Postmenarcheal Girls Research Articles

Menarche in adolescents from Vojvodina (the Republic of Serbia) in the period 2001-2019.

Objective:Menarcheal age is the starting point of reproductive life and could be a marker of health and socioeconomic status of a population.The aim of this study was to assess the temporal pattern in variability of menarcheal age from 2001 to 2019 and the relationship with biological factors and educational level of parents. Subjects and methods: A cross-sectional anthropometric survey was conducted in three intervals: 2001-2004, 2011-2014 and in 2019. In total, 5201 adolescent girls from Vojvodina (North Serbia) aged 11-18 were surveyed, 3272 (62.91%) of them with menarche. Data on the age at menarche was gathered applying status quo method and the age at menarche was calculated by probit analysis. The surveyed traits included height, weight and Body mass index (BMI). Results: Mean menarcheal age declined from 12.60 ± 1.11 years to 12.33 ± 1.20 years during the period from 2001 to 2019. Within three investigated periods variance decreased after the first decade from 1.23 year2 to 1.09 year2, and then increased to 1.44 year2. On average, postmenarcheal girls were 4.36 cm taller, 8.03 kg heavier, and their BMI was 1.96 kg/m2 higher than in premenarcheal girls of the same calendar age. An inverse effect of BMI and mother's education on the menarcheal age was detected, but the interaction between the variables was not statistically significant. Conclusion: These results indicate continuing decrease in menarcheal age in girls from Vojvodina. Menarche is closely associated with BMI and it appears that this factor effects the age at menarche irrespective of the parents' education.

Influência da classe socioeconômica, tamanho da família e a antropometria na idade da menarca

O objetivo do estudo foi verificar a idade da menarca (IM) e comparar à classe social, antropometria pré e pós-menarca. Amostra com 1026 meninas de 10 a 18 anos, divididas em dois grupos: pré-menarca 29,2% (n=299) e pós-menarca 70,8% (n=727). A IM foi obtida pelo método status quo. As comparações de diferenças entre a classe econômica e tamanho da família com a IM foi utilizada a análise de variância (ANOVA one-way), entre os grupos pré-menarca e pós-menarca o teste “t” de Student. A média total da IM na classe social foi de 11,91 ± 0,41 e tamanho da família 11,90 ± 0,21. As meninas de famílias classe A alta (p=0,02) atingiram menarca em torno de 6,0 a 8,0 meses mais cedo do que os seus pares de famílias de classe média e baixa. A comparação entre o pré e pós-menarca apresentaram diferenças significativas nas variáveis antropométricas p<0,001. Com base nos achados as meninas de famílias de classe elevada parecem menstruar mais cedo do que as meninas de classe social inferior. Na antropometria, as meninas do pós-menarca foram significativamente mais altas e mais pesadas. Já, as meninas pré-menarca mostraram um corpo linear melhor refletido pelo índice ponderal.

The association between menarche and myopia and its interaction with related risk behaviors among Chinese school-aged girls: a nationwide cross-sectional study.

Nearly 80% of new cases of myopia arise between 9 and 13 years old when puberty development also progresses rapidly. However, little is known about the association between myopia and puberty. We aim to evaluate the association between myopia and menarche, the most important puberty indicator for girls, and to test whether menarche could modify the effects of myopia-related behaviors. The participants came from two consecutive national surveys conducted in 30 provinces in mainland China in 2010 and 2014. We included 102,883 girls (61% had experienced menarche) aged 10-15 years. Risk behaviors for myopia which included sleep duration, homework time, and outdoor activity were measured by self-administrated questionnaire. Myopia was defined according to a validated method, and its relationships with menarche status and behaviors were evaluated by robust Poisson regression models based on generalized estimated equation adjusting for cluster effect of school. We found that postmenarche girls were at 13% (95% confidence interval: 11%-16%) higher risk of myopia than premenarche girls, after adjusting for exact age, urban-rural location, survey year, and four behavioral covariates. Short sleep duration (<7 h/d), long homework time (>1 h/d) and low frequency of weekend outdoor activity tended to be stronger (with higher prevalence ratios associated with myopia) risk factors for myopia in postmenarche girls than in premenarche girls, and their interaction with menarche status was all statistically significant (P < 0.05). Overall, our study suggests that menarche onset may be associated with increased risk of myopia among school-aged girls and could also enhance girls' sensitivity to myopia-related risk behaviors.

