Oligomenorrhea Research Articles

The impact of the war in Ukraine on the physical and sexual development of girls with menstrual disorders

Background. Puberty and the formation of menstrual function are significant stressors for a girl. Traumatic war experience can deepen maladaptive reactions of the body and lead to more serious consequences of menstrual disorders. The purpose of the study was to investigate the features of changes in physical and sexual maturation in girls with menstrual disorders under the influence of a long stay in a front-line city. Materials and methods. One hundred and fifty-three adolescent girls aged 11–18 years were examined, including 69 patients with abnormal uterine bleeding (AUB) and 84 with oligomenorrhea (OM), who resided in a front-line city. The comparison group was girls with similar menstrual disorders who were treated at the pediatric gynecology department of the State Institution “Institute for Children and Adolescents Health Care” in 2019–2021. Clinical anthropometry was performed to assess physical development, and body mass index was calculated. The main indicators of sexual maturation were the degree of development of secondary sex characteristics (breast development, pubic and axillary hair), and the time of onset of the first menstruation. Results. Slightly more than half of the girls with OM (51.9 %) and a third with AUB (37.1 %) had growth within the normative values before the start of the full-scale war. During the war, a tendency to decrease these indicators was noted. Among the deviations both before and during the war, precocious puberty and tall stature prevailed. Stay in the combat zone leads to a decrease in the proportion of adolescents with physiological body mass index. The number of girls with excess body weight and obesity is significantly increasing (in AUB, from 16.7 % before the war to 32.4 % during the war, P < 0.001; in OM, from 12.3 % before the war to 33.3 % during the war, P < 0.0001). A significant increase in precocious puberty among 11–13-year-old girls has been recorded (in AUB, from 75 % before the war to 83.9 % during the war, P < 0.05; in OM, from 38.5 % before the war to 92.3 % during the war, P < 0.000001). The age of menarche has probably decreased due to early menarche (in AUB, the percentage of girls with early menarche in relation to the total number of those surveyed increased from 18.2 % before the war to 31.9 % during the war, P < 0.01; in OM, from 8.5 % before the war to 14.3 % during the war, P < 0.02). Conclusions. The physical and sexual development of girls with menstrual disorders are among the most important indicators of the impact of stress on the body, which can be used as the main, most evident and reliable criteria for the adverse course of menstrual disorders against the background of war.

The association between the follicular distribution pattern of polycystic ovaries and metabolic syndrome development in patients with polycystic ovary syndrome a prospective cohort study

Since a limited number of studies have investigated the different pattern of follicular distribution in the ovaries of PCOS patient, the present study was designed to evaluate the relationship of the follicular distribution pattern (FDP) in the ovaries and MetS as well as insulin resistance index, the sex hormones levels and menstrual status in women with PCOS diagnosis. This prospective study was carried out at Arash Women’s Hospital (Tehran, Iran) from September 2023 to June 2024. All PCOS women who were referred for any gynecological examination were screened. The ultrasound images of polycystic ovarian morphology ovaries were further classified as having a peripheral cystic pattern (PCP) if the follicles were arranged at the periphery of the ovary, or a general cystic pattern (GCP) if the follicles were dispersed heterogeneously throughout the ovarian stroma. The association between the ultrasound follicular distribution patterns and the reproductive items (menstrual status, sex hormones levels and Ferriman-Gallwey score), as well as the metabolic features (insulin resistance index and the MetS rate) were evaluated. Of the 108 PCOS patients evaluated during the study, 51 patients were classified in the PCP ovaries group and 57 patients in the GCP ovaries group. There was no statistically significant difference in terms of women’ age, body mass index, waist circumstance, and the Ferriman-Gallwey score between groups. The frequency of cases with oligo menorrhea in the PCP group was significantly higher than the GCP group (P = 0.006). However, no significant relationship was found between FDP and the baseline serum hormonal levels, total testosterone, and insulin resistance index as well as MetS rate and any components of MetS. No association was identified between the FDP and the rate of MetS, as well as other sex hormones, glucose, and lipids profiles in patients with PCOS; however, the PCP ovaries was linked to menstrual irregularities.

