Menstrual Irregularities Research Articles

Associations of adolescent academic performance, sports, disordered eating, and menstrual dysfunction

Abstract Background Regular menstruation is a crucial indicator of comprehensive well-being in adolescents. We aimed to assess risk factors associated with menstrual cycle dysfunction in a population-based cohort of high school students, focusing on academic performance, sports participation, and disordered eating. Methods In 2022, we recruited 1161 female first-year students from 21 diverse high schools in the capital region of Finland. They completed an online survey comprising questions about menstrual cycle, academic achievement, sports involvement, disordered eating and school burnout. Results Of 935 (81%) participants (mean age 16) not using hormonal preparations, 336 (37%) reported irregular menstruation. Adolescents with irregular menstruation showed higher middle school grade point average (GPA) (OR 1.4, 95% CI 1.1-1.8), lower body mass index (OR 2.2, 95% CI 1.3-3.5), and more disordered eating symptoms (OR 2.1, 95% CI 1.4-3.0) than adolescents with regular menstruation. While overall physical activity showed no significant correlation with irregular menstruation, casual exercisers with irregular menstruation exhibited both higher GPAs (OR 1.4, 95% CI 1.4-1.9) and more disordered eating symptoms (OR 2.6, 95% CI 1.6-4.1) than competitive athletes, whereas competitive athletes with irregular menstruation showed higher school burnout scores than casual exercisers but no disordered eating. Conclusions We recommend the use of screening tools to recognize disordered eating and school burnout among female high school students facing menstrual irregularities. Key messages • A third of adolescent females had irregular menstruation. Casual exercisers with irregular menstrual cycle were at risk of eating disorders and competitive athletes at risk of school burnout. • Screening of disordered eating and school burnout among adolescent females facing menstrual irregularities could be beneficial.

A Review of Medicinal Plants in the Therapy of Polycystic Ovary Syndrome (PCOS) in Woman

Context: Polycystic ovary syndrome (PCOS) is a neuroendocrine metabolic disorder, one of the symptoms of which is irregular menstrual cycles. Polycystic ovary syndrome treatment using chemical drugs has been effective, however, PCOS patients have received effective results from herbal treatment Methods: Scopus, PubMed, Google Scholar, Crossref and Hinari databases were searched for the effect of medicinal plants in the treatment of polycystic syndrome. Result: The results showed that medicinal plants and their active substances are effective in the treatment of polycystic syndrome. Conclusions: This study showed that the search and isolation of effective substances in plants can be a good treatment alternative for polycystic syndrome.

The effect of spironolactone versus eplerenone on blood pressure targets in resistant hypertension patients

Abstract Objective to evaluate different effects on blood pressure (BP) control in two treatment options spironolactone (SPIR) versus eplerenone (EPL) as an add-on therapy in resistant hypertensive (RAH) patients. Design and methods: We studied 208 patients with true RAH confirmed by the office and ambulatory BP monitoring (ABPM) despite the use of 3 antihypertensive medications including a calcium channel blocker, a blocker of the renin-angiotensin system, and a thiazide diuretic with maximally tolerated doses for at least 3 months. Patients were randomized into 2 groups throughout 12 weeks of once-daily treatment with SPIR (25–50 mg) or EPL (25-50 mg) in addition to their baseline triple-combination and then rotated with drugs. BP was measured in the office and by ABPM. Changes in laboratory tests were also studied. The predictive values of plasma aldosterone, active renin concentration (ARC), aldosterone-renin ratio (ARR), and serum potassium were analyzed to determine the antihypertensive response. Results There were no significant differences in the reduction of average office BP, average systolic 24-h, daytime, and nighttime BP by SPIR and EPL. SPIR reduced average diastolic 24-h BP by 7.3 mm Hg, diastolic daytime BP by 7.2 mm Hg, and diastolic nighttime BP by 7.5 mm Hg compared with a reduction of 5.6 mm Hg (P = 0.01), 5.6 mm Hg (P = 0.03) and 4.2 mm Hg (P = 0.0001) with EPL, respectively. Overall, 40.7 % RAH patients achieved targets of clinical BP and 24-h ABPM levels on SPIR and 33.3 % on EPL (Р = 0.002). After 12 weeks of treatment mean plasma potassium concentrations increased by 7.1 (P = 0.0001) on SPIR and by 5.0 % (Р = 0.0001) on EPL, but eGFR did not significantly change on the two drugs. Plasma aldosterone (β = 0.498, Р = 0.02) and ARC (β= -0.374, Р = 0.04) were predictors of the BP-lowering effect of SPIR and plasma aldosterone (β = 0.453, Р = 0.04) was a predictor of reduction BP for EPL in multivariate modeling. Breast pain or tenderness, changes in sex drive, and irregular menstrual cycles or spotting were more often by SPIR than by EPL (5.2 % vs 1.9 %, respectively, P = 0.04). Conclusions The greater antihypertensive effect of SPIR is related to aldosterone status, ARS level in resistant hypertension. EPL may be recommended for RAH patients who have high serum potassium levels that cannot tolerate spironolactone and for people with systolic resistant hypertension.

