Premenarcheal Girls Research Articles

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.

Prevalence and associated factors of stunting and thinness among adolescent Somalian refugee girls living in eastern Somali refugee camps, Somali regional state, Southeast Ethiopia

BackgroundAdolescence is a critical time of life stage with a continuum of physical, cognitive, behavioral and psychosocial changes. It is also a period of physical growth, reproductive maturation and cognitive transformations with the highest nutrient requirements. Among the macronutrient deficiencies, stunting and thinness are the most common nutritional problems in many parts of the world but the highest burden is in developing countries with the highest number of adolescents and the displaced population. Overall, there is a scarcity of studies on refugee adolescent girls stunting, thinness, and contributing factors. Therefore, this study aimed to fill this identified gap.MethodCross-sectional study design was employed. A total of 423 adolescent refugee girls were selected by using simple random sampling technique. A structured & pre-tested questionnaire was used after translating into the Somali language to collect the data. The physical measurement of the height and the weight were done as per the standard. Descriptive statistics were employed. Variables were considered for multivariable logistic regression if a P-value was ≤0.2 during univariate logistic regression. The odds ratio with a 95% CI was calculated and a P-value of ≤0.05 was considered to declare the statistical significance of variables after fitting into the multivariable logistic regression.ResultA total of 415 adolescent girls was included in the study with a response rate of 98.1%. The overall prevalence of stunting and thinness was 9.7% (95% CI: 7.0, 12.3), and 15.2% (95% CI: 11.8, 18.9) respectively. The older adolescent girls were 2 (AOR: 2.10, 95% CI: 1.12, 3.93) times more likely to develop stunting as compared to younger adolescents. The pre-menarcheal adolescent girls were 64% (AOR: 0.36, 95% CI: 0.12, 0.75) less likely to be thin as compared to post-menarche.ConclusionThe prevalence of stunting and thinness among adolescent refugee girls was a low and moderate public health problem respectively. The stunting was significantly associated with the age and thinness was associated with the menarcheal status of the adolescent girls. So, stakeholders should enable intervention to encourage and increase the intake of calorie-dense food adapted to adolescent’s girl’s age and menarcheal status.

In vitro maturation rates in young premenarche patients

To evaluate invitro maturation (IVM) efficacy and oocyte retrieval rates after ovarian tissue cryopreservation in young premenarche girls facing chemo- and radiotherapy. A retrospective cohort study. University-affiliated tertiary medical center. A total of 84 chemotherapy-naïve patients ages 0-18years referred for fertility preservation between 2004 and 2017: 33 premenarche and 51 postmenarche patients. None. IVM in the pre- and postmenarche groups and in the subgroups of very young (up to age 5years) and older (5-10years) premenarche girls. The number of oocytes retrieved did not significantly differ between the postmenarche and premenarche groups (10.8 ± 8.5 and 8.1 ± 6.8, respectively). However, the overall IVM rate was significantly higher in the postmenarche group (28.2% vs. 15.5%, respectively; odds ratio = 0.47). A separate analysis for patients up to 5years of age demonstrated significantly lower oocyte yield compared with the older (5-10years) premenarche girls (4.7 ± 5.2 vs.10.3 ± 7.0 oocytes, respectively) and much lower IVM rates (4.9% and 18.2%, respectively). Correlation of age with number of retrieved and matured oocytes showed a positive significant correlation (r = 0.45 and r = 0.64, respectively). IVM performed after ovarian tissue cryopreservation in premenarche girls and specifically in very young girls (4years and younger) yields substantially decreased maturation rates compared with postmenarche patients, raising a question as to the utility of current IVM technique in this age group. Further studies are required to assess modification of the IVM technique for young girls.

MON-242 Early Breast Development in Overweight Girls: Does Estrogen Made by Adipose Tissue Play a Role?

