Duration Of Amenorrhea Research Articles

Carboxyhemoglobin in umbilical cord blood and maternal smoking.

Background Smoking during pregnancy still exists in daily life but the effect on the newborn in the early stage of life is still unclear. This study investigates the normal reference range of carboxyhemoglobin (HbCO) in umbilical cord blood gas (UBG). Methods A single center retrospective cross-sectional cohort study was performed with 1172 cases. We analyzed HbCO values in umbilical cord blood, maternal smoking, birth weight percentiles, duration of amenorrhea and maternal admission duration prior to delivery. Results HbCO levels in newborns range from 0 to 7.7% with a mean of 0.6% (standard deviation 0.6). Newborns from women who smoked during pregnancy have a significant higher HbCO value compared to newborns from women who did not smoke. Birth weight is negatively correlated with HbCO (P = 0.001). Conclusion Our results show the normal reference range in this study is 0-1.2% for HbCO in the umbilical blood of newborns. Smoking prior to delivery leads to a higher HbCO value in the UBG sample of the newborn, a lower birth weight and may be potential harmful.

OR03-6 Tibial and Radial Bone Structure as Assessed by HRpQCT May Explain Differences in Peripheral Skeletal Integrity and Fracture Risk Across the Weight Spectrum That Cannot Be Explained by Areal BMD Alone

No study has investigated tibial or radial bone structure or estimated strength by high-resolution peripheral quantitative CT (HRpQCT) in women across the weight spectrum. We studied 139 women, 17-46yo: 1) anorexia nervosa (AN n=74), 2) lean controls (HC n=33) and 3) overweight/obese (OB n=32). All HC and OB were eumenorrheic. Areal BMD (aBMD) and appendicular lean mass (ALM) were measured by DXA; cortical and trabecular volumetric BMD (vBMD), cortical thickness, cortical porosity, failure load (finite element analysis) and trabecular plate parameters (individual trabecular segmentation) at the tibia and radius by HRpQCT. Mean age was similar among groups. Mean BMI was 17.7 ± 2.1 vs 22.6 ± 1.4 vs 35.2 ± 3.2 kg/m2 (p<0.0001). Mean aBMD Z-scores were lowest in AN, intermediate in HC and highest in OB (PA spine -1.6 ± 1.3 vs -0.5 ± 0.8 vs 0.5 ± 0.8; total hip -1.0 ± 1.1 vs 0.2 ± 0.9 vs 1.0 ± 0.9; radius -0.6 ± 1.0 vs 0.1 ± 0.9 vs 0.7 ± 0.9; p<0.0001). At the tibia and radius, mean trabecular vBMD and failure load were lowest in AN, intermediate in HC and highest in OB, while mean trabecular plate bone volume fraction, plate number density and plate-plate junction density were lower in AN (p<0.05) and similar in HC and OB. Mean cortical vBMD and cortical porosity were similar among groups, but cortical thickness was lower in AN vs OB (p<0.01). There was a quadratic relationship between BMI and trabecular vBMD, failure load and all plate parameters (R=0.40-0.67, p<0.0001), such that the higher the BMI, the smaller the increase in these parameters. In contrast, ALM had a consistent positive linear relationship with these parameters (R=0.37-0.78, p<0.0001). IGF-1 levels were positively associated with tibial and radial estimated strength and trabecular structure (R=0.21-0.37, p<0.05). Duration of amenorrhea in AN was negatively associated with radial estimated strength and trabecular structure (R= -0.25- -0.37, p<0.01). Despite similar mean aBMD at all sites, those with a history of fracture (n=57) had lower mean tibial and radial trabecular vBMD and plate-plate junction density; lower mean tibial cortical vBMD, plate bone volume fraction and plate number; and higher mean tibial cortical porosity compared to those without (n=72) (p<0.05). Conclusions: Trabecular bone structure and estimated strength were generally higher with greater weight, but the incremental increase was smaller as BMI increased into the obese range. Cortical bone parameters generally did not increase with greater weight. This suggests that the skeleton in women with obesity may not be able to fully adapt to an increased weight load. Muscle mass and IGF-1 levels were positive, and duration of amenorrhea a negative, determinant of bone structure and estimated strength. Across the weight spectrum, tibial and radial bone structure by HRpQCT may explain differences in peripheral skeletal integrity and fracture risk that cannot be explained by aBMD alone.