Menstrual Pattern, Reproductive Hormones, and Transabdominal 3D Ultrasound in 317 Adolescent Girls.

The knowledge of normal variation of reproductive hormones, internal genitalia imaging, and the prevalence of gynecological disorders in adolescent girls is limited. The study aimed to describe reproductive parameters in postmenarchal girls from the general population including the frequency of oligomenorrhea, polycystic ovary syndrome, and use of hormonal contraception. The Copenhagen Mother-Child Cohort is a population-based longitudinal birth cohort of 1210 girls born between 1997 and 2002. University hospital. A total of 317 girls were included, with a median age of 16.1 years and time since menarche of 2.9 years. Tanner stage, height, weight, age at menarche, menstrual cycle length and regularity, ovarian/uterine volume, and number of follicles were recorded. Serum concentrations of FSH, LH, anti-Müllerian hormone (AMH), inhibin B, estradiol, testosterone, SHBG, androstenedione, dehydroepiandrosterone sulfate, 17-OH-progesterone, and IGF-1 were measured. Twenty girls (6.3%) had oligomenorrhea and differed significantly in serum androgens and AMH, age at and time since menarche from girls with regular cycles. Twenty-seven girls were classified with PCOS (8.5%) and had significantly higher 17-OH-progesterone, estradiol, AMH, LH, and age at menarche than the reference group. Girls on oral contraception had significantly higher serum SHBG concentrations and lower serum concentrations of all hormones except AMH and IGF-1. Ovarian follicles 2 to 29.9 mm correlated positively with serum AMH (P < 0.0001). Most 16-year-old girls had regular menstrual cycles, normal reproductive hormones, and uterine and ovarian ultrasound. Serum AMH reflected ovarian follicle count and may be a useful biomarker of ovarian reserve.

Prevalence and predictors of dysmenorrhea among a population of adolescent's schoolgirls (Morocco).

Dysmenorrhea is the most common gynaecological problem among young females. In Arabic countries, few studies on gynaecological problems of adolescent’s girls were published. Objective: the aim of the study was to determine the prevalence of dysmenorrhea and associated factors among adolescents in public schools at Marrakesh. Methods: we conducted a cross-sectional study; our data was collected via a questionnaire and the statistical analysis was done using SPSS version 21. Our random sample counted 364 post-menarcheal girls aged between 12 and 20 years who participated voluntarily in our study. Results: the mean age at menarche was 12.89 ± 1.34 years; the prevalence of dysmenorrhea was 78% and 58.1% of them suffering from severe dysmenorrhea that increased clearly with the chronological age. Dysmenorrhea was cause for missing school among 13% of girls and the most common symptoms associated with it were backache, fatigue, irritability and anxiety. The gynecological age was found to be the only predictive factor of dysmenorrhea among schoolgirls. Conclusion: reproductive health education should be improved enough by including them in the school curriculum to prepare girls for menstruation and inform them about problems related to this phenomenon, especially dysmenorrhea.

OR27-07 11-oxygenated C19 Steroids in Normal Weight, Overweight, and Hyperandrogenic Girls