Overweight/obese girls (OB) undergo thelarche but not menarche significantly earlier than normal weight girls (NW). It has been proposed that estrogen synthesized by adipose tissue may be contributory, yet OB do not have higher serum estrogen levels than NW matched on breast stage. We hypothesized that in OB, adipose tissue overlying the breast bud may be a ready source of estrogen that is sufficient to initiate thelarche because the primitive breast bud is intimately associated with the mammary fat pad during development (Anbazhagan Am J Anat ’91, Neville J Mammary Gland Biol Neoplasia ’98). Estrogen derived from mammary fat could act locally to induce thelarche but would not be detected in the circulation and therefore would not act systemically to induce uterine maturation/menses. To address this hypothesis, we measured reproductive hormones and imaged the breast, uterus, and ovaries in 80 pubertal, pre-menarchal girls (26 OB, 54 NW) aged 8.2-14.7 yrs. We used total percent body fat (%BF), determined by DXA, as a proxy for mammary fat, taking advantage of the positive correlation between these two measures (Novotny Am J Hum Biol ’11, Schautz Eur J Clin Nutr ’11, Zhu Eur Radiol ’16). We predicted that if estrogen derived from mammary fat contributes to breast maturation, then girls with higher %BF (and thus more mammary fat) would demonstrate immaturity of other estrogen-sensitive tissues (e.g. uterus, endometrial lining, vaginal epithelium) compared with girls of the same breast morphological stage (stages A-E based on Bruni et al. Adolesc Pediatr Gynecol ‘90) with lower %BF. OB were younger than NW (10.1 ± 1.1 vs. 11.3 ± 1.3 yrs, p<0.001) and more likely to be non-Hispanic Black or Hispanic (p=0.03). %BF ranged from 13.1-53.5% (3rd-97th percentiles). The distribution of Tanner breast and pubic hair stages was similar in NW and OB, and the full spectrum of breast development (A-E) was observed with stages D and E being the most common (59%) overall. Uterine volume, endometrial thickness, sex steroids (E1, E2, T, A’dione), and gonadotropins increased (p<0.001 for all), as expected, with breast morphological stage but %BF was not associated with any index of systemic estrogen action or reproductive hormones in a linear regression model controlled for breast morphological stage. These studies suggest that neither total %BF nor local (mammary) are clinically significant sources of estrogen capable of inducing breast development in OB. Taken together with the comparable gonadotropin levels observed in girls of the same breast morphological stage across a broad range of total %BF, these findings point to earlier activation of the hypothalamic-pituitary-ovarian axis in OB as the most likely cause of earlier thelarche in OB compared with NW. Longitudinal follow-up of this cohort is underway to investigate the effect of %BF on the maturational trajectory of the central components of the female reproductive axis.

Distinctive Reproductive Phenotypes in Peripubertal Girls at Risk for Polycystic Ovary Syndrome.

Increased testosterone (T) levels are a cardinal feature of polycystic ovary syndrome (PCOS). Female relatives of affected women, including premenarchal daughters, have elevated T levels supporting a genetic susceptibility to this phenotype. Girls with obesity (OB-g) also have increased T levels throughout puberty, which may indicate risk for PCOS. We tested the hypothesis that premenarchal daughters of women affected with PCOS (PCOS-d) have distinctive phenotypic features compared with OB-g. Forty-eight PCOS-d, 30 OB-g, and 22 normal weight (NW-g) premenarchal girls were studied. Mothers of OB-g and NW-g had no evidence for PCOS. Reproductive hormones were measured. Body mass index differed by design, was highest in OB-g, followed by PCOS-d (P > 0.001). PCOS-d and OB-g had similar increases in free T levels compared with NW-g (PCOS-d vs NW-g, P = 0.01; OB-g vs NW-g, P = 0.0001). Sex hormone binding globulin levels were lowest in OB-g and lower in PCOS-d than in NW-g (PCOS-d vs NW-g, P = 0.005; OB-g vs NW-g, P < 0.0001; PCOS-d vs OB-g, P < 0.0001). Anti-Müllerian hormone (AMH) levels in PCOS-d were significantly increased compared with OB-g, who tended to have lower AMH levels than NW-g (PCOS-d vs OB-g, P < 0.0001; PCOS-d vs NW-g, P = 0.10). Despite similarly elevated free T levels, PCOS-d had increased AMH levels compared with OB-g. This finding suggests that OB-g lack alterations in ovarian folliculogenesis, a key reproductive feature of PCOS. Causal mechanisms may differ in PCOS-d or OB-g, or elevated T in OB-g may not be an early marker for PCOS.

