Gynecological Age Research Articles

Natural History of Menstrual Pain and Associated Risk Factors in Early Adolescence

Study ObjectiveTo determine the natural history of menstrual pain without pelvic pathology, the role of progesterone in its pathophysiology, and associated risk factors in a longitudinal study of early post-menarchal girls in North Carolina. MethodsParticipants contributed daily urine samples for up to 3.5 years to measure pregnanediol-3-glucuronide [PdG] (mean 589 urines/participant), completed menstrual diaries, and reported menstrual pain using the Menstrual Symptom Questionnaire (MSQ) biannually. MSQ scores were log-transformed and generalized estimating equations assessed associations with gynecologic age, cycle peak PdG, presumed ovulation, physical activity, anxiety, and depression. Models were adjusted for age at menarche, baseline body mass index, race/ethnicity, parental education and employment, and gynecologic age. ResultsForty-three girls, aged 12.6 ± 1.1 years (mean ± SD) at enrollment with a gynecologic age 0.3 ± 0.2 years, participated. Total MSQ scores were higher for every 1-year increase in gynecologic age (MSQ score ratio: 1.12; 95% CI: 1.08, 1.17; p<0.0001). Overall MSQ (ratio: 1.04; 95% CI: 1.02, 1.06; p=0.0002) and abdominal pain-specific (ratio: 1.04; 95% CI: 1.01, 10.7; p=0.004) scores were higher for every 1000 ng/mg creatinine increase in peak PdG in the preceding cycle. Overall MSQ scores were higher (ratio 1.26; 95% CI: 1.11, 1.44; p=0.0005) if the preceding cycle was presumed ovulatory. Menstrual pain was not associated with physical activity, anxiety, or depression. ConclusionsIn early post-menarchal girls, gynecologic age and PdG were associated with menstrual pain, suggesting a pathophysiologic role for progesterone and other unknown factors in the development of menstrual pain.

6962 Natural History of Menstrual Pain and Associated Risk Factors in Early Adolescence

Abstract Disclosure: M. Sofia: None. R. Modarelli: None. S. Molsberry: None. S. Denslow: None. D. Zaccaro: None. C. Kamoun: None. N.D. Shaw: None. Background: Primary dysmenorrhea (PD), or menstrual pain of uterine origin without pelvic pathology, affects up to 93% of adolescents and is a leading cause of school and work absenteeism. The theory that PD only occurs when progesterone levels fall in the late-luteal phase, triggering production of uterine prostaglandins, has dominated the literature. However, recent studies identifying PD among girls with anovulatory cycles cast doubt on this theory. We took advantage of an ongoing longitudinal study of healthy early post-menarchal girls to test the hypothesis that ovulation is associated with increased PD and to explore other participant factors associated with PD. Methods: Participants contributed daily urine samples to measure Cr-corrected LH, estrone conjugates, and pregnanediol-3-glucuronide [PdG], completed menstrual diaries, and reported dysmenorrhea symptoms using the 24-item Menstrual Symptom Questionnaire (MSQ) approximately biannually. A cycle was defined as ovulatory if peak PdG &amp;gt;2500 ng/mg Cr. Scores were natural log-transformed and modeled to assess associations with gynecologic age, ovulation, anxiety, depression, and physical activity exposures using generalized estimating equations with a normal distribution and autoregressive covariance structure. Models were adjusted for age at menarche, baseline BMI Z-score, race, ethnicity, maternal age at menarche, parental education and employment, and gynecologic age (ovulation models only). Results: The 43 participants were 12.38 ± 1.06 years old (mean ± SD) with a gynecologic age of 2.99 ± 2.22 months. The majority were non-Hispanic White and of normal weight. Average maternal age at menarche was 12.64 ± 1.09 years. Among parents of participants, most were both at least college-educated and nearly 50% were both employed. Participants completed 155 MSQs (1-9/participant). Dysmenorrhea scores increased over time (scores 1.14x higher for every 1-year increase in gynecologic age, p&amp;lt;0.001). Dysmenorrhea scores were 1.12x higher (p=0.03) if the preceding cycle was ovulatory vs. anovulatory and 1.11x higher if all cycles in the preceding 6 months were ovulatory vs all anovulatory (p=0.11). Gynecologic age remained significant in models with ovulation-based exposures, and maternal age at menarche was inversely associated with dysmenorrhea score (beta -0.08, p=0.04) in the model with gynecologic age as the exposure. Conclusion: In early-postmenarchal girls, dysmenorrhea scores were higher when associated with ovulatory cycles but also increased over time independent of ovulatory status, suggesting a pathophysiologic role for progesterone and other unknown factors. There was no association between age at menarche, BMI, race/ethnicity, and dysmenorrhea scores whereas maternal age at menarche was inversely associated with dysmenorrhea scores. Presentation: 6/1/2024

12559 Objective Versus Subjective Measures Of Reproductive Development And Psychological Well-Being In Peri-Menarcheal Adolescents: A Pilot Study

