identify the studies reporting any menstrual abnormalities after the COVID-19 vaccine. Detailed patient-level study characteristics including the type of study, sample size, administered vaccines, and menstrual abnormalities were abstracted. A total of 78 138 vaccinated females were included in this review from 14 studies. Of these, 39 759 (52.05%) had some form of a menstrual problem after vaccination. Due to the lack of published research articles, preprints were also included in this review. Menorrhagia, metrorrhagia, and polymenorrhea were the most commonly observed problems and the overall study-level rate of menstrual abnormality ranged from 0.83% to 90.9%. Age, history of pregnancy, systemic side-effects of COVID-19, smoking, and second dose of COVID-19 vaccine were predictors of menstrual problems after vaccination.
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Affiliation(s)
- Maheen Nazir
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Shumaila Asghar
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Muhammad Ali Rathore
- Department of Hematology, Armed Forces Institute of Transfusion, Rawalpindi, Pakistan
| | - Asima Shahzad
- Faculty of Medical Sciences, Army Medical College, Rawalpindi, Pakistan
| | - Anum Shahid
- Department of Obs/Gyne, Shifa International Hospital, Islamabad, Pakistan
| | | | - Asmara Malik
- Department of Community Medicine, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Tehniat Fakhar
- Department of Medicine, Shifa Tameer e Millat University, Islamabad, Pakistan
| | - Hafsa Kausar
- Department of Medicine, Shifa Tameer e Millat University, Islamabad, Pakistan
| | - Jahanzeb Malik
- Department of Electrophysiology, Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
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Sharp GC, Fraser A, Sawyer G, Kountourides G, Easey KE, Ford G, Olszewska Z, Howe LD, Lawlor DA, Alvergne A, Maybin JA. The COVID-19 pandemic and the menstrual cycle: research gaps and opportunities. Int J Epidemiol 2022; 51:691-700. [PMID: 34865021 PMCID: PMC8690231 DOI: 10.1093/ije/dyab239] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/26/2021] [Indexed: 12/26/2022] Open
Affiliation(s)
- Gemma C Sharp
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Gemma Sawyer
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Kayleigh E Easey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Gemma Ford
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Laura D Howe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Deborah A Lawlor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Alexandra Alvergne
- School of Anthropology, University of Oxford, Oxford, UK
- Institut des Sciences de l'Évolution, Université de Montpellier, Montpellier, France
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Madaan S, Talwar D, Jaiswal A, Kumar S, Acharya N, Acharya S, Dewani D. Post-COVID-19 menstrual abnormalities and infertility: Repercussions of the pandemic. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:170. [PMID: 35847136 PMCID: PMC9277727 DOI: 10.4103/jehp.jehp_1200_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/19/2021] [Indexed: 05/31/2023]
Abstract
While battling the life-threatening complications of COVID-19, its effect on the menstrual cycle and infertility has been somewhat ignored. This brief review aims on highlighting the importance of menstrual abnormalities being experienced during the post-COVID period and to make the clinicians aware about what to expect in regard of menstrual abnormalities by learning from various studies that have been conducted worldwide. This review article was written with systematic literature review with the help of data search machine such as PubMed, Scopus, Web of Sciences, and Google Scholar. A search strategy leads to the extraction of 160 related articles that after the removal of inappropriate and duplicate articles, 33 articles were selected for the review. To find other potentially relevant articles, the references of the extracted articles were thoroughly examined. The search was carried out using keywords including "COVID-19," "Menstrual abnormalities," and "Infertility." Using OR and AND, the keywords mentioned above were combined and then utilized in the search box of the databases. Articles published from January 2020 to September 2021 were included in this study. It includes worldwide data ranging from studies done in China, India, Ireland, Turkey, Jordan, and Germany. During the post-COVID period, there is a significant alteration in the sex hormones of females infected by COVID-19 which may manifest as menstrual cycle abnormalities such as decreased cycle length or prolonged menstrual cycle bleeding. It may also manifest as infertility due to ovarian failure due to suppression of ovarian function COVID-19 a novel coronavirus which is presently a pandemic has affected the world in manner reminding the world of 1918 Spanish flu. However, while battling the deadly pandemic, the clinicians should also be aware of the repercussions of the effect this infection has on multiple organs such as ovarian suppression leading to infertility, oligomenorrhea, or menorrhagia.
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Affiliation(s)
- Sparsh Madaan
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Dhruv Talwar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Arpita Jaiswal
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Deepika Dewani
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
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