Gynecological Age Research Articles

Disrupted physical pain sensation by social exclusion in women with dysmenorrhea

PurposeDysmenorrhea (DM), which involves both acute and chronic pain, is associated with abnormalities in pain modulation. Previous studies have shown that social pain relies on some of the same neural regions that process physical pain, highlighting a possible physical–social pain overlap. However, evidence suggesting that social pain modulates the sensitivity to physical pain remains controversial. The present study aimed to assess the effects of social pain manipulation on sensitivity to physical pain in DM sufferers and healthy female controls (HC).Materials and methodsFifty-nine otherwise healthy patients with DM and 55 HC matched for age, education, calendar age, and gynecological age were randomly assigned to inclusion or exclusion conditions of Cyberball, a virtual ball tossing game used to induce social pain (social exclusion). Pain threshold and pain tolerance in response to nociceptive pressure and cold stimuli were assessed before and after the study condition.ResultsIn response to cold stimulation, pain threshold and tolerance significantly reduced in DM compared to HC participants in the inclusion condition, indicating increased pain sensitivity in DM group. However, exclusion increased the pain threshold and tolerance compared to inclusion in DM but decreased pain threshold and tolerance in HC. Neither inclusion nor exclusion altered pressure pain sensitivity in DM, but, after social exclusion, DM participants were more fearful of being evaluated unfavorably. No significant differences were observed in self-esteem scores between DM and HC after both inclusion and exclusion.ConclusionWe observed altered pain sensation in DM participants in response to social pain manipulation, suggesting that DM not only impacts menstruation but also modulates the perception of pain more generally, especially its affective processes. The present study suggests that the effect of social pain on pain sensation and certain psychometric properties depends on previous pain experience, implicating a reciprocal influence of social and physical pain processes.

Results of Cervical Cancer Screening in the Rural Population of Lucknow West, India, through a Camp Approach

Objective: Cytological screening was carried out in rural women of Lucknow West, India, through a camp approach to detect cervical cancer in its preinvasive phase and to see whether the primitive living conditions in the villages have any effect on the incidence of precancer and carcinoma of the cervix and the associated predisposing factors of cervical carcinogenesis. Study Design: During a span of 4 years (May 2013 to March 2017), a total of 135 camps were organized under the auspice of Era’s Lucknow Medical College and Hospital (Lucknow, India). Only 4,269 (31.2%) out of 13,500 women who were motivated and counseled attended the camp and 2,369 (55.1%) of them underwent a Pap smear examination. Results: The incidence of squamous intraepithelial lesions of the cervix (SIL) was found to be very high (18.2%) in the 2,369 women who were screened, but the majority of them were of a low grade. The SIL incidence was very high for all predisposing factors like gynaecological symptoms, age, and clinical lesions of the cervix. However, the SIL rate showed a rise with increasing parity. Candida albicans was more common in rural women (4.7%) than Trichomonas vaginalis (1.1%), and a low incidence of viral sexually transmitted diseases (STD) was seen. Conclusions: Organizing camps in the villages through proper counseling and motivation may help in the screening of larger numbers of women for early detection of cervical cancer, the adequate treatment of which will check the progression of the disease and thus minimize the incidence of carcinoma of the cervix and its associated mortality in the rural population of India.

Extending the safety evidence for opportunistic salpingectomy in prevention of ovarian cancer: a cohort study from British Columbia, Canada