Hyperandrogenism (HA) often begins during puberty and may be a forerunner to polycystic ovary syndrome (PCOS). PCOS women have elevated 11-oxygenated androgens (O’Reilly MW et al, JCEM 2017), but the contribution of these androgens to HA in peri-pubertal girls is unknown. To address this uncertainty, we assessed classical and 11-oxygenated steroid levels at baseline and in response to both ACTH and recombinant human chorionic gonadotropin (r-hCG) administration in peri-pubertal girls. Girls (n=35) were studied in the mid-follicular phase (as relevant): age 13.1±3.1 (7.3-18.8) y (mean ± SD [range]); BMIz 1.1±1.1 (-1.08 to +2.65); Tanner breast 3.8±1.4 (1-5); bone age 14.1±3.1 (7.3-18) y. Of pre-menarcheal (PRE) girls, 4 were normal weight (NW, BMI% 5-84) and 7 overweight (OW, BMI% ≥ 85). Of post-menarcheal (POST) girls, 10 were NW, 6 OW, and 8 HA (3 NW, 5 OW). Blood was drawn at baseline (8 am, no meds); post-ACTH (60 m after 250 mcg IV, 10 h after dexamethasone [DEX, 1 mg PO]); and post-r-hCG (24 h after 50 mcg IV, 10 h after second dose DEX). Serum concentrations of classic (dehydroepiandrosterone [DHEA], androstenedione [A4], testosterone [T], dihydrotestosterone [DHT]) and 11-oxygenated androgens (11OHA4, 11KA4, 11OHT, and 11KT) were measured by liquid chromatography-tandem mass spectrometry. Wilcoxon Rank Sum and simple Spearman correlations were used for comparisons. Unless stated otherwise, p≤0.05 for all results reported below. At baseline, 11KT was 3-fold higher than T in PRE girls (1.2±0.6 vs. 0.4±0.2 nmol/L), while they did not differ in non-HA POST girls (1.4±0.6 vs. 1.1±0.5 nmol/L). The ratio of A4/T was 6.6±2.7 and 6.0±1.6 in PRE and non-HA POST girls, respectively, while 11KA4/11KT was 3.8±1.8 and 3.7±2.9, respectively; this suggests more efficient activation of 11-oxygenated androgens. Compared to NW POST girls, OW POST girls had higher T at baseline (1.9±0.9 vs. 1.2±0.8 nmol/L) and higher A4 post-ACTH (10.0±4.3 vs. 6.6±1.5 nmol/L). Compared to non-HA POST girls, HA girls had higher T at baseline (2.2±1.1 vs. 1.1±0.5 nmol/L) and higher DHEA, A4, and T post-r-hCG (DHEA: 8.8±2.7 vs. 5.6±2.2; A4: 11.3±4.1 vs. 7.3±2.8; T: 3.4±2.9 vs. 1.2±0.6 nmol/L). 11-oxygenated androgens were not elevated in OW or HA girls. In the entire cohort, HA status correlated with DHEA, A4, and T (r=0.40, 0.54, 0.63), while hirsutism correlated with A4 and T (r=0.47, 0.57). No androgen correlated with BMIz, but T correlated with fasting insulin and HOMA-IR (r=0.37, 0.38). The ratio of classic (DHEA, A4, T) to 11-oxygenated (11OHA4, 11KA4, 11OHT, 11KT) androgens trended higher in non-HA POST girls vs. PRE girls (58%:42% vs. 44%:56%, p=0.056). From early to late puberty, there appears to be a shift away from the 11-oxygenated pathway. Most androgens in HA girls derive from the classic androgen pathway. The mechanisms of the later switch to 11-oxygenated androgen pathway predominance in adult PCOS remain to be elucidated.

SAT-029 AMH Is Higher Across the Menstrual Cycle in Early Post-Menarchal Girls Than in Ovulatory Women