Abstract Disclosure: K.C. McCormick: None. M.E. Lujan: None. J. Chang: None. L. Ipp: None. A. Alladeen: None. H. Lamar: None. J. Mendle: None. H. Vanden Brink: None. Introduction: Risk of psychopathology emerges during the pubertal and peri-menarcheal years; however objective physiological measures of maturation often differ from adolescents’ own reports of their development. Understanding how psychological symptoms emerge in relation to both objective and subjective evaluations of reproductive development can provide critical insights into mental health risk and variability in psychological symptom severity during the pre-menarcheal and early post-menarcheal years. Methods: 52 females 9-15 years old (n=16 pre-menarcheal, n=36 &amp;lt;2 years post-menarche) underwent a non-fasting blood draw for reproductive hormones (estradiol, anti-mullerian hormone (AMH), luteinizing hormone (LH), follicle stimulating hormone (FSH)), anthropometry, detailed reproductive and menstrual history, and a series of surveys to evaluate depression (CES-DC), anxiety (MASC), perceptions of pubertal-related change (POPS), and transdiagnostic psychological processes (rumination, emotional clarity) which can contribute to, and are risk factors for, psychopathology. Whether psychological symptoms are associated with objective measures (menarche, gynecological age, reproductive hormone concentrations) versus subjective measures (self-reported tanner stage, severity of dysmenorrhea) were contrasted using t-tests and Pearson Correlation Coefficient analyses (JMP Pro (v17)). Results: The majority of participants (26/36 post-menarcheal and 11/16 pre-menarcheal) exceeded the standard cut-off of 15 for depressive symptoms, consistent with research on mental health symptomatology in this cohort of youth. POPS scores were higher (39±10.9) in post-menarcheal versus pre-menarcheal (31±12.6) adolescents indicating post-menarcheal adolescents reported more puberty-linked change in their lives (Pttest=0.04). Lower emotional clarity was associated with higher AMH concentrations (r= -0.27, p=0.0944). Depressive symptoms tended to be greater (27+14.8) in those with moderate dysmenorrhea versus mild/no dysmenorrhea (19±11.1, Pttest=0.08). Depression (r=0.30, p=0.032) and anxiety symptoms (r=0.32, p=0.027), and rumination (r=0.30, p=0.033) were associated with higher self-reported Tanner scores; POPS was trending (r=0.25, p=0.0776). Neither estradiol nor FSH were associated with any measures of psychological well-being. Conclusion: Both objective measures of reproductive development and adolescent self-reports may help providers assess individual vulnerability to internalizing psychopathology, such as depression and anxiety. Additionally, given population level increases in depressive symptoms in adolescents, researchers should avoid utilizing simple cutoffs for depression and anxiety, which lack specificity and overlook critical variability which can further elucidate mental and physical health dynamics. Presentation: 6/2/2024

Functional Ovulatory Menstrual Health Literacy Amongst Adolescent Females in Western Australia

Study objectiveTo assess the knowledge of ovulation and menstruation of adolescent females in Western Australia. MethodsA validated adolescent ovulatory menstrual health literacy questionnaire was used in a cross-sectional study, which included an open-response question inviting participants’ reflections. ResultsParticipants (n=297) were from two single sex and seven co-educational schools of varied socio-educational advantage. Mean chronological age was 15 years and mean gynaecological age was two years. The prevalence of dysmenorrhoea was 69%. Primary sources of information included mothers (91%), friends (61%) and, for post-menarcheal participants (n=274), mobile applications (52%). Most adolescents enjoyed finding out information about ovulatory menstrual health, and understood the information given to them. However, participants’ knowledge of ovulation, menstruation and their occurrence in the cycle were low. Attendance at a single sex or Catholic school or use of mobile applications did not confer a knowledge advantage overall (p<0.05), except for knowing the meaning of cervical mucus. Thematic content analysis of open-ended responses resulted in five themes, including normality, menstrual flow, charting, ovulation and dysmenorrhoea. ConclusionInadequate functional ovulatory menstrual health literacy hampers progression to acquiring complete health literacy. This has negative implications for progressing towards the interactive and critical ovulatory menstrual health literacy domains, which include providing an accurate menstrual history when engaging with healthcare providers.

Functional connectivity associations with menstrual pain characteristics in adolescents: an investigation of the triple network model.

Menstrual pain is associated with deficits in central pain processing, yet neuroimaging studies to date have all been limited by focusing on group comparisons of adult women with vs without menstrual pain. This study aimed to investigate the role of the triple network model (TNM) of brain networks in adolescent girls with varied menstrual pain severity ratings. One hundred participants (ages 13-19 years) completed a 6-min resting state functional magnetic resonance imaging (fMRI) scan and rated menstrual pain severity, menstrual pain interference, and cumulative menstrual pain exposure. Imaging analyses included age and gynecological age (years since menarche) as covariates. Menstrual pain severity was positively associated with functional connectivity between the cingulo-opercular salience network (cSN) and the sensory processing regions, limbic regions, and insula, and was also positively associated with connectivity between the left central executive network (CEN) and posterior regions. Menstrual pain interference was positively associated with connectivity between the cSN and widespread brain areas. In addition, menstrual pain interference was positively associated with connectivity within the left CEN, whereas connectivity both within the right CEN and between the right CEN and cortical areas outside the network (including the insula) were negatively associated with menstrual pain interference. Cumulative menstrual pain exposure shared a strong negative association with connectivity between the default mode network and other widespread regions associated with large-scale brain networks. These findings support a key role for the involvement of TNM brain networks in menstrual pain characteristics and suggest that alterations in pain processing exist in adolescents with varying levels of menstrual pain.