Recent evidence has suggested that the fallopian tube may often be the site of origin for the most common and lethal form of ovarian cancer. As a result, many Colleges of Obstetrics and Gynecology, including the American College of Obstetricians and Gynecology, are recommending surgical removal of the fallopian tube (bilateral salpingectomy) at the time of other gynecologic surgeries (particularly hysterectomy and tubal sterilization) in women at general population risk for ovarian cancer, collectively referred to as opportunistic salpingectomy. Previous research with the use of hospital data has indicated good perioperative safety of opportunistic salpingectomy, but no data on minor complications have been presented. Herein, we examine whether women who undergo opportunistic salpingectomy are at increased risk of minor complications after surgery. We identified all women in British Columbia who underwent opportunistic salpingectomy between 2008 and 2014 and examined all physician visits in the 2 weeks after discharge from the hospital. We compared women who underwent opportunistic salpingectomy at hysterectomy with women who underwent hysterectomy alone and women who underwent opportunistic salpingectomy for sterilization with women who underwent tubal ligation. We examined visits for surgical infection, surgical complication, orders for laboratory tests, and orders for imaging (x-ray, ultrasound scan, or computed tomography scan) and whether women who underwent opportunistic salpingectomy were more likely to fill a prescription for an antibiotic or analgesic in the 2 weeks after discharge from the hospital. We calculated adjusted odds ratios for these outcomes, adjusting for other gynecologic conditions, surgical approach, and patient age. We included 49,275 women who had undergone a hysterectomy alone, a hysterectomy with opportunistic salpingectomy, a hysterectomy with bilateral salpingo-oophorectomy, a tubal ligation, or an opportunistic salpingectomy for sterilization. In women who had undergone opportunistic salpingectomy, there was no increased risk for physician visits for surgical infection, surgical complication, ordering a laboratory test, or ordering imaging in the 2 weeks after discharge. There was no increased risk of filling a prescription for an antibiotic. However, women who underwent opportunistic salpingectomy were at approximately 20% increased odds of filling a prescription for an analgesic in the 2 weeks after discharge from the hospital (adjusted odds ratio, 1.23; 95% confidence interval, 1.15-1.32 for hysterectomy with opportunistic salpingectomy; adjusted odds ratio, 1.21; 95% confidence interval, 1.14-1.29 for opportunistic salpingectomy for sterilization). We report no differences in minor complications between women who undergo opportunistic salpingectomy and women who undergo hysterectomy alone or tubal ligation, except for a slightly increased likelihood of filling a prescription for analgesic medication in the immediate 2 weeks after discharge.

Post-menarcheal Trabecular Bone Score as a Function of Organized Physical Activity

PURPOSE: Trabecular bone score (TBS) grades lumbar spine trabecular texture based on DXA scan gray level variation. In adults, TBS correlates with trabecular density indices and predicts fracture risk, independent of areal bone mineral density (BMD). However, few pediatric studies have evaluated TBS, with none demonstrating significant exercise loading associations. Bone accrual accelerates circum-menarche; thus, we hypothesized that circum-menarcheal organized physical activity (OPA, h/wk) would correlate with post-menarcheal TBS, suggesting potential for improvement of baseline adult trabecular texture via circum-menarcheal exercise. METHODS: Annual DXA scans and semi-annual OPA records were collected via a prospective, longitudinal study of exercise and bone accrual. Analysis inclusion criteria were: 1) a postero-anterior lumbar spine DXA scan (Hologic, Waltham MA) from 0-1 year post-menarche; 2) prior year OPA records. Raw TBS data were generated using proprietary TBS iN-sight software (v2.2, Medimaps, France), adjusted for pediatric-specific soft-tissue effects. Multiple regression evaluated linear and quadratic associations between prior year OPA and TBS, accounting for gynecological age; β and significance are reported for each predictor. To reduce variance inflation, the quadratic function was mean-centered. RESULTS: Data were included for 111 girls, with means as follows: age 13.4 yrs (10.0 to 15.6, sd 1.1), age at menarche 12.9 yrs (sd 1.1), gynecological age 0.5 yrs (sd 0.3), OPA 8.0 h/wk (sd 5.8) and TBS 1.38 (1.15 to 1.58, sd 0.08). In a regression model entering OPA, OPA2 and gynecological age, a significant non-linear association was observed with OPA (respective β= 0.003, -0.001, 0.043, p=0.08, 0.003, 0.12). CONCLUSIONS: Our data suggest a target circum-menarcheal OPA range of 5 to 15 h/wk. Further research is needed to confirm that TBS is modifiable via pediatric exercise to optimize baseline adult trabecular texture.