Analysis of the Reproductive Outcome of Patients with Cesarean Scar Pregnancy Treated by High-Intensity Focused Ultrasound and Uterine Artery Embolization: A Retrospective Cohort Study

To investigate risk factors for infertility and recurrent cesarean scar pregnancy (CSP) after previous CSP. A retrospective cohort study (Canadian Task Force classification II-1). University hospital. Between January 2007 and April 2016, a total of 650 patients were included, all diagnosed with CSP and treated by high-intensity focused ultrasound (HIFU) and uterine artery embolization (UAE), followed by suction curettage under hysteroscopic guidance. None. Follow-up of the reproductive outcomes ended in June 2017. A total of 135 of the 650 patients with CSP were involved in the study, among whom 32 became infertile, 78 had an intrauterine pregnancy, and 25 had recurrent CSP after previous CSP. Age (≥35 years; odds ratio [OR], 4.252; p = .002), β-human chorionic gonadotropin (≤5000 mIU/mL; OR, 3.778; p = .011), and longer duration of amenorrhea (>56 days; OR, 2.507; p = .05) were risk factors for infertility. Treatment with UAE (OR, 5.796; p = .003), more abortions (≥4; OR, 2.851; p = .022), and being asymptomatic (OR, 4.175; p = .039) were risk factors for recurrent CSP. There was no statistically significant difference in the subsequent outcomes of pregnant women in the HIFU and UAE groups (p >.05). More attention should be given to subsequent reproductive outcomes after CSP, not only for intrauterine pregnancy, but also for infertility and recurrent CSP. Early diagnosis and treatment of CSP could reduce the risk of infertility and recurrent CSP. HIFU seemed to be superior to UAE in reducing the risk of recurrent CSP. Patients with CSP should adhere to strict contraception if they do not desire more children.

Postpartum fertility behaviours and contraceptive use among women in rural Ghana

BackgroundAlthough most women would want to wait for more than two years before having another baby, their fertility behaviours during the first year following birth may decrease or increase the length of the birth interval. The objectives of this study were to: assess how protected postpartum women in the Mfantseman municipal were against pregnancy, based on their patterns of amenorrhoea and sexual abstinence; determine the timing of postpartum contraception in relation to amenorrhoea and sexual abstinence; and determine the predictors of postpartum contraceptive use.MethodsThis was a prospective study carried out in the Mfantseman Municipality of the Central region of Ghana. Out of 1914 women attending antenatal clinic in the municipal within the study period, 1350 agreed to be part of the study to ascertain their postpartum fertility and contraceptive behaviours a year following delivery. These women were traced to their communities using telephone and house numbers provided and only 1003 of the women were finally traced and interviewed. The women were asked about their breastfeeding behaviour, postpartum sexual abstinence, duration of amenorrhoea and postpartum contraceptive use.ResultsThe mean age of the respondents was 29.9 ± 6.5 years; adolescents constituted the least proportion (3.3%) of the women. More than half (54.1%) of the women had Middle, Junior secondary school or Junior high school education. Most (43.3%) of the women were married by means of traditional rites and more than half (51.4%) of them were petty traders. The mean durations of breastfeeding, amenorrhoea and sexual abstinence were 6.6 ± 2.8 months, 7.8 ± 3.8 months and 4.4 ± 3.1 months respectively, whilst mean time of first contraceptive uptake was 3.5 ± 2.7 months postpartum. The time to first use of modern contraceptive method during the postpartum period indicates that about 50% of the women had started use of modern contraceptive methods by 2.7 months postpartum, and occured 0.6 and 3.6 months before sexual relations and resumption of menses respectively. Occupation (likelihood ratio p = 0.013), area of residence (likelihood ratio p = 0.004), mode of delivery (likelihood ratio p < 0.001), breastfeeding (p = 0.024), period since delivery (p < 0.001), preferred number of children (p < 0.001) and parity (p < 0.001) were found to be predictors of postpartum contraceptive use.ConclusionPostpartum women in the Mfantseman municipal who did not use contraceptives or delayed in the use of contraceptives after birth were least likely to be protected against pregnancy in the post partum period, whilst those who adopted postpartum family planning were likely to be better protected because they were likely to adopt it within the first three months after birth and before the onset of sexual relations and first menses. The predictors of postpartum contraceptive use were breastfeeding pattern, occupation, parity, preferred number of children, period since delivery, place of residence and mode of delivery.