Adolescents diagnosed with polycystic ovary syndrome under the Rotterdam criteria but not meeting the diagnosis under the updated guideline.

What are the characteristics of adolescents diagnosed with polycystic ovary syndrome (PCOS) based on the 2003 Rotterdam criteria, but who do not meet the diagnosis according to the international evidence-based guideline? Adolescents who had features of PCOS but did not meet the evidence-based guideline adolescent criteria exhibited unfavorable metabolic profiles compared to controls and shared considerable metabolic and hormonal features with adolescents who did meet the adolescent criteria. The international evidence-based PCOS guideline recommended that ultrasound should not be used for the diagnosis of PCOS in girls with a gynecological age of <8 years. Thus far, few studies have evaluated the clinical characteristics of the girls diagnosed with PCOS based on the Rotterdam criteria but who do not meet the diagnosis according to the updated guideline. This is a retrospective study, and subjects attended for care from 2004 to 2022. Adolescent girls with PCOS diagnosed according to the 2003 Rotterdam criteria and healthy controls. All participants were between 2 and 8 years since menarche. Of the 315 girls diagnosed with PCOS according to the Rotterdam criteria, those with irregular menstruation (IM)/hyperandrogenism (HA)/polycystic ovary (PCO), IM/HA, HA/PCO, and IM/PCO phenotypes accounted for 206 (65.4%), 30 (9.5%), 12 (3.8%), and 67 (21.3%) participants, respectively. According to the evidence-based guideline, 79 girls (25.1%) with the HA/PCO or IM/PCO phenotypes were not diagnosed with PCOS, and aligned to the international guideline; they were designated as the 'at-risk' group. As expected, the girls meeting the evidence-based guideline adolescent criteria showed the worst metabolic profiles (degree of generalized or central obesity, frequency of insulin resistance, prediabetes or diabetes, and metabolic syndrome) and higher hirsutism scores than the at-risk group or controls. Approximately 90% of the at-risk group were not overweight or obese, which was similar to the controls. However, they showed worse metabolic profiles, with higher blood pressure, triglyceride, and insulin resistance parameters than controls; furthermore, these profiles were similar to those of the girls meeting the adolescent criteria. The at-risk group showed similarly elevated serum LH levels and LH/FSH ratio with the girls meeting adolescent criteria. We could not evaluate hormonal or ultrasound parameters in controls. Compared to the conventional Rotterdam criteria, the recent international evidence-based guideline-avoiding ultrasound in PCOS diagnosis in adolescents-still gives the opportunity to identify young girls at risk, aligned to the findings in this study. A practical approach to this adolescent population would involve establishing IM or HA (with ultrasound not indicated) and designating 'at-risk' PCOS status with regular check-ups for newly developed or worsening PCOS-related symptoms or metabolic abnormalities, with subsequent reassessment including ultrasound or anti-Müllerian hormone, once 8 years post-menarche. No funding was received in support of this study. The authors have no conflicts of interest to disclose. N/A.

A histopathological review of gynaecological malignancies in Katsina state North-Western Nigeria.

Gynaecological cancers, which affect the female genital tract, constitute a significant public health problem, especially in developing countries. Some of these malignancies have known aetiology and premalignant stages making them preventable. Understanding the burden of gynaecological malignancies in our environment will provide baseline information and help form strategies for their control. To describe the histological subtypes of gynaecological cancers, their frequency and age distribution trends in Katsina State over the 10-year study period. This was a 10-year retrospective cross-sectional multicenter study of all histologically diagnosed gynaecological cancer cases seen from 1st January 2012 to 31st December 2021 at Federal Teaching Hospital Katsina, General Hospital Katsina and General Amadi Rimi Specialist Hospital Katsina. Data for this study were extracted from departmental record registers of the pathology laboratories of the corresponding hospitals whose laboratories provide pathology services to the State. Cancer distribution over the years was sorted based on the primary site of diagnosis, histological diagnosis and age. Data were analysed using Statistical Package for Social Science version 28 and results were presented in tables and charts. Two thousand three hundred and fifty-nine cancers were seen over the 10-year study period. Of these cases, 58.4% (n = 1,378) were females. Gynaecological malignancies accounted for 18.7% (441/2,359) of all cancers and 32.0% (441/1,378) of all female cancers. The highest frequency of gynaecological cancers was seen in women who were within the age groups of 40-49 and 50-59, and the lowest was seen in women who were ≥90 years old. The mean age was 48.9 ± 14.9 years. The most common site of gynaecological malignancies was the cervix uteri (n = 262, 59.4%) followed by the ovary (n = 106, 24.0%). Other sites in descending order were corpus uteri (n = 29, 6.6%), vulva (n = 9, 2.0%) and vagina (n = 2, 0.5%). The most common histo-morphologic subtypes were large-cell keratinizing squamous cell carcinoma in the cervix, large-cell non-keratinizing squamous cell carcinoma in the cervix and cystadenocarcinoma in the ovary. Choriocarcinoma was found in 33 cases (7.5%). This study demonstrated the various histotypes of gynaecological malignancies and their trends in Katsina state. The leading cancer was found to be cervical cancer which is mainly preventable. It is hoped that data from this study will provide a basis for making and implementing policies and strategies to lessen the problems of gynaecological malignancies through regular screening programs, especially for cervical cancer and accepting human papilloma virus (HPV) vaccination take-up.

