Menstrual Regularity Research Articles

FAKTOR-FAKTOR YANG MEMPENGARUHI KETERATURAN SIKLUS MENSTRUASI PADA REMAJA PUTRI DI SMA NEGERI 2 SINGARAJA

Menstrual disturbance in adolescense often related with reproductive health problem. Nearly 75% of adolescents experience menstrual-related disorders such as irregular menstrual cycles. This study aims to analyze the factors that affect the regularity of the menstrual cycle in adolescent girls, including body mass index, hemoglobin levels, physical activity, stress levels, and age of menarche. This research is a correlational analytic study with a cross sectional approach. A total of 65 young women became respondents in this study, which were determined using stratified simple random sampling technique. The data collection tools used were questionnaires, weight scales, height gauges and HBmeter. Data were analyzed using descriptive and correlational statistics with a confidence level of 95%. Based on the results of data analysis, it was found that in general the majority of respondents had a normal BMI (50.8%), 18 years old (60%), low Hb (52.3%), light physical activity (50.8%), stress levels. moderate (44.6%), and the age of menarche was at the age of 13 years (36.9%). The results of the correlation analysis showed that the relationship between body mass index, hemoglobin levels, physical activity, stress levels, and age of menarche was respectively (p = 0.219; r - 0.155, p = 0.007; r = -0.330, p = 0.047 ; r = -0.232, p = 0.005; r = 0.334, p = 0.696; r = -0.044). There is a relationship between Hb levels, physical activity and stress levels on menstrual cycle regularity. There is no relationship between BMI and age of menarche with menstrual cycle regularity in adolescent girls.

Prolactin secretion pattern among female flight attendants.

Epidemiological observations indicate that female flight attendants are exposed to some reproductive and endocrine system disturbances. The aim of the study was to determine the incidence of hyperprolactinemia among female flight attendants, and to identify factors affecting the secretion of prolactin in female flight attendants working within 1 time zone as well as on long-distance flights. The cross-sectional study covered 103 women aged 23-46 years. The study group (I) was divided into 2 subgroups: subgroup Ia comprising female flight attendants flying within 1 flight zone, and subgroup Ib composed of female flight attendants working on long-distance flights. The control group (II) included women of reproductive age who sought medical assistance due to marital infertility in whom the male factor was found to be responsible for problems with conception in the course of the diagnostic process. The assessment included: age, the body mass index, menstrual cycle regularity, the length of service, the frequency of flying, the prolactin, estradiol and progesterone concentrations, and the result of endometrial biopsy. Descriptive and inferential statistics methods were used to compile the data. The incidence of hyperprolactinemia in the female flight attendants (46%) was significantly higher than in the control group (9%), p < 0.001. Differences between subgroups Ia and Ib regarding individual concentrations were not statistically significant (p = 0.425). Hyperprolactinemia among the female flight attendants working ≥15 years is present slightly more often than in those working <15 years: 46% vs. 45% (p > 0.05). No significant difference was revealed in the secretion of prolactin between the study participants spending <60 h/month flying and those spending ≥60 h/month flying (p > 0.05). Hyperprolactinemia is more common in female flight attendants than in the general population. High values of prolactin concentration in flight attendants are rarely manifested in clinical symptoms. The frequency of flying and the length of service do not affect the development of hyperprolactinemia or the mean prolactin concentration. Int J Occup Med Environ Health. 2021;34(3):351-61.

Menarche characteristics in association with total and cause-specific mortality: a prospective cohort study of Mexican teachers

We evaluated the relation between age at menarche and time to menstrual regularity with all-cause and cause specific mortality in a cohort of Mexican women. We followed 113,540 women from the Mexican Teachers' Cohort. After a mean follow-up time of 9.2 years, 1,355 deaths were identified. We estimated hazard ratios from Cox regression models for total mortality and a competitive risk models for cause-specific mortality adjusting for year of birth and childhood factors. Women with extreme age of menarche were at increased risk of all-cause mortality (HR [95% CI]: <11years 1.50 [1.20, 1.87]; 14years 1.19 [0.97, 1.43]) relative to those with menarche at 13 years. Extreme ages at menarchehad higher risk of mortality for diabetes (HR: <11years 1.66 [0.90, 3.05]; 14years 1.47 [0.90, 2.40]), breast cancer (HR: <11years 1.34 [0.56, 3.20]), and other cancer (HR:<11years 1.65 [1.10, 2.48]) compared to menarche at 13 years. Women who took three or more years to achieve menstrual regularity had a higher risk of all-cause mortality compared to those who took less (HR: 1.27 [1.01, 1.58]). Extreme ages at menarche and longer time to reach menstrual regularity were associated with an increased rate of all-cause and cause-specific mortality.

