Cause Of Menstrual Irregularity Research Articles

Diagnosis of hyperprolactinemia in women: A Position Statement from the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) and the Brazilian Society of Endocrinology and Metabolism (SBEM).

Hyperprolactinemia is a frequent cause of menstrual irregularity, galactorrhea, hypogonadism, and infertility. The most common etiologies of hyperprolactinemia can be classified as physiological, pharmacological, and pathological. Among pathological conditions, it is essential to distinguish prolactinomas from other tumors and pituitary lesions presenting with hyperprolactinemia due to pituitary stalk disconnection. Proper investigation considering clinical data, laboratory tests, and, if necessary, imaging evaluation, is important to identify the correctcause of hyperprolactinemia and manage the patient properly. This position statement by the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) and Brazilian Societyof Endocrinology and Metabolism (SBEM) addresses the recommendations for measurement of serum prolactin levels and the investigations of symptomatic and asymptomatic hyperprolactinemia and medication-induced hyperprolactinemia in women.

Menstrual Irregularity, Hormonal Contraceptive Use, and Bone Stress Injuries in Collegiate Female Athletes in the United States.

Menstrual irregularity (MI) is common in female athletes and is a component of the Female Athlete Triad (Triad). Many athletes with the Triad are started on hormonal contraceptives (HC) for MI, but this interferes with the ability to monitor menstrual cycle regularity and can mask other causes of MI. There are limited studies investigating the relationship between MI, HC use, and injury in female collegiate athletes. To examine the prevalence of and relationship between HC use, MI, and bone stress injuries in female collegiate athletes in the United States. Cross-sectional study. Online survey. 1020 U.S. female collegiate athletes (age ≥ 18 years). Assessment of risk factors for menstrual irregularity and bone stress injuries was conducted via a one-time survey. HC use, MI, history of stress fractures. Current HC use prevalence was 65% (95% confidence interval [CI], 61.9%, 67.8%). Of all athletes, 47% reported past MI. Of the athletes who were not currently using HCs, 32% had current MI. Compared with athletes without past MI, more athletes with past MI reported current HC use (73% vs. 57%) and indicated menstrual cycle consistency as the primary reason for use (24% vs. 4%) (P < .001). Additionally, 25% of athletes reported a history of stress fractures, which was associated with lean/aesthetic sports participation (odds ratio [95% CI]: 1.9 [1.4, 2.5]; P < .001) and less oral contraceptive pill (OCP) use (0.7 [0.5, 1.0]; P = .043). Compared with OCPs, injectable HCs were associated with greater odds of a history of stress fractures (4.5[1.6, 12.3]; P = .004). HC use was prevalent among this cohort of female collegiate athletes, and almost half of the athletes reported past MI. A goal of menstrual cycle regularity was cited by 24% of athletes as a primary reason to use HCs, which shows that more athlete education is needed to avoid masking MI and the Triad with HCs. Further studies elucidating the relationship between HC use, MI, and sports-related injury are warranted.

Ovulation hormonal imbalance recognition system using saliva’s conductivity analysis based on potentiometric method

&lt;span lang="EN-US"&gt;Hormonal imbalance is often pointed out by medical experts to be the cause of menstrual irregularity, a common problem of women. This study aims to develop a device that would determine if a patient has hormonal imbalance by testing saliva’s conductivity onto the device for 28 consecutive days, thus, determining the cause of the patient’s menstrual irregularity. To test the accuracy of the device, the researchers selected three women residing in one home to use the device. To determine if a woman has hormonal imbalance, the data, when plotted in a chart, should have a sudden peak. However, data can’t be analyzed through visual assumptions only. Therefore, the data is analyzed through sample standard deviation. If one data is higher or lower than the sum and difference of the sample standard deviation and the mean, the woman is negative in hormonal imbalance. Comparing the result from the device and from the blood test, it is concluded that the results from the device matched the results from the blood test and medical expert interpretation.&lt;/span&gt;

Gynecological problems among adolescent girls in a tertiary care centre of South Andaman district.

