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Attia GM, Alharbi OA, Aljohani RM. The Impact of Irregular Menstruation on Health: A Review of the Literature. Cureus 2023; 15:e49146. [PMID: 38130524 PMCID: PMC10733621 DOI: 10.7759/cureus.49146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Women are considered to have an irregular menstrual cycle if their cycle length is less than 21 days or more than 35 days, accompanied by less or very severe blood flow. The prevalence of menstrual cycle irregularities varies across countries. Irregular periods can occur due to changes in the body's levels of estrogen and progesterone hormones, which disrupt the normal pattern of the period. Menstrual irregularity has been found to be associated with various diseases and medical conditions, such as metabolic syndrome, coronary heart disease, type 2 diabetes mellitus, and rheumatoid arthritis. Anemia, osteoporosis, psychological problems, impaired quality of life, and infertility have also been recorded. Moreover, a significant correlation between irregular periods and the risk of developing pregnancy-related hypertensive disorders, as well as an increased risk of adverse obstetric and neonatal outcomes, has been proven. Therefore, irregular menstruation is considered an important health indicator among women. Physical, mental, social, psychological, and reproductive problems are often associated with menstrual irregularities. Thus, evaluating the factors associated with irregular menstruation is necessary to determine appropriate preventive and treatment strategies and to decrease the associated health problems. The aim of this review was to define normal and irregular menstruation, their types, and prevalence, to recognize the risk factors and causes of irregular menstruation, and to understand their impact on women's health.
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Affiliation(s)
- Ghalia M Attia
- Medical Histology and Cell Biology, Mansoura University, Mansoura, EGY
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Kerns J, Itriyeva K, Fisher M. Etiology and management of amenorrhea in adolescent and young adult women. Curr Probl Pediatr Adolesc Health Care 2022; 52:101184. [PMID: 35525789 DOI: 10.1016/j.cppeds.2022.101184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this article, we will review the etiology and management of amenorrhea in adolescent and young adult women, beginning with the diagnostic work-up and followed by etiologies organized by system. Most cases of amenorrhea are caused by dysfunction of the hypothalamic-pituitary-ovarian (HPO) axis, which is the major regulator of the female reproductive hormones: estrogen and progesterone. We begin by reviewing hypothalamic etiologies, including eating disorders and relative energy deficiency in sport. Then, pituitary causes of amenorrhea are reviewed, including hyperprolactinemia, empty sella syndrome, Sheehan's syndrome and Cushing's syndrome. Next, ovarian causes of amenorrhea are reviewed, including polycystic ovarian syndrome and primary ovarian insufficiency. Finally, other etiologies of amenorrhea are discussed, including thyroid disease, adrenal disease and reproductive tract anomalies. In conclusion, there is a wide and diverse range of causes of amenorrhea in adolescents that originate from any level of the HPO axis, as well as anatomic and chromosomal etiologies. Treatment should be focused on the underlying cause. Preservation of bone density and risk of fractures should be discussed with amenorrheic patients since many causes of amenorrhea can result in decreased bone density and may be irreversible.
