Menstrual Function Research Articles

Standardising health history and injury surveillance of participants in endurance events: a modified Delphi consensus statement from the AMSSM runner health consortium.

Endurance events are popular worldwide and have many health benefits. However, runners and Para athletes may sustain musculoskeletal injuries or experience other health consequences from endurance events. The American Medical Society for Sports Medicine (AMSSM) Runner Health Consortium aimed to generate consensus-based survey items for use in prospective research to identify risk factors for injuries in runners and Para athletes training and competing in endurance events. The study design employed a modified Delphi approach, with a panel comprising 28 experts, including healthcare professionals, coaches, and athletes. Potential survey items were generated by panel members who subsequently engaged in three rounds of voting using Research Electronic Data Capture. Items were graded by clarity, relevance, and importance. Items achieving 80% consensus on all three aspects were retained. The response rate was 100% in R round 1 and 96% in Rrounds 2 and 3. Of 124 initial survey items, consensus was reached on 53, 34 and 22 items during Rrounds 1, 2, and 3, respectively. Two accepted items were removed due to redundancy. Combined with 10 non-voting items, 117 items covered key domains, including training and injury history, dietary behaviours and associated factors (such as menstrual function), footwear, mental health, and specific considerations for Para athletes. The consensus-based survey items should be considered by researchers to better understand the health of runners and Para athletes who train and compete in endurance sports to identify risk factors for injury.

Female Athlete Triad: Understanding the Interrelationship between Energy Availability, Menstrual Function, and Bone Health

The Female Athlete Triad (FAT) is a complex medical condition characterized by three interrelated components: low energy availability (EA) with or without disordered eating, menstrual dysfunction, and decreased bone mineral density (BMD). This syndrome is particularly prevalent among female athletes who engage in sports that prioritize leanness, endurance, and aesthetic performance, such as gymnastics, dance, and long-distance running. Prolonged exposure to inadequate caloric intake relative to energy expenditure can disrupt hormonal regulation, leading to irregular or absent menstrual cycles (amenorrhea) and compromising bone health. This cross-sectional study aims to investigate the prevalence and impact of low EA on menstrual function and BMD among 180 female athletes aged 18-30 years. Participants were divided into three menstrual status categories: eumenorrhea, oligomenorrhea, and amenorrhea. The study also categorized athletes into sports groups (aesthetic, endurance, and power sports) to identify patterns across different disciplines. Data collection included dietary intake records, exercise logs, menstrual history questionnaires, and DEXA scans to measure BMD at the lumbar spine and hip. Results indicate that 67% of participants exhibited low EA (< 30 kcal/kgFFM/day), which was significantly associated with menstrual dysfunction (p < 0.001). Among participants, 25% reported oligomenorrhea (irregular cycles), and another 25% experienced amenorrhea (absence of menstruation for more than three months). BMD analysis revealed that 30% of the athletes had osteopenia, while 5% were diagnosed with osteoporosis, highlighting the long-term risks associated with chronic low EA and menstrual irregularities. Notably, athletes engaged in aesthetic sports had the highest prevalence of low EA (80%) and menstrual dysfunction (45%), followed closely by those in endurance sports. These findings underscore the urgent need for targeted interventions to promote energy balance, safeguard reproductive health, and prevent bone deterioration among female athletes. Educational programs focusing on nutritional counseling, regular monitoring of menstrual health, and multidisciplinary care involving coaches, sports dietitians, and healthcare providers are essential to mitigate the risks of the Female Athlete Triad. Future research should further explore psychological factors influencing energy availability, including body image concerns and disordered eating patterns, to develop comprehensive prevention strategies.

Triad of female athletes

The female sports triad is a spectrum of dysfunctions related to energy availability, menstrual function, and bone mineral density. Energy availability is considered the trigger for the triad. Scientists have proven that women who do sports consume approximately 30% less energy and carbohydrates in relation to their body weight. Sufficient energy availability ensures the presence of a menstrual cycle, directly affects the stimulation of the production of female sex hormones (estrogen in particular). Thus, it prevents resorption of bone tissue. When energy availability is too low, a physiological mechanism reduces the amount of energy used for cell maintenance, thermoregulation, growth, and reproductive function. This compensation tends to restore energy balance and promotes survival, but impairs health. Low body weight in women of reproductive age, particularly in adolescence and the first reproductive age, is a biological marker of somatic and reproductive dysfunction. Osteoporosis in young female athletes is manifested by fractures unusual for young women or by frequent and multiple bone fractures during an athletic career. In this review article, an analytical review of literary and informational sources regarding the history of research on the problem of the triad of female athletes is carried out. The specifics of the negative impact of the athlete triad on the female body, the components of the athlete triad (amenorrhea, eating disorders, and osteoporosis) are examined in detail. The article focuses on its main cause - energy imbalance. The impact of the triad of female athletes on the psyche and behavior is considered. The question of its consequences for health both in the short-term and in the long-term perspective is considered. The prevention of RED-S syndrome was also investigated. The purpose of the study: Systematization of current knowledge about the triad of female athletes (relative energy deficiency syndrome (RED-S)). Research methods. Theoretical analysis of literary sources, systematization, generalization of scientific-methodical and special literature.