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.

08: A clitoral cyst of “epidermal” proportions

To show the surgical excision and reconstruction of an epidermal inclusion cyst found in the clitoral hood of a patient in the absence of trauma. Epidermal inclusion cysts are commonly found on the face, ears and trunk. Rarely, they are found on the vulva, most often associated with prior trauma. Our case is a 22 year old nulliparous patient with a seven year history of a vulvar mass with anorgasmia over the prior year. On exam she had a 4cm vulvar mass, fusion of the labia with hypestrogenic epithelium and no visible clitoris. Imaging revealed a cyst localized to the clitoral hood without communication with the urethra or the clitoris. The patient underwent surgical excision of the cyst with goals to restore normal anatomy, avoid injury to the dorsal clitoral nerve and minimize bleeding. A transverse incision was made at the inferior aspect of the cyst. The cyst wall was identified and the overlying vaginal epithelium was sharply dissected away from the cyst using traction and counter-traction with our instruments as well as digital manipulation. The cyst wall was isolated and removed without compromising surrounding tissue utilizing tenotomy scissors for greater precision. The cyst was opened off the surgical field with contents consistent with an epidermal inclusion cyst. Pathologic findings confirmed the diagnosis. The labia were reconstructed with a series of interrupted monocryl stitches. Six weeks following surgery, she had no residual pain and had restored sensation to the clitoris. Surgical resection and reconstruction of this clitoral cyst allowed for return of function in our patient. In the absence of trauma, risk factors for epidermal inclusion cysts of the clitoral hood include hypoestrogenism and labial fusion as similar cases have been reported in the literature. Most reported cases of clitoral cysts occur in premenarchal girls, supporting the role of estrogen in the development of such cysts.

Clinicopathological Evaluation of Ovarian Juvenile Granulosa Cell Tumor: Is Fertility-Sparing Surgery Safe?

Objective: To retrospectively investigate the clinicopathological characteristics of ovarian juvenile granulosa cell tumors (JGCTs) and to evaluate the safety of fertility-sparing surgery. Methods: In this study, surgically treated patients with JGCTs diagnosed between January 2004 and October 2018 in our center were identified. Clinicopathological data, survival outcomes, and recurrence rates were examined in these patients. Results: A total of 8 patients were included. All patients were premenarchal girls or young women (age range, 9–32 years). Irregular vaginal bleeding was the most common presenting symptom. Of them, seven patients were classified with Stage I JGCTs, and they underwent fertility-sparing surgery. One patient who had Stage IIIC JGCT and had completed childbearing underwent complete surgery. Seven patients received adjuvant chemotherapy. The median follow-up duration in the total cohort was 64 months (range, 2–117 months). The overall survival rate in the fertility-sparing group was 100%, whereas the patient with Stage IIIC JGCT died 1 month after the treatment. Conclusions: Fertility-sparing surgery might not show a negative impact on oncologic outcomes. Fertility sparing could be considered a modified option for patients with Stage I JGCTs. However, due to the limited number of patients, the conclusion must be interpreted with caution, and larger or multicenter studies are needed before conclusions can be drawn.

Endometriosis in Adolescence: Challenges and Opportunities for Managing Future Infertility

Endometriosis is defined as the presence of endometrial stroma and glands outside the normal uterus. The prevalence of endometriosis in adolescents undergoing laparoscopy for chronic pelvic pain is reported to be between 19% and 73%. Interestingly, endometriosis has also been identified in premenarcheal girls with some breast development. Several factors have been incriminated for endometriosis, while no single theory can explain the variety of symptoms. Genetic factors seem to play a role, while lifestyle characteristics and environmental factors are likely related to the development of the disease. The main symptoms during diagnosis of endometriosis in adolescence, is chronic pelvic pain (27%-96%) and dysmenorrhea (18%-100%). Medical history and clinical examination are of great importance, while imaging exams are very helpful during evaluation of these girls, while endometriosis can only be diagnosed by visual inspection during laparoscopy, ideally confirmed by histology. Treatment options include not only medical regimens, with Non-Steroidal-Anti-Inflammatory Drugs and Combined Oral Contraceptives been the most common used, and other medications such as Danazol, Progestins, GnRH agonists with Add-Back therapy and cyproterone acetate, but also surgical treatment. Surgical management alone or in combination with postoperative hormonal suppression seems to improve future fertility options of adolescents with endometriosis.