A Comparison of the Relationship between Gynecological Age with Birth Weight and Chronological Age with Birth Weight in Teenage Mothers in Kota Bekasi West Java

Background: Teenage pregnancy is high-risk pregnancies are associated with a high incidence of premature birth, low birth weight (LBW), and other adverse pregnancy outcomes. Aim: We examined the relationship between gynecological age and birth weight and chronological age with birth weight in teenage mothers in eight, Puskesmas Kota Bekasi. We determined differences in the strength of the relationship between gynecological age and chronological age with birth weight in teenage mothers in Bekasi. Research methods: This is a cross-sectional study to investigate the correlation between gynecological age and chronological age as an independent variable, with birth weight as the dependent variable. Result. Mothers with gynecological age <4 years than their chronological age had a 4 fold risk of having a baby weighing <3000 grams, which is the birth weight-related to non-communicable diseases in adulthood, and mothers with chronological age < 16 years had a 2 times higher risk of giving birth to babies weighing <3000 grams. Pre-pregnancy stature, pre-pregnant BMI, the increase in weight during pregnancy and anemia were found to be confounding factors in the relationship between gynecological age and chronological age with birth weight of babies. Conclusion: Gynecological age and chronological age are associated with infant birth weight in teenage mothers in Bekasi 2015. Gynecological age is more strongly correlated with birth weight compared with chronological age. Suggestion: It is advisable to delay the first pregnancy for women in Indonesia to at least 18 years of age. Another study is done by looking at the risk of gynecological age and chronological age with low birth weight and stunted growth.

Prevalence of dysmenorrhea among University students in Northern Ghana; its impact and management strategies

BackgroundThe period of menstruation is an eventful one for a significant number of post-pubescent females as they experience lower abdominal pains referred to as dysmenorrhea. This study conducted among female students of the Tamale campus of the University for Development Studies assessed the prevalence of dysmenorrhea, its impact on the students and treatment methods applied.MethodsA cross-sectional study using a self-administered questionnaire was used to obtain data from 293 randomly selected female students. Data was analyzed using Graph Pad 5.01. Association between different variables was tested.ResultsThe prevalence rate of dysmenorrhea was 83.6% with more than half describing their pain which lasts less than 3 days as moderate. This dysmenorrhea during menstruation affects the daily activities of up to 61.2% of respondents. Lower chronological age (χ2 = 8.28; df = 2; p = 0.016) and gynecological age (χ2 = 10.09; df = 2; p = 0.006) were the factors that were significantly associated with the presence of dysmenorrhea. Chronological and gynecological ages, age at menarche, menstrual duration or flow level do not influence the severity of dysmenorrhea but irregular menstrual flow is significantly associated with severe dysmenorrhea (χ2 = 10.54; df = 2; p = 0.005). Only 16.3% ever reported their dysmenorrhea to the hospital but increasing pain level is significantly associated with respondents visiting a hospital (χ2 = 65.61; df = 2; p < 0.0001) or use an allopathic medication (χ2 = 32.77; df = 2; p < 0.0001). Paracetamol preparation was the most common medication used notwithstanding the severity of the pain.ConclusionsThere is high prevalence of dysmenorrhea among the female students of the Tamale campus of the University for Development studies which negatively affects the daily activity of majority of them. Although, bed rest was the most common treatment method practised, paracetamol preparation was the most common allopathic drug used in self- management of their dysmenorrhea.

Prevalence and patterns of dysmenorrhea and premenstrual syndrome among Egyptian girls (12–25 years)

Abstract Objectives Most girls experience pain and other discomforting symptoms during their menstrual periods. The aim of this study is to investigate the prevalence, and patterns of dysmenorrhea and premenstrual syndrome (PMS) amongst girls in Beni-Suef, Egypt. Study design Population-based, cross sectional study. Methods This study was conducted on 4122 girls (12–25 years) representing Beni-Suef City. A structured questionnaire was used and a team of data collectors interviewed the girls. Results High rates of dysmenorrhea (92%) and PMS (86.3%) among girls. A solid association between dysmenorrhea and PMS was detected. While gynaecological age was the only risk factor for dysmenorrhea, gynaecological age, marriage, educational level and sleeping hours were determinants for PMS (p Conclusion and recommendations Dysmenorrhea and PMS are highly prevalent among girls in Beni-Suef. Many risk factors have been suggested to be linked with dysmenorrhea and PMS. Health awareness programs should be encouraged to improve girls' knowledge regarding menstrual disorders. Further research should focus on the adaptive techniques used by girls to avoid the negative consequences of menstrual disorders.