Health effects of breastfeeding on the mother

We evaluated the effect of breastfeeding on maternal health outcomes. We distinguished between long-term effects (breast carcinoma, ovarian carcinoma, endometrial carcinoma, osteoporosis, and type2 diabetes mellitus) and short-term effects (lactational amenorrhea, postpartum depression, and postpartum weight change).Predominant breastfeeding increases the duration of lactational amenorrhea, which has ashort-term effect on the reduction of fertility. There are many studies that show that breastfeeding is protective against breast, ovarian carcinoma, and endometrial carcinoma. The effects depend on the duration of breastfeeding. There is evidence that breastfeeding reduces the risk of type2 diabetes and metabolic syndrome and cardiac diseases. However, an association between breastfeeding and bone mineral density or maternal depression or postpartum weight change was not clearly evident.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Tubal Pregnancy and a Device Innovation from Our Institution

Natural orifice transluminal endoscopic surgery (NOTES) is a relatively new technique currently being studied around the world. Between June 2015 and June 2017, 12 patients diagnosed with ectopic pregnancy underwent transvaginal NOTES to remove their fallopian tubes. All 12 surgeries were completed successfully. The median age of patients was 33years (range, 28–42), and the median body mass index was 23.47 (range, 20.55–27.68). The median duration of amenorrhea was 53days (range, 41–60). The median serum β-human chorionic gonadotropin was 8887 U/mL (range, 392–25 695). The median ectopic mass longest diameter was 2.95 cm (range, 2.1–5.0). The median surgical time was 47.5 minutes (range, 40–70). The median hemoperitoneum was 52.5 mL (range, 20–300), and the median blood loss was 7.5 mL (range, 2–20). Our study has proven the feasibility and repeatability of transvaginal NOTES for less difficult ectopic pregnancies. The success of transvaginal NOTES lies in the choice of patients and the establishment of the transvaginal operating platform. We added a plastic ring between the inner and outer rings outside the wound retractor. The modified platform can lessen the technical difficulties of performing transvaginal NOTES and broaden its applicability to other procedures.

Effects of the two types of anorexia nervosa (binge eating/purging and restrictive) on bone metabolism in female patients.

This study compared the profiles of the two types of anorexia nervosa (AN; restrictive: AN-R, and binge eating/purging: AN-BP) in terms of body composition, gynaecological status, disease history and the potential effects on bone metabolism. Two hundred and eighty-six women with AN (21.8±6.5years; 204 AN-R and 82 AN-BP) and 130 age-matched controls (CON; 22.6±6.8years) were enrolled. Areal bone mineral density (aBMD) was determined using DXA and resting energy expenditure (REE) was indirectly assessed using calorimetry. Markers of bone formation (osteocalcin [OC], procollagen type I N-terminal propeptide [PINP] and resorption (type I-C telopeptide breakdown products [CTX]) and leptin were concomitantly evaluated. Anorexia nervosa patients presented an alteration in aBMD and bone turnover. When compared according to type, AN-BP were older than AN-R and showed less severe undernutrition, lower CTx levels, longer duration of AN, and higher REE levels and aBMD at radius and lumbar spine. After adjustment for age, weight and hormonal contraceptive use, the aBMD and CTx differences disappeared. In both AN groups, aBMD was positively correlated with anthropometric parameters and negatively correlated with durations of AN and amenorrhoea, the bone formation markers (OC and PINP) and the leptin/fat mass ratio. REE was positively correlated with aBMD in AN-R patients only. This study shows the profiles of AN patients according to AN type. However, the impact of the profile characteristics on bone status, although significant, was minor and disappeared after multiple adjustments. The positive correlation between REE and aBMD reinforces the concept that energy disposal and bone metabolism are strongly interdependent.