The impact of COVID-19-related mental health issues on menstrual cycle characteristics of female healthcare providers.

AimTo investigate the association between menstrual cycle regularity in healthcare providers and COVID‐19 pandemic‐related anxiety, depression, stress.MethodsA cross‐sectional study was conducted by administrating online questionnaires to female healthcare workers in Turkey. Women aged 18–40 years with regular menstrual cycles for more than 1 year before the beginning of the pandemic were included in the study and they were divided into two groups according to menstrual cycle regularity during the pandemic. The questionnaires included sociodemographic characteristics, medical and reproductive history, lifestyle information of participants, COVID‐19 Stress Scales (CSS), and a short version of the Depression Anxiety Stress Scale (DASS‐21).ResultsA total of 952 women were included in the study, 679 had regular menstrual cycles, and 273 had irregular menstrual cycles. The prevalence of irregular menses among Turkish women healthcare workers aged 18–40 years was 28.7%. The CSS subdimensions and total scores were significantly higher in the irregular menstruation group than in women with regular menstruation (p < 0.001). The DASS‐21 depression, anxiety, and stress subdimensions were likewise significantly higher in women with irregular menstruation (p < 0.001). Besides, both the univariable and the multivariable logistic regression results showed the relationship between irregular menstruation and CSS total score.ConclusionThe current study showed the association between the COVID‐19 pandemic‐induced anxiety, perceived stress, depressive symptoms, and increased prevalence of menstrual cycle irregularity among healthcare providers.

Life History Recorded in the Vagino-cervical Microbiome Along with Multi-omes

The vagina contains at least a billion microbial cells, dominated by lactobacilli. Here we perform metagenomic shotgun sequencing on cervical and fecal samples from a cohort of 516 Chinese women of reproductive age, as well as cervical, fecal, and salivary samples from a second cohort of 632 women. Factors such as pregnancyhistory, delivery history, cesarean section, and breastfeeding were all more important than menstrual cycle in shaping the microbiome, and such information would be necessary before trying to interpret differences between vagino-cervical microbiome data. Greater proportion of Bifidobacterium breve was seen with older age at sexual debut. The relative abundance of lactobacilli especially Lactobacillus crispatus was negatively associated with pregnancy history. Potential markers for lack of menstrual regularity, heavy flow, dysmenorrhea, and contraceptives were also identified. Lactobacilli were rare during breastfeeding or post-menopause. Other features such as mood fluctuations and facial speckles could potentially be predicted from the vagino-cervical microbiome. Gut and salivary microbiomes, plasma vitamins, metals, amino acids, and hormones showed associations with the vagino-cervical microbiome. Our results offer an unprecedented glimpse into the microbiota of the female reproductive tract and call for international collaborations to better understand its long-term health impact other than in the settings of infection or pre-term birth.

POS-291 ASSOCIATION BETWEEN CHRONIC KIDNEY DISEASE, MENSTRUAL REGULARITY AND REPRODUCTIVE LIFESPAN: A SYSTEMATIC REVIEW AND META-ANALYSIS