Presence of Atrial Fibrillation (AF) is a poor prognostic marker in patients with Heart Failure with reduced Ejection Fraction (HFrEF) and Left Bundle Branch Block (LBBB)

Abstract Background Observational data indicate that between 20-30% of patients with HFrEF have LBBB. While numerous independent variables are implicated in the overall prognosis of these patients, this group of patients respond poorly to medical therapy. Presence of AF further impairs the functioning of the left ventricle by several mechanisms e.g., left atrial dilatation, decreased left ventricular filling, irregular cycle length, functional mitral regurgitation etc. Literature is sparse on the cumulative effect of AF in this group of patients. Purpose To assess the effect of AF on left ventricular ejection fraction (LVEF) and mortality in patients presenting with HFrEF and LBBB Methods Single centre, retrospective, observational study over 33 months (Jan 2021 – Sept 2023). Patients with HFrEF and LBBB (as defined by the European Society of Cardiology, 2021) identified from the heart failure database. Results (Table) N=80 Whole cohort: age 74.8 +/- 13.6 years (median:79, range 39-96); 57/80 (67.5%) males. Hypertension [41/80 (51.3%)] was most common comorbidity. Majority were on 3 drugs (23/80, 28.8%) of guideline directed medical therapy (GDMT) with ~1 in 4 patients [19/80 (23.8%)] on all 4 drugs. 32/80 (40.0%) were in AF, remainder in sinus rhythm (SR). Mean baseline LVEF: 21.8 +/- 8.4. Mean LVEF continued to be ≤35% (paired echocardiograms available in 50.0% patients) inspite of GDMT. The QRS duration continued to prolong on follow-up. Patients in AF were statistically significantly older, were less often on all 4 GDMT drugs (particularly sodium glucose transporter 2 inhibitors - SGLT2i’s), and were less likely to survive than those in SR. No difference in comorbid conditions or QRS prolongation on follow-up were seen between patients with AF versus SR. There was trend towards a larger increase in mean LVEF in patients with SR than AF. Conclusions In our experience, patients with HFrEF and LBBB continue to have a high mortality (45.0% at ~ 3 years) inspite of GDMT. AF is seen in a high percentage of patients (40.0%) in this cohort, worsening the prognosis further, with mortality nearly 3 times higher than those in SR. Aggressive management of patients with HFrEF and LBBB with, where indicated, early cardiac resynchronisation therapy (CRT) and more so, of those with AF (with +/- atrioventricular node ablation or left atrial ablation) should be considered at an early stage after diagnosis.Table

Specific features of cytokine synthesis in adolescent girls with oligomenorrhea and low body mass index

The article is devoted to the study of the cytokine component of immunity in teenage girls with oligomenorrhea, underweight and with normal body weight in comparison with teenage girls with a normal menstrual cycle and normal body weight, which is of great importance to pediatric gynecology. Studying of the cytokine profile in oligomenorrhea will allow early identification of the development of many gynecological pathologies, including polycystic ovary syndrome, endometrioid neoplasms, as well as for understanding the pathogenesis of these conditions and developing approaches to their diagnosis and treatment, which is of great practical importance. The authors conducted an immunological study of teenage girls with oligomenorrhea with underweight and normal body weight in comparison with teenage girls with a normal menstrual cycle and normal body weight. Purpose of the study: to study the levels of IL-6, IL-17A, IL-18 and IL-10 in adolescent girls with oligomenorrhea and underweight. Teenage girls (N = 52) aged 13 to 17 years with established menstrual irregularities were examined. The control group consisted of 24 practically healthy girls of the same age. From the study, it was established that girls with oligomenorrhea and underweight have a pronounced increased synthesis of proinflammatory cytokines IL-6, IL-17A and IL-18. In the same group of girls, an increase in the level of the anti-inflammatory cytokine IL-10 was detected, which may be an attempt by the body to compensate for inflammatory processes. However, IL-10 levels remain elevated, which may indicate an immune imbalance. The discovered imbalance in the cytokine profile emphasizes the complexity of the pathogenesis of oligomenorrhea in girls with underweight, and the identified levels of the studied cytokines can serve as biomarkers that will help in diagnosis, assessment of severity, and prediction of the course of the disease state.