Effects of oral contraceptives to bone mineral density of young women

The influence of consumption of contraceptives to female body’s hormones could affect bone formation. The purpose of this study was to assess any possible change in bone density of young women who were taking oral contraceptives, compared with those who were not. Women who participated in this study were 18-25 years old and were divided into two groups, experimental and control. Contraceptive tablets containing 20 μgrs ethinyl estradiol and 3 mgr drosperinonis were given to women of the experimental group for 21 days. Data necessary for every woman was recorded (weight, height, gynecological age, chronological age). Bone density was measured at the lumbar spine [O2-O4] and femoral neck with the DEXA method [DMS Challenger]. Measurements were taken at the beginning of the study and after the period of 12 and 24 months. Our study concluded that oral contraceptive use did not cause any significant change to bone density group of young women.

A focused evaluation of lumbar spine trabecular bone score in the first year post-menarche.

Trabecular bone score (TBS) evaluates lumbar spine (LS) trabecular texture from DXA images. Limited evidence suggests low TBS in pre-pubertal girls. TBS has not been assessed in the context of the key peri-menarcheal bone accrual phase. Thus, we evaluated (1) whether "normal" adult TBS (≥1.35) is reached in the first year post-menarche and (2) the role of maturational timing (menarcheal age) and status (gynecological age) in TBS variation. For 44 healthy girls aged 11 to 13years, whole body and LS DXA scans were obtained within 1year post-menarche. As TBS is optimized for adults and can be affected by body thickness, custom software provided unadjusted "rawTBS" and adjusted for tissue thickness "corrTBS" (TBS iNsight, Medimaps, France). Correlations evaluated menarcheal age and gynecological age as factors in LS bone mineral content (BMC), areal bone mineral density (BMD), and TBS. Lowest observed TBS exceeded 1.35 (rawTBS=1.362; corrTBS=1.352). Menarcheal age correlated negatively with rawTBS (r=-0.34, p=0.02), with a similar trend for corrTBS (r=-0.29, p<0.06). Gynecological age did not correlate with TBS but was positively correlated with LSBMD (r=+0.37, p=0.01). Correlations with body composition variables differed between rawTBS and corrTBS. In this healthy cohort, "normal" adult TBS is present by 1year post-menarche, 2years before projected LS peak bone mass. Thus, TBS may be a useful bone architectural screen during the first post-menarcheal year, enabling intervention to improve structure prior to "peak bone mass". Longitudinal studies are needed to elucidate TBS development and intervention response.

Fall risk and function in older women after gynecologic surgery

Purpose of studyTo examine change in balance-related fall risk and daily functional abilities in the first 2 post-operative weeks and up to 6 weeks after gynecologic surgery. Materials and methodsProspective cohort study in gynecologic surgery patients age 65 and older. Balance confidence (Activities-specific Balance Confidence Scale) and functional status (basic and instrumental activities of daily living) were recorded pre- and post-operatively daily for 1 week and twice the second week. Physical performance balance and functional mobility were measured pre- and 1 week post-operatively using the Tinetti Fall Risk Scale, Timed Up and Go, and 6-Minute Walk test. Measures were repeated 6 weeks after surgery. Non-parametric tests for paired data were used comparing scores baseline to post-operative (POD) 7 and to POD 42. ResultsMedian age was 72 years (range 65–88). Fall risk was elevated during the first 2 post-operative weeks, greatest on the median discharge day, POD 2 (p<0.01). Balance performance and functional mobility at 1 week were significantly lower than baseline (p<0.01). Functional abilities declined, including new dependence in medication management at home in 22% of these independent and cognitively intact women. ConclusionsAfter gynecologic surgery, older women’s fall risk is highest on POD 2 and remains elevated from baseline for 2 weeks. Functional limitations in the early home recovery period include the anticipated (bathing, cooking, etc.) and some unanticipated (medication management) ones. This information may help with post-operative discharge planning.