Clinical features of girls with oligomenorrhea based on disease duration

Adolescence is a period between puberty and psychophysical maturity, marked by endocrinological, metabolic, and somatic changes. Menstrual cycle disorders are among the most common abnormalities during this period. Objective — to study the features of physical and sexual development as well as the establishment of menstrual function in adolescent girls with oligomenorrhea, depending on the duration of the disease. Materials and methods. The study involved 194 adolescent girls aged 12—18 years with oligomenorrhea (OM). Depending on the duration of OM at the time of examination, they were divided into four groups. Physical and sexual development as well as the age of menarche onset were evaluated. Results and discussion. The majority of girls had growth within the optimal range. Minor deviations in growth, both delays and advancements, were observed in approximately one-third of patients (26.7 %). Among significant deviations, tall stature predominated, and these changes gradually increased with the duration of oligomenorrhea (OM). With physiological BMI indicators, growth changes were noted in 81.3 % of patients. Hirsutism manifestations intensified with the progression of the disease, potentially signaling the development of polycystic ovary syndrome. The level of sexual development in the vast majority of patients with OM (83 %) was within chronological age. However, acceleration was observed in 75 % of girls aged 11—13 years, while delays were noted in 7.2 % of girls aged 14—18 years. Thus, deviations in sexual development were most frequently registered in younger girls (12—13 years). Early and late menarche occurred significantly more often in adolescents with OM lasting more than 2 years. Conclusions. It was established that oligomenorrhea (OM) in nearly half of the girls (49.5 %) is accompanied by disturbances in physical development, the nature and severity of which depend on the duration of OM. A characteristic feature for younger adolescents with OM was accelerated sexual development (76.7 %). A combination of physical and sexual development disorders was recorded in 61.1 % of the girls. Early menarche was registered in 10.7 % of patients and was a predictor of disease chronicity. Hirsutism increased with prolonged OM duration, suggesting a risk for developing polycystic ovary syndrome.

Peculiarities of echography of pelvic organs disorders of menstrual function during puberty

Background. Pelvic ultrasonography is the method of choice for evaluating genitalia in children as an accurate, painless, non-invasive method that does not require sedation or ionizing radiation. Purpose – to determine the characteristics of ultrasound parameters of the pelvic organs, the level of steroid hormones and insulin in teenage girls with various disorders of the menstrual cycle (oligomenorrhea and abnormal uterine bleeding). Materials and methods. 393 girls with various disorders of the menstrual cycle were examined. 192 adolescents with abnormal uterine bleeding (AUB) and 201 patients with oligomenorrhea (OM). All patients underwent ultrasound examination of the pelvic organs. Serum levels of estradiol, testosterone, cortisol, DHEA-S and insulin were determined. Results. Peculiarities of echosonographic parameters of the uterus and ovaries in girls with various pathologies of the menstrual cycle-AUB and OM have been established. It was found that the increase in the size of the uterus and ovaries with age was characteristic of adolescents with OM, as it also happens during the physiological course of puberty. Such dynamics are not observed in patients with AUB. Phenomena of endometrial hyperplasia were 2.3 times more frequent in AUB (p ˂ 0.0001). Moreover, the thickness of the endometrium depended on the duration of bleeding, and decreased with prolonged uterine bleeding. In girls with OM, the thickness of the endometrium decreased with the increase in the period of existence of the violation of menstrual function. The location of ovarian cysts was observed in every 8–9 girls with disorders of menstrual function and did not differ significantly depending on the type of menstrual disorder. Multifollicular ovaries were detected twice as often. Morphometric and hormonal indicators had different effects on the parameters of the uterus and ovaries in girls with the opposite pathology of menstruation. The size of the uterus and ovaries during bleeding was influenced by BMI, cortisol, and testosterone, and in OM, primarily by age, estradiol, and insulin. Conclusions. The high diagnostic value and safety of ultrasound examinations make them the method of choice for pathology of the pelvic organs in teenage girls, which make it possible to reliably assess the anatomical features and hormonal status of children, to speed up the final diagnosis, which will contribute to the timely and differentiated appointment of treatment to girls with menstrual disorders.

The state of gonadotropic and prolactin-synthesizing function of the pituitary gland in adolescent girls with oligomenorrhea depending on the disease duration

Objective of the study: to find out the characteristics of the content of gonadotropins (luteinizing (LH) and follicle-stimulating (FSH) hormones)and prolactin (PRL) at different duration of oligomenorrhea (OM) in adolescent girls.Materials and methods. A general clinical examination, laboratory study of gonadotropins, PRL, carbohydrate metabolism was conducted in 194 adolescent girls aged 12–18 years with OM. The control group included 30 adolescent girls without OM.Results. The average content of gonadotropins had significant differences with the control group and in comparing the groups with each other. The mean LH values were significantly higher compared to the control group. The duration of OM had a negative effect on the LH level. LH value was increased by almost 3 times during the OM prolongation. PRL value significantly increased in girls with the existence of OM for more than 2 years. Almost 23% of patients had deviations in the content of PRL, both in the direction of increase and decrease. FSH, on the contrary, mostly fluctuated within physiological values. An increase LH/FSH ratio was registered in every fourth girl with OM at the beginning of the disease. Number of girls with high values of this ratio increased by 1.5–1.6 times.OM is characterized by dysgonadotropinemia. It was found in more than half of the patients (53.5%). Normogonadotropinemia was registered in a less than a third of patients (26.3%). Every fifth to sixth girl had hypergonadotropinemia (both gonadotropin hormones are elevated). Hypogonadrtropinemia (both gonadotropin hormones are decreased) was noted in isolated cases. The most frequent variants of dysgonadotropinemia were a combination of high LH and normative FSH, or normative LH and reduced FSH. That is, a relative deficiency of FSH is formed. Conclusions. The most important cause of OM is a violation of hormonal relationships. An increase in the levels of LH and PRL with the extension of the OM duration increases the risk of polycystic ovary syndrome. Regardless of FSH fluctuations, mainly within reference values, a relative FSH insufficiency is formed. Even reduced PRL leads to the metabolic disorders.