Juridical Analysis of Abortion Legalization in Government Regulation Number 61 Of 2014 Concerning Reproduction Health

Purpose: the purpose of this treatise is to enshrine the legalization of abortion in Government Regulation Number 61 of 2014. This is an analysis of laws originating from statutory regulations. Theoretical reference: The definition of abortion or abortion according to the World Health Organization (WHO) is the cessation of fruitful life during pregnancy under 28 weeks or a fetus weighing less than 1000 grams. The act of abortion that is carried out intentionally is called abortion provocatus. Gynecological age for abortion or abortion World Health Organization (WHO) which states that 24 weeks of gestation is the maximum safe gestational age for women to have an abortion. Method: Research results from doctrinal studies with a legislative approach . Doctrinal research results from studying the regulations relating to abortion law in Indonesia, while the legislative approach used in this research aims to see and analyze in depth how the regulations regarding abortion in Indonesia are enforced. To strengthen the analysis, this research also uses several research results related to abortion. Apart from that, this research also uses various information related to abortion case data, this is used so that the analysis carried out is accurate and appropriate to the abortion issues and problems that occur in Indonesia. Results and Conclusion: Abortion of a pregnancy resulting from rape which can cause psychological trauma to the rape victim can only be carried out if the conditions specified in Article 75 paragraph (3) and Article 76 of the Law of the Republic of Indonesia Number 36 of 2009 concerning Health have been met. Pregnancy as a result of rape violates the reproductive rights of rape victims, therefore the exclusion of abortion for rape victims aims to provide guarantees and legal protection of rape victims' reproductive rights as a manifestation of human rights. Thus it can be concluded that Article 31 of Government Regulation Number 61 of 2014 concerning Reproductive Health can be carried out based on indications regarding medical emergencies. Implications of research: Government Regulation Number 61 Of 2014 Concerning Reproduction Health Originality/value: Abortion, Reproductive health, legalization.

Perimenstrual Asthma and Premenstrual Disorders in Adolescents with Asthma

IntroductionAsthma is a common chronic disease in pediatric patients, and perimenstrual asthma (PMA) refers to the worsening of asthma symptoms during the perimenstrual period, mainly reported in adult women. However, there is limited information regarding the exacerbation of symptoms in the presence of premenstrual disorders (PMDs) in adolescents. This pilot observational study aims to investigate the frequency and potential association of PMA and PMDs in a clinical sample of adolescents with asthma. Patients and MethodsThe study included 50 adolescents (aged 12-18 years, mean 16.08 ± 2.35) with asthma and at least 2 years of gynecological age. The participants completed the Asthma Control Test (ACT) to assess asthma control (considered pathological if ACT score<20) and the modified Premenstrual Symptoms Screening Tool for Adolescents (PSST-A) to evaluate PMDs. ResultsA total of 75.5% of adolescents reported PMA. The prevalence of premenstrual symptoms did not significantly differ between the PMA and no-PMA group. Among the study sample, 38.7% experienced symptoms indicative of moderate/severe premenstrual syndrome (PMS), and 8.1% exhibited symptoms of premenstrual dysphoric disorder (PMDD). Compared to no-PMA group, patients with PMA showed a significant impairment in daily and home activities (p=0.03 and p=0.02, respectively) and exhibited a difference in the frequency of asthma symptoms (p<0.001) and medication use (p=<0.01). ConclusionsPerimenstrual worsening of asthma symptoms may be common in adolescents with severe form of asthma. Prospective data collection through menstrual diaries is necessary to further explore the association between PMA and PMDs. Identifying early risk factors for PMA could facilitate the development of preventive strategies and early interventions for adolescents with asthma.

Determinants of dysmenorrhoea among female adolescents: results from a community-based cohort study in Amsterdam

What is the contribution of sociodemographic, psychosocial, lifestyle and reproductive factors up to the age of 11-12 years to the occurrence of dysmenorrhoea at age 15-16 years within the Amsterdam Born Children and their Development (ABCD) study? Data of 1038 female adolescents were used. Participants' baseline characteristics were obtained using self-reported questionnaires up to the age of 11-12 years, as well as the obstetric information of their mothers during pregnancy. Dysmenorrhoea was assessed at the age of 15-16 years, and was deemed to be present if an adolescent reported menstrual abdominal and/or back pain and therefore took medication and/or hormonal contraception. Using a backward selection approach, potential determinants of dysmenorrhoea were selected and multivariable associations were determined. The overall prevalence of dysmenorrhoea was 49.5% among the participants. Intake of 3-4.5 sugar-sweetened beverages/day (P = 0.035) and higher gynaecological age (i.e. years since menarche) (P < 0.001) were significantly associated with higher occurrence of dysmenorrhoea in the final model, which explained 8.1% of the total variance in the occurrence of dysmenorrhoea. No significant associations were found between the occurrence of dysmenorrhoea and sociodemographic or psychosocial factors. This investigation of various potential risk factors for dysmenorrhoea suggests that diet and reproductive factors are particularly important predictors of the occurrence of dysmenorrhoea among young adolescents. Specifically, intake of sugar-sweetened beverages and higher gynaecological age were predictive of the occurrence of dysmenorrhoea. Other lifestyle factors were also identified as possible risk factors. Using this knowledge, effective strategies can be developed to reduce the burden of dysmenorrhoea among adolescents, and to provide appropriate care for those suffering from the condition.