Dan'e fukang decoction reduces hemorrhage in a rat model of mifepristone induced incomplete abortion and may correlate with cell adhesion molecule signaling interference

Ethnopharmacological relevanceDan'e fukang decoction(DFD) is a traditional Chinese medicine formula. DFD obtains 10 herbs, including Salvia yunnanensis C.H.Wright (Zidanshen) , Curcuma zedoaria (Christm.) Roscoe (Ezhu), Angelica sinensis (Oliv.) Diels (Danggui), Cyperus rotundus L. (Xiangfuzi), Corydalis yanhusuo (Y.H.Chou & Chun C.Hsu) W.T.Wang ex Z.Y.Su & C.Y.Wu, Bupleurum marginatum Wall. ex DC. (Yanhusuo), Sparganium stoloniferum (Buch.-Ham. ex Graebn.) Buch.-Ham. ex Juz. (Sanleng), Panax notoginseng (Burkill) F.H.Chen (Sanqi), Paeonia lactiflora Pall. (Shaoyao) and Glycyrrhiza uralensis Fisch. (Gancao). DFD is now clinically used for the treatment of menstrual irregularities, dysmenorrhea and menstrual discomfort caused by blood stasis and easing of endometriosis. Based on this, it is reasonable to presume that DFD may be effective in treating incomplete abortion and reducing postpartum bleeding, but no specific studies have been reported so far. Aim of the studyTo investigate the efficacy of Dan'e fukang decoction (DFD) in reducing prolonged vaginal bleeding followed by mifepristone induced incomplete abortion and explore the mechanisms of action of DFD in treating incomplete abortion. MethodsAn incomplete abortion model of rat was established by single intragastrically administered 8.5 mg/kg mifepristone on the 7th day of pregnancy. From the 8th day of pregnancy, the abortive rats were administered solvent, a positive control drug, or different doses of DFD, respectively for seven consecutive days. The efficacy of DFD was assessed by measuring the vaginal bleeding volume of the rats. Four coagulation parameters and platelet counts were measured. Hematoxylin and eosin (HE) staining was performed to evaluate pathological changes in the uterine embryos. Serum levels of progesterone and estrogen were measured using ELISA. Network pharmacology and transcriptomics were used to predict potential targets and pathways for DFD to reduce hemorrhage. The levels of mRNA related to cell adhesion molecules (CAMs) were detected by RT-qPCR. The levels of progesterone and estrogen receptors and the proteins associated with CAMs pathway in uterine tissues were detected by Western Blot. ResultsDFD significantly reduced the volume of vaginal bleeding of the abortive rats and significantly downgraded the pathological scores of uterine embryos. DFD significantly increased serum levels of E2, and had no impact on serum levels of P4 and the protein expression of ER and PR in the uteri of the abortive rats. Pathways in cancer, lipid, focal adhesion and immune-related signaling were predicted to be influenced by DFD via the analysis of network pharmacology. The CAMs signaling was found the most critical pathway regulated by both mifepristone and DFD via RNA-seq assay, followed by axon guidance, basal cell carcinoma, hippo signaling pathway and neuroactive ligand-receptor interaction. Combining the two analytical methods, ICAM-1 was predicted likely the key targeted gene by DFD. Finally, DFD was validated to decrease the protein expression of ICAM-1, ITGB2, ITGB7 and RASSF5 in the uterine tissues, which correlated to suppress the CAMs signaling pathway. ConclusionDFD significantly reduced hemorrhage. DFD significantly increased the serum levels of E2 and inhibited CAMs signaling pathway, which was likely to be involved in the mechanism of action of DFD facilitating residual uterine embryo expulsion in the rat model of incomplete abortion.

Ductal lavage followed by observation versus oral corticosteroids in idiopathic granulomatous mastitis: A randomized trial

Oral corticosteroids represents the most prevalent treatment for idiopathic granulomatous mastitis. Ductal lavage with triamcinolone acetonide and antibiotics followed by observation (DL-OBS) has emerged as a novel strategy, but a comparison of them remains lacking. Here in this multicenter, open-label, non-inferiority, randomized trial (ClinicalTrials.gov identifier: NCT03724903), we assigned 140 patients to oral corticosteroids (N = 71) and DL-OBS (N = 69), stratified by baseline M-score. The primary outcome is complete Clinical Response rate at 1 year. The non-inferiority margin is −15%. The primary outcome is 85.5% in DL-OBS and 87.3% in oral corticosteroids (difference: −1.8%; 95%CI, 13.2 to 9.5; Pnon-inferiority = .01) in intention-to-treat population, and 92.6% vs 98.2% (difference −5.6%; 95%CI −13.4 to 2.2; Pnon-inferiority = .01) in per-protocol population, respectively. The most common (>15%) adverse events were Cushingoid, epigastric pain and arthralgia in oral corticosteroids, and irregular menstruation in DL-OBS, respectively. Here, we report that DL-OBS shows similar efficacy to oral corticosteroids but with better safety profile.