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

The aim of the study was to determine the relationship between disorders of menstrual function in adolescence and the risk of nonalcoholic fatty liver disease (NAFLD) with comorbid gastrointestinal pathology. Materials and methods. We examined 129 adolescent girls aged 12–17 years with menstrual disorders (61 with abnormal uterine bleeding (AUB) and 68 with oligomenorrhea (OM)) and measured anthropometrics, indices of lipid and carbohydrate metabolism and liver enzymes. Data are presented in the form of mean (M), standard deviation (SD) and median (Me), a factorial model was developed. Results. The study shows the peculiarities of the clinical course of menstrual function disorders in girls of puberty age. Patients with AUB were characterized by significantly lower average body mass indices, they were younger compared to patients with OM. The nature of metabolic changes that depended on the type of menstrual disorders in teenage girls was clarified. Adolescents with AUB had statistically significantly higher average levels of immunoreactive insulin, HOMA index, triglycerides, very low-density lipoprotein cholesterol, aspartate aminotransferase. This creates conditions for the formation of nonalcoholic fatty liver disease. A model was created regarding the participation of dyslipoproteinemia, changes in the carbohydrate spectrum and levels of liver enzymes in the formation of nonalcoholic fatty liver disease in girls with menstrual cycle disorders. Conclusions. Disorders of menstrual function are associated with an increased risk of NAFLD formation. Adolescent girls with menstrual disorders need metabolic screening. The atherogenic profile of lipoproteinemia, marked changes in the carbohydrate spectrum and increased serum levels of liver enzymes in girls with menstrual cycle disorders are the basis for the formation of nonalcoholic fatty liver disease.

Determination of predictive factors in families of girls with menstrual disorders comorbid with endocrine system pathology

Objective — to determine predictive factors in the families of girls with menstrual disorders comorbid with endocrine system pathology. Materials and methods. The genealogical analysis was carried out in the families of 47 girls with oligomenorrhea (OM) and 44 girls with abnormal uterine bleeding (AUB) comorbid with endocrine system pathology. The comparison group consisted of the pedigrees of 30 families of healthy girls living in Kharkiv and Kharkiv Region. During the genealogical study, we observed the principles of the Declaration of Helsinki, the Council of Europe Convention for the Protection of Human Rights and Dignity of the Human Being, and the relevant laws of Ukraine. The Student’s t­test was used to determine the significance of the differences between the signs. The predictive implications of the studied signs were determined by the Wald method with informativity estimation using the Kullback criterion. Results and discussion. Hereditary burden of reproductive, gynecological non­inflammatory, endocrine diseases and environmental factors was identified in the families of girls with OM and AUB comorbid with endocrine pathology: pernicious habits and stress in the mothers of sick girls before and during pregnancy, threatened miscarriage. Risk factors for the sick girls included artificial feeding of a girl, stress, traumatizing of a girl, and prolonged use of the Internet and gadgets. Among non­communicable diseases in relatives of sick girls, the most common were gynecological non­inflam­matory diseases when compared with the relatives of girls with AUB and healthy girls (p < 0.001), while relatives of healthy girls mostly suffered from nervous system disorders (p < 0.05). Common and distinct predictive signs in the families of girls with OM and AUB and comorbid endocrine pathology have been identified. Conclusions. The predictive factors in the families of girls with OM and AUB have been identified, the use of which will allow forming high-risk groups as regards the high risk of menstrual disorders based on the genealogical analysis.

Vitamin and microelement supply of adolescent girls with menstrual function disorders