Menstrual irregularity and short reproductive lifespan have been identified as cardiovascular risk factors in the general population, though the prevalence and effect of these disturbances in the high cardiovascular risk chronic kidney disease (CKD) population is unclear. We aimed to summarize the state of the science of menstrual regularity and reproductive lifespan in women with CKD and kidney failure (KF) treated with dialysis or kidney transplantation. Utilizing a peer-reviewed search strategy, electronic bibliographic databases (Medline, EMBASE, CINAHL) were searched for relevant articles published between inception and October 2020. Studies (prospective or retrospective cohort, case-control and cross-sectional) that examined menstrual regularity and/or reproductive lifespan in women with CKD or KF treated with dialysis or kidney transplantation were eligible for inclusion. Two reviewers independently completed all abstract screening, full text review, data extraction, and quality assessments using the National Institute for Health Quality Assessment for cohort studies. Results are presented descriptively, and random effects meta-analysis models will be used to derive pooled effect estimates. Database searching identified 3,527 studies in total. 157 studies were retained after abstract screening, and 52 studies were deemed eligible for inclusion after full-text review. Reviewer agreement through the abstract screen and full text review was 90.4% and 76.5%, respectively. Data-extraction and analysis is ongoing. Preliminary results indicate a large proportion of women with CKD experience menstrual irregularity and short reproductive lifespan that is more pronounced in the later stages of CKD and those with KF. It is unclear whether menstrual regularity is improved after treatment with kidney transplantation. This systematic review and meta-analysis will provide an important overview of the prevalence and effect of menstrual regularity and reproductive lifespan in people with CKD and KF. Given the high cardiovascular risk of the CKD population, description and analysis of these novel sex-specific cardiovascular risk factors will inform care of this understudied population.

Bariatric Surgery on Reproductive Outcomes: the Impact According to the Diagnosis of Polycystic Ovarian Syndrome and Surgical Procedures.

There is limited evidence on the impact of bariatric surgery (BS) on reproductive outcomes in the general population and specifically in patients with polycystic ovarian syndrome (PCOS) or the effect of different BS techniques. The study aims to investigate the impact of BS on fertility, pregnancy, and newborn outcomes in reproductive age women who have undergone BS and the outcomes according to surgical procedure and PCOS diagnosis. This was a retrospective, descriptive, cross-sectional study performed in women from 18-39 years undergoing BS in our centre from January 2005 to December 2010. We performed a telephone interview including a structured reproductive health survey on fertility, pregnancy, and offspring outcomes before and after BS. Of the women, 872 underwent BS during the study period, 298 were 18-39 years old, and reproductive data was obtained from 217. Women with regular menstrual cycles increased from 52.9% before BS to 72.9% 1 year after surgery. The percentage of patients with a time-to-pregnancy longer than 12 months was higher after laparoscopic sleeve gastrectomy (LSG) (17.8%) compared to laparoscopic Roux-en-Y gastric bypass (7.1%; p = 0.02). Menstrual regularity was less frequent in PCOS (n = 43) (26.0%) compared to non-PCOS women before BS (60.1%; p = 0.01), with no differences after surgery. Several perinatal results showed an improvement after BS, with a reduction in macrosomia rate and birth weight. BS was associated with an improvement in several reproductive outcomes. Menstrual regularity was especially improved in PCOS women. Further research may clarify the impact of LSG on fertility.

Menstrual Irregularity, Hormonal Contraceptive Use, and Bone Stress Injuries in Collegiate Female Athletes in the United States.

Menstrual irregularity (MI) is common in female athletes and is a component of the Female Athlete Triad (Triad). Many athletes with the Triad are started on hormonal contraceptives (HC) for MI, but this interferes with the ability to monitor menstrual cycle regularity and can mask other causes of MI. There are limited studies investigating the relationship between MI, HC use, and injury in female collegiate athletes. To examine the prevalence of and relationship between HC use, MI, and bone stress injuries in female collegiate athletes in the United States. Cross-sectional study. Online survey. 1020 U.S. female collegiate athletes (age ≥ 18 years). Assessment of risk factors for menstrual irregularity and bone stress injuries was conducted via a one-time survey. HC use, MI, history of stress fractures. Current HC use prevalence was 65% (95% confidence interval [CI], 61.9%, 67.8%). Of all athletes, 47% reported past MI. Of the athletes who were not currently using HCs, 32% had current MI. Compared with athletes without past MI, more athletes with past MI reported current HC use (73% vs. 57%) and indicated menstrual cycle consistency as the primary reason for use (24% vs. 4%) (P < .001). Additionally, 25% of athletes reported a history of stress fractures, which was associated with lean/aesthetic sports participation (odds ratio [95% CI]: 1.9 [1.4, 2.5]; P < .001) and less oral contraceptive pill (OCP) use (0.7 [0.5, 1.0]; P = .043). Compared with OCPs, injectable HCs were associated with greater odds of a history of stress fractures (4.5[1.6, 12.3]; P = .004). HC use was prevalent among this cohort of female collegiate athletes, and almost half of the athletes reported past MI. A goal of menstrual cycle regularity was cited by 24% of athletes as a primary reason to use HCs, which shows that more athlete education is needed to avoid masking MI and the Triad with HCs. Further studies elucidating the relationship between HC use, MI, and sports-related injury are warranted.