Imaging manifestations and treatment efficacy of Granulomatous Lobular Mastitis: An analysis of 29 cases with internal and external traditional Chinese medicine approaches

Objectives: Using magnetic resonance imaging (MRI), we analysed the clinical manifestations of granulomatous lobular mastitis (GLM) before and after treatment with traditional Chinese medicine (TCM). Methods: This was a retrospective study. Clinical manifestations and imaging features of patients with biopsy-proven GLM before and after treatment were retrospectively analysed from April 2021 to April 2023 at Xiyuan Hospital, China Academy of Chinese Medical Sciences. Results: Among 29 women of childbearing age (mean age, 34.3±3.6 years), Compared to pre-therapy, the number of patients with lumps, ruptures, pain, and menstrual irregularities was significantly reduced (P < 0.05). The Chinese medicine staging demonstrated a transition from bulk to ulcerated (P=0.041). Pre- and post-treatment MRI changes included lesion number, distribution, maximal diameter, time-signal intensity curves (TIC), apparent diffusion coefficients (ADC), and BI-RADS categories 3 and 4a (all P＜0.05). Furthermore, substantial changes were seen in chest wall invasion, nipple discharge, increased feeding arteries, and skin edema (all P＜0.05). Conclusion: Combining internal and external Traditional Chinese Medicine (TCM) therapy proved successful for GLM. A reliable assessment of therapy efficacy is provided by MRI examination of lesion changes before and after treatment. doi: https://doi.org/10.12669/pjms.40.10.8981 How to cite this: Ning Q, Zhang Z, Ren H, Fan T, Li C. Imaging manifestations and treatment efficacy of Granulomatous Lobular Mastitis: An analysis of 29 cases with internal and external traditional Chinese medicine approaches. Pak J Med Sci. 2024;40(10):2410-2415. doi: https://doi.org/10.12669/pjms.40.10.8981 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Application of Fluorescent Composite Materials as a Sustained Release System in Treatment of Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is a multifactorial disease characterized by oxidative stress and follicular dysfunction, leading to menstrual irregularities, hyperandrogenism, and infertility. Traditional drug delivery methods often result in drug loss and side effects on normal tissues. To address these issues, we synthesized two novel Co(II)-containing coordination polymers (CPs), {[Co(L)(H2O)2]·2H2O}n (1) and {[Co(L)(H2O)2]·1.5H2O}n (2), through the reaction of the T-shaped ligand (4 - 3'-pyridyl-,6 - 4'-carboxylphenyl)picolinic acid (H2L) with Co(NO3)2·6H2O via a solvothermal process. Fluorescence spectroscopy revealed that the fluorescence emission of the CPs originates from the ligand, indicating their potential application as blue fluorescence materials. Subsequently, we encapsulated these CPs with hyaluronic acid (HA) and carboxymethyl chitosan (CMCS) hydrogels to create two types of metal gel particles carrying spironolactone (HA/CMCS-CPs@spironolactone). SEM and TEM analyses showed that the material consists of tightly stacked sheet-like structures with an average size of approximately 100nm. Thermogravimetric analysis (TGA) indicated that the material begins to decompose at around 115°C, demonstrating good thermal stability. We assessed the inhibitory effects of these materials on oxidative stress induced by PCOS. The results showed that both types of spironolactone-loaded metal gel particles significantly reduced malondialdehyde (MDA) levels, particularly the particles constructed with CP2. HA/CMCS-CP1@spironolactone reduced MDA levels by approximately 17% and 46% at low and high concentrations, respectively, while HA/CMCS-CP2@spironolactone decreased MDA levels by about 55% and 39% at high and low concentrations, respectively. Therefore, the novel drug delivery system reported in this study has the potential to become a safe and effective option for the localized treatment of PCOS.

Impact of COVID-19 Vaccination on Menstrual Cycle, Quality of Life and Perception on Fertility: A Mixed Methods Study of Women in Delhi-NCR

The COVID-19 pandemic presented extraordinary challenges which led individuals to make global efforts to develop a vaccine that could help battle the spread of the infection. The COVID-19 vaccine came as a sigh of relief for the world, but whilst we assess the positives, we must consider looking into the potential impacts it has had on aspects of health, including female reproductive health. The current study aimed at assessing the potential impacts that COVID-19 vaccination had on menstrual cycles and the perception of women about fertility-related issues following the jab through a comprehensive mixed methods design. A structured survey, using the Menstrual Symptom Questionnaire (MSQ) and WHO Quality of life scale was carried out with a diverse sample (n=500) of women (18-40 years) in the Delhi-NCR region, collecting data on menstrual cycle changes post receiving the Vaccine. Additionally, semi-structured interviews were conducted with a subset of the participants (n=15) to understand the perceptions of women about fertility-related issues following the Vaccine. The study suggests that most of the participants reported facing menstrual concerns such as missed periods, menstrual irregularities, excessive menstrual bleeding and increased cramping on the first day of their period. Through semi-structured interviews, the themes that emerged were fear regarding conception, early menopause, infertility, mood changes, anxiety, fatigue, less pain tolerance and problems with menstrual flow. Alongside, many had low scores on the quality-of-life questionnaire which was understood better through semi-structured interviews. Cognitive distortions were observed among participants while they explained their perceptions of the whole scenario. The study seeks to address a critical topic and fill knowledge gaps to understand the possible health impacts the COVID-19 vaccine has on women’s reproductive health. The study would contribute to creating scientific evidence and valuable insights for the health industry to understand any potential side effects the vaccine could have.