Objective — to identify the relationship between changes in the concentration of vitamins A, E, D, magnesium content, and comorbid pathology in adolescent girls with menstrual function disorders. Materials and methods. Examinations involved 237 girls with menstrual function disorders aged 11—18 years. Oligomenorrhea (OM) was diagnosed in 103 patients, and abnormal uterine bleeding (AUB) in 134 girls. Results and discussion. Comorbid pathology was revealed in most patients, regardless of the type of menstrual function disorder. Endocrine system disorders were the most frequent comorbidities. In girls with OM, comorbid endocrine disorders were accompanied by a decrease in the levels of vitamins A (pu < 0.01) and E, due to decrease in the frequency of their elevated indicators (pφ < 0.03). At the same time, mostly normal magnesium levels were registered (pφ < 0.001) due to a decrease in the frequency of its reduced and elevated levels compared to patients without pathology. In girls with AUB, comorbid endocrine system pathology was accompanied by decrease in the frequency of optimal levels of 25(OH)D3 (pφ < 0.03), and comorbid pathology of the neuro-­psychiatric sphere was accompanied by decrease in the frequency of elevated levels of vitamins A (pφ < 0.01) and E (pφ < 0.03) compared to girls without pathology. Regardless of the type of menstrual disorder, the greatest number of changes in the vitamin status were found in girls with comorbid pathology of the endocrine system. In patients with OM, the retinol levels were lower than in girls with AUB (pφ < 0.01), and a decrease in tocopherol levels was observed (pφ > 0.05). In girls with AUB, elevated levels of vitamin A (pφ < 0.03), vitamin E (pφ < 0.04), and moderate vitamin D deficiency (pφ < 0.03) were more frequently registered compared to girls with OM. Vitamin D deficiency in girls with abnormal uterine bleeding was less frequently registered compared to patients with oligomenorrhea (pφ < 0.05). It should be noted that comorbid pathology of the digestive system in abnormal uterine bleeding was mostly often accompanied by the decreased tocopherol levels (pφ < 0.05) and normal magnesium values (pφ < 0.04) compared to patients with oligomenorrhea. Conclusions. The study revealed a correlation between fluctuations in the content of vitamin status components and comorbid pathology in girls with menstrual disorders. The most pronounced changes in oligomenorrhea were found under conditions of concomitant pathology of the endocrine system, while in abnormal uterine bleeding, they were identified in the presence of endocrine disorders and disturbances in the neuro­psychiatric sphere. The combination of oligomenorrhea and endocrine pathology, as well as abnormal uterine bleeding and nervous disorders, is accompanied by a decrease in retinol and tocopherol reserves, creating conditions for the deterioration of compensatory­adaptive reactions of the body by suppressing the low-­molecular-­weight link of the antioxidant defense system. Abnormal uterine bleeding and concomitant endocrine disorders are associated with more pronounced moderate vitamin D deficiency.

Features of steroid hormone levels in girls with menstrual cycle disorders and mental health disorders

Objectives of the study: to investigate the peculiarities of the steroid hormone status in girls with menstrual function disorders, depending on comorbid psychopathology.Materials and methods. A total of 174 girls with menstrual function disorders (78 with abnormal uterine bleedings (AUB) and 96 with oligomenorrhea (OM)) were examined. The diagnosis of psychopathology was determined based on the clinical presentation at the time of examination. The comparison group consisted of 35 girls with a normal menstrual cycle.The laboratory examination included the assessment of estradiol, testosterone, cortisol (C), and dehydroepiandrosterone sulfate (DHEA-S) levels. The C/DHEA-S ratio was calculated using the unprocessed raw values. Results. Menstrual function disorders are often associated with hypoestrogenemia, a prevalent phenomenon. It was observed in almost a third of patients with AUB, whereas in girls with OM this number was significantly higher. Significant reduced values are found in girls with accompanying depressive states, especially in cases of AUB and OM. In instances of AUB and OM, the number of individuals with elevated levels of testosterone increased by 1.97–2.2 times in the presence of psychopathology. DHEA-S in patients with AUB was reduced in more than half of the girls, while in patients with OM it varies evenly in both directions, regardless of the presence or absence of psychopathology. A C level were more often reduced than increased, and achieves statistical significance when OM combined with neurotic disorders and AUB combined with depressive states. The C/DHEA-S ratio, as a stress indicator, was statistically significantly elevated in patients with AUB. This may suggest more pronounced manifestations of stress in patients with AUB than in girls with OM and a higher adaptability of the girls’ bodies with OM.Conclusions. Thus, the understanding of the role of reproductive steroids in the development of menstrual function disorders during adolescence has been deepened. Distinctive features of their interrelations in the presence of psychopathology have been identified. The impact of cortisol and DHEA-S, as well as C/DHEA-S ratio, on mental well-being in endocrine-related gynecological disorders in girls has been established

Характер психічних відхилень та їх гормональний супровід у дівчат-підлітків з розладами менструальної функції

