Menstrual Recovery Research Articles

Fertility and social reintegration after modified CODOX‐M/IVAC with or without rituximab: A questionnaire survey of non‐Hodgkin lymphoma

Introduction: Although malignant lymphoma is one of the most common malignancies among adolescents and young adults (AYAs), there has been limited information regarding their long-term outcome after completion of anti-lymphoma therapies, especially for non-Hodgkin lymphoma. Modified (m) CODOX-M/IVAC ± rituximab (R) therapy is one of the most frequently applied intensive regimens, mainly for patients (pts) with Burkitt lymphoma (BL) and primary mediastinal large B-cell lymphoma (PMBL) at our institution [Int J Hematol. 2010 and Hematol Oncol. 2013]. We aimed to investigate the long-term outcome after mCODOX-M/IVAC ± R therapy focusing on fertility and social reintegration. Methods: We conducted a questionnaire survey of pts with BL or PMBL who underwent mCODOX-M/IVAC ± R as an initial therapy between 2003 and 2015 at our institution. Quality of life (QOL) was assessed using the 36-Item Short Form Health Survey (SF-36) version 2. Results: A total of 65 pts were eligible; however, 5 pts were lost to follow-up. Finally, 60 pts (16 BL and 44 PMBL) were identified as subjects of this study. At the time of abstract preparation, 75% (45 pts: 29 females and 16 males) of questionnaires were retrieved. Median age at diagnosis was 34 years (range, 16-55) and median follow-up duration was 6 years (range, 1-16). Of 26 premenopausal females at initial diagnosis, fertility preservation was performed in 8 pts (30%) as follows: gonadotropin-releasing hormone analog (7), embryo cryopreservation (2) and oocyte cryopreservation (1). Menstrual recovery was observed in 21 out of the 26 premenopausal pts (80%) after completion of therapy with a median of 2.3 months, whereas 5 (19%) became amenorrheic. Of 16 males, sperm cryopreservation had been performed in 6 (38%). After the end of therapy, 5 pregnancies and 3 deliveries were observed. Regarding marital status, 3 were divorced and 5 got married. Furthermore, all 4 students returned to school within 7 months after the therapy. Of 36 working adults, 25 pts (69%) came back to their full-time work with a median of 4 months after completion of the therapy. The SF-36 showed that the physical component summary score of all pts was higher than Japanese national norms and the other summary scores were also comparable with the norms. Conclusions: To the best of our knowledge, this is the first report evaluating QOL after mCODOX-M/IVAC ± R therapy. Our findings demonstrate that this intensive regimen retains the potential for reproduction and social reintegration in pts with BL and PMBL, including AYAs. Sex Female Male 29 (64) 16 (35) 26 (72) 10 (27) 3 (33) 6 (66) Age Median, years (range) 34 (16-55) 34 (19-52) 34 (16-55) Follow-up from diagnosis Median, years (range) 6 (1-16) 5 (1-11) 8 (1-16) Fertility preservation (premenopausal female, n = 26) Yes Gonadotropin-releasing hormone analog Embryo cryopreservation Oocyte cryopreservation No 8 7 2 1 18 7 6 2 1 17 1 1 0 0 1 Fertility preservation (male, n = 16) Yes (sperm cryopreservation) No 6 10 4 6 2 1 Pregnancy after therapy Yes Female Male No 5 (11) 4 (8) 1 (2) 40 (88) 4 (11) 3 (8) 1 (2) 32 (88) 1 (11) 1 (11) 0 8 (88) Delivery after therapy Yes Female Male No 3 (6) 2 (4) 1 (2) 42 (93) 3 (8) 2 (5) 1 (2) 33 (91) 0 0 0 9 (100) SF-36v2 summary score, median (range) Physical component summary Mental component summary Social-role component summary 56.1 (40.5-68.4) 49.5 (13.5-71.2) 51.6 (19.8-71.2) 56.4 (40.5-68.4) 49.5 (13.5-71.2) 51.5 (19.8-71.2) 55.3 (46.4-62.6) 51.0 (42.0-65.7) 53.1 (47.0-58.4) Keywords: Burkitt lymphoma (BL); primary mediastinal large B-cell lymphoma (PMLBCL)

The role of total body fat mass and trunk fat mass, combined with other endocrine factors, in menstrual recovery and psychopathology of adolescents with Anorexia Nervosa