Beneficial Effects of Curcumin in Polycystic Ovary Syndrome: A Review of Recent Literature and Underlying Mechanisms.

Polycystic Ovary Syndrome (PCOS) is a common endocrinological disorder that affects women of reproductive age and can lead to infertility. The prevalence of PCOS ranges from 5-21% depending on the diagnostic criteria and study population. Clinical manifestations include irregular or absent menstrual periods, obesity, and signs of hyperandrogenism. PCOS can also lead to long-term consequences such as metabolic syndrome, increased risk of cardiovascular diseases, endometrial cancer, diabetes mellitus, and hypertension. Metformin and oral contraceptive pills are the most commonly used drugs for PCOS management, but their efficiency is limited and they have some considerable side effects. Researchers are looking into alternative therapeutic options such as phytochemicals. Curcumin (CUR) is a polyphenolic compound found in the rhizome of Curcuma longa and has shown promising effects for females with PCOS. CUR exerts its anti-PCOS effects through different mechanisms such as reducing oxidative stress and inflammation, balancing hormone levels, and controlling the blood sugar and lipid profile. It can also reduce insulin resistance, regulate menstruation, and improve ovarian morphology and function. Despite its beneficial effects, CUR faces several challenges and limitations in clinical use, such as low bioavailability, instability, and rapid elimination. Therefore, researchers are investigating the potential of CUR nanoformulations and new drug delivery systems to overcome these barriers. With growing evidence regarding the potential role of CUR in PCOS treatment, we decided to provide an updated summary of the recent literature from clinical and preclinical studies on this topic.

Efficacy and safety of combined topical ethinylestradiol with minoxidil versus topical minoxidil in female pattern hair loss. A trichoscopic randomized controlled clinical study.

Female pattern hair loss (FPHL) is widely common and negatively impacts the quality of life. FPHL is more challenging to treat than male pattern hair loss with minoxidil being the gold standard treatment. Several studies used 17α-estradiol solution for treating FPHL with variable results either alone or combined with minoxidil. to study the safety and efficacy of topical 17α-estradiol 0.01% combined with minoxidil 2% in comparison to minoxidil 2% in the treatment of FPHL. Forty-three women with FPHL were asked to blindly apply 6 puffs twice daily of a spray on solution containing either 17α-estradiol 0.01% combined with minoxidil 2% (EMX group) or minoxidil 2% alone (MX group). Treatment continued for 6 months. Clinical and trichoscopic assessments were performed at baseline and at the end of the treatment. At the end of the treatment period, both groups showed signs of improvement. Improvement parameters were better for the EMX group Vs the MX group, but this was not statistically significant. More patients in the EMX group experienced menstrual irregularities. Limited number of patients and follow-up periods. Estradiol effect was not studied on cellular or molecular levels and systemic absorption of both medications was not determined. the use of a 0.01% 17α-estradiol with 2% minoxidil solution in the treatment of FPHL does not seem to offer a statistically significant advantage than minoxidil alone and may carry a higher risk of associated menstrual irregularities.

Deer Blood Hydrolysate Protects against D-Galactose-Induced Premature Ovarian Failure in Mice by Inhibiting Oxidative Stress and Apoptosis.