The pubertal period is accompanied by the tension of the adaptation system during the hormonal adjustment. Purpose - to define the hormonal determinants of stress-related menstrual disorders in adolescent girls with comorbid mental disorders and the peculiarities of adaptation reactions. Materials and methods. 150 adolescent girls with menstrual cycle disorders were examined. The levels of luteotropic hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), estradiol (E2), testosterone (T), cortisol (K), dehydroepiandrosterone sulfate (DHEA-S) were determined. They were divided into three groups depending on the examination by a psychiatrist: without mental status disorders, with anxiety-phobic disorders and depressive states. The control group included 35 girls of similar age with a normal menstrual cycle who were examined in the early follicular phase. Results. There were no significant differences in the content of gonadotropic hormones in girls with menstrual function disorders in view of the state of mental health. However, in girls with oligomenorrhea (OM), in relation to patients with abnormal uterine bleeding (AUB), elevated LH values are significantly more often registered (p<0.03). Levels of peripheral T, as well as its precursor DHEA-S and metabolite (E2), were associated with mental health status. The lowering of E2 significantly elevated in adolescents with comorbid psychopathology. The number of girls with high T values increased in the presence of psychopathology in AUB and remained unchanged in OM. Cortisol in psychopathology, regardless of the type of menstrual function disorders, was reduced in relation to the control group, however, in girls with OM, its content was significantly higher, especially in depressive states (p˂0.05). The specific gravity of girls with a reduced level of DHEA-S in patients with AUB increased with comorbid psychopathology. In case of OM, a reduced and increased content of DHEA-S was registered with the same frequency. An increase in the C/DHEA-S indicator of the functioning of the hypothalamic-pituitary-adrenal system in patients with OM was noted much less frequently than in patients with AUB (p˂0.006). Conclusions. It is believed that the hormonal relationship between cortisol and DHEA-S indicates the body’s response to stressors and can be used as one of the biomarkers of neurotic and depressive states. An increase in the C/DHEA-S ratio suggests a possible dissociation of their secretion. Adolescents with AUB, unlike girls with OM, have a decrease in the “protective” hormone DHEA-S, which can affect the deterioration of mental health. 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.

Клінічні особливості порушень менструальної функції, асоційованих із психопатологією

The health of the younger generation is a public value. Today, the state of health of teenage girls is of particular concern due to its progressive deterioration. Purpose - to study the features of the clinical course of menstrual function disorders in adolescent girls with comorbid mental health disorders. Materials and methods. 154 girls aged 11-17 were examined with menstrual cycle disorders (77 with oligomenorrhea (OM) and 77 with abnormal uterine bleeding (AUB)). Assessment of physical and sexual development, age of menarche was carried out. Depending on the examination by a psychiatrist, all girls with OM and AUB were divided into groups: without deviations in mental status, with anxiety-phobic disorders and depressive states. Results. It was found that the average growth indicators were probably higher in girls with OM in relation to adolescents with AUB, especially in the presence of psychopathology. The use of BMI did not reveal a significant difference when comparing patients with OM and AUB. Abnormalities of sexual development were probably more often registered in patients with AUB, with its advance, this acquired a significant difference (p˂0.01) and depended on both body mass index (BMI) and psychopathology. If the percentage of patients with disorders of sexual development did not differ depending on psychopathology in girls with AUB, then in adolescents with OM, the specific weight of girls with abnormalities of sexual development increased with the appearance of psychopathology. The average age of menarche was significantly lower in patients with AUB compared to patients with OM (p˂0.003). Early menarche was more typical for AUB. Much more often in adolescents with AUB, it was registered with normative fluctuations of BMI and its excess, as well as with anxiety-phobic disorders both with AUB and OM. Conclusions. The analysis of the conducted studies indicates reliable differences regarding the clinical course of menstrual function disorders by the type of OM and AUB with comorbid psychopathology. It was established that there are significant differences in such indicators as growth, puberty, time of menarche, which depended on the type of menstrual disorders and comorbid psychopathology. 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 participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

Hormonal profiles and adjustment disorders in adolescent girls with menstrual abnormalities and comorbid pathology

Background. The reproductive health of girls has acquired great social significance in connection with the problem of quantitative and qualitative reproduction of the population. The purpose of the study was to determine the hormonal status of adolescent females with menstrual disorders and various somatic pathologies and to investigate the state of adaptive-compensatory capacities in these patients. Materials and methods. The hormonal background was studied in 391 girls aged 12–17 years: 175 with abnormal uterine bleeding (AUB) and 216 with oligomenorrhea (OM). All patients were examined by a multidisciplinary team. Results. A comorbid pathology was found in the absolute majority of girls with menstrual abnormalities. Endocrine disorders were noted more often (pϕ < 0.001–0.00001). Indicators of hormone concentration in patients with menstrual disorders had no significant differences depending on the type of comorbidity. Probable changes in the content of some hormones were observed depending on the type of menstrual disorders. A significant increase in the level of luteinizing hormone (pu < 0.02) and a decrease in estradiol (pu < 0.02) were observed in patients with OM compared to those with AUB. The assessment of the adjustment state revealed that in girls with menstrual disorders, the average cortisol content did not differ from that of controls, and insulin was higher than in the comparison group (pu < 0.001). Ho­wever, high cortisol values (above 90 percentile) were noted in 8–13 % of patients with AUB and OM. The stress index (C/In) as a marker of a nonspecific stress response was lower than in the comparison group (pu < 0.0001), and it was probably higher in girls with OM than in adolescents with AUB (pu < 0.004). Conclusions. An interdisciplinary approach is a mo­dern strategy in the treatment of menstrual disorders in adolescence. A decrease in the stress index was found in girls with menstrual disorders, which may indicate a decrease in adaptive capacity. Moreover, adolescents with OM are more adjusted to menstrual disorders than girls with AUB.