Risk for low energy availability, disordered eating and sleep disturbance among female football players.

Low energy availability (LEA) and mental health issues are prevalent among female athletes and can have adverse effects on health and sports performance. This study aimed to assess energy availability and, mental health status (depression, anxiety, sleep deprivation, drug misuse, alcohol misuse, and disordered eating) among female football players. Despite the availability of validated tools for the triads and REDs, few studies have focused on the prevalence of LEA and mental health in female football players. Furthermore, limited information is available on LEA and its consequences in India. Professional female football players (n=25) aged 19-30 years were recruited using incidental sampling. LEA was estimated based on energy availability [energy intake - activity energy expenditure] and LEA female questionnaire (LEAF-Q). Sports mental health assessment tool-1 (SMHAT-1) was used to assess the mental health status. Descriptive statistics and chi square test were used to test the hypotheses. According to the factorial method and LEAF-Q, 24% and 12% of players had LEA, respectively. LEA symptoms, such as decreased gastrointestinal and menstrual function, were observed in 16% of participants, while 8% had a history of injury. 44% of the participants exhibited poor mental health. Sleep disturbance (12%) and disordered eating (44%), were among the most common mental health issues. No significant difference was found between LEA, disordered eating, and sleep disturbance. Female football players were more likely to develop LEA and mental health disorders, such as disordered eating and sleep disturbance. LEA was not linked with disordered eating or sleep disturbance. Early detection of LEA and effective intervention enhances the health and performance of female football players.

The impact of chronic stress on the hormonal state of women affected by hostilities and displaced women

During times of war, refugee women often have high levels of chronic stress due to factors such as war, displacement and uncertainty. The study focuses on examining the hormonal responses of female refugees experiencing chronic stress from war and displacement.The objective: to assess the impact of chronic stress caused by war and displacement on the hormonal balance of refugee women.Materials and methods. 60 women were examined, who were divided into groups: the 1st group included women who were affected by hostilities (20 persons), and the 2nd group included displaced women (20 individuals). In these 40 women the hormonal studies were conducted in the conditions of military aggression in Ukraine. The control group (3rd group) included healthy women who were examined in the pre-war period. All examined women were 20–25 years old with an average body weight of 55–60 kg. Concentrations of progesterone, estradiol, follicle-stimulating hormone (FSH) and luteinizing hormone, prolactin in the I and II phases of the menstrual cycle (MC), cortisol in the I phase of the MC were determined in blood serum using the enzyme immunoassay method. An analysis of the results of research on the role of the hypothalamic-pituitary-adrenal system in the regulation of the stress response was carried out.Results. In the examined women, various disorders of MC were observed, such as: menometrorrhagia, hypermenorrhea, acyclic uterine bleeding, oligomenorrhea, and amenorrhea. The most pronounced changes in menstrual function were observed in women who were affected by hostilities. Such significant disorders of MC in women of this group coincided with changes in indicators of gonadotropic hormones of the pituitary gland and sex hormones in the blood.A study of the psycho-emotional state of women who suffered from hostilities established that these women have a significant stressful effect of various risk factors on the body. Changes in the levels of cortisol, prolactin and other hormones were detected.Conclusions. Studies have shown that chronic stress affects the hormonal status of women affected by hostilities and of displaced women, including FSH, estradiol, and prolactin levels.A significant increase in the level of FSH in the follicular phase of the menstrual cycle and an increase in the level of estradiol in the luteal phase were determined, which may indicate a compensatory reaction of the body to stress. A significant increase in the level of prolactin was also found, which can cause disorders of menstrual function and affect the psycho-emotional state.