Objective: To determine the threshold of total body and trunk fat mass required for menstrual recovery and to assess the impact of body composition in psychopathology of adolescents with Anorexia Nervosa (AN).Methods: Prospective study of 60 adolescents presented with secondary amenorrhea and diagnosed with AN. Anthropometrics, body composition by dual-energy X-ray absorptiometry, hormonal studies and responses to mental health screens (EAT-26), were obtained at the beginning and at complete weight restoration, in all adolescents, independently of menstrual recovery (Group A) or not (Group B).Results: At weight restoration, Group A total body fat mass, trunk fat mass, and trunk/extremities fat ratio were significantly higher (p < .001) than Group B. Menstruation was expected in 20% of total body fat mass and 20% of trunk fat mass (% of total trunk tissue). At time of menstrual recovery, total body fat mass (%) and trunk fat mass (%) were significantly negatively correlated with EAT-26 (r = −0.363, p = .032) and (r = −0.416, p = .013), respectively, while an increase of 0.40% of trunk fat mass (%) lowers EAT-26 by one unit.Discussion: Trunk fat mass distribution can positively influence psychopathology of adolescents with AN.

Clinical observation of small dose mifepristone combined with traditional Chinese medicine in the treatment of uterine gland disease

Objective To observe the clinical effect of small dose mifepristone combined with traditional Chinese medicine in the treatment of uterine gland disease. Methods 76 patients with uterine gland disease were selected, they were divided into the observation group(n=38) and control group(n=38) by using random number table method.The control group was treated with small dose of mifepristone, while the observation group was treated with small dose of mifepristone combined with traditional Chinese medicine.The clinical curative effects of the two groups were compared. Results After treatment, in the observation group, the pain degree of patients[(21.30±6.70)points], influence activity level[(17.30±12.00)points], activity loss[(1.80±0.70)spots] and grades of dysmenorrheal[(0.60±0.20)stages] were lower than those in the control group, the differences were statistically significant(t=5.645, 7.023, 4.932, 3.994, all P<0.05). After treatment, in the observation group, the uterine volume[(56.20±2.00)mm3], CA125 level [(32.10±2.10)U/mL] were lower than those of the control group (t=4.024, 4.413, all P<0.05). The incidence rate of adverse reaction of the observation group was 7.89%, which was significantly lower than that of the control group, the difference was statistically significant(χ2=14.757, P<0.05). The patients were followed up for 8 months, the recurrence rate of the observation group was 5.26%, which was lower than 26.32% of the control group, the difference was statistically significant (χ2=16.678, P=0.000). The menstrual recovery ratio less than or equal to three months of the control group was 81.58%, which was significantly higher than 63.16% of the control group, the difference was statistically significant (χ2=8.484, P=0.003). Conclusion In the treatment process of adenomyosis, the small dose of mifepristone combined with traditional Chinese medicine can alleviate the clinical symptoms, reduce the pain and reduce the volume of uterus, and it has less adverse reaction, safe and reliable, it is worth of clinical application. Key words: Uterine gland disease; Mifepristone; Traditional Chinese medicine; Curative effect

Effects of Anorexia Nervosa on the Endocrine System.

Anorexia nervosa (AN) is characterized by severe undernutrition associated with alterations in multiple endocrine axes, which are primarily adaptive to the state of caloric deprivation. Hormonal changes include growth hormone (GH) resistance with low insulin like growth factor-1 (IGF-1) levels, hypothalamic hypogonadism, relative hypercortisolemia and changes in appetite regulating hormones, including leptin, ghrelin, and peptide YY. These alterations contribute to abnormalities in bone metabolism leading to low bone mass, impaired bone microarchitecture, and increased risk for fracture, and may also negatively impact cognition, emotions and mood. The best strategy to improve all biologic outcomes is weight and menstrual recovery. Physiological estrogen replacement improves bone accrual rates and measures of trait anxiety in adolescents with AN. Other therapies including testosterone and IGF-1 replacement, and use of DHEA with oral estrogen-progesterone combination pills, bisphosphonates and teriparatide have also been studied to improve bone outcomes.