Ovaries of young girls contain healthy and degenerating follicles from the primordial to antral stage, suggesting coordination of growth and atresia. At age 6 yrs, antral follicle (AF) number and size increase; by late puberty, AF count is higher than at any other life stage. The discovery of AMH, a biomarker of AFs, has facilitated the study of the immature ovary. AMH, a granulosa cell product of pre-antral and small AFs, inhibits primordial follicle growth and AF selection. As a marker of AF count, AMH should be highest during puberty, yet cross-sectional studies suggest that AMH peaks in the mid-20’s. In the current studies we compared AMH levels in early post-menarchal girls and regularly cycling adults. The rich phenotypic data available for this adolescent cohort (Sun 2019) was used to investigate further the relationship between AMH, LH, FSH, and sex steroids, and the propensity for anovulatory cycles (ANOV) in girls. 23 healthy girls (12.8–17.6 yrs;1.7±0.2 yrs post-menarche; 56% overweight/obese [OB]) underwent hormone measurements and pelvic ultrasounds during 2 consecutive menstrual cycles. Cycles were classified as ovulatory (OV) based on an LH and E2 peak and P4 >1.65 ng/mL (Sun 2019). AMH was measured in a random subset of samples (5x/subject) with the Ansh ultrasensitive ELISA. Maximum average ovarian volume (VOL) was calculated in the absence of a dominant follicle. Hormones were compared with data from 32 historic adult controls (18–34 yrs; 44% OB) with regular cycles (Lambert-Messerlian 2016). In adults, AMH was measured during the follicular and luteal phase of an OV (5x/subject) using the Ansh assay. AMH was compared among groups using a mixed model. AMH (in adults), LH (in both) and androgens (in girls) were natural log-transformed (ln) before analysis. 11 girls had 2 OV, 5 girls had 1 OV, and 5 girls had no OV; 2 could not be classified due to loss to follow-up. Girls had higher AMH than women (5.2 ± 0.3 vs. 3.3 ± 0.4 ng/mL; p<0.01) and girls with more OV tended to have lower AMH than those with ANOV (2 OV 4.5 ± 0.2, 1 OV 5.7 ± 1.1, 0 OV 6.8 ± 1.1 ng/mL; p=0.1). In girls, AMH correlated with ln_LH (r=0.4, p=0.02), ln_a’dione (r=0.4, p=0.04), ln_testosterone (r=0.5, p=0.02) and VOL (r=0.6, p=0.01) but not with FSH, E2, or BMI. In women, AMH correlated with E2 (r=-0.4, p=0.03) and not with ln_LH or BMI. Within-person variability in AMH was similar in girls and adults (CV 18%). During the early post-menarchal years, AMH levels exceed those of adults with OV, particularly among girls with ANOV, and correlate with LH and androgens. The finding of higher AMH in adolescents is consistent with previous studies demonstrating a peak in AF count during this stage of development. Investigation into how the normal ovary matures and is pruned of excess AFs, either by increased recruitment and growth or by atresia, may provide insights into the pathogenesis of PCOS, wherein follicles are arrested at the pre-antral and antral stage.

AMH is Higher Across the Menstrual Cycle in Early Postmenarchal Girls than in Ovulatory Women.

Adolescents have more small, growing follicles and larger ovaries than normal women and are prone to anovulatory cycles (ANOV). It is unknown if a higher antral follicle count (AFC) per se contributes to ANOV in early postmenarchal girls. To determine the relationship between AMH (an AFC biomarker), other reproductive hormones, and ANOV in postmenarchal girls and to compare AMH in girls and regularly cycling adults. A total of 23 girls (1.7 ± 0.2 years postmenarche) and 32 historic adult controls (≤34 years) underwent serial hormone measurements during 1 to 2 menstrual cycles. Girls also had pelvic ultrasounds. AMH was measured 5 times/subject using the Ansh ultrasensitive ELISA. Girls had higher AMH than women (5.2 ± 0.3 vs. 3.3 ± 0.4 ng/mL; P < 0.01) and girls with more ovulatory (OV) cycles tended to have lower AMH than those with ANOV (2 OV 4.5 ± 0.2, 1 OV 5.7 ± 1.1, 0 OV 6.8 ± 1.1 ng/mL; P = 0.1). In girls, AMH correlated with natural-log (ln) transformed LH (r = 0.5, P = 0.01), ln_androstenedione (r = 0.6, P = 0.003), ln_testosterone (r = 0.5, P = 0.02), and ovarian volume (r = 0.7, P < 0.01) but not with FSH, estradiol, P4, or body mass index. In women, AMH correlated with estradiol and P4 (both r = -0.4, P ≤ 0.03) but not with ln_LH or body mass index. In postmenarchal girls, AMH is higher than in ovulatory women and is associated with LH, androgens, and a propensity for anovulatory cycles. The cause of the transient increase in AMH and AFC during late puberty and the steps underlying the transition to a mature ovary deserve further study.

Menarche among rural adolescent girls in Dervan (Data from the KONKAN region of the state of Maharashtra, India).