Risk of malignancy on suspicion of polyps in menopausal women

Improved performances in gynaecological ultrasonography have enabled an increasing number of often asymptomatic endometrial polyps to be detected. Most of these polyps are removed surgically, as a precautionary measure, so as not to miss a case of endometrial cancer. Nonetheless, this management strategy is based solely on the sonographer’s judgement and a number of these operations, which are probably of no benefit, could be avoided. In order to do so, risk factors for malignancy need to be identified. ObjectiveEstimate the prevalence of lesions in menopausal patients with a pre-operative diagnosis of endometrial polyp. Establish risk factors for malignancy. Study designThis is a single-centre retrospective study. Enrolment criteria were menopausal patients aged over 45 who had undergone hysteroscopic resection of a polyp. Pre-op diagnosis was made either by ultrasonography or diagnostic hysteroscopy. Malignant lesions included cancers and atypical hyperplasia. Benign lesions consisted of simple polyps, non-atypical simple hyperplasia and non-atypical complex hyperplasia. Risk factors studied were existing abnormal uterine bleeding, endometrial thickness, personal or first-degree family history of gynaecological cancer (breast, cervix, endometrium, ovary) and age on diagnosis. Results631 patients were enrolled of whom 30 presented a malignant disorder (4.75%); 579 patients (91.76%) presented a simple polyp, 11 a non-atypical simple hyperplasia (1.74%) and 11 a non-atypical complex hyperplasia (1.74%).On univariate analysis age alone proved to be statistically significant (OR 1.05; 95%CI=[1.02–1.09] p<0.01), with a threshold of 59 years of age on the ROC curve. On multivariate analysis, factors predictive of a malignant lesion were age (OR=1.06; 95%CI [1.02–1.10]), existence of AUB (OR=2.4; 95% CI [1.07–5.42]) and family history (OR=2.88; 95%CI [1.08–7.67]). Neither the univariate nor multivariate model was able to demonstrate a statistically significant relationship with respect to endometrial thickness.The risk of malignancy was 12.3% in patients aged over 59 presenting AUB. For all other subgroups, the risk varied between 2.31 and 3.78%. ConclusionThe risk of a malignant lesion appears to be high (12%) in menopausal patients aged over 59 presenting an endometrial polyp detected when there is pre-existing AUB. In this situation, hysteroscopic resection of endometrial polyps should therefore be routinely proposed.For other patients, the risk of a malignant lesion is low but not insignificant, standing at about 3%. Each patient record should therefore be discussed on an individual case basis, taking into consideration the patient’s pre-existing conditions, after providing clear and appropriate information.

Association of Concussion With Abnormal Menstrual Patterns in Adolescent and Young Women

Brain injury may interrupt menstrual patterns by altering hypothalamic-pituitary-ovarian axis function. Investigators have yet to evaluate the association of concussion with menstrual patterns in young women. To compare abnormal menstrual patterns in adolescent and young women after a sport-related concussion with those after sport-related orthopedic injuries to areas other than the head (nonhead). This prospective cohort study of adolescent and young women with a sport-related concussion (n = 68) or a nonhead sport-related orthopedic injury (n = 61) followed up participants for 120 days after injury. Patients aged 12 to 21 years who presented within 30 days after a sport-related injury to a concussion or sports medicine clinic at a single academic center were eligible. Menstrual patterns were assessed using a weekly text message link to an online survey inquiring about bleeding episodes each week. The first patient was enrolled on October 14, 2014, and follow-up was completed on January 24, 2016. Inclusion criteria required participants to be at least 2 years postmenarche, to report regular menses in the previous year, and to report no use of hormonal contraception. Sport-related concussion or nonhead sport-related orthopedic injury. Abnormal menstrual patterns were defined by an intermenstrual interval of less than 21 days (short) or more than 35 days (long) or a bleeding duration of less than 3 days or more than 7 days. A total of 1784 survey responses were completed of the 1888 text messages received by patients, yielding 487 menstrual patterns in 128 patients (mean [SD] age, 16.2 [2.0] years). Of the 68 patients who had a concussion, 16 (23.5%) experienced 2 or more abnormal menstrual patterns during the study period compared with 3 of 60 patients (5%) who had an orthopedic injury. Despite similar gynecologic age, body mass index, and type of sports participation between groups, the risk of 2 or more abnormal menstrual bleeding patterns after injury was significantly higher among patients with concussion than among those with an orthopedic injury (odds ratio, 5.85; 95% CI, 1.61-21.22). Adolescent and young women may have increased risk of multiple abnormal menstrual patterns after concussion. Because abnormal menstrual patterns can have important health implications, monitoring menstrual patterns after concussion may be warranted in this population. Additional research is needed to elucidate the relationship between long-term consequences of concussion and the function of the hypothalamic-pituitary-ovarian axis.