Exogenous type CSP cesarean section the safety of the application of combined hysteroscopy surgery in uterine artery embolization and application value

Objective To investigate the clinical value and safety of uterine artery embolization combined with hysteroscopy in the treatment of uterine scar pregnancy after cesarean section. Methods A total of 84 patients uterine scar pregnancy were selected after cesarean section cases with surgical treatment from January 2015 to January 2016 in Heze city of Shandong province maternal and child health care. According to the random principle, the cases were divided into two groups, all patients underwent hysteroscopic surgery, control group received intramuscular injection of methotrexate, and observation group underwent bilateral uterine artery embolization, compared between the two groups in operative time, bleeding volume, postoperative first anal exhaust time, postoperative blood HCG clearance time, total length of time, the lesion disappeared, menstrual recovery time and adverse reaction incidence rate. Results Control group of operative time, postoperative first anal exhaust time and total hospital stay were longer than observation group, and bleeding volume also was more than in the observation group, the differences were statistically significant(P 0.05). Conclusion For patients with uterine scar pregnancy after cesarean section, undergoing hysteroscopy surgery also combined with uterine artery embolization can effectively improve the operation efficiency, reduce injury to patients, help patients recovery from the illness, and adverse reaction rate is low, the operation is safe and reliable, it is worth clinical promotion. Key words: Cesarean section; Uterine scar pregnancy; Arterial embolization; Hysteroscopy

Therapeutic effects of metformin and clomiphene in combination with lifestyle intervention on infertility in women with obese polycystic ovary syndrome

Objective:To evaluate the therapeutic effects of metformin and clomiphene in combination with lifestyle adjustment on infertility in women with obese polycystic ovarian syndrome (PCOS).Methods:A total of 101 infertile women with obese PCOS admitted to our hospital from July 2013 to July 2015 were randomly divided into an observation group (n=51) and a control group (n=50). The control group was treated with metformin plus clomiphene, based on which the observation group was also subjected to lifestyle adjustment. The body weight, body mass index (BMI) and waist-to-hip ratio (WHR) were measured before and after treatment. The changes of reproductive hormones, ovaries and endometrium were detected, and the rates of menstrual recovery, ovulation and pregnancy were observed.Results:The body weight and BMI of the observation group after treatment were significantly lower than those before treatment and of the control group (P<0.05). There was no significant difference in WHR between the two groups. In the observation group, there were significant differences in LH, T, LH/FSH, FINS and TG levels before and after treatment and from those of the control group after treatment (P<0.05). Both the left and right ovarian volumes of the observation group after treatment were significantly lower than those before treatment and of the control group after treatment (P<0.05). The menstrual recovery, ovulation and pregnancy rates of the observation group were significantly higher than those of the control group (P<0.05).Conclusion:Lifestyle adjustment combined with metformin and clomiphene can improve the reproductive endocrine and lipid metabolism of obese PCOS patients, decrease the volumes of left and right ovaries, and increase the menstrual recovery, ovulation and pregnancy rates.

Body composition and menstrual status in adults with a history of anorexia nervosa-at what fat percentage is the menstrual cycle restored?

To study the association between body composition measures and menstrual status in a large sample of adult patients with a history of anorexia nervosa and to calculate the predicted probability of resumption of menstrual function. Furthermore, to establish whether fat percentage is superior to body mass index in predicting the resumption of menses. One hundred and thirteen adult women with a history of anorexia nervosa underwent a dual energy X-ray absorptiometry (DXA) scan and completed questionnaires regarding medication prescription and menstrual function. Fifty percent of patients were expected to resume their menstrual function at a body mass index of 19 kg m-2 or a fat percentage of 23%. Twenty-five percent of patients were expected to resume their menstrual function at body mass index 14 kg m-2 or fat percentage 11%. Fat percentage and body mass index were equally capable of predicting the resumption of menses. Fat percentage and body mass index were positive predictors of the resumption of menses, however, body composition measured by dual energy X-ray absorptiometry was not superior to body mass index in predicting menstrual recovery, which is of great clinical relevance as body mass index is easier and cheaper to obtain. Body composition measures only account for one of numerous factors involved in the resumption of menses. Regression models based on our data had a R2 value of 0.14, indicating that only 14% of the variation in menstrual recovery could be explained by the variables included. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:370-377).