The Relationship Between Body Mass Index (BMI) and Menstrual Disorders at Different Ages of Menarche and Sex Hormones

ObjectiveThe present research aimed to study the relationship between body mass index and menstrual disorders at different ages of menarche and sex hormones. MethodsIn this cross-sectional study, 2000 girls aged between 9 and 18 in all levels were selected through cluster sampling in Shiraz. Data were collected using demographic characteristics, menstrual disorders, body mass index and hormones' measure questionnaires. To analyze the data, we used SPSS 16 and Chi-square test. ResultsA total of 1024 (51.2%) out of 2000 subjects had normal BMI and the smallest group belonged to 26 subjects (1.3%) with BMI ≤ 30. There is a significant relationship between body mass index, menstrual cycle length (p = 0.006), spotting (p = 0.005), passing clots (p = 0.001) and menstrual bleeding (p = 0.04), and this relationship is insignificant between body mass index and duration of bleeding (p = 0.95), amenorrhea (p = 0.03), dysmenorrhea (p = 0.26) and menstrual regularity (p = 0.95). Investigating the relationship between body mass index and some of sex hormones shows that there is no significant relationship among BMI and TSH (p = 0.94), FSH (p = 0.21), LH (p = 0.21), Prolactin (p = 0.97), Testosterone (p = 0.66), and DHEAS (p = 0.94). ConclusionsA significant relationship among BMI and menstrual cycle length, spotting, passing clots and menstrual bleeding, and was insignificant with sex hormones.

Brain-derived neurotrophic factor (BDNF) plasma concentration in patients diagnosed with premature ovarian insufficiency (POI)

Premature ovarian insufficiency (POI) is defined as a cessation of function of ovaries in women younger than 40 years old. Brain-derived neurotrophic factor (BDNF) is a protein critically involved in neuronal growth and metabolism. BDNF also has been shown to be important regulator of oocyte maturation. Recent data show that BDNF can be potentially involved in POI pathology. The aim of the study was to assess the BDNF plasma concentrations in patients diagnosed with idiopathic POI. 23 women diagnosed with POI (age 31 ± 7 years) and 18 (age 31 ± 3) controls were included to the study, matched according to age and body mass index. The BDNF concentrations were measured using competitive enzyme-linked immunosorbent assay (ELISA). Hormonal and metabolic parameters were measured in all individuals, in controls in late follicular phase. The POI group demonstrated lower mean plasma concentrations of BDNF (429.25 ± 65.52 pg/ml) in comparison to healthy controls (479.75 ± 34.75 pg/ml, p = 0.0345). The BDNF plasma concentration correlated negatively (R = −0.79, p < 0.001) with number of months since last menstrual period. There was a positive correlation between BDNF and progesterone in controls. In conclusion, POI patients show significantly lower BDNF plasma concentration and it correlates with the duration of amenorrhea. This observation brings important potential insights to the pathology of POI.

Anorexia Nervosa: Analysis of Trabecular Texture with CT.

Purpose To determine indexes of skeletal integrity by using computed tomographic (CT) trabecular texture analysis of the lumbar spine in patients with anorexia nervosa and normal-weight control subjects and to determine body composition predictors of trabecular texture. Materials and Methods This cross-sectional study was approved by the institutional review board and compliant with HIPAA. Written informed consent was obtained. The study included 30 women with anorexia nervosa (mean age ± standard deviation, 26 years ± 6) and 30 normal-weight age-matched women (control group). All participants underwent low-dose single-section quantitative CT of the L4 vertebral body with use of a calibration phantom. Trabecular texture analysis was performed by using software. Skewness (asymmetry of gray-level pixel distribution), kurtosis (pointiness of pixel distribution), entropy (inhomogeneity of pixel distribution), and mean value of positive pixels (MPP) were assessed. Bone mineral density and abdominal fat and paraspinal muscle areas were quantified with quantitative CT. Women with anorexia nervosa and normal-weight control subjects were compared by using the Student t test. Linear regression analyses were performed to determine associations between trabecular texture and body composition. Results Women with anorexia nervosa had higher skewness and kurtosis, lower MPP (P < .001), and a trend toward lower entropy (P = .07) compared with control subjects. Bone mineral density, abdominal fat area, and paraspinal muscle area were inversely associated with skewness and kurtosis and positively associated with MPP and entropy. Texture parameters, but not bone mineral density, were associated with lowest lifetime weight and duration of amenorrhea in anorexia nervosa. Conclusion Patients with anorexia nervosa had increased skewness and kurtosis and decreased entropy and MPP compared with normal-weight control subjects. These parameters were associated with lowest lifetime weight and duration of amenorrhea, but there were no such associations with bone mineral density. These findings suggest that trabecular texture analysis might contribute information about bone health in anorexia nervosa that is independent of that provided with bone mineral density. © RSNA, 2016.