Bone mineral density in vocational and professional ballet dancers.

The aims of this study were to (a) assess bone mineral density (BMD) in vocational (VBD) and professional (PBD) ballet dancers and (b) investigate its association with body mass (BM), fat mass (FM), lean mass (LM), maturation and menarche. The total of 152 VBD (13±2.3years; 112 girls, 40 boys) and 96 controls (14±2.1years; 56 girls, 40 boys) and 184 PBD (28±8.5years; 129 females, 55 males) and 160 controls (27±9.5years; 110 female, 50 males) were assessed at the lumbar spine (LS), femoral neck (FN), forearm and total body by dual-energy X-ray absorptiometry. Maturation and menarche were assessed via questionnaires. VBD revealed lower unadjusted BMD at all anatomical sites compared to controls (p<0.001); following adjustments for Tanner stage and gynaecological age, female VBD showed similar BMD values at impact sites. However, no factors were found to explain the lower adjusted BMD values in VBD (female and male) at the forearm (non-impact site), nor for the lower adjusted BMD values in male VBD at the FN. Compared to controls, female PBD showed higher unadjusted and adjusted BMD for potential associated factors at the FN (impact site) (p<0.001) and lower adjusted at the forearm (p<0.001). Male PBD did not reveal lower BMD than controls at any site. Both females and males VBD have lower BMD at impact and non-impact sites compared to control, whereas this is only the case at non-impact site in female PBD. Maturation seems to explain the lower BMD at impact sites in female VBD.

High Prevalence of Polycystic Ovary Syndrome in Type 1 Diabetes Mellitus Adolescents: Is There a Difference Depending on the NIH and Rotterdam Criteria?

Background: Polycystic ovary syndrome (PCOS) is more frequently observed in type 1 diabetes mellitus (T1DM) adult women than in nondiabetic women. No such prevalence has yet been studied in adolescent girls with T1DM. Aim: The aim of this study was to evaluate the prevalence of PCOS in adolescent girls with T1DM and to determine the clinical and hormonal features associated with the disorder. Methods: A cross-sectional study of 53 adolescent girls (gynecological age >2 years) referred for routine evaluation for T1DM was conducted. We diagnosed PCOS using the National Institutes of Health (NIH) and Rotterdam criteria. Results: 26.4 and 47.9% of adolescents had PCOS according to NIH (NIH-PCOS) and Rotterdam (Rotterdam-PCOS) criteria. 66.7% of NIH-PCOS adolescents had a complete phenotype associated with hyperandrogenism, oligomenorrhea, and polycystic ovarian morphology, unlike only 33.3% of the Rotterdam-PCOS adolescents. A family history of type 2 diabetes mellitus (T2DM) was more frequent in PCOS than in non-PCOS girls, whichever criteria were used. Late pubertal development and a T1DM diagnosis close to puberty were factors associated with NIH-PCOS. Conclusion: Adolescents with T1DM had a high prevalence of PCOS. More differences between PCOS and non-PCOS patients were found using the NIH criteria, suggesting that clinical characteristics might be more accurate for diagnosing PCOS in girls with T1DM. A family history of T2DM is associated with a high risk of PCOS.