Background Gynecological problems of adolescents occupy a special space in the spectrum of gynecological disorders because they are often different from the conditions that affect adult women. The objective of study was to determine the different gynecological problems in adolescent girls attending outpatient departments. Methods Adolescent girls of age 10-19 years were included in this study. Various gynecological problems were evaluated by detailed history taking and thorough clinical examination. Investigations like haemogram, coagulation profile, hormonal assays and ultrasonography were done wherever indicated. Descriptive analysis was done and results are expressed in terms of percentage. Results A total of 824 (8.33%) adolescent girls attended the gynecology outdoor patient department (GOPD) during the study period. Menstrual disorders (67.11%) were the commonest complaint, followed by vaginal discharge (18.68%) and UTI (9.8%). Menstrual disorders varied from irregular menstruation (55.15%), dysmenorrhea (30.74%) and amenorrhea (14.10%). Dysfunctional uterine bleeding was the commonest cause of menstrual irregularity followed by polycystic ovarian disease (PCOD). Teenage pregnancy (0.84%) and ovarian tumor (0.60%) was found in a few cases. Conclusion Adolescent girls' gynecological problems should be evaluated thoroughly and managed accordingly. Adolescent health education needs to increase awareness and give further attention to gynecological problems.

Does the Pituitary Gland Volume Change in Polycystic Ovary Syndrome?

Aims: Polycystic ovary syndrome (PCOS) is the commonest cause of menstrual irregularity and hirsutism during reproductive age. We hypothesized in the alterations in the pituitary gland in PCOS. Methods: We measured the volume of the pituitary gland in 39 PCOS patients and 42 age-matched healthy controls using 0.35 mm thick T1-weighted sagittal cranial images. Serum levels of estradiol (E2), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were measured on days 3–5 of the menstrual cycle of the participants. Results: There was a significant difference in terms of LH, FSH, and LH/FSH ratio (p < 0.05) between groups. Mean pituitary gland volume (PGV) was 4.1 ± 1.36 mm³ for the study group and 3.4 ± 0.77 mm³ for the control group. PGV was statistically significantly higher in PCOS group than the control group (p < 0.05). There was no correlation between hormone levels and PGVs in groups. Conclusion: Enlarged pituitary volume in PCOS may be due to excessive LH release.

Polycystic ovary syndrome (PCOS)

Key content The symptoms of polycystic ovary syndrome (PCOS) include menstrual cycle disturbance and features of hyperandrogenism (hirsutism, acne and alopecia), with associated fertility problems, obesity and psychological issues. There are ethnic variations in expression of PCOS related to differences in insulin metabolism and this may impact upon treatment algorithms. Obesity has a major impact on the expression of PCOS and the efficacy of the management of all aspects of the syndrome, in particular infertility. The management of anovulatory infertility involves lifestyle modification and therapies to induce ovulation, namely clomifene citrate, gonadotrophin therapy and laparoscopic ovarian diathermy. For those who do not wish to conceive the management of menstrual problems requires prevention of endometrial hyperplasia and adenocarcinoma and consideration of the long term metabolic risks. Learning objectives To understand the full spectrum of the syndrome that is PCOS to include how to make the diagnosis and differentiate from other causes of menstrual irregularity and androgen excess. To appreciate the role of insulin resistance and the long‐term health implications for women with PCOS. To understand how to manage the issues that may affect a woman in different ways at different times in her life, namely menstrual cycle irregularity, hyperandrogenism and infertility. Ethical issues A contentious issue is the appropriateness to deny fertility treatment based upon a cut‐off for body mass index (BMI), when BMI is a crude measure of metabolic risk and the risks of conception at a high BMI are not absolute. This also has to be balanced against the decline in fertility with age which may have an additional impact. To what extent should young women who are found to have polycystic ovaries on ultrasound scan but without any features of the syndrome be advised about the potential for developing problems in the future? Should relatives of individuals with PCOS be screened for either PCOS or metabolic syndrome (the latter may apply to male relatives too)?

Can Animal Models of PCOS Help Point the Way Towards Early and Effective Therapeutic Intervention in Women With the Syndrome?