How weight gain change bone turnover with women in anorexia nervosa

Objective Our objective was to investigate how bone metabolism change through body weight gain in women with anorexia nervosa (AN). Patients and methods This retrospective research at one hospital included 36 women with AN (mean age ± SEM, 30 ± 11.3 years, mean BMI ± SEM 12.1 ± 1.2 kg/m2) treated with our CBT program. We measured their bone mineral density (BMD) of the spine and whole body by dual-energy x-ray absorptiometry, serum intact N-terminal propeptide of type 1 procollagen (P1NP), tartrate-resistant acid phosphatase-5b (TRACP-5b) and sclerostin before and after the treatment. Results At baseline, BMD negatively correlated with amenorrhea duration. Upon completion, the body weight increased 8.8 ± 2.9 kg. But they all remained amenorrhea. BMD significantly decreased (posteroanterior spine, –2.7 ± 1.3%; whole body, –1.7 ± 0.5%). Serum intact P1NP levels increased (p Conclusions This study demonstrates that weight gain induces bone formation and reduces bone resorption in women with severe AN regardless of BMD change. Levels of sclerostin at baseline could be a good predictor of reaction of BMD.

Reassessment of patients with Eating Disorders after moving from DSM-IV towards DSM-5: a retrospective study in a clinical sample.

To compare the relative prevalence of eating disorders moving from DSM-IV to DSM-5, and to reassess the overall medical impairment in the revised diagnostic classes. We applied DSM-5 to 206 patients (age 15-56years) previously studied and classified according to DSM-IV. Medical impairment was classified as low, medium, or high, based on a cumulative score of clinical severity (SCS), computed as the sum of specific weights assigned to different pathological conditions and their ascertained prognostic impact. Application of DSM-5 produced a decrease in Eating Disorders Not Otherwise Specified (EDNOS) by 17%, an increase in anorexia (AN) by 14% and bulimia (BN) by 2.4%; 44.6% of EDNOS migrated to AN, 8% to BN, and 30.8% was reclassified as Other Specified Feeding and Eating Disorders (OSFED). Mean SCS was higher in AN than in other diagnoses independent of classification. Differently from EDNOS, no high score was found in OSFED. BMI (OR 0.74, 95% CI 0.56-0.98) and duration of amenorrhea >1year (OR 6.63, 95% CI 1.29-34.16) resulted significantly associated with the risk for medium-high SCS level in AN classified with DSM-5. The results confirmed that DSM-5 reduces the number of EDNOS. DSM-5 seems to better represent the clinical picture in OSFED than in EDNOS. The clinical relevance of BMI and duration of amenorrhea should be considered even more now that they are no longer used as diagnostic hallmarks of AN.

Risk of Pregnancy in Breastfeeding Mothers: Role of the Progesterone Vaginal Ring on Birth Spacing

The progesterone vaginal ring (PVR) Progering® has been shown to be effective as a contraceptive in breastfeeding women who need safe and effective methods of spacing pregnancies. Previous clinical trials, of 1-year duration, demonstrated its efficacy to be similar to that of the intra-uterine device (IUD) during lactation. The duration of lactational amenorrhoea is significantly prolonged in PVR users in comparison with IUD users with fewer median numbers of bleeding/spotting episodes and days. This delivery system designed for 3-month use needs to be renewed every 3 months as long as breastfeeding continues, for up to 1 year. The frequency of breastfeeding, breast milk volume, and infant growth were not different in PVR or IUD users, and the safety of this new method has been well documented. This article reviews the literature and describes the mechanism of action of the PVR during lactation to bring additional protection over exclusive breastfeeding only, during the first year postpartum. Further evaluation of the PVR acceptability in different populations where breastfeeding is popular and highly recommended for the infant’s benefit is warranted.