Оцінка адаптаційно-компенсаторних можливостей дівчат із розладами менструальної функції

The duration and regularity of the menstrual cycle are influenced by many factors, including psychosocial stress, which can lead to activation of the hypothalamic-pituitary-adrenal system. Purpose - to assess the levels of stress hormones cortisol, insulin (IRI), prolactin, and the cortisol/insulin (K/In) index in adolescent girls with menstrual disorders. Materials and methods. 177 adolescent girls aged 12–17 years with menstrual disorders were examined (87 with abnormal uterine bleeding (АUB), 90 - with oligomenorrhea (OM)). The comparison group consisted of 57 girls of the same age with normal menstrual cycles examined in the early follicular phase. The level of cortisol, insulin, prolactin (PRL) was measured in blood serum on an empty stomach using the immunoenzyme method to determine the level of organism’s adaptive capabilities. All hormones were defined according to the instructions for the kits. The ratio of K/In was calculated. Results. In girls with menstrual disorders, three types of reaction from the adrenal glands were found, which were expressed in increased levels of cortisol above 75 and 90 percentile, a decrease (below 10 percentile) and its fluctuations within physiological values. At cortisol values above the 90 percentile, the average level of glucose, IRI, and HOMA in teenage girls with OM did not differ from the normative values, and in patients with AUB these indicators were significantly higher than in adolescents with OM. The K/In ratio in girls with OM by 1.8 times exceeded the similar indicator of adolescents with AUB (p<0.04) and was slightly higher than in the comparison group, which indicates a satisfactory reaction of stress tolerance. With AUB, this coefficient decreased, which may indicate exhaustion of the body’s adaptive capabilities. The same situation was observed when cortisol increased above the 75 percentile. When the cortisol level was within physiological values, the content of glucose and IRI also did not go beyond the limits of normative fluctuations. The stress ratio (K/In) had no significant difference depending on the type of violations and was significantly reduced. The absence of changes in the content of cortisol and IRI in the blood serum in response to the onset of menstrual disorders may indicate a certain instability in the development of the body's protective reactions in teenage girls with menstrual disorders. Conclusions. The revealed changes in the content of cortisol, insulin, K/In and PRL as markers of a non-specific stress reaction in the structure of the adaptive response in disorders of menstrual function carry additional information about impaired adaptation to stress and the state of compensatory capabilities of the girl's body, expand the understanding of pathogenetic mechanisms these disorders and can be used both in the assessment of the state of adaptation and in the development of appropriate preventive strategies. 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 all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

The relationship between comorbid pathology, vitamin D status, and disorders of menstrual function in adolescent girls

Objective — to determine the nature of comorbid pathology in modern adolescent girls with disorders of menstrual function, and to establish the relationship between vitamin D status and comorbid pathology. Materials and methods. The analysis has been performed for the results of clinical and paraclinical examination of 333 adolescent girls aged 11—17 with menstrual disorders (primary oligomenorrhea and abnormal uterine bleeding). Physical and sexual development was determined, body mass index was calculated. The serum levels of vitamin D, prolactin, thyroid­stimulating hormone were evaluated. Results and discussion. Comorbid pathology was diagnosed in the absolute majority of adolescent girls with disorders of menstrual function, both of abnormal uterine bleeding (AUB) and oligomenorrhea (OM) types. Diseases of the endocrine system were registered mostly often; digestive pathologies and neuropsychological abnormalities were less common. In patients with OM, comorbid conditions of the digestive system and the neuropsychological area were registered significantly more often. Peculiarities of physical, sexual development, and menstrual function were established, which depended on the presence of various comorbid pathologies and the type of menstrual function disorders. Vitamin D insufficiency and its deficiency were observed in the majority of girls with both AUB and OM, and no significant difference was found in various comorbid pathologies. Normative values of vitamin D were noted in no more than 12—18 % of cases and tended to decrease in presence of the diseases of endocrine system. Conclusions. The obtained results demonstrated the importance of a multidisciplinary approach to the examination of patients with menstrual cycle disorders, as a guarantee of increasing the effectiveness of treatment and preventive measures with the aim of restoring reproductive potential.

Effect of the presence of polycystic ovary syndrome-related features on anti-Mullerian hormone and androstenedione levels in adolescents with or without menstrual irregularity.