Assessment of the Thyroid Functions among Female Flight Attendants.

Introduction: Epidemiological observations indicate that stewardesses are exposed to reproductive and endocrine system disturbances. The aim of the study was to assess of thyroid function disturbances as well as to identify factors affecting the thyroid function among stewardesses working both within one time zone and on long-distance flights. Material and methods: The cross-sectional study covered 103 women aged 23–46. The study group (I) was divided into two subgroups: group Ia comprising stewardesses flying within one flight zone and group Ib stewardesses working on long-distance flights. The control group (II) were women of reproductive age who sought medical assistance due to marital infertility in whom the male factor was found to be responsible for problems with conception in the course of the diagnostic process. The assessment included: age, BMI, menstrual cycle regularity, length of work, frequency of flying, thyroid stimulating hormone (TSH) concentration, level of free thyroxine (fT4), antibodies to thyroglobulin (aTG) and to thyroperoxidase (aTPO), prolactin concentration, sex hormone binding globulin (SHGB) concentration, total cholesterol, and low density lipoprotein (LDL) fraction. Descriptive methods and inferential statistics methods were used to compile the data. Results: The difference between the concentrations of TSH in the study group (2.59 mcIU/mL) and the control group (1.52 mcIU/mL) was statistically significant (p < 0.01). An elevated titer of thyroid antibodies (aTPO and/or aTG) was revealed in 46.3% of stewardesses and in 15.1% of patients from the control group (p < 0.001). Groups Ia and Ib in individual concentrations were not statistically significant. The frequency of occurrence of an elevated titer of thyroid antibodies depended on the length of work in the study group (p > 0.05). No statistically significant difference was found in patients spending up to 60 h a month flying and in patients spending more than 60 h flying, the percentage of the occurrence of thyroid antibodies was 50% and 43.5, respectively. Conclusions: The occurrence in stewardesses of a higher TSH concentration than in the control group can signify that stewardesses are burdened with a higher risk of the development of hypothyroidism in the future. The character of the work of stewardesses (frequency of flying as well as length of work) does not affect the immunological profile of the thyroid.

Menstrual Cycle Patterns and the Prevalence of Premenstrual Syndrome and Polycystic Ovary Syndrome in Korean Young Adult Women.

Menstruation is one of the important indicators of reproductive health. Therefore, in order to improve the reproductive health of women in puberty and early adulthood, it is necessary to investigate menstrual health and symptoms. This cross-sectional descriptive correlational study was conducted to identify young women’s menstrual cycle patterns, prevalence of Premenstrual Syndrome (PMS), Polycystic Ovary Syndrome (PCOS) and the relationships of health-related factors according to menstrual regularity and PCOS. 462 women participated in the first phase of the study and completed the menstrual health and health-related behaviors questionnaire. In the second phase, 88 women with irregular menstruation in phase one had blood tests taken and body composition measured. As a result, Menarche was slightly later in irregular menstruation group. Women with regular menstruation had a mean number of 11.7 menstrual cycles over the past year, 93.0% of them reported a normal menstruation cycle frequency (21–35 days), 95.2% reported a normal duration (2–7 days) and 55.9% of participants had heavy menstrual bleeding. In the irregular menstrual group, there were higher percentages of underweight and obese women as well as more women experiences weight and diet changes. The estimated prevalence rates of PMS and PCOS were 25.5%, 5.2% respectively. This study provides updated basic data about menstrual health among Korean young women but more extensive and sophisticated studies are needed in the future.