Quality Improvement

Quality Improvement

Longitudinal sex and stress hormone profiles among reproductive age and post-menopausal women after severe TBI: A case series analysis

Primary objectives: To describe hormone profiles for pre-/post-menopausal women, to monitor time to resumption of menstruation among pre-menopausal women and to describe cortisol associated LH suppression and phasic variation in other sex hormones over timeMethods and procedures: This study determined amenorrhea duration and characterized acute (days 0–7) and chronic (months 1–6) gonadotropins [luteinizing hormone and follicle stimulating hormone (LH, FSH)], sex hormones (progesterone, estradiol) and stress hormone (cortisol) profiles. Women were pre-menopausal (n = 3) or post-menopausal (n = 3). Among pre-menopausal women, menstrual cycle resolution and phase association (luteal/follicular) was monitored using self-report monthly reproductive history questionnaires. This study compared post-TBI hormone profiles, stratified by menopausal status, to hormone levels from seven controls and described 6- and 12-month outcomes for these women.Main outcomes and results: Consistent with functional hypothalamic amenorrhea (FHA), menstruation resumption among pre-menopausal women occurred when serum cortisol normalized to luteal phase control levels. For post-menopausal women, serum cortisol reductions corresponded with resolution of suppressed LH levels.Conclusions: The stress of TBI results in anovulation and central hypothalamic-pituitary-ovarian (HPG) axis suppression. Future work will examine acute/chronic consequences of post-TBI hypercortisolemia and associated HPG suppression, the temporal association of HPG suppression with other neuroendocrine adaptations and how HPG suppression impacts multidimensional recovery for women with TBI.

Perimenopause and Menopause Are Associated With High Frequency Headache in Women With Migraine: Results of the American Migraine Prevalence and Prevention Study.

To examine the relationship of headache frequency to the stages of the menopausal transition in mid-life women with migraine. Past studies suggest that the perimenopause is associated with an increased prevalence of migraine, particularly in those with a history of premenstrual syndrome. The effect of the menopausal transition on the frequency of headache attacks in women with migraine has not been explored. This was a cross-sectional observational study. Using data from the 2006 American Migraine, Prevalence and Prevention study survey, women meeting modified ICHD-3 beta criteria for migraine between the ages of 35-65 years were included in analyses. Women who had never menstruated or were pregnant, breastfeeding, or using exogenous sex hormones were excluded. The 2006 survey was selected because it included detailed questions on the menstrual cycle. The stages of the menopausal transition were defined based upon the self-reported cycle length and/or duration of amenorrhea. The primary outcome, high vs low headache frequency, was defined using a cut score of ≥10 headache days per month. Binary logistic regression models were used to assess the influence of menopausal stage on headache frequency category using premenopause as the reference group. Adjustments for stage of menopausal transition and sociodemographics (eg, age and income) were included in the first model, while the second model included sociodemographics, depression, body mass index, preventative medications, and medication overuse. The study sample included 3664 women at a mean age of 46 years. Among women who were premenopausal, 8.0% (99/1242) were in the high frequency headache group in comparison with 12.2% (154/1266) of perimenopausal and 12.0% (131/1095) of postmenopausal women. Compared with premenopausal women, the adjusted odds of being in the high frequency headache group was 1.62 (95% CI = 1.23, 2.12) for perimenopausal and 1.76 (95% CI = 1.23, 2.52) for postmenopausal women (Model 1). In model 2, high frequency headache was only increased in perimenopausal women with an OR of 1.42 (95% CI = 1.03, 1.94). The risk of high frequency headache is increased in women during the perimenopause compared to premenopause in the fully adjusted model. The fact that the increased risk of high frequency headache was not statistically significant for menopause in the fully adjusted models suggests that different mechanisms might account for the increased risk for this stage of the menopausal transition. Recognition of the increased risk of high frequency headache during the menopausal transition suggests a need for optimized preventive treatment of migraine during this time of women's life.

A systematic review and meta-analysis of the association between eating disorders and bone density.