Rapidly growing juvenile granulosa cell tumor of the ovary arising in adult: a case report and review of the literature

BackgroundOvarian granulosa cell tumors (GCTs) are divided into adult GCT (AGCT) and juvenile GCT (JGCT). The AGCT is more common type, conversely, less than 5% of tumors are the JGCT and occur in mainly premenarchal girls and in women younger than 30 years. Although JGCT have different histologic features compared to AGCT, the two types have similar imaging features because they have similar gross appearance. Therefore, it is difficult to distinguish two types by radiologic findings. In addition, it has not been described about the growth rate of JGCTs in past literatures. The aims of this report were to describe a case of rapidly growing JGCT arising in adult with difficulty in diagnosing and to review the literatures.Case presentationA 38-year-old woman, presented with abdominal distension and frequent urination, was found to have a pelvic mass measuring approximately 12 cm on ultrasonography. On magnetic resonance imaging (MRI), right ovarian multiloculated cystic mass accompanied with hemorrhagic foci was demonstrated. Although the presumptive diagnosis of GCT was made based on MR findings, the intraoperative differential diagnoses included GCT, yolk sac tumor or malignant mucinous tumor due to cytologic atypia and lack of the typical findings for AGCT such as nuclear grooves and Call-Exner bodies. As a result, abdominal simple total hysterectomy, bilateral oophoro-salpingectomy, partial omentectomy and appendectomy were performed. Moreover, she had a history of laparoscopic uterine myomectomy about one year before, and during that surgery bilateral ovaries were found to be macrospically normal. Therefore, it was suspected the tumor became enlarged within the short period of time.ConclusionsEven though it is difficult to distinguish two types of GCT by imaging findings, in some cases without typical findings for AGCT pathologically, MRI could provide useful information in accurately diagnosing JGCT. Moreover, in this case, the tumor growth rate seemed to be rapid regardless of its borderline malignant potential. It may be related with nuclear atypia and high mitotic rate of the tumor.

Tending the \u2018monthly flower:\u2019 a qualitative study of menstrual beliefs in Tigray, Ethiopia

BackgroundMenstruation is a universal aspect of human female reproductive life. Management of menstrual flow presents hygiene challenges to girls and women in low-income countries, especially when they first start their periods. As part of a project to improve menstrual hygiene management in the Tigray Region of Ethiopia, we explored the local understanding of menstruation through focus-group discussions and individual interviews.MethodsA detailed ethnographic survey of menstrual beliefs was carried out through 40 focus group discussions, 64 in-depth key informant interviews, and 16 individual case histories in the Tigray Region of northern Ethiopia. A total of 240 individuals participated in six types of focus groups (pre-menarchal girls, menstruating adolescents, married women of reproductive age, post-menopausal women, adolescent males, and married men). In-depth interviews were also carried out with 80 individuals, including Orthodox Christian priests, imams from the Muslim community, principals of primary and secondary schools, teachers and nurses, as well as menstruating schoolgirls and women. Audio data were transcribed and translated, then broken down into discrete codes using Atlas Ti software (version 7.5.4, Atlas.ti Scientific Software Development Mnbh, Berlin) and further grouped into related families and sub-families based on their content. The results were then synthesized to produce a cohesive narrative concerning menstruation in Tigray.ResultsRecurrent themes identified by participants included descriptions of the biology of menstruation (which were sometimes fanciful); the general unpreparedness of girls for menarche; cultural restrictions imposed by menstruation on females (particularly the stigma of ritual uncleanliness in both Christian and Muslim religious traditions); the prevalence and challenges of unmet menstrual hygiene needs at schools (including lack of access to sanitary pads and the absence of acceptable toilet/washing facilities); and the stigma and shame associated with menstrual hygiene accidents in public.ConclusionsChanges in the educational system in northern Ethiopia are required to improve student understanding of the biology of menstruation, to foster gender equity, to overcome the barriers to school attendance presented by poor menstrual hygiene management, and to create a society that is more understanding and more accepting of menstruation.