Saudi women perception, attitude and awareness about abnormal nipple discharge

Background: Nipple discharge (ND) is known as any fluid that leaks from one or both nipples of a non-pregnant and non-breastfeeding breast. Intraductal papilloma, duct ectasia, papillomatosis, mastitis, or fibrocystic changes are the most frequent causes of abnormal benign conditions. Up to authors' knowledge; there are not enough published papers regarding perception and attitude of Saudi women about abnormal ND and its causes. The main objective of this study was to examine perception and attitude of Saudi women about abnormal ND among Saudi women in Kingdom of Saudi Arabia. Methods: A community-based cross-sectional study was conducted from September to November 2020. A pre-designed online questionnaire was distributed on social media targeting Saudi women in different age groups to be self administered. Data were compiled and analyzed using a statistical package for the social sciences. The relation between abnormal ND and sociodemographic characters was determined using the chisquare test. A p-value of less than 0.05 was considered to be statistically significant. Results: According to our results, 8.2% (n = 176) of participants reported abnormal breast secretions other than during pregnancy or breastfeeding. Among 30.7% (n = 54) of cases, the secretions were accompanied by redness, 41.5% reported breast pain, 48.8% had small pits or wrinkles in the skin, 36.4% suffered from nipple retraction, 35.2% reported itchy sores or a rash on the nipple, in 32.4% of cases the secretions accompanied with a change in the size or shape of the breasts, and 25.6% observed that secretions were accompanied with a change in the internal composition of the breast or the appearance of an unknown mass. Conclusion: Abnormal ND was relatively prevalent among Saudi women. There was a significant relationship between social status, smoking, menstrual cycle regularity, having children, and late for childbearing.

The potential role of incretin-based therapies for polycystic ovary syndrome: a narrative review of the current evidence.

Introduction:Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women of reproductive age. Metabolic consequences associated with PCOS include, but are not limited to, insulin resistance (IR), type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). This narrative review aims to provide a comprehensive overview of the potential therapeutic roles of the incretin-based therapies in the management of PCOS.Methods:We performed a systematic search of databases including PubMed, MEDLINE and EMBASE up to 1 October 2020. We developed a search string of medical subject headings (MeSH) including the terms PCOS, incretin mimetics, glucagon-like peptide-1 (GLP-1), glucagon-like peptide-1 receptor antagonists (GLP-1 RAs), liraglutide, exenatide, semaglutide, dipeptidyl peptidase-4 (DPP-4) inhibitors, combined with IR, testosterone and sex hormone-binding globulin (SHBG).Results:We identified 854 relevant articles and, after the initial screening, eight interventional animal studies, one observational animal study, 14 interventional human studies, two case–control studies and one systematic review were included. These studies showed the potential significant roles of GLP-1 RAs and DPP-4 inhibitors in the management of PCOS, with significant improvements in the metabolic parameters, including substantial weight reduction and improved insulin sensitivity. These agents also improved the hormonal parameters through decreased free androgen and increased SHBG. Moreover, they improved menstrual regularity, increased fertility with enhanced ovulation and pregnancy in obese women with PCOS.Conclusion:GLP-1 RAs and DPP-4 inhibitors have a promising therapeutic role in PCOS; however, larger clinical trials are needed to establish the role of incretin-based therapies in the management of PCOS.

Relationship Between General Health and Dysmenorrhea in Students at Shahrekord University in 2018