This meta-analysis investigates the effect of an eating disorder on bone mineral density in two eating disorder subtypes. Following conflicting findings in previous literature, this study finds that not only anorexia nervosa, but also bulimia nervosa has a detrimental effect on BMD. Key predictors of this relationship are discussed. This systematic review and meta-analysis investigates bone mineral density (BMD) in individuals with anorexia nervosa (AN) and bulimia nervosa (BN) in comparison to healthy controls (HCs). AN has been associated with low BMD and a risk of fractures and mixed results have been obtained for the relationship between BN and BMD. Deciphering the effect these two ED subtypes on BMD will determine the effect of low body weight (a characteristic of AN) versus the effects of periods of restrictive eating and malnutrition which are common to both AN and BN. We conducted a systematic search through the electronic databases MedLine, EMBASE and PsychInfo and the Cochrane Library to investigate and quantify this relationship. We screened 544 articles and included 27 studies in a random-effect meta-analysis and calculated the standardised mean difference (SMD) in BMD between women with a current diagnosis of AN (n = 785) vs HCs (n = 979) and a current diagnosis of BN (n = 187) vs HCs (n = 350). The outcome measures investigated were spinal, hip, femoral neck and whole body BMD measured by DXA or DPA scanning. A meta-regression investigated the effect of factors including age, duration since diagnosis, duration of amenorrhea and BMI on BMD. The mean BMI of participants was 16.65kg/m(2) (AN), 21.16kg/m(2) (BN) and 22.06kg/m(2) (HC). Spine BMD was lowest in AN subjects (SMD, -3.681; 95% CI, -4.738, -2.625; p < 0.0001), but also lower in BN subjects compared with HCs (SMD, -0.472; 95% CI, -0.688, -0.255; p < 0.0001). Hip, whole body and femoral neck BMD were reduced to a statistically significant level in AN but not BN groups. The meta-regression was limited by the number of included studies and did not find any significant predictors. This meta-analysis confirms the association between low BMD and AN and presents a strong argument for assessing BMD not only in patients with AN, but also in patients with BN.

MINERAL METABOLISM AND BONE MINERAL DENSITY IN PATIENTS WITH CENTRAL HYPOGONADISM AS INDICATORS OF PREMATURE AGING

Aim of this study was to estimate the markers of mineral turnover and BMD in young women with the central hypogonadism, to compare them with healthy young women and healthy postmenopausal women of middle/advanced age. Materials and methods. One hundred seventy women were included in the study: 73 patients with the central hypogonadism (isolated hypogonadism n=35, hypopituitarism n=38), age of 25 [21.2; 30.5] y.o., amenorrhea duration 5 [2.3; 10.1] years; 47 healthy women with regular menstrual cycles, age 24 [23.1; 28.0] y.o., and 50 healthy women with natural menopause, age 56 [53; 58] y.o., menopause duration 6.0 [2.1; 10.0] years. Groups did not differ by age. Results. In patients with central female hypogonadism concentrations of calcium and alkaline phosphatase were significantly higher than in healthy women of similar age, however did not differ from the parameters in postmenopausal women. T-scores &lt;-2.5 SD in lumbar spine were noted in 55% and 28% patients with central hypogonadism and in menopause respectively (р&lt;0.001), and in a hip - 27% and 7%, respectively (r=0.002). The factors promoting lower values of BMD in young women with central hypogonadism were the amenorrhea duration, low level of total testosterone, primary amenorrhea. Distinctions of mineral turnover and BMD in isolated hypogonadism and a hypopituitarism were not revealed. Conclusions. Central hypogonadism in women at young age is a higher prognostic factor of low BMD than natural menopause, and might be considered as a marker of premature aging.

Breastfeeding and maternal health outcomes: a systematic review and meta-analysis.

AimTo evaluate the effect of breastfeeding on long-term (breast carcinoma, ovarian carcinoma, osteoporosis and type 2 diabetes mellitus) and short-term (lactational amenorrhoea, postpartum depression, postpartum weight change) maternal health outcomes.MethodsA systematic literature search was conducted in PubMed, Cochrane Library and CABI databases. Outcome estimates of odds ratios or relative risks or standardised mean differences were pooled. In cases of heterogeneity, subgroup analysis and meta-regression were explored.ResultsBreastfeeding >12 months was associated with reduced risk of breast and ovarian carcinoma by 26% and 37%, respectively. No conclusive evidence of an association between breastfeeding and bone mineral density was found. Breastfeeding was associated with 32% lower risk of type 2 diabetes. Exclusive breastfeeding and predominant breastfeeding were associated with longer duration of amenorrhoea. Shorter duration of breastfeeding was associated with higher risk of postpartum depression. Evidence suggesting an association of breastfeeding with postpartum weight change was lacking.ConclusionThis review supports the hypothesis that breastfeeding is protective against breast and ovarian carcinoma, and exclusive breastfeeding and predominant breastfeeding increase the duration of lactational amenorrhoea. There is evidence that breastfeeding reduces the risk of type 2 diabetes. However, an association between breastfeeding and bone mineral density or maternal depression or postpartum weight change was not evident.