Premature ovarian failure (POF) is a common disease among women, which can cause many complications and seriously threaten women's physical and mental health. Currently, hormone replacement therapy is the primary treatment for premature ovarian failure. However, the side effects are serious and will increase the chance of breast cancer and endometrial cancer. Deer blood hydrolysate (DBH) is the product of enzymatic hydrolysis of deer blood, has antioxidant, anti-ageing, and anti-fatigue effects, and has the potential to improve premature ovarian failure. In our experiment, a mouse model of premature ovarian failure was established through intraperitoneal injection of 400 mg/kg/d of D-gal for 42 days. At the same time, different doses of DBH were gavaged to observe its ameliorative effect on premature ovarian failure. The experimental findings indicated that DBH could restore the irregular oestrus cycle of POF mice, improve the abnormal amounts in serum hormones follicle-stimulating hormone (FSH), luteinising hormone (LH), progesterone (P) and estradiol (E2), increase the number of primordial follicles and decrease the number of atretic follicles. In addition, DBH also raised the level of superoxide dismutase (SOD) and reduced the level of malondialdehyde (MDA) and reduced the apoptosis of ovarian granulosa cells in mice. The WB assay results showed that gavage of DBH restored the decrease in the indication of nuclear factor erythroid 2-related factor 2 (Nrf2), Heme Oxygenase-1 (Ho-1), and B-cell lymphoma-2 (Bcl-2) proteins and reduced the elevated expression of Kelch-like ECH-associated protein 1 (Keap1), Bcl-2 associated X protein (Bax), and Cysteinyl aspartate specific proteinase-3 (Caspase-3) proteins that were induced by D-gal. To sum up, the present research indicated that DBH can ameliorate D-gal-induced oxidative stress and apoptosis by regulating the Nrf2/HO-1 signalling pathway and the Bcl-2/Bax/caspase-3 apoptosis pathway, which can be used for further development as a nutraceutical product to improve premature ovarian failure.

Health-Related Quality of Life Among Iranian Women With Uterine Fibroids: A Cross Sectional Study.

Uterine fibroids (UFs) are the most common benign tumors in women, and their prevalence varies between 5.4 and 77.0% in reproductive-aged women. Patients with UFs may experience severe symptoms that they can affect different aspects of their lives, including quality of life. This study aimed to investigate the health-related quality of life among Iranian women with UFs. This cross-sectional study was conducted at Imam Hossein Hospital, Tehran, Iran, between November 2023 and February 2024, Data collection was based on the census method. Uterine Fibroid Symptom and Health-related Quality of Life (UFS-QOL) questionnaire was used to assess symptom severity and health-related quality of life (HRQOL) of women with UFs. Data were analyzed using the SPSS software version 23.0. Overall, 220 patients with a mean age of 43.10±5.01 years were included in the study. Patients had total UFS-QOL score of 64.11±20.35 with the following subscales' scores: symptom severity: (19.00±6.39), concern: (60.79±26.47), activities: (71.76±23.02), energy/mood: (54.39±25.14), control: (66.52±22.82), self-consciousness: (77.63±26.39), and sexual function: (59.40±31.18). Furthermore, patients with multiparity history (P= 0.001), obesity (P<0.001), increased menstrual duration (P<0.001), irregular menstruation (P<0.001), and hyper menorrhea (P<0.001) had lower HRQOL scores. All subscales' scores of HRQOL were over 50 in patients with UF. HRQOL in these patients can be affected by certain factors, such as features of the menstrual cycle, multiparity, and obesity.

Polycystic ovary syndrome underdiagnosis patterns by individual-level and spatial social vulnerability measures.

To use electronic health records (EHR) data at Boston Medical Center (BMC) to identify individual-level and spatial predictors of missed diagnosis, among those who meet diagnostic criteria for PCOS. The BMC Clinical Data Warehouse was used to source patients who presented between October 1, 2003 and September 30, 2015 for any of the following: androgen blood tests, hirsutism, evaluation of menstrual regularity, pelvic ultrasound for any reason, or PCOS. Algorithm PCOS cases were identified as those with International Classification of disease (ICD) codes for irregular menstruation and either an ICD code for hirsutism, elevated testosterone lab, or polycystic ovarian morphology as identified using natural language processing on pelvic ultrasounds. Logistic regression models were used to estimate odds ratios (ORs) of missed PCOS diagnosis by age, race/ethnicity, education, primary language, body mass index (BMI), insurance type and social vulnerability index (SVI) score. In the 2003-2015 BMC-EHR PCOS at-risk cohort (n=23,786), there were 1,199 physician-diagnosed PCOS cases and 730 algorithm PCOS cases. In logistic regression models controlling for age, year, education, and SVI scores, Black/African American patients were more likely to have missed a PCOS diagnosis (OR = 1.69 [95% CI, 1.28, 2.24]) compared to non-Hispanic White patients, and relying on Medicaid or charity for insurance was associated with an increased odds of missed diagnosis when compared to private insurance (OR = 1.90 [95% CI, 1.47, 2.46], OR = 1.90 [95% CI, 1.41, 2.56], respectively). Higher SVI scores were associated with increased odds of missed diagnosis in univariate models. We observed individual-level and spatial disparities within the PCOS diagnosis. Further research should explore drivers of disparities for earlier intervention.