The Science of Healthy Menstruation in Exercising Women

An understanding of the health consequences of abnormal menstrual function is an important consideration for all exercising women. Menstrual disturbances in exercising women are quite common and range in severity from mild to severe and are often associated with bone loss, low energy availability, stress fractures, eating disorders, and poor performance. The key factor that causes menstrual disturbances is low energy availability created by an imbalance of energy intake and energy expenditure that leads to an energy deficit and compensatory metabolic adaptations to maintain energy balance. Practical guidelines for preventing and treating amenorrhea in exercising women include evidence-based dietary practices designed to achieve optimal energy availability. Other factors such as gynecological age, genetics, and one’s susceptibility to psychological stress can modify an individual’s susceptibility to menstrual disturbances caused by low energy availability. Future research should explore the magnitude of these effects in an effort to move toward more individualized prevention and treatment approaches.

Sociodemographic, sexual, reproductive and relationship characteristics of adolescents having an abortion in Portugal: a homogeneous or a heterogeneous group?

Objectives: The aims of the study were to describe the sociodemographic, sexual, reproductive and relational characteristics of adolescents having an abortion in Portugal and to explore the differences between three adolescent age groups.Methods: We recruited a nationally representative sample of 224 adolescents (<16 years, n = 18; 16–17 years, n = 103; 18–19 years, n = 103) who had an abortion. Data were collected from 16 health care services that provide abortion.Results: The adolescents were predominantly single, were from non-nuclear families, had low-socioeconomic status and were students. Mean age at first sexual intercourse was 15 years and mean gynaecological age was 5 years. Most had had multiple sexual partners, and for most it was their first pregnancy. At conception, the majority were involved in a long-term romantic relationship, were using contraception but did not identify the contraceptive failure that led to the pregnancy. Significant age group differences were found. Compared with the younger age groups, the 18–19 year age group was more frequently married or living with a partner, had finished school, had attained a higher educational level (as had their partner), intended to go to university, and had a greater number of sexual partners. Compared with the other groups, those under 16 years of age reported earlier age at menarche and at first sexual intercourse, and had a lower gynaecological age.Conclusions: Our study characterises the life contexts of Portuguese adolescents who had an abortion. It highlights the need to recognise the heterogeneity of this group according to age. The findings have important implications for the development of age-appropriate guidelines to prevent unplanned pregnancy.

Sexual activity and functioning in women treated for gynaecological cancers

A description and comparison of sexual activity and function in relation to various gynaecological cancer diagnoses, treatment modalities, age groups, psychological distress and health-related quality of life. Various forms of gynaecological cancer have the potential to negatively influence sexual functioning, but there are few studies that describe and compare sexual activity and functioning according to diagnosis. A descriptive cross-sectional study. The study includes 129 women from an intervention study. The questionnaires addressed sexuality, psychological distress, health-related quality of life and demographics. Disease and treatment characteristics were extracted from medical records. Close to two-thirds of the women were sexually active. However, 54% of the sexually active women reported that they were not satisfied or little satisfied with their sexual activity. About half of the women reported dryness in the vagina, and 41% reported pain and discomfort during penetration. There were no significant differences concerning pleasure and discomfort related to treatment modality, diagnoses or FIGO stage. Health personnel should make a priority of sexuality throughout a patient's cancer treatment and in the follow-up, as sexuality is a vital part of a good life. Since the patients experience relatively low satisfaction with their sexual activity and many report pain during penetration, health personnel need to be sensitive to the woman, her questions, and her needs. Of importance are also the personnel's ability to communicate and their expertise in diagnosing and treating difficulties relating to sexuality.

Unique Effects of Energy versus Estrogen Deficiency on Components of Bone Strength in Exercising Women