Morphology of endometrial inflammatory changes in foci of endometriosis and adenomyosis

The high prevalence of endometriosis, its impact on menstrual and reproductive functions, obstetric complications, and the quality of life of women in the reproductive age determines the urgency of the problem.The objective: to assess the prevalence of inflammatory changes in foci of heterotopic endometrium in patients with endometriosis and adenomyosis.Materials and methods. 92 women of reproductive age – from 21 to 46 years old – who applied for surgical treatment for symptomatic adenomyosis (47 women – 1st group) and ovarian endometriosis (45 patients – 2nd group), and 30 practically healthy women of the same age (control group) were examined.Histological examination of adenomyosis and ovarian endometriosis biopsies was performed using a light microscope at magnifications of 40 and 100. For immunohistochemical examination, primary and secondary antibodies were used to determine CD34, CD68, and CD138 markers.Results. In patients with adenomyosis and ovarian endometriosis the following concomitant gynecological pathologies as uterine fibroids, endometrial hyperplasia, chronic endometritis, chronic abnormal uterine bleeding, the frequency of which is significantly higher in adenomyosis, were diagnosed. This may indicate the pathogenetic role of chronic inflammation in the development of these pathological conditions.In patients with adenomyosis the positive expression of CD68 in the epithelial component of heterotopias was determined in 8 (17.0±5.6%) women, and in 4 (8.9±4.2%) women with ovarian endometriosis, which indicated a low phagocytic activity. During the assessment of CD34 expression in vessel walls and the stromal component of endometrioid heterotopias, a positive reaction was determined in 16 (34.0±6.9%) patients with adenomyosis and in 10 (22.2±6.2%) patients with ovarian endometriosis, which reflects the processes of neoangiogenesis and the activity of the pathological process.Positive expression of CD138 in endometrioid heterotopias prevailed in the group of patients with adenomyosis – 12 (25.5±6.4%) cases versus 4 (8.9±4.2%) cases in the group of patients with ovarian endometriosis (p<0.05). This confirmed the histological results and clinical data regarding the presence of chronic endometritis and isthmocele.Conclusions. The identified inflammatory changes, weak phagocytic activity and signs of neoangiogenesis in foci of heterotopic endometrium are more significant in patients with adenomyosis, which is confirmed by clinical and morphological data.

Disorders of menstrual function during puberty and the risk of nonalcoholic fatty liver disease with comorbid diseases of the gastrointestinal tract

Disorders of menstrual function during puberty and the risk of nonalcoholic fatty liver disease with comorbid diseases of the gastrointestinal tract

Salivary Metabolites in Breast Cancer and Fibroadenomas: Focus on Menopausal Status and BMI.

to study the influence of the menopause factor and body mass index (BMI) on the biochemical composition of saliva and to evaluate the applicability of metabolic markers of saliva for the diagnosis of breast cancer. The case-control study involved 1438 people (breast cancer, n = 543; fibroadenomas, n = 597; control, n = 298). A comprehensive study of the biochemical composition of saliva was carried out using 36 parameters. When comparing the salivary biochemical composition in breast cancer, fibroadenomas, and controls, it is necessary to take into account the menopausal status, as well as BMI (less than 25 or more) for the group of patients with preserved menstrual function. A complex of biochemical parameters has been identified that change in saliva during breast cancer, regardless of menopause and BMI (total protein, urea, uric acid, NO, α-amino acids, GGT), as well as specific parameters that must be taken into account when analyzing individual subgroups (imidazole compounds, LDH, catalase, α-amylase). During the study of a separate group of patients with leaf-shaped (phyllodes) tumors, we found similarities with breast cancer in the changes in some biochemical parameters that can be attributed to metabolites of malignant growth (protein, α-amino acids, calcium, NO, pyruvate, peroxidase, α-amylase). We demonstrated changes in a wide range of salivary biochemical parameters depending on the presence of fibroadenomas and breast cancer. From the point of view of clinical practice, this may be useful information for monitoring the condition of patients with fibroadenomas, which are difficult to unambiguously classify based on instrumental diagnostics alone.

Dietary and Lifestyle Management of Functional Hypothalamic Amenorrhea: A Comprehensive Review.