Polycystic ovary syndrome (PCOS) is a major cause of reproductive and metabolic dysfunction in women, but it remains an enigmatic condition whose treatment is necessarily empirical (1). It is the principal cause of menstrual irregularity, anovulatory infertility and the distressing cutaneous manifestations of hirsutism and persistent acne, as well being a significant risk factor for development of type 2 diabetes mellitus. The etiology of the syndrome clearly involves both genetic and environmental factors, but there is still much work to be done in identification of the key genes and getting a clearer understanding of the nature of the interaction between genes and environment. Animal models of PCOS have provided valuable insight into the pathogenesis of the syndrome (2–7), particularly large animals, sheep or rhesus monkeys (3–5, 7), which, as predominantly monoovulatory species, most resemble humans. These animals, exposed in utero to very high concentrations of androgens, develop both reproductive and metabolic abnormalities that resemble clinical PCOS, suggesting that the syndrome arises, at least in part, as a result of androgen programming of fetal and postnatal development (6, 8). They also offer, as illustrated by the article by Padmanabhan et al (23) in this issue of Endocrinology, the prospect of testing therapeutic options that are targeted at reversing, or at least attenuating, during puberty or before, the adverse effects of PCOS and thereby altering the natural progression of the syndrome into adult life. From a clinical viewpoint, it is a constant frustration that management of the reproductive and metabolic sequelae of PCOS is more a matter of controlling symptoms than preventing or attenuating the development of the disorder. PCOS is usually first manifest during adolescence and, indeed, there may even be biochemical clues about susceptibility to development of the syndrome in premenarchal girls (9, 10). So an important question to be answered is: if we can intervene therapeutically to reduce hyperandrogenemia and/or improve insulin sensitivity when symptoms first appear during adolescence, can we reduce the impact of the syndrome on menstrual function, fertility, hirsutism and risk of type 2 diabetes mellitus? This very question was posed in the last millennium by Dan Apter in an article entitled “How possible is the prevention of polycystic ovary syndrome development in adolescent patients with early onset of hyperandrogenism?” (11). He concludes: “Well controlled, long-term follow-up studies are needed on the role of prepubertal hyperandrogenism, hyperinsulinemia, gonadotropins, and ovarian morphological aspects in the development of PCOS, and possibilities of prevention.” Unfortunately, we still lack definitive interventional studies. There is good evidence, from the small number of randomized clinical trials, that diet and lifestyle changes in overweight girls (12, 13), and drugs that improve insulin sensitivity, particularly metformin (14, 15), have a positive effect on both ovarian and metabolic function, which is unsurprising given the results from studies in older women. Antiandrogens alone or in combination with insulin sensitizers or combined oral contraceptives appear beneficial in selected subjects (16–19). And there are tantalizing hints that these therapies may be more effective (in terms of preventing progression of symptoms) in adolescent girls than in later

Primary ovarian insufficiency in the adolescent

To raise awareness about the importance of early diagnosis of primary ovarian insufficiency (POI) in the adolescent. Menstrual cycle irregularity or amenorrhea in the adolescent has historically been treated with oral contraceptives or ignored, with no evaluation done to determine the cause. However, it is now becoming clear that the health consequences of menstrual irregularities differ depending on the cause, and evaluation to determine the cause of menstrual irregularity is warranted. Although POI is classically diagnosed when menstrual cycle irregularity is accompanied by high circulating levels of gonadotropins and low estradiol, anti-Mullerian hormone is emerging as a biomarker of increasing importance. When POI is diagnosed, further evaluation including karyotype, FMR1 premutation analysis, and 21-hydroxylase or adrenal antibody is warranted. Girls at high risk for the development of POI (e.g. because of planned cancer treatment) should be offered the option of oocyte or ovarian tissue cryopreservation. POI should be ruled out in adolescents with menstrual cycle irregularity. Early diagnosis of POI facilitates the individualization of therapy, as the health consequences of POI differ from those of other causes of menstrual cycle irregularity. In addition, recognition of premature oocyte depletion allows for the option of fertility preservation to be discussed when oocytes are still present.

A 27-Year-Old Woman Diagnosed as Polycystic Ovary Syndrome Associated with Graves' Disease

Polycystic ovary syndrome (PCOS) and Graves' disease are the common causes of menstrual irregularity leading to infertility in women of child-bearing age. A 21-year-old female patient visited us with complaints of oligomenorrhea and hand tremor. She was diagnosed as having PCOS and hyperthyroid Graves' disease, simultaneously. She had low body weight (BMI: 16.4 kg/m(2)), mild hirsutism, and thyrotoxicosis. The patient was treated with anti-thyroid drug and beta-blocker for about two years, and then recovered to normal thyroid function. Although some studies have suggested a connection between PCOS and autoimmune thyroiditis, no study indicated that PCOS is associated with Graves' disease until now. Here, we describe the first case report of a lean woman with normal insulin sensitivity presenting PCOS and Graves' disease simultaneously.