Ovarian Torsion in Premenarchal Girls.

To investigate characteristics that differentiate premenarchal girls with ovarian torsion (OT) from those without OT at the time of surgery. Retrospective chart review of 36 premenarchal girls who underwent 42 surgeries for either OT (n=33) or a nontorsed ovarian mass (n=9) from 2006 to2017. Large, tertiary care academic institution. We included patients aged 0-12years with International Classification of Diseases, Ninth Revision codes for torsion of the ovary, adnexa, ovarian pedicle, or fallopian tube. Controls had International Classification of Diseases, Ninth Revision codes for ovarian mass or cyst, who also underwent surgery and did not have OT. Records were reviewed for patient characteristics including laboratory and imaging studies, surgical intervention, and pathologic diagnosis. Fischer exact test and the nonparametric Mann-Whitney U test were used for statistical analysis. Characteristics predictive of OT in premenarchal girls. Twenty-nine premenarchal patients were diagnosed with 33 episodes of OT. Nine patients underwent surgery for ovarian masses but did not have OT. All patients with OT reported abdominal pain (compared with 55.6%without OT; P<.001) and most had nausea and/or emesis (81.8% vs 33.3%; P<.009). Ultrasound findings of ovarian enlargement and decreased Doppler flow were significant in the OT group (P<.083, P<.009). There were 2 cases of malignancy in each group. Patients with OT had significantly more nausea, emesis, and abdominal pain compared with those without OT. Additionally, 2 of 4 malignancies were found in patients with OT, indicating that malignancy should still be considered with large, complex masses.

Characteristics of premenarchal girls with and without ovarian torsion

Characteristics of premenarchal girls with and without ovarian torsion

Case 1: Hemoptysis, Hypoxia, and Anemia in a 10-year-old Girl

1. Tony Tarchichi, MD* 2. Kathryn Lupo, MD* 1. *Diagnostic Referral Group, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA A 10-year-old premenarchal girl with a history of chromosome 16 short arm duplication, seizures, and global developmental delay is transferred to us from another hospital for evaluation of new-onset severe anemia, hypoxia, and hemoptysis. At an outside hospital, her heart rate was 140 beats/min, blood pressure was 160/80 mm Hg, and oxygen saturation level was 88% on room air (100% on nonrebreather oxygen supplementation), and she was afebrile. There was no obvious bleeding source on examination. Laboratory evaluation revealed a hemoglobin level of 6.4 g/dL (64 g/L) compared with 13.2 g/dL (132 g/L) 3 years earlier. Chest radiography revealed bilateral diffuse infiltrates. She was transferred to our hospital. On admission to our hospital, the patient’s mother reports that the patient is acting more aggressive than usual and appears pale. Two weeks before admission she had a brief episode of mild upper respiratory tract symptoms without fever. The review of systems is otherwise negative, including no history of weight loss, hematochezia, black tarry stool, epistaxis, bruising/bleeding, scleral icterus, jaundice, or hematuria. Vital signs on hospital admission are as follows: temperature, 98.8°F (37.1°C); heart rate, 98 to 137 beats/min; respiratory rate, 22 to 36 breaths/min; and blood pressure, 96 to 120/47 to 89 mm Hg. Her oxygen saturation level is 80% on room air and increases to 100% on 100% nonrebreather mask. She is not …

Induction of the LH Surge in Premenarchal Girls Confirms Early Maturation of the Hypothalamic-Pituitary-Ovarian Axis.