SAT352 Reliability Of Two- And Three-dimensional Ultrasonographic Assessments Of Ovarian Morphology In Adolescents

Abstract Disclosure: E. Rahman: None. B. Smith: None. H. Vanden Brink: None. N. Zaman: None. A. Malik: None. T. Burgert: None. R. Barral: None. M.E. Lujan: None. Background: Distinct features of ovarian morphology using transabdominal ultrasonography (TAUS) have been observed in adolescents with polycystic ovary syndrome (PCOS). Standardized approaches to assess ovarian morphology using transvaginal ultrasonography result in excellent reliability and close agreement among multiple raters, which can lead to more precise estimates of follicle counts and ovarian size. The degree to which these methods translate to TAUS is unknown. Establishing standardized methods to analyze ovarian features via TAUS are needed to clarify the utility of ovarian morphology in the clinical evaluation of PCOS in adolescence. Objectives: To determine the reliability of follicle counts and ovarian size assessments obtained using 2D and 3D TAUS in early adolescence. Methods: Three raters evaluated images of 30 ovaries garnered from adolescents via TAUS (n=19, 6 - 20 months post-menarche) for the following 2D parameters: follicle number per ovary (2D FNPO), follicle number per cross-section (FNPS), ovarian volume (2D OV), ovarian area (OA) and stromal area (SA). Three dimensional assessments of follicle counts (3D FNPO) and ovarian volume (3D OV) were also performed using SonoAVCantralTM and VOCALTM software (GE Healthcare), respectively. Intraclass correlation coefficients (ICCs) were used to determine interrater reliability for each variable. An ICC &amp;lt;0.5 was defined as poor, 0.50-0.75 as moderate, 0.75-0.90 as good, and &amp;gt;0.900 as excellent reliability. Results: Across 2D measures of ovarian morphology, interrater reliability was highest for 2D FNPO (ICC = 0.698), followed by OA (0.655), SA (0.619), and FNPS (0.516). Ovarian volume measurements by 2D methods demonstrated poor reliability (0.297). Three-dimensional assessments of follicle counts were not associated with improved interrater agreement (0.609). By contrast, better reliability was detected for 3D OV versus 2D OV - albeit 3D measures still met criteria for poor reliability (0.397 vs 0.297). Conclusions: Assessments of ovarian morphology using TAUS are associated with moderate-to-poor reliability using standardized approaches. Follicle counts per ovary were moderately reliable with 2D and 3D TAUS, in contrast to OV which demonstrated poor reliability across raters irrespectively of modality. Poor reliability for measures of OV is concerning given current practice guidelines for the ultrasonographic assessment of PCOS advocate for measures of OV over FNPO when using TAUS. Factors impacting reliability, such as gynecological age, body habitus, and image quality will be evaluated in subsequent investigations to refine training, image acquisition protocols, and method development. Presentation: Saturday, June 17, 2023

FRI422 The Fates Of Ovarian Dominant Follicles In The First Two Gynecologic Years: An Investigation Of Morphologic And Endocrinologic Features

Abstract Disclosure: M. Calvert: None. S. Molsberry: None. S. Denslow: None. H. Vanden Brink: None. M.E. Lujan: None. N. Shaw: None. Introduction: Irregular menses are common during the early, post-menarchal years owing to the immaturity of the hypothalamic-pituitary-ovarian axis. Few studies have attempted to delineate the factors that contribute to cycle irregularity during this time. In the current study, we aimed to characterize the fate of ovarian dominant follicles in a longitudinal cohort of healthy, early post-menarchal girls. Methods: Participants contributed daily urine samples for reproductive hormone profiling (Cr-corrected LH, estrone conjugates [E1C], and pregnanediol-3-glucuronide [PdG]), and underwent periodic transabdominal ultrasound scans and body composition analysis. The current analysis includes cycles: 1) with an LH surge and ultrasounds performed 1-9 days before and/or &amp;lt;11 days after the surge, or 2) without an LH surge but with ultrasound documentation of a dominant follicle. LH surge requirements were &amp;gt; 40 mIU/mg Cr with concentrations &amp;gt; mean+3sd of the preceding 5 days. Ultrasounds were evaluated offline by two investigators using a standardized rubric for ovarian structures. Results: 26 participants contributed 74 ultrasound scans, spanning 45 cycles. Participants were 12.6 (range 9.8-14.7) years-old, 2.7 (range 0.3-9.6) months post-menarche, predominantly non-Hispanic White (65.4% vs. 26.9% Black, 3.8% Asian, 3.8% Multiracial), and of normal weight (76.9% with BMI &amp;lt;85th percentile). In 41/45 cycles, there was morphological (antral follicle diameter &amp;gt; 10 mm observed ultrasonographically, n=22) and/or endocrinological (LH surge, n=38) evidence for the presence of a dominant follicle. In 4/45 cycles, a dominant follicle was observed but peak LH did not meet LH surge criteria. In 17/41 cycles, dominant follicle fate could not be determined for technical reasons. In the remaining 24/41 cycles, dominant follicles fates post LH-surge were: corpus luteum (CL, 15/24, 71%), CL or luteinized unruptured follicle [LUF] (2/24, 8%), persistent dominant follicle (3/24, 13%), or no structure observed, implying follicular regression/collapse (4/24, 17%). In logistic GEE models, there was no association between peak E1C or LH, follicular phase length, gynecologic age, or free testosterone with odds of having a CL versus any other dominant follicle outcome. There were marginally significant associations between peak PdG (OR: 1.0003, 95% CI: 0.9999, 1.00008) and total body fat percent (OR: 0.86, 95% CI: 0.74, 1.01) with odds of having a CL versus any other dominant follicle outcome. Conclusion: In the first two gynecologic years, dominant follicles develop in most cycles and frequently ovulate. A variety of mechanisms, however, contribute to anovulation, including an absent LH surge, the formation of LUFs, and follicle regression. Whether degree of adiposity is related to ovulatory success of a dominant follicle early in gynecological life will be pursued in future research. Presentation: Friday, June 16, 2023