To determine the variation in anti-Mullerian hormone (AMH) and androstenedione (A4) concentrations in adolescent girls, with or without menstrual cycle disorder in relation to phenotypic features of. PCOS. Adolescent girls (n = 129), age range 14-19years, were recruited in the cohort study. All participants were in the 4th or 5th year after menarche. Sixty-eight had menstrual irregularities, usually oligomenorrhea (OM), and 61 had regular menstruation (RM). AMH and A4 concentrations were measured. Hirsutism was recorded. Polycystic ovarian morphology (PCOM) was evaluated by transabdominal pelvic ultrasonography. Polycystic ovary syndrome (PCOS) features were defined according to Rotterdam consensus criteria. AMH and A4 were significantly higher in adolescent girls with OM than in girls with RM (p < 0.05). A4 and body mass index (BMI) of adolescents with OM was significantly higher in those with hirsutism than those without hirsutism (p = 0.01 and 0.008, respectively). There was a positive correlation between A4 and BMI (r: 0.327, p < 0.01). Logistic regression showed that the frequency of OM in the presence of PCOM was 10.8 times (95% CI 2.04-12.09) compared to those without PCOM. The highest AMH concentrations were found in girls with OM, hirsutism, and PCOM (p < 0.05). AMH and A4 are elevated in adolescents with oligomenorrhoea. High A4 is more prominent in the presence of hirsutism and is associated with increased BMI. PCOM, increases the likelihood of oligomenorrhea by about 10 times. AMH increase as the combination of clinical features of PCOS increases in adolescents with menstrual irregularity.

Associations of diet, physical activity and polycystic ovary syndrome in the Coronary Artery Risk Development in Young Adults Women\u2019s Study

BackgroundCurrent evidence supports the adoption of healthy diet and physical activity (PA) behaviors in patients with polycystic ovary syndrome (PCOS), given the positive effects of those behaviors on physical well-being. An improved understanding of the associations between diet and PA with PCOS is needed to ascertain whether tailored dietary and PA recommendations are needed for this population. Thus, we investigated the associations of diet and PA with PCOS and its isolated features.MethodsCross-sectional study. Of the 748 women who were included in this study from the Coronary Artery Risk Development in Young Adults (CARDIA) Women’s Study, 40 were classified as having PCOS, 104 had isolated hyperandrogenism (HA) and 75 had isolated oligomenorrhea (OA). Dietary intake was measured using the CARDIA diet history questionnaire and diet quality was scored using the Alternative Healthy Eating Index 2010; a higher score indicated a better quality diet. Self-reported PA was measured using a validated interviewer-administered questionnaire. Polytomous logistic regression analyses examined the associations between diet and PA with PCOS, HA, and OA status (outcomes), adjusting for age, race, total energy intake, education, and/or body mass index. The threshold for statistical significance was set at p < 0.05.ResultsMean age of the participants was 25.4 years (SD 3.6) and 46.8% of participants were Black women. There was little to no association of total energy intake, nutrients, diet quality, and PA with PCOS, HA or OA status.ConclusionEnergy intake, nutrient composition, diet quality, and PA were not associated with PCOS, supporting recent PCOS guidelines of using national recommendations for the general population to encourage health-promoting behaviors among women with PCOS. However, longitudinal studies evaluating changes in diet and physical activity in relation to the development and/or the progression of PCOS are needed to establish a causal association.

Changes of vitamin E level in adolescent girls with uterine hypoplasia against the background of hypomenstrual syndrome during follow-up study

Objective — to assess changes of vitamin E level in adolescent girls with uterine hypoplasia against the background of hypomenstrual syndrome (HMS) during follow-up study.Materials and methods. We examined 40 adolescent girls, aged 14–18 years, with HMS against the background of uterine hypoplasia, particularly those with oligomenorrhea (OM) and secondary amenorrhea (SA), vitamin E level in whose blood serum we had determined before and after the 2 weeks of treatment. Patients were subjected to background therapy and ultraphonophoresis (UP) of vitamin E.Results and discussion. In the process of follow-up study we identified a correction of tocopherol level in blood serum of patients with HMS: increase in frequency of normal indices and decrease in that of low ones. Moreover, during background therapy this is observed mostly in girls with OM, while during treatment with UP of vitamin E it is evident mostly in those with SA. With background therapy positive dynamics of change in tocopherol level are more frequently registered in girls with ineffective treatment, while in case of using UP of vitamin E they are more often registered in patients with effective treatment.Conclusions. Using non-hormonal methods in treatment of adolescent girls with HMS against the background of uterine hypoplasia leads to positive dynamics of change in concentration of vitamin E, which in turn contributes to emergence of menstruations in every third girl in case of background therapy and in 61% of them in case of UP of vitamin E.

POLYCYSCTIC OVARIAN SYNDROME (PCOS);