Effectiveness of estrogen treatment before transcervical resection of adhesions on moderate and severe uterine adhesion patients

Intrauterine adhesion (IUA), also known as Asherman’s syndrome, is a common disease for among women. The extent of adhesion and pre-surgery hormone therapy greatly affects the function of uterine cavity. This current study investigates the association of different doses of estrogen before transcervical resection of adhesions (TCRA) surgery and clinical outcome in serious IUA. About 120 newly diagnostic serious IUA patients who underwent TCRA were randomly divided into three study groups: Estradiol valerate (progynova) 3 or 9 mg per diet before surgery and the control group. Follow-up hysteroscopy checkups were taken in 1- and 3-month post-operation. The effective power of 9 mg group was significantly higher than other groups. The 9 mg group achieved the best menstrual recovery rate in all study groups compared with the other two groups in 6 months post-operatively (p < 0.05). Our results confirmed estradiol valerateas an alternative effective drug for the prevention of IUAs before and after hysteroscopic surgery.

Percentage body fat by dual-energy X-ray absorptiometry is associated with menstrual recovery in adolescents with anorexia nervosa.

To evaluate mediators of resumption of menses (ROM) in adolescents with anorexia nervosa (AN). Anthropometrics, body composition by dual-energy X-ray absorptiometry, hormonal studies, and responses to mental health screens were obtained at 6-month intervals for 18 months in 37 adolescents with AN randomized to the placebo arm of a double-blind treatment trial. Outcomes were compared between subjects with menstrual recovery and those without. Twenty-four subjects (65%) had ROM. Higher percentage body fat was associated with ROM (odds ratio, 1.19; 95% confidence interval, 1.06, 1.33; p < .01), as was body mass index and percent median body weight. Estradiol ≥30 ng/mL alone did not predict menses (p = .08) but was associated with ROM when coupled with percent mean body weight (odds ratio, 2.49; 95% confidence interval, 1.09, 5.65; p = .03). Changes in leptin, cortisol, and mental health were not associated with return of menses. Percentage body fat may be an additional, useful clinical assessment to follow in caring for adolescents with AN.

Percentage Body Fat by Dual-energy X-ray Absorptiometry is Associated with Menstrual Recovery in Adolescents with Anorexia Nervosa

To evaluate correlates of menstrual recovery in adolescents with anorexia nervosa. 37 adolescents with anorexia nervosa and amenorrhea randomized to the placebo arm of a double-blind treatment trial, of whom 29 completed the 18-month follow-up visit, were included in the analysis. Anthropometrics, body composition by dual-energy X-ray absorptiometry (DXA), hormonal studies, and responses to the Beck Depression Inventory-I and the 26-item Eating Attitudes Test were compared between those subjects with menstrual recovery and those without. Logistic regressions fit via generalized estimating equations to account for repeated measurement over time were used to test the association of each factor and return of menses over the 18-month study. Subjects were aged 18 ± 2.8 years (mean ± SD), and self-identified primarily as white (86%). Sixty-five percent (n = 24) had recovery of menses during the study. Length of illness (19 ± 26 months) was similar between those subjects with menstrual recovery and those without, as was the duration of amenorrhea (20 ± 12 months) at baseline. Subjects exercised 7 ± 3 hours/week. Percentage body fat by DXA was associated with menstrual recovery [OR 1.19 (1.06, 1.33), p < 0.01], as were BMI [OR 1.48 (1.13, 1.95), p < 0.01] and percent median body weight [OR 1.09 (1.03, 1.16), p = 0.004]. Estradiol = 30ng/mL, alone, was not associated (p = 0.08), but when coupled with percent mean body weight it was an important predictor of menstrual recovery [OR 2.49 (1.09, 5.65), p = 0.03]. Changes in leptin levels were not associated with return of menses, but the sample size was small (n = 11). Serum cortisol levels and scores on both mental health screens were, similarly, not associated with return of menses. While weight gain is an important goal of treatment in adolescents with anorexia nervosa, percentage body fat may be a useful clinical measure to follow to inform menstrual recovery and can be obtained at the same time as bone density measures.