Rol de la ecografía ginecológica en la evaluación del desarrollo puberal en niñas y adolescentes

Introduction and objectivesTransabdominal ultrasonography (US) is the technique of choice for pelvis evaluation in pediatric population. The results of studies regarding US findings show a wide variation. The objectives of our study were: to estimate and correlate uterine and ovarian ultrasound measures (longitudinal diameter and volume) with chronological age (CA), breast Tanner stage (TS) and gynecological age (GA); to evaluate presence and size of follicles in patients according to their pubertal stage; and to determine the endometrial length in prepubertal and pubertal girls. Material and methodsUnicentric, observational, retrospective, analytical study, conducted between 2010 and 2019. Healthy girls between 8.0 and 16.0years, attended in the department of radiology were evaluated. Breast TS was evaluated and gynecological age was determined. Ultrasounds were performed by a pediatric diagnostic radiospecialist. Uterus length (UL) and ovarian length (OL) were measured; uterus and ovarian volume were calculated (UV and OV). Diameter of the largest follicle and endometrial thickness were measured. Results292 patients were analyzed, mean age was 12.5years (SD: 2.1). A significant correlation was observed between uterine and ovarian measurements with CA, TS and GA (P<.0001). A significant increase in UL and UV is described as the CA intervals increase, also in ovarian measurements. No significant differences in measurements were observed between TSI andII. An increase was evidenced at menarche. In 30.9% of pubertal patients and 11.8% of prepubertal patients showed ovarian follicles. The endometrium was not measurable in 88.24% of the pre-pubertal population and was always measurable in patients with TSIV andV. ConclusionsUterine and ovarian measurements increased with CA and ET (except ETI andII). The greatest increase occurred with menarche. Ovarian follicles and endometrium thickness less than or equal to 1mm were presented in prepubertal patients.

Prevalence of Polycystic Ovarian Syndrome in Girls with a History of Idiopathic Central Precocious Puberty

Introduction: The prevalence of polycystic ovarian syndrome (PCOS) in adolescent girls is between 1 and 4.3%. It remains controversial whether women with a history of idiopathic central precocious puberty (ICPP) are at increased risk for PCOS. Our objective was to assess the prevalence of PCOS in adolescents with a history of ICPP compared with healthy adolescents and the prevalence of PCOS among ICPP girls who have received or not gonadotropin-releasing hormone analogue (GnRHa) treatment. Methods: We assessed post-menarcheal girls with a history of ICPP. Girls were evaluated at gynecological age ≥2.5 years. Data collected were age at menarche, menstrual cycle characteristics, BMI, clinical hyperandrogenism (HA), total and free testosterone levels. PCOS diagnosis was defined by criteria for adolescents. Subjects were also analyzed regarding whether or not they had received GnRHa treatment. Results: Ninety-four subjects were assessed, and 63 had been treated with GnRHa. Menstrual disorders were found in 29%, clinical HA in 36%, and biochemical HA in 23%. Twelve percent met the diagnostic criteria for PCOS. There was no difference in BMI or in the incidence of menstrual dysfunction or hyperandrogenemia between treated and untreated patients. A higher proportion of clinical HA was found in untreated patients when compared to treated girls. The relative risk (RR) of developing PCOS in ICPP girls was 2.5 compared to a population of healthy adolescents. This RR was not higher in patients who received treatment with GnRHa than in those who did not. Conclusion: Adolescent girls with a history of ICPP have an increased risk of PCOS. This risk seems not to be related to GnRHa treatment.

1371-P: Factors Influencing the Development of Polycystic Ovary Syndrome in Premenopausal Women with Type 1 Diabetes