Functional Hypothalamic Amenorrhea (FHA) is a condition characterized by the absence of menstruation, which is increasingly affecting young women. However, specific recommendations for treating and preventing this condition are lacking. Based on a review of the available literature, this article provides practical and feasible dietary management recommendations for healthcare professionals and researchers in women's health and nutrition. It answers the question of what interventions and nutritional recommendations are necessary to restore menstrual function in women struggling with FHA. Physicians recommend an energy availability threshold of 30 kcal/kg FFM/day to prevent FHA. Also, energy availability below and above this threshold can inhibit LH pulsation and cause menstrual disorders. In addition, the risk of menstrual disorders increases with a decrease in the caloric content of the diet and the duration of the energy deficit, and women with FHA have significantly lower energy availability than healthy women. It is essential to ensure that adequate kilocalories are provided throughout the day (regular meals that are a source of proper glucose) to avoid a negative energy balance, as glucose has been proven to affect LH pulses and T3 and cortisol concentrations in the body. Dietary intervention should focus on increasing the caloric content of the diet, thus increasing energy availability and restoring energy balance in the body. Treatment and diagnosis should also focus on body composition, not just body weight. An increase in body fat percentage above 22% may be required to restore menstrual function. In women with FHA, even an increase in body fat mass of one kilogram (kg) increases the likelihood of menstruation by 8%. It is advisable to reduce the intensity of physical activity or training volume, while it is not advisable to give up physical activity altogether. It is also important to ensure adequate intake of micronutrients, reduce stress, and incorporate cognitive-behavioral therapy.

A local audit evaluating bone health in patients with functional hypothalamic amenorrhoea secondary to an eating disorder and a review of the application of hormone therapy in this clinical setting.

It is widely known that estrogen has a fundamental role to play in skeletal homeostasis. In the most reductionist sense, the action of estrogen can be surmised as anti-resorptive. Estrogen prevents the break-down of bone. It therefore follows that estrogen deficiency states, such as the menopause and functional hypothalamic amenorrhoea (FHA), are often characterised by increased bone remodelling and disrupted skeletal homeostasis. FHA is the cessation of menstruation secondary to abnormal signalling between the hypothalamus and pituitary gland due to deficient pulsatile secretion of Gonadotrophin Releasing Hormone (GnRH). Functional hypothalamic amenorrhoea is frequently a consequence of women suffering with eating disorders. The development of FHA secondary to eating disorders is an evolutionary adaptive response to chronic metabolic energy deficiency. Fundamentally, preservation of life is biologically prioritised over dispensable physiological process such as reproduction. Consequently, the hypothalamic-pituitary-ovarian (HPO) axis fails, which disrupts menstrual function and ovulation, culminating in a state of estrogen deficiency. One of the most important and long-lasting deleterious consequences of FHA is disrupted skeletal homeostasis and bone loss. Estrogen replacement, most commonly in the form of combined hormone replacement therapy (HRT) or the combined oral contraceptive pill (COCP), is advised for women with an early menopause to prevent bone loss. Arguably, estrogen replacement should also be utilised in the context of FHA. However, the optimum estrogen regime for women with FHA remains under-researched and so management is not evidence-based.

RISK FACTORS OF LOW PLACENTATION

The purpose of the study – to assess the risk factors for the occurrence of low placentationin the early stages of gestation.Materials and methods. A clinical and statistical analysis of 150 individual charts ofpregnant women and women in labor in women with a low lying placenta (main group)and 80 pregnant women with a normal localization of the placenta in the fundus andbody of the uterus (control group), who were under dispensary supervision in a women’sconsultation, was carried ou.tThe results. After conducting the analysis, it was established that the main groupwas dominated by women over 30 years old (40.7 % of cases), compared to 25.0 %of pregnant women in the control group (p<0.05). The age of onset of menarche after14 years is marked significantly more often in pregnant women with low placentation –in 22.7 %, compared to normal localization of the placenta – in 8.8 % of cases. Thedevelopment of the menstrual cycle by one year in the main group was 2.5 times lessfrequent than in the control group. 58.7 % of pregnant women with low placentationhad 2 or more artificial abortions, 46 % had a history of spontaneous miscarriages, inpregnant women with normal placentation, these indicators were 32.5 % and 18.8 % ofpregnant women, respectively (p<0.05). In 20.7 % of cases of women in the main group,childbirth was completed by cesarean section, and in the control group – in 7.5 % ofcases. In pregnant women with low placentation, 26.0 % had inflammatory diseases ofthe uterine appendages, 50.7 % had cervical erosion, 10.7 % had uterine fibroids, 16.7 %had endometriosis, compared to the control group in 17 .5 %, 36.3 %, 3.8 % and in 6.3 %of cases, respectively (p<0.05). Conservative myomectomy was performed in 30 % ofcases of the main group and 12.5 % of women in the control group. Conclusions. Risk factors for low placentation are a woman’s age over 30 years, latemenarche and late onset of menstrual function, history of gynecological diseases, highbirth parity, history of spontaneous miscarriages and artificial abortions, uterine scar,and manual revision of the uterine cavity walls. Identifying the risk factors for lowplacentation will reduce the level of perinatal and obstetric complications.