Clinical efficacy and safety of mifepristone in the treatment of abortive remnants of induced abortion

To evaluate the efficacy and safety of treating abortive remnants of induced abortion with different doses of mifepristone. A total of 101 women undergoing post-abortion treatment at our family planning clinic from October 2009 to February 2011 were recruited and divided randomly into 4 groups. They were diagnosed as abortive remnants by ultrasound and blood level of β-HCG (human chorionic gonadotrophin). Three test groups received different doses of mifepristone and one group as control. The efficacy and safety of four groups were evaluated by clinical observations, ultrasonic examinations and blood level of β-HCG. The effective rates of mifepristone test and control groups were 61.60% and 21.40% respectively. And there were statistical significances between two groups (P < 0.01). After a 2-week treatment, the changes of blood level of β-HCG and reduction of residual size tested by ultrasound were better than those of the control group. And there were significant statistical differences (P < 0.01). The group with high dose in short term achieved the best outcomes. After four weeks of treatment, blood level of β-HCG of test groups had no statistical significance (P > 0.05). There was statistical significance in pairwise comparison on reduction of residual size tested by ultrasound among test groups (P < 0.05). The high-dose group with achieved the largest short-term reduction. Statistical significances existed in the hemostatic time of vaginal hemorrhage and menstrual recovery between three test groups and the control group (P < 0.05). No statistical significance was found in healing time and the occurrence of adverse events among these 3 test groups (both P > 0.05). Mifepristone is effective in the treatment of induced incomplete abortion. And a short-term large dose offers a better efficacy.

Diamel Therapy in Polycystic Ovary Syndrome Reduces Hyperinsulinaemia, Insulin Resistance, and Hyperandrogenaemia

For to determine the effect of Diamel on the insulin resistance, insulin sensitivity, and sexual hormones results in women with polycystic ovary syndrome (PCOS). A study was carried out on 37 patients with this disorder. A triple-blind clinical trial was designed in which the Diamel food supplement was compared with a placebo. The women with reproductive ages were randomly distributed in two groups, with 18 and 19 women respectively, and they took Diamel or placebo and were followed up during 6 months with clinical and biochemical evaluation. A significant decrease in the HOMA-IR from the initial value at six months was observed in the group with Diamel. The insulin sensitivity improved considerably in this group. The rate of menstrual recovery was higher in the group with Diamel, and two patients from this group obtained pregnancy. The hormone levels shows a significant decrease in testosterone at 3 months in the group with Diamel compared with the control group. The LH also decreases in the same group when comparing the start with 6 months.We concluded that the Diamel decreases insulin resistance and improves sensitivity to this hormone in women with PCOS, with improvement in the levels of LH and testosterone.

Bone metabolism in adolescents with anorexia nervosa

Adolescents with anorexia nervosa (AN) are at risk for low bone mass at multiple sites, associated with decreased bone turnover. Bone microarchitecture is also affected, with a decrease in bone trabecular volume and trabecular thickness, and an increase in trabecular separation. The adolescent years are typically the time when marked increases occur in bone mass accrual towards the attainment of peak bone mass, an important determinant of bone health and fracture risk in later life. AN often begins in the adolescent years, and decreased rates of bone mass accrual at this critical time are therefore also concerning for deficits in peak bone mass. Factors contributing to low bone density and decreased rates of bone accrual include alterations in body composition such as low body mass index and lean body mass, and hormonal alterations such as hypogonadism, a nutritionally acquired resistance to GH and low levels of IGF-I, relative hypercortisolemia, low levels of leptin, and increased adiponectin (for fat mass) and peptide YY. Therapeutic strategies include optimizing weight and menstrual recovery, and adequate calcium and vitamin D replacement. Oral estrogen-progesterone combination pills are not effective in increasing bone density in adolescents with AN. Recombinant human IGF-I increases levels of bone formation markers in the short term, while long-term effects remain to be determined. Bisphosphonates act by decreasing bone resorption, and are not optimal for use in adolescents with AN, in whom the primary defect is low bone formation.

Termination of 10 -14 weeks of gestation in women with scarred uterus by compound mifepristone combined with misoprostol

Objective To explore the efficacy of compond mifepristone in combination with misoprostol for termination of 10 - 14 weeks of gestation in women with scarred uterus. Methods 53 women with scarred uterus at 10 -14 weeks of pregnancy who requested abortion were selected as a study group. 51 women with normal uterus were selected as a control group. Both groups were administered compond mifepristone combined with misoprostol and the efficacy was compared between the two groups, Results There were no significant differences between the two groups in success rate of abortion, time to embryo release, time to vaginal bleeding, and the number of days of menstrual recovery （P〉 0.05）. Abortion-induced vaginal bleeding volumes and 24h after dilatation and curettage were greater in the study group than in the control group （P〈0.05）. Conclusions Compond mifepristone combined with misoprostol has an ideal efficacy in termination of 10 - 14 weeks of pregnancy in women with or without scarred uterus. Key words: Scarred uterus; Compound Mifepristone; Misoprostol