Abstract P3-12-05: Reduction of ovarian reserve in young early breast cancer patients: 24 months follow up of a prospective cohort trial

Abstract Background: Sideeffects of adjuvant chemotherapy on ovarian function are inadequately studied by now. Premenopausal women undergoing chemotherapy are at risk for sexual hormone deficiency and impaired fertility. This prospective cohort study searches for predictive parameters of ovarian reserve after chemotherapy. Methods: 51 premenopausal patients (average 38 years; 28-46 years) with primary breast cancer have been included. They all received neo- or adjuvant chemotherapy: anthracycline based "A"(FEC)(n= 18); anthracycline/taxane based "T"( TAC or FEC/Doc or EC/Pac)(n=30) or anthracycline- free "AF"(n=3). After chemotherapy patients received endocrine therapy (ET) for hormone receptor (HR) positive disease (tamoxifen (n=34) or goserelin/tamoxifen (n=7)). For HR negative disease (n=20) no ET was given. Before (visit 1) and 6, 12 and 24 months after initiation of chemotherapy (visit 2-4) age and chemotherapy related changes in hormone (LH, FSH, E2 and Anti-Muellerian hormone (AMH)) levels, antral follicle count and amenorrhea as parameters of endocrine function and fertility were assessed. Also quality of life (QL) and additional impact of parity, BMI and nicotine use on ovarian reserve were evaluated. Results: Antral follicle count is decreasing dramatically after chemotherapy and is not fully recovering after 2 years. Antral follicle count before and 1 year after chemotherapy are significantly correlated (p=0.012). Follicle count and age before chemotherapy are negatively correlated (p=0.004). At visit 4 the type of chemotherapy (A, T, AF) has no influence on antral follicle count or AMH levels. Tamoxifen is correlated with a significant decrease in follicle count (vs. no endocrine therapy) (p=0.039). Smoking is significantly detrimental on antral follicle count after 24 months (p=0.001). AMH levels at visits 2-4 are significantly correlated with levels at the 1 visit and are negatively correlated with age (p=0.032). Tamoxifen therapy has no impact on AMH levels. LH and FSH are increasing between visit 1 and 2 and decreasing at visits 3 and 4 (but stay above basic levels). At visit 4 LH is not and FSH is correlated with visit 1 levels (p=0.005). LH and FSH are correlated with age (p=0.0001) and are not influenced by type of chemotherapy or tamoxifen .E2 levels at visit 4 are not influenced by type of chemotherapy, but significantly decreased (p=0.003) by continued smoking. At visit 4 31/51 patients have stayed amenorrheic, 19 resumed their menstruation. This was not influenced by type of chemotherapy or age. Non- smokers are 13 times more likely to resume their menstruation (vs. smokers). Tamoxifen is correlated with a higher probability of permanent amenorrhea (p=0.058, n.s.). BMI, nicotine abuse, age, type of chemotherapy and tamoxifen have no influence on duration of amenorrhea. QL is significantly lower at visit 2, but recovers to basic values at visits 3 and 4. Conclusions: Our study contributes to a better prediction of ovarian reserve before chemotherapy. We suggest personalized counselling on fertility preserving measures before chemotherapy especially at higher age, with low AMH levels or low antral follicle counts. To stop smoking could enhance chances for ovarian preservation. Citation Format: Christoph Mundhenke, Antonia S Wenners, Jana Grambach, Juliane Koss, Ulrike von Hehn, Walter Jonat, Andreas G Schmutzler. Reduction of ovarian reserve in young early breast cancer patients: 24 months follow up of a prospective cohort trial [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-12-05.