Use of Metformin in the Treatment of Polycystic Ovary Syndrome

Metformin is quite an old drug, but it is optimal for the control of glycemia in Type 2 diabetes. It was reported, 15 years ago, that insulin resistance was abnormally high in most polycystic ovary syndrome (PCOS) patients. Starting from that moment, increasing numbers of studies were performed to demonstrate the efficacy of metformin in controlling and/or modulating several aspects of PCOS, which is the most common cause of menstrual irregularity, inesthetisms and infertility. Metformin induces higher glucose uptake, thus inducing a lower synthesis/secretion of insulin. Such an effect permits the possible restoration of the normal biological functions that are severely affected by the compensatory hyperinsulinemia reactive to the increased peripheral insulin resistance. These are the basis of the many positive effects of this drug, such as the restoration of menstrual cyclicity, ovulatory cycles and fertility, because abnormal insulin levels affect the hypothalamus-pituitary-ovarian function, as well as the use of glucose in peripheral tissues. Metformin improves the impairments typically observed in hyperinsulinemic PCOS patients, reducing the possible evolution towards metabolic syndrome and Type 2 diabetes; and when pregnancy occurs, it consistently reduces the risk of gestational diabetes, eclampsia and hypertension. PCOS seems to be the perfect physiopathological condition that might have higher benefits from metformin administration, obviously after Type 2 diabetes. This review focuses on the many aspects of PCOS and on the possible issues of this disease for which metformin might be a putative optimal treatment.

Adult polycystic ovary syndrome begins in childhood.

Polycystic ovary syndrome (PCOS) frequently presents during adolescence and is the commonest cause of menstrual irregularity and hirsutism. The characteristic endocrine abnormalities include hypersecretion of androgens and LH. Metabolic dysfunction is also a feature of many young women with PCOS. Hyperinsulinaemia and insulin resistance, which can be regarded as an exaggeration of the normal metabolic changes that occur during puberty, are further amplified by obesity. The aetiology of PCOS is uncertain but there is evidence for a primary abnormality of ovarian androgen production which is manifest at puberty but may have its origins in childhood or even during fetal development.

Hysteroscopic treatment of Asherman's syndrome

AbstractAlthough Asherman's syndrome (the presence of adhesions inside the cervical canal or uterine cavity) is relatively uncommon in the general population, it can be the cause of menstrual irregularity and subfertility in high risk women. The diagnosis is usually confirmed by hysterosalpinography, and more recently by hysteroscopy. Hysteroscopy has also become accepted as the optimum route of surgery, the aims being to restore the size and shape of the uterine cavity, normal endometrial function and fertility. Treatment can range from simple cervical dilatation in the case of cervical stenosis but an intact uterine cavity, to extensive adhesiolysis of dense intrauterine adhesions using scissors or electro- or laser energy. Patients in whom the uterine fundus is completely obscured, and those with a greatly narrowed, fibrotic cavity present the greatest therapeutic challenge. Several techniques have described for these difficult cases, but outcome is far worse than in patients with mild, endometrial-type adhesions. Non-hysteroscopic techniques area also beginning to be developed, but whether they will replace the current ‘gold’ standard of hysteroscopy remains to be seen.

IGFBP-1

Jenkins, Paul J.; Ibanez-Santos, Xavier; Holly, Jeffrey; Cotterill, Andy; Perry, Leslie; Wolman, Roger; Harries, Mark; Grossman, AshleyAuthor Information

IGFBP-1: a metabolic signal associated with exercise-induced amenorrhoea.

Severe exercise in young females is a potent cause of menstrual irregularity, although the exact pathogenesis is currently unknown. We performed a cross-sectional endocrine and metabolic analysis of a group of elite athletes and dancers in order to establish which variable, if any, was specifically associated with changes in menstruation. By using a step-wise discriminant analysis, two independent predictors, elevated serum cortisol and insulin-like growth factor binding protein 1 (IGFBP-1) levels, were found to account for the majority (67%) of the variance. IGFBP-1 is a hepatic protein which is acutely and inversely regulated by insulin, and is thought to modulate the peripheral actions of IGF-1. While the change in serum cortisol may reflect activation of central stress pathways, these findings suggest for the first time that there is a second peripheral signal, IGFBP-1, which may relate the availability of metabolic fuels to the control of reproduction.