Objective: Polycystic ovary syndrome (PCOS) is common in women with type 1 diabetes (T1D). Reported prevalence rates vary according to diagnostic criteria used for PCOS. However, not all women with T1D develop hyperandrogenic traits and factors that influence the occurrence of PCOS have not been well stablished yet. We aim to assess the factors associated to the occurrence of PCOS in premenopausal women with T1D. Methods: Cross-sectional study. For this analysis, we included 110 patients with T1D, 24 diagnosed with PCOS by ESHRE/ASRM-Rotterdam criteria (prevalence: 22%, 95%CI: 15-30%). Women aged 18 to 45 years were consecutively recruited from a Diabetes Clinic at a tertiary hospital in Madrid, Spain. All participants were under intensive insulin treatment, had been diagnosed with T1D at least 1 year ago, and had a gynecological age of at least 2 years. A comparison between both groups T1D-PCOS and T1D-without PCOS was performed. We used Stata software v23 (StataCorp LLC) for statistical analysis. Results: Mean age was 30.3 ± 8.7 yrs and mean HbA1c was 7.31 ± 1.4%. Three-quarters (75%) of these patients were on multiple insulin doses. Women with T1D and PCOS were younger than those without PCOS (26.3 ± 7.4 in DM1-PCOS vs 31.2 ± 8.7, P &amp;lt; 0.05). Total daily insulin dose (TDI) was higher in T1D-PCOS group compared to T1D-without PCOS (0.71 ± 0.35 vs 0.58 ± 0.19, P = 0.025). There was a trend towards a more common premenarcheal diagnosis of T1D in T1D-PCOS (62.5% vs 46.5%, P = 0.116). Age (OR: 0.93, P = 0.016) and TDI (OR: 7.84; P = 0.043) were significant predictors of PCOS in the univariate logistic regression analysis. After introducing these variables in a multivariate regression analysis, only age was retained as a significant predictor factor of PCOS in women with T1D (OR: 0.93; P = 0.040). Conclusions: In this study, premenopausal women with T1D and PCOS were younger, used higher daily insulin doses and tend to have a more common premenarcheal diagnosis of T1D as compared to T1D women without PCOS. Disclosure A.Bayona: None. L.Nattero-chávez: None. M.De la calle de la villa: None. E.F.Durán: None. B.Dorado avendaño: None. M.Luque-ramírez: None. H.F.Escobar-morreale: None.

Adolescent Bone Advantages 3Years After Resistance Training Trial.

We assessed maintenance of skeletal advantages 3years after completion of a 2-year, school-based, controlled exercise trial in adolescent girls. Middle-school girls participated in a resistance training program embedded in physical education classes. Effort groups (low-effort group [LO] and high-effort group [HI]) were identified; the control group (CON) participated in standard physical education at a separate school. Baseline and follow-up (FU) assessments at 6, 18, and 54 (FU3) months included densitometry, anthropometry, and questionnaires assessing physical maturity and nonintervention organized physical activity. Linear mixed effects models were fit to evaluate bone outcomes across all FU time points for CON versus LO/HI. Sixty-eight girls (23 CON/25 HI/20 LO) were 11.6 (0.3)years at baseline. Bone parameters did not differ at baseline, except femoral neck bone mineral density (LO < HI/CON, P < .05). Forty-seven participants provided FU3 assessment: 17 CON/16 HI/14 LO. After adjusting for height, gynecologic age, baseline bone, and organized physical activity, bone gains across all time points were greater for HI versus CON for legs bone mineral content, femoral neck bone mineral content/bone mineral density, and third lumbar vertebra bone mineral content/bone mineral density (P ≤ .05). At FU3, bone values were greater for HI versus CON at subhead, legs, femoral neck, and third lumbar vertebra (P < .03). Adolescent girls who exerted high effort in a school-based resistance training program demonstrated significant skeletal benefits 3years after program completion.

Prevalence of polycystic ovary syndrome under NIH criteria among the tenth-grade Chinese schoolgirls in Guangzhou area: a cross-sectional epidemiological survey

BackgroundPolycystic ovary syndrome (PCOS) is currently considered to have a peri-adolescence onset and continuously influence the reproductive and metabolic health of the patients, while the diagnostic criteria among adolescent population haven’t been universally unified till now. This survey seeks to preliminarily evaluate the prevalence of PCOS in the tenth grade schoolgirls in Guangzhou area under NIH criteria and analyze the clinical features of adolescents with PCOS.MethodsThe cross-sectional epidemiological survey was carried out among the tenth grade schoolgirls in Guangzhou area by the method of cluster sampling. The contents of this survey included the questionnaire, physical exams and serum measurements. Until now, totally 1294 girls underwent this survey and 1095 serum samples were restored. 235 non-hirsute (mFG < 6), postmenarcheally 2-year girls were randomly selected as the control group, among which the cut-off value of biochemical hyperandrogenemia was set accordingly. The prevalence of PCOS among this population was preliminarily evaluated according to the NIH criteria.ResultsAlong with the increase of gynecological age, the menstruations of girls was becoming more regular and the incidence of oligomenorrhea or amenorrhea was declining. Even among those who were less than 2 years after menarche, those whose menstrual cycle were longer than 90 days accounted for lower than 5%. The 95th percentile of mFG score was 6 among the girls who were < 2 years after menarche, and 5 among the girls who were > 2 years after menarche. Among the 235 healthy girls, the 95th percentile values of Testosterone (T), Free androgen index (FAI) and Androstenedione (A2) were 2.28 nmol/mL, 4.37, and 5.20 nmol/mL respectively. Based on the NIH criteria, the prevalence of PCOS in this survey was 3.86%. The prevalence of adolescent PCOS tend to slightly increase with age and gynecological age, but the difference was not statistically significant. The prevalence of PCOS among obese girls was markedly higher than that in lean girls.ConclusionBased on the NIH criteria, the prevalence of PCOS among the tenth grade schoolgirls in Guangzhou area was 3.86%. The diagnosis of hyperandrogenism among adolescents should also be based on both clinical and biochemical parameters.

Analysis of Infectious Characteristics of Recurrent Vulvovaginal Candidiasis in Chengdu from 2018 to 2022.