RISK FACTORS FOR THE DEVELOPMENT OF PLACENTAL DYSFUNCTION ON THE BACKGROUND OF PREGNANT WOMEN GENITAL INFECTIONS

The progress of perinatology revealed new problems related to the gestational process and antenatal protection of the fetus. Among indicators of perinatal morbidity in modern conditions, one of the leading places occupied by placental dysfunction, the frequency of which, according to the data of domestic and foreign scientists ranges from 36% to 60%. It is known that among the many factors that affect the complicated course of pregnancy and perinatal morbidity, infectious factors in modern conditions occupy one of the leading places. Despite certain achievements in elucidating the etiological factors and pathogenesis of the development of placental dysfunction (PD), the issues of diagnosis and treatment of this pathology in pregnant women need further improvement. Thus, the study of links in the pathogenesis of manifestations of placental dysfunction, which develops during pregnancy in the early stages of gestation against the background of genital infections, is relevant and promising.The purpose. To assess the risk factors for the development of placental dysfunction in pregnant women with genital infections.Material and methods. The retrospective comparative study included 55 women who gave birth after involuntary childbirth according to the regional perinatal center of Chernivtsi, who had signs of placental dysfunction and genital infections during pregnancy during the period 2021-2022.Research results. One of the most important factors affecting the fetoplacental system, which leads to the development of chronic PD (CPD), are infections of the TORCH group. Infections during pregnancy, depending on the gestational period, lead to miscarriage, abortion, stillbirth, malformations of the child, cerebral defects, as well as to acute and chronic neonatal diseases. We conducted a retrospective analysis of risk factors, the frequency and structure of obstetric complications based on the data of 55 birth stories of the regional perinatal center in Chernivtsi for 2021-2022. Manifestations of placental dysfunction against the background of genital infections were studied at different gestational periods. Placental dysfunction occurs at different gestational periods in women of different ages. However, in young people (up to 18 years old) it occurs less often at all stages of gestation, compared to other age categories. A significant number of pregnant women with manifestations of placental dysfunction suffered from infectious diseases in childhood (measles, chicken pox, acute respiratory and viral infections, angina, various disorders of menstrual function (hyperpolymenorrhea, hypomenstrual syndrome, algodysmenorrhea) were quite often observed in pregnant women with manifestations of placental insufficiency. More often, placental dysfunction develops during first births than during repeated births. Cases of stillbirth, spontaneous miscarriages, artificial abortions and ectopic pregnancies often occur in the anamnesis. A number of authors [41] indicate that pregnant women with manifestations of placental insufficiency often experience various complications of the current pregnancy. Modern scientific studies show that almost 80% of pregnant women with genital infections show significant changes in the immune, endocrine and coagulation systems, which lead to a violation of the formation of the fetoplacental complex and a violation of adaptation mechanisms in the mother-placenta-fetus system.Conclusion. Clinical and statistical analysis shows the negative impact of manifestations of genital infections in different gestational periods on the course of pregnancy and the state of the fetus and newborn. The conducted studies on this issue give reason to talk about the need to review the system of obstetric tactics for these pregnant women, and further improvement of medical measures for antenatal protection of the fetus with this complication of pregnancy.

First successful ovarian cortex allotransplant to a Turner syndrome patient requiring immunosuppression: wide implications

ObjectiveTo determine whether we can safely and successfully transplant an ovary tissue allograft from a non-identical donor to her Turner syndrome sister. DesignTransplantation of cryopreserved ovary tissue, as well as fresh transplantation of ovarian tissue between identical twins, is now well established with numerous reported successful cases. However there have not yet been any ovary transplants between non-identical women requiring immunosuppression (ovary allotransplant). This could be a much more common indication for ovary tissue transplantation if safe and reliable immunosuppression were available. SubjectsA 20 year old amenorrheic woman with non-mosaic 45-XO Turner syndrome requested ovary tissue transplantation from her fertile 22 year old 46-XX sister. They were an HLA match but were ABO incompatible, a well known contra-indication to solid tissue or organ transplantation. The Turner syndrome sister strongly preferred to be able to become pregnant naturally without donor egg IVF, and to avoid HRT (hormone replacement therapy). In her religious group, that would also be important for finding a marital match. Despite the poor prognosis associated with ABO incompatibility, an ovary from her 22 year old non-identical fertile sister was transplanted to her employing the immunosuppression protocol now used for kidney transplant patients in our centers at Washington University and Johns Hopkins. Main Outcome MeasuresPost-operatively at 5 months she developed normal monthly menstrual ovarian function, and she became spontaneously pregnant with a normal baby girl. The relation between her post-op FSH and AMH levels continues to support the theory that tissue pressure controls primordial follicle recruitment. The fact that ABO incompatibility did not prevent success suggests that diffusion and not revascularization may be all that is required for successful long term ovarian cortex transplant survival with spontaneous pregnancy. ResultsOvary allotransplantation with safe immunosuppression allows natural conception, and also normal hormone function obviates the need for HRT. Orthotopic placement of the graft and surgical technique is critical for natural conception and a higher pregnancy rate. ConclusionAllotransplantation requiring safe immunosuppression, if successful, may be a much more commonly used indication for ovary transplantation in the future than frozen ovary grafts or grafts between identical twins.