On the therapeutic effect of the traditional Chinese medicine periodic treatment after the artifitial abortion

Objective This paper aims at the therapeutic effect aft er the artifitial abortion by employing the TCM periodic treatment with respect to shortening the vaginal bleeding time and accelerating the uterine lining recovery. Methods Sampling 280 cases of artifitial abortion in early pregnancy, the author divides them at random the testing and control groups with each of the membership of 140 cases. Given the Nifuratel perorally same as the control group, the testing group is additionally under the TCM periodic treatment, that is, dosing Chinese medicine with the purpose of eliminating blood stasis,promoting tissue regeneration as well as invigorating the vital energy and nourishing the blood during the 1 to 3 days'postoperation period, giving Chinese medicine with a view of strenthening liver and kidney together with activating vital energy during the 4 to 14 days' postoperation period, instructing Chinese medicine in order to nourish the spleen and kidney as well as regulate Chong and Ren Vessels during the 15 to 25 days' postoperation period perorally and respectivelly. In contrast, the control group is given Xuefuzhuyu Capsules after the whole postoperation period. Results In terms of the time of vaginal bleeding, menstrual recovery and the regenerating condition of the uterine lining, the result (except for 3 cases in testing group and 2 cases in control group quiting the experiment) shows that after treatment (9 days after the abortion) the testing group achieves the effect superior to that of control group (P＜0.01). Conclusion The conclusion is that the TCM periodic therapy is effective in the aspect of shortening the vaginal bleeding time, accelerating the uterine lining recovery and regulating the menstrual circle. Key words: Traditional Chinese Medicine Periodic Theraphy; postoperation period ofartifitial abortion therapeutic effect observation

The olinical effect of the combined Chinese and western medicine treatment vaginal bleeding after medical abortion

Objective To observe the combined Chinese and western medicine treatment vaginal bleeding after medical abortion clinical effect.Methods The voluntary option of requesting medical abortion after pregnant women,beginners 31 cases were randomly divided into treatment group and the control group 31 cases.The treatment group wag added in drug abortion Gongxuening capsule,the control group only in the pregnancy sac to take conventional western medicine after discharge were observed after treatment of the clinical efficacy.Results The total effective rate was 96.8%:the control group.the total effective rate was 80.6%.Comparing the two groups,the treatment group than the control group(P<0.05);the treatment group more than the amount of vaginal bleeding in patients with significantly Iower than the control group(P<0.05).Conclusion The combination of Chinese and western medicine trcatment can significantly redace the amount of vaginal bleeding,improve menstrual recovery,worthy to be popularized. Key words: Capsule Gongxuening; Drug abortion; Vaginal bleeding; Efficacy

Long‐Term Skeletal Effects of Eating Disorders with Onset in Adolescence

Anorexia nervosa (AN), an eating disorder characterized by severe undernutrition and associated with hypogonadotropic hypogonadism, causes marked deficits in bone mass accrual when the disorder begins in the teenage years. Although bone mass accrual improves with weight gain and menstrual recovery, residual deficits persist. Women with a history of teenage onset of AN are more likely to be osteopenic than age-matched women without this history, even after many years of weight and menstrual recovery. Non-recovered women with persistent low weight and amenorrhea have continued decreases in bone density, with a high prevalence of both osteopenia and osteoporosis. Unlike anorexia nervosa, normal-weight bulimia is not associated with low bone density, unless there is a past history of low weight or amenorrhea. A second possible skeletal effect of teenage-onset anorexia nervosa is short stature. Duration of illness and time of onset of anorexia nervosa in relation to the pubertal growth spurt are likely important determinants of statural growth. Adolescent boys with anorexia nervosa are more likely than adolescent girls to have short stature, possibly because growth potential persists for two years longer in boys than in girls. Thus, many adolescent girls may have completed growth or be close to growth completion at the time that they develop anorexia nervosa, whereas adolescent boys may still have significant growth potential remaining. This remaining growth potential may be impaired as a consequence of low levels of insulin-like growth factor-I (IGF-I) levels from persistent undernutrition.