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Affiliation(s)
- Jessica Kerns
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, 410 Lakeville Road, Suite 108, New Hyde Park, NY 11042, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
| | - Khalida Itriyeva
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, 410 Lakeville Road, Suite 108, New Hyde Park, NY 11042, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Martin Fisher
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, 410 Lakeville Road, Suite 108, New Hyde Park, NY 11042, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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Singhal V, Bose A, Slattery M, Haines MS, Goldstein MA, Gupta N, Brigham KS, Ebrahimi S, Javaras KN, Bouxsein ML, Eddy KT, Miller KK, Schoenfeld D, Klibanski A, Misra M. Effect of Transdermal Estradiol and Insulin-like Growth Factor-1 on Bone Endpoints of Young Women With Anorexia Nervosa. J Clin Endocrinol Metab 2021; 106:2021-2035. [PMID: 33693703 PMCID: PMC8427708 DOI: 10.1210/clinem/dgab145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Anorexia nervosa (AN) is prevalent in adolescent girls and is associated with bone impairment driven by hormonal alterations in nutritional deficiency. OBJECTIVE To assess the impact of estrogen replacement with and without recombinant human insulin-like growth factor-1 (rhIGF-1) administration on bone outcomes. DESIGN Double-blind, randomized, placebo-controlled 12-month longitudinal study. PARTICIPANTS Seventy-five adolescent and young adult women with AN age 14 to 22 years. Thirty-three participants completed the study. INTERVENTION Transdermal 17-beta estradiol 0.1 mg/day with (i) 30 mcg/kg/dose of rhIGF-1 administered subcutaneously twice daily (AN-IGF-1+) or (ii) placebo (AN-IGF-1-). The dose of rhIGF-1 was adjusted to maintain levels in the upper half of the normal pubertal range. MAIN OUTCOME MEASURES Bone turnover markers and bone density, geometry, microarchitecture, and strength estimates. RESULTS Over 12 months, lumbar areal bone mineral density increased in AN-IGF-1- compared to AN-IGF-1+ (P = 0.004). AN-IGF-1+ demonstrated no improvement in areal BMD in the setting of variable compliance to estrogen treatment. Groups did not differ for 12-month changes in bone geometry, microarchitecture, volumetric bone mineral density (vBMD), or strength (and results did not change after controlling for weight changes over 12 months). Both groups had increases in radial cortical area and vBMD, and tibia cortical vBMD over 12 months. Levels of a bone resorption marker decreased in AN-IGF-1- (P = 0.042), while parathyroid hormone increased in AN-IGF-1+ (P = 0.019). AN-IGF-1- experienced irregular menses more frequently than did AN-IGF-1+, but incidence of all other adverse events did not differ between groups. CONCLUSIONS We found no additive benefit of rhIGF-1 administration for 12 months over transdermal estrogen replacement alone in this cohort of young women with AN.
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Affiliation(s)
- Vibha Singhal
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Pediatric Endocrinology, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA, USA
- Correspondence: Vibha Singhal. MD, 101 Merrimac Street, Boston, MA 01124, USA.
| | - Amita Bose
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Meghan Slattery
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Melanie S Haines
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mark A Goldstein
- Division of Adolescent Medicine, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA, USA
| | - Nupur Gupta
- Division of Adolescent Medicine, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA, USA
| | - Kathryn S Brigham
- Division of Adolescent Medicine, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA, USA
| | - Seda Ebrahimi
- Cambridge Eating Disorders Center, Cambridge, MA, USA
| | - Kristin N Javaras
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Women’s Mental Health, McLean Hospital, Belmont, MA, USA
| | - Mary L Bouxsein
- Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Karen K Miller
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David Schoenfeld
- Biostatistics Center at Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anne Klibanski
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Madhusmita Misra
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Pediatric Endocrinology, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA, USA
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Hauck C, Schipfer M, Ellrott T, Cook B. The relationship between food addiction and patterns of disordered eating with exercise dependence: in amateur endurance athletes. Eat Weight Disord 2020; 25:1573-1582. [PMID: 31654288 PMCID: PMC7581610 DOI: 10.1007/s40519-019-00794-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/03/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Examine the prevalence and potential relationships among food addiction (FA)-as measured by Yale Food Addiction Scale 2.0 (YFAS 2.0), eating disorders (ED)-as measured by Eating Disorder Diagnostic Scale (EDDS)-and exercise dependence (EXD)-as measured by Questionnaire to Diagnose Exercise Dependence in Endurance Sports (FESA), for the first time worldwide, in amateur endurance athletes. METHODS A total of 1022 German-speaking endurance athletes (44% male, Ø 36 years, Ø BMI 23 kg/m2) replied to an online questionnaire consisting of demographics, related parameters, and the German versions of YFAS 2.0, EDDS, and FESA. RESULTS Prevalence of FA, ED, and EXD was 6.2, 6.5, and 30.5%. The probability for FA increases with BMI, thoughts about food and EXD score, and decreases with age and when an ED is present. People with FA and people with ED vs. people with both, FA&ED, differed significantly in this cohort. Strong significant relationships were found between FA and EXD (X2 (1) = 15.117, p < 0.001, n = 1022). CONCLUSIONS A considerable number of amateur endurance athletes may suffer from FA. The association between FA and EXD is stronger than between ED and EXD, indicating FA as a potentially more relevant subject-than ED-for prevention or therapy in people with EXD. Further studies are needed to investigate parameters and relationships between the possibly involved types of ED, FA, and EXD. LEVEL OF EVIDENCE Level III, well-designed cohort analytic study.