Fertility and teratogenic study of the aqueous extract of Hibiscus sabdariffa L. in female Sprague Dawley rats

Hibiscus sabdariffa (roselle) has long been gaining attention in phytotherapy research due to its medicinal properties. Despite its benefits, there is very scarce information available on the reproductive toxicity of this plant. The aqueous extract of H. sabdariffa (AEHS) was tested in the present study to investigate its potential effects on fertility and teratogenicity in 40 female Sprague Dawley rats. AESH treatment was administered orally by gavage at four different dosages: 250, 500 and 1000 mg/kg/day or distilled water (control). Treatment began from pre-mating and continued through mating up to the 19th day of pregnancy periods. Throughout this study, the reproductive parameters were evaluated until the day of sacrifice (day 20th of pregnancy). Results obtained revealed no significant differences in general physical health, behaviours and maternal body weights throughout the treatment period. Furthermore, the mean length of the oestrous cycle was not statistically affected, even though a few rats displayed irregular cycles. In addition, there was no statistical significance in the mating and pregnancy indices, number of corpora lutea and implantation sites, percentages of pre-implantation loss and postimplantation death and reproductive organ weights. Foetal parameters such as the number of live foetuses, sex ratio and body weight were also not statistically affected by AESH. Ultimately, there were no signs of teratogenicity observed since none of the foetuses exhibited congenital malformations. In conclusion, these findings imply that the oral administration of AEHS up to 1000 mg/kg/day did not pose any significant toxicity on the fertility and teratogenicity but slightly affected the oestrous cycle in rats.

Therapeutic Effects of Althaea officinalis L. and Metformin on Estradiol-Induced Polycystic Ovary Syndrome in Rats: Insights into The PI3K/AKT Pathway, Inflammation, and Oxidative Stress.

Polycystic ovary syndrome (PCOS) is one of the most important causes of infertility, irregular menstrual cycles, and anovulation in women. The current study aimed to investigate the therapeutic effects of Althaea officinalis L. (A. officinale) extract on PCOS in rats. In this experimental study, 70 rats in 7 groups (n=10/group) were studied for three weeks as follows; healthy control (HC), patient (PCOS), metformin (PCOS+MET), A. officinale treatment (PCOS+250 and 500 mg/kg A. officinale) and synergistic (PCOS+MET+250 and 500 mg/kg A. officinale) groups. Luteinizing hormone (LH), folliclestimulating hormone (FSH), progesterone (P) and testosterone (T) levels as well as inflammatory cytokines were measured. Total antioxidant capacity and lipid peroxidation levels were analyzed in ovarian tissue. The expression of GLUT-4, AKT, PI3K, PTEN genes and Ki-67 was assessed by real-time polymerase chain reaction (PCR) and immunohistochemistry, respectively. A. officinale alone and especially in combination with MET moderated inflammatory and antioxidant parameters compared to the PCOS and MET groups. A. officinale in synergistic groups increased the apoptosis of granulosa cells by activating the PI3K/AKT pathway, resulting in a rise in the number of Ki-67 positive cells (P<0.05). Furthermore, following A. officinale treatment the LH/FSH rate decreased and FSH and P increased (P<0.05). Also, A. officinale extract could effectively normalize estrus cycle duration close to the normal group. The extract of A. officinale, in combination with metformin, can enhance the hypothalamic-pituitaryovary (HPO) axis with synergistic anti-inflammatory and antioxidant effects. Additionally, the extract showed apoptotic effect on cystic granulosa cells.

Hydrotherapy Application for Women with Polycystic Ovary Syndrome: a Randomized Study

INTRODUCTION. Recently, alternative methods of treating patients with menstrual disorders have become increasingly in demand. One of these methods is hydrotherapy, which has a complex effect on the body. AIM. To evaluate the effectiveness of contrast baths and underwater shower-massage as part of complex treatment of women with polycystic ovary syndrome. MATERIAL AND METHODS. A prospective randomized study was conducted in 120 women with polycystic ovary syndrome, grade 1 obesity, and menstrual irregularities. During the study, 2 groups were allocated by randomization: the first (main) included 60 patients, whose treatment included a special diet and a 24-day course of hydrotherapy, consisting of a single daily intake of fresh water contrast baths (12 days), alternating every other day with underwater shower-massage procedures (12 days). The second group, the control group, was represented by 60 patients who received only a special diet. RESULTS AND DISCUSSION. After treatment, a significantly significant decrease in body mass index was noted in both groups of the study (by 4.9 % in the control group and by 11.3 % in the main group). In women receiving a course of hydrotherapy, there was an improvement in lipid and carbohydrate metabolism with a decrease in the atherogenic index by 36.1 % and an insulin resistance index by 31.0 %, as well as an improvement in indicators of psycho-emotional state, characterized by a decrease in situational anxiety on the Spielberger Hanin scale (p 0.05) and improvement in overall mood on the “Well-being, activity, mood” scale (p 0.05). CONCLUSION. Based on the results of the study, it was proven that the use of hydrotherapy in complex treatment programs for women with polycystic ovary syndrome is an effective and safe method that can be included in standard treatment regimens for this condition.