Predictors of recovery of ovarian function after weight gain in subjects with amenorrhea related to restrictive eating disorders

Objective. The aim of the present study was to investigate the anthropometric and endocrine characteristics of subjects with amenorrhea related to eating disorders after weight recovery, in order to identify factors connected with the resumption of menses.Methods. Clinical data, body composition parameters and serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, cortisol, leptin and insulin were assessed in two groups of young women classified according to menstrual status after weight rehabilitation: 43 subjects who displayed persistent amenorrhea and 34 who resumed menses. Univariate and multivariate logistic regression analyses were used to examine the relationships between the different parameters and menstrual recovery.Results. The patients who resumed menses had low initial weight and BMI, and a greater difference between current and initial BMI (ΔBMI), than those with amenorrhea. No differences were observed in lean mass, body fat or bone density between the two groups. Moreover, the reduction in FSH and the increase in LH, insulin and leptin emerged as significant predictors of menstrual recovery. Increased ΔBMI and insulin continued to be positive predictors in the multivariate analysis.Conclusion. Following weight rehabilitation, the individual's metabolic set point before weight loss and the current insulin levels appear significant in predicting the reactivation of reproductive function.

Weight Gain and Restoration of Menses as Predictors of Bone Mineral Density Change in Adolescent Girls with Anorexia Nervosa-1

Adolescents with anorexia nervosa (AN) have low bone mineral density. However, the effect of disease recovery, first, on bone density measures assessed using the Molgaard approach, which differentiates between reported low bone density resulting from short bones (based on height Z-scores) and that resulting from thin bones [based on measures of bone area (BA) for height] or light bones [based on measures of bone mineral content (BMC) for BA]; and second, on height-adjusted bone density measures, has not been well characterized. We hypothesized that menstrual recovery and weight gain (> or =10% increase in body mass index) would predict an increase in these measures of bone density. In a prospective observational study, lumbar and whole-body (WB) bone density was measured at 0, 6, and 12 months in 34 AN girls aged 12-18 yr and 33 controls. Using Ward's modification of the Molgaard approach, we determined measures of BMC for BA and BA for height at the lumbar spine and WB and also determined spine bone mineral apparent density and WB BMC adjusted for height. Girls with AN had lower spine BMC for BA Z-scores (P = 0.0009), and lower WB BA for height Z (P < 0.0001), compared with controls. Menstrual recovery and weight gain in AN (AN-recovered) (median 9 months) resulted in a stabilization of BMD measures, whereas BMD continued to decrease in AN who did not gain weight and recover menses (AN-not recovered). AN-recovered also predicted greater increases in spine BMC for BA and WB BA for height, compared with AN-not recovered (P < 0.05). Even short-term weight gain with menstrual recovery is associated with a stabilization of BMD measures.

Leuprorelin Acetate Every-3-Months Depot Versus Cyclophosphamide, Methotrexate, and Fluorouracil As Adjuvant Treatment in Premenopausal Patients With Node-Positive Breast Cancer: The TABLE Study

Ovarian suppression with luteinizing hormone-releasing hormone (LHRH) agonists is an effective adjuvant treatment for premenopausal women with estrogen receptor (ER) -positive breast cancer. Whereas monthly LHRH agonist therapy has been well established, the value of every-3-months (3-monthly) formulations is unclear. This randomized phase III trial was performed to compare the 3-monthly depot LHRH agonist leuprorelin acetate (LAD-3M; n = 299) and chemotherapy with cyclophosphamide, methotrexate, and fluorouracil (CMF; n = 300) in pre- or perimenopausal patients with ER-positive, node-positive breast cancer. With a median follow-up of 5.8 years, recurrence-free survival was similar for patients treated with LAD-3M or CMF (hazard ratio [HR], 1.19; 95% CI, 0.94 to 1.51; P = .15). There was no substantial heterogeneity in the relative treatment effect among subgroups defined by age, progesterone receptor (PR) status, nodal status, hormone levels, or menstrual recovery after treatment. Exploratory overall survival analysis favored LAD-3M (HR, 1.50; 95% CI, 1.13 to 1.99; P = .005). Chemotherapy-related adverse effects such as nausea, vomiting, and alopecia were more common with CMF, whereas symptoms of estrogen suppression such as hot flushes and sweating were initially more pronounced with LAD-3M. The 3-monthly depot LHRH-agonist leuprorelin acetate is an effective adjuvant treatment in premenopausal patients with hormone receptor-positive, node-positive breast cancer that is not inferior to CMF.