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Affiliation(s)
- Carolin Hauck
- Institute for Nutrition and Psychology at the University of Goettingen, Humboldtallee 32, 37073, Göttingen, Germany.
| | - Melanie Schipfer
- Martin-Luther-University Halle-Wittenberg, Universitaetsplatz 10, 06108, Halle (Saale), Germany.,Profusa Inc., 345 Allerton Avenue, South San Francisco, CA, 94080, USA
| | - Thomas Ellrott
- Institute for Nutrition and Psychology at the University of Goettingen, Humboldtallee 32, 37073, Göttingen, Germany
| | - Brian Cook
- Alsana: An Eating Disorder Recovery Community, 2545 W Hillcrest Dr, Suite 205, Thousand Oaks, CA, 91320, USA
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Pires SAP, Soares JC, Luz AMBD, Moleiro P. OUTPATIENT ANALYTIC ASSESSMENT OF ANOREXIA NERVOSA - THE IMPORTANCE OF VENOUS BLOOD GASES. ACTA ACUST UNITED AC 2020; 38:e2018358. [PMID: 31939517 PMCID: PMC6958540 DOI: 10.1590/1984-0462/2020/38/2018358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/13/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate serum biochemical parameters' evolution, especially venous blood gas (VBG), in anorexia nervosa (AN), correlating with clinical parameters. METHODS Retrospective study including out-patient AN adolescents, between January 2014 and May 2017. Three evaluations were compared: t1) first consultation; t2) consultation with the lowest body mass index (BMI) z-score and t3) with the highest BMI z-score. RESULTS A total of 24 adolescents (87.5% females) were included, mean age of presentation of 14.9±1.7 years, onset of symptoms 6.4±3.2 months before the first visit. In t1, BMI z-score of -1.91±1.11 kg/m2 and ideal weight % of 84.3±9.2. Amenorrhea was present in 88%. In t2 the analytical alterations were: altered VBG in 100%, altered ferritin (72% elevated), altered thyroid function (53% with thyroxine decrease), dyslipidemia (31% elevation of high density lipoprotein, 25% hypercholesterolemia), elevation of urea (25%), elevation of alanine aminotransferase (14%), hypoglycemia (14%), anemia (9%). Respiratory acidosis was present in 91% in t1, 100% in t2 and 94% in t3. There was a significant decrease between t2 and t3 in mean pCO2 (57.2 versus 53.6 mmHg; p=0.009) and mean HCO3 (30.0 versus 28.8 mEq/L; p=0.023). CONCLUSIONS Respiratory acidosis and increased ferritin were common in this group. Respiratory acidosis was the most frequent abnormality with significant pCO2 and HCO3 variation in the recovery phase. VBG should be considered in AN evaluation, once it seems to be important in assessing the severity of the disease and its subsequent follow-up.
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Hill JW, Elias CF. Neuroanatomical Framework of the Metabolic Control of Reproduction. Physiol Rev 2019; 98:2349-2380. [PMID: 30109817 DOI: 10.1152/physrev.00033.2017] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A minimum amount of energy is required for basic physiological processes, such as protein biosynthesis, thermoregulation, locomotion, cardiovascular function, and digestion. However, for reproductive function and survival of the species, extra energy stores are necessary. Production of sex hormones and gametes, pubertal development, pregnancy, lactation, and parental care all require energy reserves. Thus the physiological systems that control energy homeostasis and reproductive function coevolved in mammals to support both individual health and species subsistence. In this review, we aim to gather scientific knowledge produced by laboratories around the world on the role of the brain in integrating metabolism and reproduction. We describe essential neuronal networks, highlighting key nodes and potential downstream targets. Novel animal models and genetic tools have produced substantial advances, but critical gaps remain. In times of soaring worldwide obesity and metabolic dysfunction, understanding the mechanisms by which metabolic stress alters reproductive physiology has become crucial for human health.