Background and aims: Dysmenorrhea is one of the most common problems that women experience. Dysmenorrhea brings about psychological problems for women and adversely affects their performance. Therefore, providing, maintaining, and promoting the health of women is an important goal. The present study was conducted to determine the relationship between general health and Dysmenorrhea in students of Shahrekord University in 2018. Methods: In the present cross-sectional study, 245 female students were selected by random cluster sampling method from Shahrekord University in 2018. Data were collected using the GHQ28, visual analogue scale (VAS), and a reliable and valid questionnaire designed by the researchers to determine menstrual pattern. Data were analyzed using descriptive statistics, chi-square test, and independent samples t test. Results: The mean age at menarche was 13.5 years. Dysmenorrhea was observed in 82.8% of students. The severity of pain was measured by the VAS scale, indicating that 22.3% of the participants had severe menstrual pain. The prevalence of dysmenorrhea in participants with a family history of Dysmenorrhea was greater and statistically significant. The result of the t-test showed that there is a relationship between dysmenorrhea and the general health of the participants (P=0.036). There was also a significant relationship between menstrual cycle regularity and physical characteristics of the participants (P=0.019). Significant relationships were also found regarding the interval between menstrual cycles and physical symptoms (P=0.026), and depression and general health (P=0.0001). Conclusion: Due to the importance of dysmenorrhea and its high prevalence among female students, it is important to provide education and control on this disorder to improve the quality of life of women. It is also beneficial to create counseling centers to raise awareness of the psychological health of female students suffering from dysmenorrhea.

Myoinositol In Restoring Spontaneous Ovarian Activity in Patients with Polycystic Ovarian Syndrome (PCOS)

Objective: To assess the efficacy of myoinositol in the management of patients with Polycystic ovarian syndrome (PCOS) Methods: It was quasi experimental study conducted inDepartment of Obstetrics and Gynecology Services institute of Medical Sciences, Services Hospital, Lahore from 30-6-2018 to 31-12-2018. 140 sub fertile patients with PCOS were selected through random sampling. Patients were given 2gram of myoinositol/day. The effect was assessed after 3 and 6 months of treatment by monthly menstrual cycle regularity and ovulation. All this information was recorded in proforma. Results: The mean age of patients was 26.90±5.52years. The mean BMI of patients was 37.38±4.08kg/m2. After 3 months of treatment, menstrual cycle become regular in 34 (24.3%) patients and ovulation occurred in 54 (38.6%) cases. After 6 months of treatment, menstrual cycle become regular in 75 (53.6%) patients and ovulation occurred in 101 (72.1%) cases. Conclusion: The myoinositol is an effective treatment in terms of regularity of menstrual cycle and ovulation induction in subfertile women with PCOS. Keywords: Myoinositol, Polycystic ovarian syndrome, Menstrual irregularity, Ovulation

Correlation Between Recovery of Menstrual Cycle and Improvement of Glucose and Lipid Metabolism in Patients with Sleeve Gastrectomy in a Small Chinese Cohort Sample.

ObjectiveTo analyze the status of insulin resistance and hyperlipidemia in the regulation of menstrual cycle in patients undergoing sleeve gastrectomy (LSG).Materials and MethodsRetrospective analysis of a typical metabolic syndrome population: 65 cases of sexually mature women underwent weight reduction surgery from January 2015 to June 2018, and for 35 of these cases we collected all clinical data including age, menstrual status, body mass index (BMI), waist-to-hip ratio (WHR), blood lipid level, homeostasis model assessment in insulin resistance (HOMA-IR) and free androgen index (FAI). Sixteen of these patients had menstrual disorder that was characterized by oligomenorrhea and their menstrual cycle was >2 months or <24 days before operation, while their menstrual cycle recovered approximately 1 month to one year after sleeve gastrectomy.ResultsThe age of our 35 patients with metabolic syndrome was 15–40 years; 19 cases were in the menstrual regularity group and 16 cases in the menstrual disorder group. On analysis of metabolic factors in the two groups, only BMI and FAI distribution in the two groups were statistically different, while lipid levels and insulin resistance levels for abnormal menstrual cycle were not statistically significant. The analysis of blood lipid components showed that high triglyceride levels and high cholesterol levels increased the occurrence of menstrual disorders.ConclusionBMI can be used as one of the important metabolic indicators of menstrual disorders in patients with metabolic syndrome. Excess androgen can increase the occurrence of menstrual disorders, leading to polycystic ovarian syndrome (PCOS). Although insulin resistance is universal in patients with metabolic syndrome, it is not a specific factor that affects menstrual cycle. Hyperlipidemia, especially triglyceride composition, may be one of the driving factors of menstrual disorder.