Context:Associations between age at menarche and risk of type 2 diabetes and cardiovascular disease are well established in adults. But little is known about these risks in adolescents.Aim:To examine the association between age at menarche and anthropometric indicators, and also examine nutrition among the rural adolescent girls of KONKAN region.Setting and Design:We investigated 1,071 school going adolescent girls who underwent holistic education and various clinical investigations as a part of community program. Age at menarche was recorded and anthropometric measurements were performed. Macronutrient intake was estimated by 24 h recall.Statistical Analysis Used:We used trend statistics and logistic regression to examine the association.Results:A total of 813 girls had attained menarche. Mean age at menarche was 13.0 years. When compared with premenarchal girls anthropometric parameters were significantly higher in postmenarchal girls (P < 0.05 for all) and the prevalence of stunting and thinness was lower (P < 0.001 for both). There was a decreasing trend for weight (P < 0.001), BMI (P < 0.001), and waist circumference (P < 0.05) with increasing age of onset of menarche, and increasing trend for stunting and thinness (P < 0.001 for both). More than 65% of the girls were eating below the recommended daily allowance of calories, protein, and fat. Adolescents with late onset of menarche had increased likelihood of stunting (P < 0.01) and thinness (P < 0.001).Conclusions:Adolescent girls in the KONKAN region with late menarche are thin and stunted. There is an urgent need to improve nutritional status of adolescent girls from KONKAN as malnutrition can affect the onset of menarche.

Emocionalna reakcija djevojaka na menarhu: uloga značajne druge osobe

Menarche is a key pubertal change for girls which is accompanied by different psychosocial changes, both pleasant and unpleasant, shaped by cultural and societal influences. This study aimed to examine: (1) the main source of information about menstruation before menarche among Croatian girls, (2) to whom girls confide about menarche and how they perceive the response of the significant other, (3) the role of preparedness and response of significant other for emotional reaction to menarche in adolescent girls. Postmenarcheal girls (N = 246) from primary and secondary schools from Croatia filled out the Expected/ Experienced Emotions related to Menarche Scale measuring pleasant and unpleasant emotional reactions; Preparedness for the Menarche; Significant Other’s Responses to Girl’s Menarche Checklist measuring informational support and positive emotional responses; and a set of specific questions. For most adolescent girls, the mother is both the main source of information (97.2%) and the first person to confide about the menarche (83.7%). Girls perceived the response of the significant other more as informational support (such as providing information on the use of sanitary products) than as positive emotional response. However, the positive emotional response of the significant other, together with higher levels of preparedness, predicted higher levels of girl’s pleasant personal experience at menarche. Psychoeducation should be focused both on girls and their mothers so they could know how to prepare their daughters timely and respond positively to this important event. Key words: menarche, menstruation, preparedness, mother, puberty

Sexual maturation in girls: association with physical activity and sedentary behaviour

Abstract Introduction During adolescence, physical activity tends to decline, especially among girls. Adolescent inactivity is due in part to biological factors, among which pubertal development may play a role. Our aim was to study in girls, the relationship of sexual maturation based on menarche with physical activity and sedentary behaviour. Methods Analyses were based on a two-stage random sample of 3,911 10-15-year-old girls included in the 2018 cross-sectional Health Behaviour in School-aged Children survey carried out in French-speaking schools. Menarche, sufficient levels of physical activity (PA) (global PA: at least 60 min. of moderate- to vigorous-intensity PA daily, and vigorous PA: at least 3 times/week), sedentary week time based on all-screen use duration (SWT; categories based on tertiles), and sociodemographic characteristics were self-reported. Multilevel multiple binary (for PA) and multinomial (for SWT) logistic regressions were performed, stratified by age group (≤12.5 years vs. &amp;gt;12.5 years). Results Twenty percent of girls aged ≤ 12.5 years and 85.0% of girls aged &amp;gt; 12.5 years have had their first period. Within the group aged ≤12.5, post-menarcheal girls were more likely to spend long SWT (≥8h/day) than pre-menarcheal girls (vs. short SWT (&amp;lt;4h/day): aRRR= 1.74 [1.27-2.37]; NS for moderate SWT (4-7h/day)). Within those aged &amp;gt;12.5, post-menarcheal girls were less likely to engage in sufficient vigorous PA (aOR=0.76 [0.59-0.98]) than pre-menarcheal girls. Moreover, they were more likely to spend moderate (aRRR=1.70 [1.19-2.42]) and long SWT (aRRR=2.74 [1.94-3.88]) than pre-menarcheal girls of same ages. Additional adjustments for age modified the strength of associations. Conclusions Our results suggest that during adolescence, the physiological changes induced by sexual maturation may contribute to the decline in physical activity (in &amp;gt; 12.5 years), and in the increase in sedentary behaviour in girls. Potential confounding by age will be explored further. Key messages Development of strategies aimed at improving physical activity among adolescent girls should take into account, among other aspects, pubertal development. Specific interventions, targeting pubescent girls, should also be developed to reduce screen time in order to prevent its potential negative consequences.

Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding: ACOG COMMITTEE OPINION SUMMARY, Number 785.

Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman's physical, social, emotional, or material quality of life. If obstetrician-gynecologists suspect that a patient has a bleeding disorder, they should work in coordination with a hematologist for laboratory evaluation and medical management. Evaluation of adolescent girls who present with heavy menstrual bleeding should include assessment for anemia from blood loss, including serum ferritin, the presence of an endocrine disorder leading to anovulation, and evaluation for the presence of a bleeding disorder. Physical examination of the patient who presents with acute heavy menstrual bleeding should include assessment of hemodynamic stability, including orthostatic blood pressure and pulse measurements. The first-line approach to acute bleeding in the adolescent is medical management; surgery should be reserved for those who do not respond to medical therapy. Use of antifibrinolytics such as tranexamic acid or aminocaproic acid in oral and intravenous form may be used to stop bleeding. Nonmedical procedures should be considered when there is a lack of response to medical therapy, if the patient is clinically unstable despite initial measures, or when severe heavy bleeding warrants further investigation, such as an examination under anesthesia. After correction of acute heavy menstrual bleeding, maintenance hormonal therapy can include combined hormonal contraceptives, oral and injectable progestins, and levonorgestrel-releasing intrauterine devices. Obstetrician-gynecologists can provide important guidance to premenarchal and postmenarchal girls and their families about issues related to menses and should counsel all adolescent patients with a bleeding disorder about safe medication use and future surgical considerations.

Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding: ACOG COMMITTEE OPINION, Number 785.

Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman's physical, social, emotional, or material quality of life. If obstetrician-gynecologists suspect that a patient has a bleeding disorder, they should work in coordination with a hematologist for laboratory evaluation and medical management. Evaluation of adolescent girls who present with heavy menstrual bleeding should include assessment for anemia from blood loss, including serum ferritin, the presence of an endocrine disorder leading to anovulation, and evaluation for the presence of a bleeding disorder. Physical examination of the patient who presents with acute heavy menstrual bleeding should include assessment of hemodynamic stability, including orthostatic blood pressure and pulse measurements. The first-line approach to acute bleeding in the adolescent is medical management; surgery should be reserved for those who do not respond to medical therapy. Use of antifibrinolytics such as tranexamic acid or aminocaproic acid in oral and intravenous form may be used to stop bleeding. Nonmedical procedures should be considered when there is a lack of response to medical therapy, if the patient is clinically unstable despite initial measures, or when severe heavy bleeding warrants further investigation, such as an examination under anesthesia. After correction of acute heavy menstrual bleeding, maintenance hormonal therapy can include combined hormonal contraceptives, oral and injectable progestins, and levonorgestrel-releasing intrauterine devices. Obstetrician-gynecologists can provide important guidance to premenarchal and postmenarchal girls and their families about issues related to menses and should counsel all adolescent patients with a bleeding disorder about safe medication use and future surgical considerations.

Long-Term Ultrasound Follow-Up After Pediatric Adnexal Torsion.

Conservative surgical management of adnexal torsion in pre- and post-menarchal girls by de-torsion and adnexal conservation is the current standard of care. The aim of this study is to investigate the long-term outcome of adnexal torsion in this population in terms of ultrasound appearance and ovarian volume. Patients who were surgically treated for adnexal torsion and were < 18 years old at time of surgery were prospectively invited for ultrasound follow-up. The ultrasound exam included measurements of ovarian volume and grayscale appearance including identification of ovarian follicular activity. 84 cases of torsion in this population were identified, and 37 of them were included in the study. Of those, the affected ovary could not be demonstrated on follow-up scan in six (16.2 %) cases. A difference of ≥ 2 cm3 in ovarian volume between the affected and non-affected ovaries was diagnosed in 12 (32.4 %) cases, but follicular activity was observed in 10 of those. Thus, possible ovarian injury (including cases of non-demonstrated ovary and volume difference of ≥ 2 cm3 between the affected and non-affected ovaries) was found in 18 (48.6 %) cases. Of the clinical and surgical parameters (including age at time of torsion, duration of pain prior to admission, cystectomy procedure and intraoperative "bluish" appearance of the ovary), only the presence of fever on admission was significantly associated with possible ovarian injury (p = 0.01). Long-term ultrasound follow-up of pre- and post-menarchal girls with a history of adnexal torsion may identify patients with adversely affected ovarian volume. The significance of this finding in terms of fertility is unknown.