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Affiliation(s)
- Jennifer W Hill
- Center for Diabetes and Endocrine Research, Departments of Physiology and Pharmacology and of Obstetrics and Gynecology, University of Toledo College of Medicine , Toledo, Ohio ; and Departments of Molecular and Integrative Physiology and of Obstetrics and Gynecology, University of Michigan , Ann Arbor, Michigan
| | - Carol F Elias
- Center for Diabetes and Endocrine Research, Departments of Physiology and Pharmacology and of Obstetrics and Gynecology, University of Toledo College of Medicine , Toledo, Ohio ; and Departments of Molecular and Integrative Physiology and of Obstetrics and Gynecology, University of Michigan , Ann Arbor, Michigan
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Nam GE, Han K, Lee G. Association between sleep duration and menstrual cycle irregularity in Korean female adolescents. Sleep Med 2017; 35:62-66. [DOI: 10.1016/j.sleep.2017.04.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/17/2017] [Accepted: 04/18/2017] [Indexed: 01/10/2023]
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Drosdzol-Cop A, Bąk-Sosnowska M, Sajdak D, Białka A, Kobiołka A, Franik G, Skrzypulec-Plinta V. Assessment of the menstrual cycle, eating disorders and self-esteem of Polish adolescents. J Psychosom Obstet Gynaecol 2017; 38:30-36. [PMID: 27584558 DOI: 10.1080/0167482x.2016.1216959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Eating disorders are an important factor in menstrual cycle disorders in girls. Moreover, low self-esteem among adolescent girls may be a risk factor for eating disorders. The aim of the study was to assess the menstrual cycle, eating habits and self-esteem of Polish adolescents. METHODS The study was conducted from January 2014 to March 2015 and included 623 girls, aged 15-19, from randomly selected junior high schools in Silesia, Poland, in which their menstrual cycle, risk of eating disorders and self-esteem were evaluated. A five-part questionnaire was used to assess basic demographic data, lifestyle and physical activity, gynecological history, as well as Rosenberg Self-Esteem Scale (SES) and Eating Attitude Test (EAT-26). RESULTS Irregular menstrual cycles were observed in 236 (37.88%) girls; 5.20% presented secondary amenorrhea. Based on the EAT-26 test, 101 (16.21%) girls were indicated being at risk for an eating disorder. Low self-esteem was observed in 340 (54.57%) study girls on the base of SES. DISCUSSION Girls with irregular menses had higher scores on the EAT-26 test in subscales: EAT-overall score, EAT-diet and EAT-bulimia, while lower scores on the SES. In our study, we did not observe a significant relationship between exercise intensity, body mass, BMI and menstrual cycle regularity. Low self-esteem among adolescent girls may be a risk factor for eating disorders which could interrupt the menstrual cycle.
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Affiliation(s)
- Agnieszka Drosdzol-Cop
- a School of Health Sciences in Katowice, Medical University of Silesia , Katowice , Poland
| | - Monika Bąk-Sosnowska
- b School of Health Sciences in Katowice, Medical University of Silesia , Katowice , Poland
| | - Dominika Sajdak
- a School of Health Sciences in Katowice, Medical University of Silesia , Katowice , Poland
| | - Agnieszka Białka
- a School of Health Sciences in Katowice, Medical University of Silesia , Katowice , Poland
| | - Agnieszka Kobiołka
- a School of Health Sciences in Katowice, Medical University of Silesia , Katowice , Poland
| | - Grzegorz Franik
- c Department of Endocrinological Gynecology , Medical University of Silesia , Katowice , Poland
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