Study changes in insulin secretion depending on anthropometric, anamnestic and laboratory parameters using a univariate linear model

Insulin is a peptide hormone which is produced by β-cells of the pancreas. It is difficult to underestimate the effect of insulin, it has a significant impact on organs and systems. Insulin is a carbohydrate “conductor”, disorders of the regulation process of which lead to metabolic disorders and irreversible changes in the human body.Insulin resistance (IR) is a state of reduced response of tissues to the action of insulin, which leads to disorders, including the reproductive function of a woman. Long-term IR leads to the development of hyperandrogenism, as a result of which anovulatory cycles, hirsutism, skin problems, vaginal dysbiosis, and an increased rate of anxiety and depression.The objective: to determine the influence of anthropometric, anamnestic and laboratory indicators on insulin secretion before and after a load of 75 g of glucose.Materials and methods. The study included 82 women of early reproductive age. 52 women are involved in the main group, 30 women – in the control group. The patients signed an informed voluntary consent, and the main aspects of the study were explained to them. In the course of the research we developed a questionnaire and conducted a survey.Anthropometric parameters (height, body weight, waist circumference) were measured, and BMI was calculated. Laboratory indicators were studied: luteinizing hormone (LH), follicle-stimulating hormone (FSH), sex hormone binding globulin (SHBG), thyroid-stimulating hormone (TSH), prolactin, dehydroepiandrosterone-sulfate (DHEA-S), total testosterone, free testosterone index, HOMA-IR index, glucose tolerance test (GTT) + determination of insulin level, Matsuda index.Results. The conducted correlation analysis proved the relationship between the level of fasting insulin and the following indicators: WC – r = 0.321900051, BMI – r = 0.333470666, establishment of the menstrual cycle – r = -0.283517408, duration of bleeding during menstruation, TSH level – r = 0.249578215, DHEA-S – r = -0.209053013, total testosterone level – r = 0.278921593.A relationship was found between the level of insulin after a load of 75 g of glucose and the following indicators: body weight at the birth of female respondents – r = -0.238495649, gestational term of birth – r = -0.243025226, FSH level – r = 0.291379519.Conclusions. A small positive (direct) relationship was determined between the fasting insulin level and the following indicators: WC, BMI, TSH level, and total testosterone level. An increase of these indicators is associated with an increase in fasting insulin level. A slight inverse linear relationship was found between the level of fasting insulin and the duration of menstrual function, the duration of bleeding during menstruation and the DHEA-S level.A slight inverse relationship is observed between the level of insulin after load and body weight at birth, the term of birth. Lower birth weight and early gestational age are associated with increased insulin levels after load.There is a direct relationship between post-load insulin levels and FSH levels. An increased FSH concentration will lead to a rise of insulin level after load.

Self-reported reproductive health of retired elite women’s footballers: a cross-sectional study

ObjectivesThe primary objective of this study was to describe the self-reported reproductive health of retired elite women’s footballers with specific reference to menstrual function, pregnancy and motherhood, contraceptive use and...

ASCHERMAN SYNDROME: FROM ETIOLOGY TO PREVENTION

Asherman's syndrome is a mysterious, multifaceted disease characterized by the formation ofintrauterine synechiae, up to complete obliteration of the uterine cavity. This is a very controversial topicbecause of its pronounced effect on both the reproductive prognosis (infertility, habitual miscarriage) andgynecological symptoms (menstrual dysfunction of the type of oligo-amenorrhea). Although the syndromehas been extensively studied, there is no clear evidence of both its prevention and effective treatment. Themain reason for the formation of intrauterine adhesions is recognized by most authors as endometrial injury.Understanding the pathogenesis of their formation is necessary to prevent the development of endometrialfibrosis and sclerosis. The review article presents in detail the causes of the disease, risk factors, clinicalmanifestations, and methods for diagnosing this syndrome. Therapeutic measures are presented in step-bystep low-traumatic ways to eliminate intrauterine adhesions with subsequent restoration of menstrual andreproductive functions. Particular attention is paid to anti-relapse prevention through the prescription ofintrauterine anti-adhesion gels.