A rite of passage: a mixed methodology study about knowledge, perceptions and practices of menstrual hygiene management in rural Gambia

BackgroundAppropriate menstrual hygiene management (MHM) is impeded by taboos and secrecy surrounding menstruation. Unhygienic menstrual practices and unpreparedness for managing menstruation has been associated with adverse health and social outcomes among adolescent girls. In The Gambia, there is limited data on menstrual practices among girls and women in rural communities and the sources of information about menstruation for the adolescents. This study aimed to explore knowledge, preparedness and practices of menstruation and its management among adolescents, mothers and teachers in rural Gambia.MethodsA mixed methods study was conducted in the rural Kiang West district of The Gambia. Twenty focus group discussions and thirteen in-depth interviews were conducted among mothers, adolescents and teachers to explore their views on menstruation, cultural beliefs, sources and level of knowledge on menstruation and MHM practices. In addition, a survey was done among 331 school girls to assess their knowledge, practices and attitudes of menstruation and its management. Inductive content analysis was used to analyse the qualitative data, and descriptive analysis and chi-squared tests were used to analyse quantitative data.ResultsAll participants had different levels of knowledge about menstruation. Knowledge score was higher among post-menarche girls compare with pre-menarche girls (p = 0.0001). All groups expressed difficulties, embarrassment and shame in relation to discussing menstruation. Two thirds of the surveyed girls reported having learnt about menstruation before menarche, however at menarche most felt unprepared. Teachers were the main source of information, but when asking for advice most girls preferred to ask their mothers. Mothers reported facing difficulties in discussing menstruation with their children and felt that boys did not need to be taught about it, however boys were very curious to know about. Most girls used reusable cloth unless they are given free pads from school.ConclusionTaboos, secrecy and embarrassment associated with discussing menstruation hinder adolescents from seeking advice from parents and teachers on appropriate MHM practices. Strategies to encourage positive social norms towards menstruation would help to promote more open discussions about it at the family, community and national level, which will support improvements in MHM in this and similar communities in low and middle income settings.

Changes in Anti-Müllerian Hormone and Inhibin B in Children Treated for Cancer.

Purpose: Diminished reproductive function can be a major late effect of childhood cancer treatment. This study evaluates the changes, and occurrence of possible recovery, in gonadal function markers in children treated for cancer. Methods: Gonadal function markers were measured before (T0), directly after (T1), and 1 year after (T2) end of treatment of childhood cancer. Anti-Müllerian hormone (AMH) was measured in girls and inhibin B in boys and compared to reference populations. Repeated measures analysis of variance and t-tests were employed for data analysis. Results: Baseline gonadal function markers (T0) at diagnosis were available in 129 girls and 150 boys. Paired gonadal function markers were available in 49 girls and 54 boys for T0-T1, and in 27 girls and 32 boys for T1-T2. Gonadal function markers were significantly lower than the reference population at each time point (p < 0.001). Post-menarcheal girls showed a decrease in AMH between T0 and T1 (standard deviation scores [SDS] -0.72 to -1.32, p = 0.007), and in the boys cohort, a decrease in inhibin B (SDS -1.14 to -1.43, p = 0.045) was observed. Impaired gonadal function levels (<5th percentile) at T1 were observed in 15 of 27 (56%) girls and in 15 of 32 (47%) boys. However, gonadal function had recovered at T2 in seven girls and six boys. Conclusion: Our data suggest that gonadal function is already compromised at diagnosis and is further decreased by childhood cancer treatment. Nevertheless, about half of the children with gonadal impairment recovered over time. Evaluation of gonadal function markers before 1 year after end of treatment may therefore be unreliable.