To determine whether premenarchal girls exhibit positive estradiol feedback similar to regularly cycling adult women when given exogenous estradiol. This was a prospective clinical cohort study at 2 institutions. Nine girls and 6 women received a 7-day course of transdermal estradiol designed to produce physiologic, mid-cycle circulating estradiol levels. Participants collected daily morning urine for luteinizing hormone (LH), estradiol metabolites (E1c), and progesterone metabolites (Pdg), corrected for creatinine. Main outcomes were percentage increase in LH from nadir to peak and the absolute value of peak LH between the 2 groups, using t testing and linear mixed-effects modeling. All participants exhibited a positive feedback response to estradiol. Adult women had a 532.8% (95% confidence interval [CI]: 253.7-1119) increase in LH after estradiol exposure; premenarchal girls had a 497.9% increase (95% CI: 274.5-903.2; P = .86). The absolute value of the LH surge in women was 9.50 mLU/mgCr (95% CI: 2.59- 43 34.90) and in premenarchal girls was 2.57 mLU/mgCr (95% CI: 0.53-12.49; P = .15). Premenarchal girls can mount an LH surge proportionally similar to regularly cycling adults. This occurs earlier in puberty than previously believed, in contrast to current dogma that maturation of the hypothalamic-pituitary-ovarian axis occurs after menarche and is the rate-limiting step for the establishment of regular, ovulatory cycles. Failure to achieve regular cycles may instead be due to nutritional or ovarian factors. Young girls who fail to ovulate shortly after menarche may warrant further evaluation for endocrinopathies.

Growth Pattern and Relation with Age at Menarche

Back ground: Body composition assessment helps to growth pattern in adolescent, for body composition measurement research measures weight, height, different kind of circumferences. Chronic Energy Deficiency (CED) has been defined as a state of ‘steady’ or body energy stores. A BMI < 18.5 kg/m2 is widely used as a practical measure underweight. Methodology: This study is carried out in outpatient of sub-centre of a rural hospital of Medinipur district; some girls are school dropout and some are regular school goers, Study group girls are 10-19 years old,100 girls in each group, Anthropometry are used to take measurement of height (Anthropometry rod) weight (weighing machine), harpendent to take skinfold measurement. Results: Table 1 represents that mean height, weight, MUAC of study group is 151.02 cm (4.81), 44.56 (5.07), weight (kg) MUAC21.71 cm (2.85). Table 2 represent comparison of anthropometric value of pre-menarcheal and menarcheal girls. The Figures 1-3 represent age wise pre-menarcheal, post-menarcheal, combined status of adolescent girls, whereas the Table 3 represent age wise standard deviation and mean of height, weight and BMI. Results revealed that boys were significantly heavier than girls from age 16 onwards. Conclusion: Girls have poor knowledge on hygiene, they take bath in pond, which causes reproductive health related issues, like white discharge; they have poor concept on menstrual hygiene. To overcome all this they need counselling on their health, nutrition hygiene, how to cure reproductive tract infection.

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.

Micronutrient status in middle childhood and age at menarche: results from the Bogotá School Children Cohort.

Childhood intake of animal foods is associated with age at first menstrual period (menarche). It is unknown whether the micronutrients present in these foods could explain this association. Our objective was to investigate the associations of micronutrient status biomarkers in middle childhood with age at menarche. We quantified circulating Hb, ferritin, mean corpuscular volume, Zn, vitamin B12, erythrocyte folate and retinol in 1464 pre-menarcheal girls aged 5-12 years in Bogotá, Colombia, and followed them for a median 5·7 years for the occurrence and date of menarche. We estimated median age at menarche and hazard ratios (HR) with 95 % CI by levels of each biomarker with use of Kaplan-Meier survival probabilities and Cox regression, respectively. Median age at menarche was 12·4 years. Middle childhood Hb was inversely related to age at menarche whereas plasma ferritin was positively associated with this outcome in a linear manner. HR of menarche for every 1 sd of Hb (11 g/l) and ferritin (23·2 µg/l) were 1·11 (95 % CI 1·04, 1·18; P=0·001) and 0·94 (95 % CI 0·88, 0·99; P=0·02), respectively, after adjustment for baseline age, C-reactive protein concentration, maternal age at menarche and parity and socioeconomic status. The association with ferritin was stronger in girls aged 9-10 years at baseline. Additional adjustment for baseline height- and BMI-for-age did not change the results. We conclude that higher Fe status in middle childhood is related to later age at menarche whereas Hb concentrations are inversely associated with age at onset of menses.

Wnt Signaling-Related Osteokines and Transforming Growth Factors Before and After a Single Bout of Plyometric Exercise in Child and Adolescent Females.