Cognitive testing of a survey instrument for self-assessed menstrual cycle characteristics and androgen excess

BackgroundIn large population-based studies, there is a lack of existing survey instruments designed to ascertain menstrual cycle characteristics and androgen excess status including hirsutism, alopecia, and acne. Our objective was to cognitively test a survey instrument for self-assessed menstrual cycle characteristics androgen excess.MethodsQuestions to assess menstrual characteristics and health were designed using existing surveys and clinical experience. Pictorial self-assessment tools for androgen excess were also developed with an experienced medical illustrator to include the modified Ferrimen-Galway, acne and androgenic alopecia. These were combined into an online survey instrument using REDCap. Of the 219 questions, 120 were selected for cognitive testing to assess question comprehension in a population representative of the future study population.ResultsCognitive testing identified questions and concepts not easily comprehended, recalled, or had problematic response choices. Comprehension examples included simplifying the definition for polycystic ovary syndrome and revising questions on historic menstrual regularity and bleeding duration. Recall and answer formation examples include issues with recalling waist size, beverage consumption, and interpretation of questions using symbols (> or <). The survey was revised based on feedback and subsequently used in the Ovulation and Menstruation (OM) Health Pilot study.ConclusionWe present a cognitively tested, novel survey instrument to assess menstrual cycle characteristics and androgen excess.

Fluoride exposure and reproductive health among adolescent females in the United States: NHANES 2013-2016

Background: Fluoride can affect reproductive health in animals and is associated with later pubertal development and decreased testosterone production in adolescent and adult males. However, effects of fluoride on female reproductive health and pubertal development are unclear. Therefore, we examined associations of fluoride exposure with reproductive health outcomes among adolescent females in the United States. Methods: The sample included participants from The National Health and Nutrition Examination Surveys (2013 to 2016) who were aged 16-19. There were 524 and 460 participants who had plasma fluoride and household tap water fluoride measurements respectively, at least one reproductive health outcome examined and complete covariate data. We applied covariate adjusted survey-weighted linear or logistic regression to examine associations of fluoride exposure with age of menarche, menstrual cycle regularity, or log2 transformed serum sex steroid hormone levels. Covariates included age, race/ethnicity, body mass index and the ratio of family income to poverty. Participants taking sex hormone medication were excluded from relevant analyses (n=46 and n=41 for plasma and water fluoride samples respectively).Results: Median (IQR) water and plasma fluoride levels were 0.48 (0.53) mg/L and 0.34 (0.30) µmol/L respectively. An IQR increase in water fluoride was associated with a 3.3 month earlier first menstrual period (B= -0.28, 95%CI: -0.54, -0.02, p = 0.05). Additionally, we observed a significant interaction between plasma fluoride and race/ethnicity in association with age of menarche (p = 0.01). For non-Hispanic black females, each IQR increase in plasma fluoride was associated with a 5-month earlier age of menarche (B=-0.42, 95%CI: -0.61, -0.23, p &lt; 0.001). Conclusion: Chronic low-level fluoride exposure may influence reproductive health outcomes in adolescents. These findings, as well as whether non-Hispanic black females are uniquely vulnerable to potential reproductive impacts of fluoride, should be explored in prospective studies.

Menstrual cycle regularity and length across the reproductive lifespan and risk of premature mortality: prospective cohort study.