The Relationship Between Progesterone, Sleep, and LH and FSH Secretory Dynamics in Early Postmenarchal Girls.

During puberty, LH pulse frequency increases during sleep; in women, LH pulse frequency slows during sleep in the early/middle follicular phase (FP) of the menstrual cycle. The origin and significance of this developmental transition are unknown. To determine the relationship between progesterone (P4) exposure, sleep-related slowing of LH pulses in the FP, and the intercycle FSH rise, which promotes folliculogenesis, in early postmenarchal girls. 23 girls (gynecologic age 0.4 to 3.5 years) underwent hormone measurements and pelvic ultrasounds during two consecutive cycles and one frequent blood sampling study with concurrent polysomnography during the FP. Subjects demonstrated one of four patterns during cycle 1 that represent a continuum of P4 exposure: ovulatory cycles with normal or short luteal phase lengths or anovulatory cycles ± follicle luteinization. Peak serum P4 and urine pregnanediol (Pd) in cycle 1 were inversely correlated with LH pulse frequency during sleep in the FP of cycle 2 (r = -0.5; P = 0.02 for both). The intercycle FSH rise and folliculogenesis in cycle 2 were maintained after anovulatory cycles without P4 or Pd exposure or nocturnal slowing of LH pulse frequency in the FP. During late puberty, rising P4 levels from follicle luteinization and ovulation may promote a slower LH pulse frequency during sleep in the FP. However, a normal FSH rise and follicle growth can occur in the absence of P4-associated slowing. These studies therefore suggest that an immature LH secretory pattern during sleep is unlikely to contribute to menstrual irregularity in the early postmenarchal years.

Bone Mineral Density and Jumping Height in Pre-Menarcheal and Post-Menarcheal Physically Active Girls

Research background and hypothesis. Jumping ability correlates well with different bone values. The skeletal benefits of high-impact weight-bearing exercise have been shown to be greater when training is started prior to menarche. We hypothesized that significant differences would be apparent in the relationships between bone values and jumping height in favor of the girls’ prior menarche compared to post-menarcheal group. Research aim. The aim of the study was to investigate the relationships between jumping height and bone mineral density (BMD) in pre-menarcheal and post-menarcheal physically active girls. Research methods. In total, 113 adolescent girls from different competitive extramural athletic programs participated in this study. Femoral neck and lumbar spine BMD were measured. The heights of vertical jumps (i. e. countermovement jump (CMJ) and rebound jumps for 15 (RJ 15 s) and 30 (RJ 30 s) seconds) were obtained.Research results. After adjusting for major confounders (i. e. age, height, and body mass), the height of rebound jumps correlated only with femoral neck BMD and only in pre-menarcheal group (r = 0.37–0.46; p &lt; 0.05). No correlations were found between BMD variables and jumping height in post-menarcheal girls. The height of CMJ did not correlate with measured BMD variables in the studied groups.Discussion and conclusions. Early puberty is an opportune period to increase bone adaptation to mechanical loading due to the velocity of bone growth and endocrine changes at this time. We suggest that powerful repetitive vertical jumping may be more beneficial to bone health compared to single jumping activities in physically active girls prior to menarche rather than after it.Keywords: bone health, vertical jumps, puberty.

Girl Body Composition according to pubertal status. Methodology variation

The objective of the present paper is to analyze the differences in body composition among pre and post-menarche girls of the same chronological age using anthropometry and tetrapolar bioelectrical impedance.

Fertility Preservation in Endocrine Disorders during Transition for Girls.

Recent advances in fertility preservation (FP) techniques have led to a wide spread of indications. FP should now be discussed not only for young girls having to receive gonadotoxic treatments for cancer, but also for those with genetic or endocrine disorders, as well as benign ovarian diseases at risk of premature ovarian insufficiency. For premenarchal girls, ovarian tissue cryopreservation is still the only available technique. Oocyte cryopreservation after ovarian stimulation could be offered to postmenarchal girls. Whenever possible, the parents and the young patient should be informed of the benefits to be expected, as well as of the risks and limits of FP for children.