The aim was to discover the infectivity characteristics of recurrent vulvovaginal candidiasis (RVVC) in Chengdu, Sichuan Province, and provide a reference for RVVC clinical diagnosis and treatment. The clinical data of 500 patients with RVVC were retrospectively analyzed, including life history, clinical symptoms, combined gynecological diseases, age, and distribution of pathogenic fungi, and the in vitro drug sensitivity of isolated fungi to antifungal drugs was assessed. Among the 500 patients with RVVC, 486 (97.20%) had a sexual history, and the main clinical symptoms were vulva pruritus (394, 78.80%) and abnormal discharge (232, 46.40%). Common gynecological diseases were cervicitis (156 patients, 31.20%), human papillomavirus infection (130 patients, 26.00%), and coinfection with oth-er pathogens (127 patients, 25.40%). The high-incidence population was mainly concentrated in the 31 to 40-year-old age group, followed by the 20 to 30- and 41 to 50-year-old age groups. The number of patients gradually increased with time. Fungal culture was dominated by Candida albicans (69.80%), followed by Candida glabrata (28.40%), and Candida cerevisiae (0.60%). In vitro susceptibility testing showed that the highest drug resistance rate to antifungal drugs was to terbinafine (96.40%), followed by voriconazole (32.00%), fluconazole (26.40%), and itraconazole (17.40%), whereas the drug resistance rates to 5-fluorocytosine, caspofungin, amphotericin B, and micafungin were relatively low (1.80%, 0.60%, 0.40%, and 0.00%, respectively); the drug resistance rate to azoles gradually increased with age. The occurrence of RVVC is closely related to sexual history. The most common cases are in women of childbearing age aged 20 - 50. The main pathogen is C. albicans, and the resistance rate to common azole antifungal drugs is increasing over time.

Comparing the Effect of Ondansetron-dexamethasone and Metoclopramide-dexamethasone on Postoperative Nausea and Vomiting after Gynecological Laparoscopy: A Randomized Double-blind Clinical Trial.

Background:Nausea and vomiting is a common complication after gynecological surgeries, especially laparoscopy, which can lead to discomfort and restlessness in the patients. The aim of the study was to compare the effect of ondansetron–dexamethasone and metoclopramide–dexamethasone on postoperative nausea and vomiting following gynecological laparoscopy.Materials and Methods:In this double-blind clinical trial, 68 females scheduled for gynecological laparoscopy and age range of 18–40 years were randomly divided into two groups. Group OD received ondansetron 4 mg plus dexamethasone 8 mg and group MD received metoclopramide 10 mg plus dexamethasone 8 mg, 15 min before the end of surgery. The incidence of nausea and vomiting and need for rescue medication was assessed during the recovery period, as well as at 2, 4, 6, 12, and 24 h after surgery. The data were analyzed using STATA software version 12 and a significance level of <0.05 was considered in this research.Results:The incidence of nausea in ondansetron and metoclopramide groups was 23.3% and 33.3%, respectively, and the frequency of vomiting was 10% and 16.6%, respectively, which showed no significant difference (P > 0.05). The highest incidence of nausea and vomiting in patients belonged to the metoclopramide group inside 4–6 h after surgery.Conclusion:Our study showed that no significant difference was observed in the incidence of nausea and vomiting between ondansetron–dexamethasone and metoclopramide–dexamethasone groups following laparoscopic gynecological surgery; however, the number of patients with nausea and vomiting was lower in the ondansetron–dexamethasone group.

Clinical and statistical retrospective analysis of the anamnesis of patients with peritoneal pelvic adhesions

The objective: to identify risk factors for the formation of peritoneal adhesions in women of reproductive age. Materials and methods. A retrospective analysis of histories of 187 women who were operated by laparoscopic access and diagnosis of peritoneal adhesions was carried out as the main or concomitant. Data on somatic, reproductive and gynecological history, age and social status were assessed. The comparison group consisted of 65 women in which peritoneal adhesions were not detected during surgery. Results. Analysis of the somatic history of women with and without adhesions in the abdominal cavity showed that women with adhesions had 3.2 (14.97% compared with 4.62%; p &lt;0.05) times more often one or another type of allergy, and 3.5 times more often (10.70% and 3.07% respectively) had autoimmune diseases. Surgical interventions in the past were recorded in both groups, although their number was almost 6 times greater in patients with peritoneal adhesions (53.48% compared to 9.23%; p&lt;0.05). In women with adhesions in the abdominal cavity, the percentage of operations on the pelvic organs was 2.5 times higher (85.00% compared to 33.33%; p&lt;0.05), and only in this category of patients abdominal drainage was performed during surgery (22.4%; p&lt;0.05). The study of gynecological morbidity in the examined women showed that patients with abdominal adhesions had 3.6 times more often inflammatory diseases of the pelvic organs (61.50% compared to 16.92%; p&lt;0.05), and every third had more than one episode of this pathology in history (33.68%; p&lt;0.05). In addition, every fifth woman with adhesions in the abdominal cavity had endometriosis (17.11% compared with 3.08%; p&lt;0.05). A significant proportion of patients in the main group had 2 or more abortions in the past. Conclusions. According to the study results, risk factors for the formation of peritoneal adhesions in women of reproductive age include allergic diseases; surgery on the abdominal organs, especially repeated and performed on pelvic organs; drainage of the abdominal cavity after surgery; inflammatory diseases of the pelvic organs and their recurrences; repeated surgical abortions.