Exercising women with menstrual disturbances are at risk for poor bone health due to hypoestrogenism. Energy deficiency often instigates menstrual dysfunction resulting in metabolic adaptations that independently threaten bone. Women experiencing both an energy and estrogen deficiency face an exacerbated risk to bone health. PURPOSE: To describe volumetric bone mineral density (vBMD), bone geometry, and estimated bone strength in exercising women (n=50) grouped by energy status (energy replete (EnR: n=25); energy deficient (EnD: n=25)) and estrogen status (estrogen replete (E2R: n=24); estrogen deficient (E2D: n=26)) resulting in four groups: EnR+E2R (n=12), EnR+E2D (n=13), EnD+E2R (n=12), EnD+E2D (n=13). METHODS: Energy status was defined by the ratio of measured to predicted resting energy expenditure (mREE/pREE). Estrogen status was defined by self-reported menstrual status and confirmed by assessment of urinary metabolites of reproductive hormones over one menstrual cycle or 28 day monitoring period. Peripheral quantitative computed tomography assessed vBMD, bone geometry, and estimated bone strength at the radius and tibia. RESULTS: The groups were similar in age (21 ± 0.4 years), gynecological age (8 ± 0.5 years), height (165.7 ± 0.9 cm), and weight (57.7 ± 1.2 kg). At the proximal tibia, EnD women exhibited significantly lower total vBMD, cortical area, and cortical thickness and greater endosteal circumference than EnR women (p≤0.020). E2D women exhibited significantly lower total and cortical vBMD and bone strength index (BSI) and greater total and trabecular area (p≤0.040) at the distal radius and lower cortical vBMD and thickness (p≤0.019) at the proximal radius compared to E2R women. EnD+E2D women had significantly lower total and trabecular vBMD at the distal tibia and radius and total vBMD and cortical thickness at the proximal tibia compared to EnR+E2D women (p≤0.048). CONCLUSION: Energy versus estrogen status affected bone differently and effects were site-specific. Women with both an energy and estrogen deficiency experienced the most adverse bone adaptations. Treating energy deficiency in exercising women may improve reproductive health, in turn addressing the unique contributions of energy status versus estrogen status to bone health. Supported by US DoD (PR054531).

Morningness-Eveningness and Physical Activity in Adolescent Girls: Menarche as a Transition Point.

This study identified trajectories of morningness-eveningness (M-E) and physical activity when chronological (i.e., time since birth) versus gynecological (i.e., time since menarche) age is used to indicate maturation. Piecewise models were fit for girls (N=262, ages 11-19) using chronological or gynecological age as the time metric. Girls stayed up later (i.e., eveningness) as they approach menarche. After menarche no change in M-E was observed. In contrast, no change in M-E was detected with chronological age. No change in physical activity was observed before menarche, and physical activity declined after menarche. With chronological age, physical activity declined as girls got older. Gynecological age may be more appropriate than chronological age as a metric for understanding changes in M-E and physical activity.

Reduced ovarian reserve in patients with adult polymyositis.

Polymyositis (PM) affects female gender during reproductive age; however, there is no study assessing ovarian reserve in these patients to evaluate ovarian reserve markers in PM. Eight female patients with PM (Bohan and Peter criteria, 1975) with aged 18-40years, followed at our tertiary centre from March 2011 to May 2014, were invited to participate. They were age-matched with 16 healthy individuals (control group). All were evaluated at early follicular phase of menstrual cycle. Follicle stimulating hormone (FSH), estradiol, inhibin B, anti-Müllerian hormone (AMH) serum levels (ELISA) and sonographic antral follicle count (AFC) were determined. PM patients and controls had comparable mean age (31.4 ± 6.5 vs. 30.7 ± 6.2years, P = 0.946), ethnicity and socioeconomic class (P > 0.05). PM mean age of onset was 27.3 ± 6.5years and disease duration of 6.5 ± 4.1years. Menstrual cycles were alike in both groups with a similar frequency of age at menarche, gynaecological age, duration and length of menstrual cycle (P > 0.05). The median serum level of AMH was significantly lower in PM compared to controls [0.7(0.3-3.4) vs. 3.1(1.4-4.0), P = 0.021]. AMH levels ≤1ng/mL (50 vs. 6.3%, P = 0.024) and very low AFC (37.5 vs. 6.3%, P = 0.037) were significantly in PM patients versus controls. The other hormones (FSH, inhibin B and estradiol levels) were similar between both groups (P > 0.05). The present study was the first to identify subclinical ovarian dysfunction in PM patients during reproductive ages. Further study is necessary to assess the possible role of PM-related factors that may influence the ovarian function of these patients.