This study examined resting levels of catabolic and anabolic osteokines related to Wnt signaling and their responses to a single bout of plyometric exercise in child and adolescent females. Fourteen premenarcheal girls [10.5 (1.8) y old] and 12 postmenarcheal adolescent girls [15.0 (1.0) y old] performed a plyometric exercise trial. One resting and 3 postexercise blood samples (5min, 1h, and 24h postexercise) were analyzed for sclerostin, dickkopf-1 (DKK-1), osteoprotegerin (OPG), receptor activator of nuclear factor kappa-β ligand (RANKL), and transforming growth factors (TGF-β1, TGF-β2, and TGF-β3). Premenarcheal girls had significantly higher resting sclerostin, TGF-β1, TGF-β2, and TGF-β3 than the postmenarcheal girls, with no significant time effect or group-by-time interaction. DKK-1 was higher in premenarcheal compared with postmenarcheal girls. There was an overall significant DKK-1 decrease from baseline to 1h postexercise, which remained lower than baseline 24h postexercise in both groups. There was neither a significant group effect nor group-by-time interaction in OPG, RANKL, and their ratio. RANKL decreased 5min postexercise compared with baseline and remained significantly lower from baseline 24h following the exercise. No changes were observed in OPG. OPG/RANKL ratio was significantly elevated compared with resting values 1h postexercise. In young females, high-impact exercise induces an overall osteogenic effect through a transitory suppression of catabolic osteokines up to 24h following exercise.

Thumb Ossification Composite Index (TOCI) for Predicting Peripubertal Skeletal Maturity and Peak Height Velocity in Idiopathic Scoliosis: A Validation Study of Premenarchal Girls with Adolescent Idiopathic Scoliosis Followed Longitudinally Until Skeletal Maturity.

Background:Accurate skeletal maturity assessment is important to guide clinical evaluation of idiopathic scoliosis, but commonly used methods are inadequate or too complex for rapid clinical use. The objective of the study was to propose a new simplified staging method, called the thumb ossification composite index (TOCI), based on the ossification pattern of the 2 thumb epiphyses and the adductor sesamoid bone; to determine its accuracy in predicting skeletal maturation when compared with the Sanders simplified skeletal maturity system (SSMS); and to validate its interrater and intrarater reliability.Methods:Hand radiographs of 125 girls, acquired when they were newly diagnosed with idiopathic scoliosis prior to menarche and during longitudinal follow-up until skeletal maturity (a minimum of 4 years), were scored with the TOCI and SSMS. These scores were compared with digital skeletal age (DSA) and radius, ulna, and small hand bones (RUS) scores; anthropometric data; peak height velocity; and growth-remaining profiles. Correlations were analyzed with the chi-square test, Spearman and Cramer V correlation methods, and receiver operating characteristic curve analysis. Reliability analysis using the intraclass correlation (ICC) was conducted.Results:Six hundred and forty-five hand radiographs (average, 5 of each girl) were scored. The TOCI staging system was highly correlated with the DSA and RUS scores (r = 0.93 and 0.92, p < 0.01). The mean peak height velocity (and standard deviation) was 7.43 ± 1.45 cm/yr and occurred at a mean age of 11.9 ± 0.86 years, with 70.1% and 51.4% of the subjects attaining their peak height velocity at TOCI stage 5 and SSMS stage 3, respectively. The 2 systems predicted peak height velocity with comparable accuracy, with a strong Cramer V association (0.526 and 0.466, respectively; p < 0.01) and similar sensitivity and specificity on receiver operating characteristic curve analysis. The mean age at menarche was 12.57 ± 1.12 years, with menarche occurring over several stages in both the TOCI and the SSMS. The growth remaining predicted by TOCI stage 8 matched well with that predicted by SSMS stage 7, with a mean of <2 cm/yr of growth potential over a mean of <1.7 years at these stages. The TOCI also demonstrated excellent reliability, with an overall ICC of >0.97.Conclusions:The new proposed TOCI could provide a simplified staging system for the assessment of skeletal maturity of subjects with idiopathic scoliosis. The index needs to be subjected to further multicenter validation in different ethnic groups.