Eating Disorders in Adolescent Girls. Gynecologist’s Point of View

This review presents an analysis of the literature data for the last 10 years (2012–2022) investigating the effect of eating disorders on the health of adolescent girl, its diagnosis, and possible tactics of gynecologist. The most common predictor of restoring menstrual function in girls with this pathology is body mass index change, however normalization of weight does not lead to remission in all cases. Thus, estimation of fat percentage, insulin-like growth factor, and leptin is more effective. We suggest directing further research on the study of more effective methods of reproductive disorders correction and the development of multidisciplinary clinical guidelines for the effective diagnosis and management of eating disorders and any gynecological complications.

Фактори ризику аденоміозу в жінок репродуктивного віку

The problem of adenomyosis is of particular relevance to patients of reproductive age since these diseases are accompanied by significant violations of the menstrual and generative functions. Aim - determine the risk factors for the development of adenomyosis in women of reproductive age in order to improve a complex pathogenetically based approach in the selection of treatment. Materials and methods. Analysis of anamnestic data and examination of 90 women of reproductive age with adenomyosis, which made up the main group, was carried out. The control group - 30 gynecologically healthy non-pregnant women of reproductive age. Results. The article provides data on the results of clinical-statistical analysis among reproductive-age women with the adenomyosis. The risk factors of development of adenomyosis in investigated group are determined. Those are: complicated heredity, high frequency of the clinical abortions, spontaneous miscarriages, pathological deliveries in the past. The low index of health is observed in such category of women: high sick rate of gynecological or extragenital pathology, 3 times higher frequency of child's and respiratory illnesses, the surgical intervention on uterus and ovarium promotes the progress of the endometriosis. That the most frequent clinical manifestations of adenomyosis are pain and hemorrhagic syndrome. Conclusions. The clinical and statistical analysis of the examined patients made it possible to identify risk factors for the development of adenomyosis in women of reproductive age: burdened heredity (60%), unmarried and single women (58.5%); employees with intellectual and mental and neuropsychological stress (63.3%), high infection index, accompanying extragenital pathology (37.4%), menstrual cycle disorders (93.3%) and reduced reproductive and sexual function; aggravated gynecological history: chronic inflammatory processes of the uterus and appendages (44.2%), pathology of the cervix (36.5%), artificial (66.6%) and involuntary (14.4%) abortions; intrauterine surgical interventions (76.3%). The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Hypothyroidism and Its Impact on Menstrual Irregularities in Reproductive-Age Women: A Comprehensive Analysis at a Tertiary Care Center.

Hypothyroidism is known to affect a wide range of physiological systems, including menstrual function, in women of reproductive age. This study aims to comprehensively analyze the association between hypothyroidism and menstrual irregularities in women attending a tertiary care center. The study included 120 women aged 18-45 who presented with menstrual abnormalities. Convenience sampling was used to select participants from the outpatient department of obstetrics and gynecology. Thyroid function tests were conducted in the hospital's biochemistry laboratory, including assessments of thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), and thyroid peroxidase antibodies (TPOAb). The study aimed to determine the prevalence of hypothyroidism and its association with various menstrual irregularities, such as oligomenorrhea, polymenorrhea, menorrhagia, and amenorrhea. Data analysis was performed using SPSS software, applying descriptive statistics, Pearson correlation for continuous variables, and Chi-square tests for categorical variables. A significance level of p<0.05 was set for the analyses. The mean age of the participants was 33.1 years (SD ± 7.2). The distribution of menstrual irregularities was 60 (50%) oligomenorrhea, 24 (20%) polymenorrhea, 24 (20%) menorrhagia, and 12 (10%) amenorrhea. Elevated TSH levels (>4.0 mIU/L) were observed in 42 (35%) of the participants, low FT4 levels (<0.8 ng/dL) in 18 (15%), low FT3 levels (<2.5 pg/mL) in 12 (10%), and elevated TPOAb levels (>55 IU/mL) in 24 (20%). A significant association was found between elevated TSH levels and oligomenorrhea (66 (55%), p<0.05) and between reduced FT4 levels and menorrhagia (78 (65%), p<0.05). Additionally, elevated TPOAb levels were significantly associated with amenorrhea (60 (50%), p<0.05). The correlation analysis showed a moderately positive correlation between TSH levels and the severity of menstrual irregularities (r=0.35, p<0.01). Subclinical hypothyroidism was detected in 25% of the participants, while 15% had clinical hypothyroidism. This study underscores a notable link between hypothyroidism and menstrual irregularities in women of reproductive age. The results highlight the necessity of routine thyroid function screenings for women experiencing menstrual abnormalities, facilitating precise diagnosis and suitable treatment.