Cross-sectional study for profiling health status, health-related demographics, and health-seeking behaviour of the Scheduled Caste Population in selected areas of Chennai and Chengalpet Districts of Tamil Nadu

Background: Scheduled Caste (SC) population forms a large section of the Indian population who are often marginalised and deprived of social, economic and health benefits due to ignorance and socio-cultural milieu. Though various studies have been conducted on the socio-economic and political conditions of the SC population in Tamil Nadu, limited data is available on the status and determinants of their health. Objectives: The study's objectives were to estimate the health status of the SC population, health-related socio-demographic conditions and the population's health-seeking behaviour. Method: The observational, cross-sectional study was conducted in five SC-predominant areas of Chennai and Chengalpet districts of Tamil Nadu. Their health status, socio- demographic conditions, including household conditions, and health-seeking behaviour were estimated. Result: A total of 1452 households and 6072 participants of the SC community were studied, mostly belonging to the Adidravida community. Most households were of Upper-lower socioeconomic class with basic household amenities. A total of 11.54% of the adult population had a history of diagnosed chronic illnesses. Nearly one-fifth of reproductive-age women had menstrual irregularities. Non-communicable and infectious diseases were the most frequent reason for health care centre visits. Conclusion: Extensive and continuous screening of health status and chronic diseases is essential for early diagnosis and intervention. Focused interventions on improving socio- demographic status can further strengthen the health condition of the SC community. Integrating all systems of medicine in public health can help cater to the health requirements of all sections of the community. Concerted efforts can cut down the burden of chronic diseases.

7696 Ovarian Steroid Cell Tumor Presenting as Non-classical Adrenal Hyperplasia

Abstract Disclosure: V. Reddy: None. A. Gowda: None. V. Vattipally: None. D. Kunduru: None. IntroductionSteroid cell tumors(SCT) of the ovary make up less than 0.1% of all ovarian tumors. The three subtypes are stromal luteoma, Leydig cell tumor, and steroid cell tumor-not otherwise specified (NOS) which is the commonest subtype. Androgen excess is seen in 75% tumors and presents with virilization. Tumors are usually benign but maybe malignant in 25-43% cases. Factors predicting malignancy include size &amp;gt;7 cm, mitotic activity, necrosis, hemorrhage, and nuclear atypia. Case ReportA 29 y/o Caucasian female presented with secondary amenorrhea and hirsutism. History includes DM2,hypothyroidism,depression and morbid obesity. She reported early pubarche by age 8,menarche at age 13 and developed hirsutism and irregular menstrual cycles from age 15. No workup due to poor follow up until she saw PCP at age 21.She was diagnosed with PCOS and started on Metformin. Eventually referred to endocrinology at age 27, since amenorrhea and hirsutism persisted. On exam she had significant male pattern hair loss and hirsutism over face and body.She reported three first trimester miscarriages.Labs showed testosterone 370 ng/dl, 17 OHP 808 ng/dl, DHEAS 47 ng/dl, Estradiol 117 pg/ml, FSH 2.2 mIU/ml, LH 2.5 mIU/ml, androstenedione 319 ng/dl.Transvaginal US was unremarkable. She was diagnosed with non classical adrenal hyperplasia (NCAH) and started on treatment with prednisone 5 mg daily, drospirenone and spironolactone 100 mg daily.3 months later, labs showed 50% lowering of testosterone to 199 ng/dl and 17 OHP to 407 ng/dl.There was continued biochemical and clinical improvement at the next visit with 17 OHP 73 ng/dl and testosterone 55 ng/dl. Labs done 21 months after initial presentation, showed sudden dramatic rise in 17 OHP to 1148 ng/dl and testosterone to 639 ng/dl. Normal AFP, HCG, CEA, CA125, CA19-9, Inhibin A. CT showed 10.4 cm solid right ovarian mass and underwent right salpingo-oophorectomy. Pathology showed steroid cell tumor, NOS. Labs 1 month postoperatively showed complete normalization of testosterone to &amp;lt;3 ng/dl, 17 OHP to 11 ng/dl and DHEAS 0.66 ng/dl. Steroid therapy was tapered and discontinued. DiscussionWe present the case of a patient with ovarian SCT presenting as NCAH.SCTs are very rare accounting for only 0.1% of all ovarian tumors. Since they commonly secrete androgens, they present similarly to CAH or PCOS and may rarely even co-exist with CAH. Differentiating between NCAH and SCT is difficult especially when there is initial response to steroid therapy and imaging is unremarkable as with our patient. It is important to consider SCT in patients with hyperandrogenism even in the setting of elevated 17 OHP levels. Care should be taken to follow up both clinical and metabolic metrics closely and investigate if any change is noticed. Early diagnosis can prevent irreversible symptoms of hyperandrogenism. Presentation: 6/1/2024