ObjectiveTo evaluate whether irregular or long menstrual cycles throughout the life course are associated with all cause and cause specific premature mortality (age <70 years).DesignProspective cohort study.SettingNurses’ Health Study II (1993-2017).Participants79 505 premenopausal women without a history of cardiovascular disease, cancer, or diabetes and who reported the usual length and regularity of their menstrual cycles at ages 14-17 years, 18-22 years, and 29-46 years.Main outcome measuresHazard ratios and 95% confidence intervals for all cause and cause specific premature mortality (death before age 70 years) were estimated from multivariable Cox proportional hazards models.ResultsDuring 24 years of follow-up, 1975 premature deaths were documented, including 894 from cancer and 172 from cardiovascular disease. Women who reported always having irregular menstrual cycles experienced higher mortality rates during follow-up than women who reported very regular cycles in the same age ranges. The crude mortality rate per 1000 person years of follow-up for women reporting very regular cycles and women reporting always irregular cycles were 1.05 and 1.23 for cycle characteristics at ages 14-17 years, 1.00 and 1.37 for cycle characteristics at ages 18-22 years, and 1.00 and 1.68 for cycle characteristics at ages 29-46 years. The corresponding multivariable adjusted hazard ratios for premature death during follow-up were 1.18 (95% confidence interval 1.02 to 1.37), 1.37 (1.09 to 1.73), and 1.39 (1.14 to 1.70), respectively. Similarly, women who reported that their usual cycle length was 40 days or more at ages 18-22 years and 29-46 years were more likely to die prematurely than women who reported a usual cycle length of 26-31 days in the same age ranges (1.34, 1.06 to 1.69; and 1.40, 1.17 to 1.68, respectively). These relations were strongest for deaths related to cardiovascular disease. The higher mortality associated with long and irregular menstrual cycles was slightly stronger among current smokers.ConclusionsIrregular and long menstrual cycles in adolescence and adulthood are associated with a greater risk of premature mortality (age <70 years). This relation is slightly stronger among women who smoke.

Do depression, fatigue, and body esteem influence premenstrual symptoms in nursing students?

The purpose of this study was to investigate factors affecting premenstrual symptoms among nursing students, focusing on depression, fatigue, and body esteem. The participants were 145 nursing students at a university located in Changwon, Korea. Data were collected from November 2 to November 30, 2019 using self-reported structured questionnaires, and analyzed using descriptive statistics, independent t-test, analysis of variance, Pearson correlation coefficients, and multiple regression analysis. The mean item score for premenstrual symptoms was 2.52±0.92, indicating a low level. The mean score for depression was 16.05±7.72, and 15.2% of participants were found to be moderately depressed and 9.7% severely depressed. The mean item score for fatigue was 4.84±0.84, indicating a moderate level, and body esteem was 2.94±0.44, indicating a moderate level. The premenstrual symptoms of nursing students showed a statistically significant correlation with depression (r=-.58, p<.001), fatigue (r=.33, p<.001), and body esteem (r=-.28, p<.001). Factors impacting premenstrual symptoms of nursing students were depression (β=.47, p<.001), dysmenorrhea (β=-.18, p=.009), menstrual cycle irregularity (β=.17, p=.013), and body esteem (β=-.14, p=.038). The total explanatory power of these variables was 41.0%. Findings from this sample of nursing students suggest that intervention programs to relieve premenstrual symptoms should focus on depression, menstrual cycle regularity, dysmenorrhea, and body esteem.

Comparative Study of Desogestrel- Containing Oral Contraceptive and Levonorgestrel- Containing Oral Contraceptive in Dysfunctional Uterine Bleeding

Dysfunctional uterine bleeding is a type of abnormal uterine bleeding where vaginal bleeding occurs outside of the menstrual cycle in the absence of any known pelvic pathology. Dysfunctional uterine bleeding can be treated safely with hormone therapy. Combined oral contraceptives help in increased menstrual cycle regularity and decreased blood loss. In this study, a reliable drug for the dysfunctional uterine bleeding with maximum effectiveness and minimal side effects were assessed. This study was conducted on 120 cases of dysfunctional uterine bleeding. Patients who were diagnosed with dysfunctional uterine bleeding were randomly assigned into two groups. Group D and group L included patients who were given Ethinyl estradiol 0.02mg + desogestrel 0.15mg and Ethinyl estradiol 0.03mg + levonorgestrel 0.15mg respectively for the four consecutive 28- day cycles. Menstrual blood loss was assessed using the pictorial blood assessment chart (PBAC) score on 2nd and 4th months of recruitment. Side effects such as weight gain, acne and headache were assessed in both groups. This study shows 56.68% reduction in mean PBAC score in 2 months in desogestrel group whereas only 44.96% reduction in levonorgestrel group and 79.87% reduction in mean PBAC score in desogestrel group in 4 months whereas only 74.46% reduction in levonorgestrel group. Side effects like weight gain, acne and headache were more prominent in the levonorgestrel group than desogestrel group. Desogestrel containing combined oral contraceptive can be a useful and safe treatment for dysfunctional uterine bleeding.