Müllerian anomalies and endometriosis as potential explanatory models for the retrograde menstruation/implantation and the embryonic remnants/celomic metaplasia pathogenic theories: a systematic review and meta-analysis.

Does endometriosis prevalence differ in patients with obstructive Müllerian anomalies (OMA) versus those with nonobstructive Müllerian anomalies (NOMA), and in patients with NOMA versus those without Müllerian anomalies? The quantitative synthesis of published data demonstrates a substantially increased prevalence of endometriosis in patients with OMA compared with those with NOMA, and a similar prevalence in patients with NOMA and those without Müllerian anomalies. The pathogenesis of endometriosis has not been definitively clarified yet. A higher prevalence of endometriosis in patients with OMA than in those with NOMA would support the retrograde menstruation (RM)/implantation theory, whereas a higher prevalence of endometriosis in the NOMA group than in the group without Müllerian anomalies would support the embryonic remnants/celomic metaplasia hypothesis. This systematic review with meta-analysis was restricted to full-length, English-language articles published in peer-reviewed journals between 1980 and 2023. The PubMed and EMBASE databases were searched using the keyword 'endometriosis' in combination with 'Müllerian anomalies', 'obstructive Müllerian anomalies', 'female genital malformations', 'retrograde menstruation', 'infertility', 'pelvic pain', and 'classification'. References from relevant publications were screened, and PubMed's 'similar articles' and 'cited by' functions were used. Studies were selected if they reported the prevalence of surgically confirmed endometriosis in either individuals with OMA compared to those with NOMA, or patients with NOMA compared to those without Müllerian anomalies. Cohort and case-control studies and case series were deemed eligible for inclusion. Noncomparative studies, studies not reporting both the number of individuals with endometriosis and the total number of those with Müllerian anomalies or with other gynecological conditions, those including exclusively data on patients with absent or uncertain menstrual function (e.g. complete Müllerian agenesis category), or with imperforate hymen were excluded. Two reviewers independently abstracted data. The risk of bias was assessed with the Risk of Bias In Non-randomized Studies of Exposures tool. The overall certainty of the evidence was graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Seven retrospective studies were included. The overall mean estimate of endometriosis prevalence was 47% (95% CI, 36-58%) in patients with OMA, and 19% (95% CI, 15-24%) in patients with NOMA, with a common odds ratio (OR) of 4.72 (95% CI, 2.54-8.77). The overall mean estimate of endometriosis prevalence in patients with NOMA was 23% (95% CI, 20-27%), and that in patients without Müllerian anomalies was 21% (95% CI, 20-22%), with a common OR of 0.95 (95% CI, 0.57-1.58). The overall certainty of the evidence according to GRADE guidelines was judged as low for both comparisons. Some NOMA subtypes may create a partial obstacle to menstrual efflux and/or generate dysfunctional myometrial contractions that favor transtubal reflux, thus increasing the risk of endometriosis and limiting the difference between OMA and NOMA. As infertility and pelvic pain are strongly associated with endometriosis, women with these symptoms are inappropriate controls. Confounding by indication could explain the lack of difference in endometriosis prevalence between patients with NOMA and those without Müllerian anomalies. The results of this meta-analysis support the validity of the RM theory but do not definitively rule out alternative hypotheses. Thus, RM may be considered the initiator for the development of endometriotic lesions, while not excluding the contribution of both inheritable and tissue-specific genetic and epigenetic modifications as disease-promoting factors. No funding was received for this review. P.Ve. is a member of the Editorial Board of Human Reproduction Open, the Journal of Obstetrics and Gynaecology Canada, and the International Editorial Board of Acta Obstetricia et Gynecologica Scandinavica; has received royalties from Wolters Kluwer for chapters on endometriosis management in the clinical decision support resource UpToDate; and maintains both a public and private gynecological practice. E.S. discloses payments from Ferring for research grants and honoraria from Merck-Serono for lectures. All other authors declare they have no conflict of interest. N/A.