Objective: To compare effectiveness of clomiphene alone and in combinationwith metformin in terms of conception rate in patients presenting with polycystic ovary syndrome.Study Design: Randomized clinical trail. Place and duration of study: Department Obstetricsand Gynecology Unit I, Nishtar Hospital Multan, 6 months from 12th September 2009 to 11thMarch 2010. Methodology: Primary subfertile women visiting outpatient department of NishtarHospital Multan with significant irregular menstrual cycle, oligo menorrhea and ultrasonographicfeatures of polycystic ovaries were enrolled in the study. Semen samples from male partners wereanalyzed according to the WHO criteria. Women whose partner’s semen analysis was abnormalwere excluded from study. Group ‘A’ was given clomiphene citrate alone and second group (i.e.group B) was given colmiphene citrate and metformin. All patients were followed till six cycles forregularity of menstrual cycle (determined by history) ovulation by follicular tracking onultrasonography, if patient (conceived), conception was confirmed by urine pregnancy test andgestational sac on ultrasonography pelvis. Final outcome was measured at six month.Information was entered in specifically designed proforma. Results: Frequency of PCOS was14.05%. Mean age of the patients was 31.03 ± 0.58 vs. 29.89 ± 0.53 years in group A and Brespectively. Oligomenorrhea was present in 18(50%) vs. 18 (50%) women, amenorrhea in7(19.4%) vs. 8(22.2%) patients and weight gain in 14(38.9%) vs. 15(41.7%) cases in group A andB respectively. Conception was achieved in 26(72.2%) vs. (18(50.0%) patients in group A and Brespectively. Conclusions: Metformin does not seem to help in achieving higher rates ofpregnancy when combined with CC as compared to CC alone.

Protective effects of GABA against metabolic and reproductive disturbances in letrozole induced polycystic ovarian syndrome in rats

BackgroundPCOs is a heterogeneous disorder with anovulation/oligo ovulation usually taken as oligo menorrhoea or amenorrhoea, hyperandrogenemia, hirsutism, acne, androgen alopecia and polycystic ovaries as the key diagnostic feathers. The study was undertaken to investigate the possible protective and ameliorating effects of GABA in Letrozole induced PCOS model in rats by targeting insulin resistance.MethodsPCOs in Adult female rat was induced by the daily gastric administration of letrozole (1 mg/kg/day) in CMC (0.5%) for 36 days. Rats were given metformin (2 mg/kg), GABA (100 mg/kg/day) and GABA (500 mg/kg/day) along with letrozole. One group severed as vehicle control. On the 37 day, the animals were euthanized, and anthropometrical, biochemical (glucose, insulin, lipids, testosterone, Estradiol, Progesterone, oral glucose tolerance test, total protein content in ovary, cholesterol level, triglyceride, HDL, LDL), Antioxidants (CAT, POD, GSR, ROS, GSH, TBARS), and histopathological evaluation of ovaries were carried out. Daily colpocytological examination was also carried out until the termination.ResultsBoth the doses of GABA significantly reduced body weight, body mass index and testosterone. While the levels of CAT, SOD, POD and Estradiol (E2) were significantly increased in the both doses of GABA. A favourable lipid profile, normal glucose tolerance, and decreased in the percentage of estrus smears were observed. Histopathological examination of ovary revealed a decreased in the number of cystic follicles, and decreased in the adipocytes respectively. The effects observed with GABA were comparable to that with metformin.ConclusionThe results suggest that GABA treatment has shown protective effect in PCOs and provide beneficial effect either by reducing insulin resistance or by inducing antioxidant defence mechanisms.

A Population-Based Study of the Prevalence of Abnormal Uterine Bleeding and its Related Factors among Iranian Reproductive-Age Women: An Updated Data.

Abnormal uterine bleeding (AUB) is one of the most common gynecologic complaints among reproductive-age women. The purpose of this study was to investigate the prevalence of AUB and its related factors among reproductive age Iranian women. A population-based cross-sectional study was conducted on 1393 women aged 15 - 45 years who participated in the Tehran Lipid and Glucose Study in 2009 - 2012. FIGO terminology and previous definitions were used for classification of AUB. Logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals to check the association between AUB and the women's demographic characteristics. P < 0.05 was considered statistically significant. A total of 35.8% (95% CI: 31.5% - 40.2%) of the participants suffered from one or more types of AUB. About 10.6% (95% CI: 6.3% - 12.5%) of them had disturbances of regularity and 23.8% (95% CI: 18.4% - 26.1%) reported experiencing disturbances of frequency. Also, disturbances of heaviness of flow and duration of flow were reported in 16% (95% CI: 12.7% - 19.2%) and 11.5% (95% CI: 8% - 15.4%), respectively. About 4.3% of the women (95% CI: 2.1% - 10.5%) reported irregular non-menstrual bleeding. According to previous definitions, the prevalence of heavy periods, metrorrhagia, polymenorrhea, oligomenorrhea, amenorrhea and inter-menstrual bleeding in reproductive aged women was 15.2%, 18.9%, 10.6%, 15.2%, 2.2%, and 4.3%, respectively. In addition, the proportions of women with AUB rose in the early and late reproductive years. After adjustment of confounders, logistic regression analysis showed that age (adjusted OR = 1.08, 95% CI: 1.07 - 3.97, P = 0.03) and BMI (adjusted OR = 1.05, 95% CI: 1.02 - 3.04, P = 0.04) had statistically significant associations with AUB. The prevalence of AUB as a possible clinical indicator of underlying disorders was high among Iranian reproductive age women. Healthcare providers and policy makers are required to acknowledge these disorders and provide education and counseling opportunities for the public to inform them when and how to seek medical advice.