Regular Menstrual Cycles Research Articles

PS-BPR01-7: CONCURRENT SOMATIC MUTATIONS IN CTNNB1 AND GNA11 IN AN ALDOSTERONE-PRODUCING ADENOMA

Background: Aldosterone-producing adenoma (APA) is a major subtype of primary aldosteronism (PA), a common form of secondary hypertension. In the past decade, there has been significant progress in the determination of genetic causes of APA. The use of next-generation sequencing (NGS) has led to the identification of somatic mutations in APA that cause excess aldosterone production. Most of the affected genes encode ion channels or transporters. Somatic activating mutations in CTNNB1 (β;-catenin) have also been detected in 2–5% of APA. As a possible pathogenesis, an association of CTNNB1-mutated APA with pregnancy and menopause has been proposed. A recent study reported double somatic mutations in CTNNB1 and GNA11/Q in APA. However, due to its rare incidence, characteristics of APA with these mutations are not well determined. Herein, we report a case of APA harboring somatic CTNNB1 and GNA11 mutations. Case presentation: A 46-year-old Japanese woman presented with hypertension and spontaneous hypokalemia. She had no history of pregnancy-induced hypertension. She had regular menstrual cycle at presentation. Endocrine testing showed elevated plasma aldosterone concentration (677.5 pg/mL) under suppressed renin (plasma renin activity, 0.3 ng/mL/h). Computed tomography revealed a 2 cm right adrenal mass. Adrenal venous sampling indicated excess aldosterone production from the right adrenal gland. NP-59 scintigraphy further demonstrated increased tracer uptake in the right adrenal lesion. She underwent right laparoscopic adrenalectomy. Histologic diagnosis of the resected tumor was adrenocortical adenoma based on the Weiss criteria. Notably, Ki-67 labeling index was high (6% at hotspots). After surgery, her blood pressure and serum potassium both normalized. Based on the PASO (the primary aldosteronism surgical outcome) study criteria, PA remained clinically and biochemically cured at follow-up 18 months after surgery. Methods: Formalin-fixed, paraffin-embedded adrenal tumor tissue was used for immunohistochemical and genetic analysis. Results: Immunohistochemistry (IHC) showed high and diffuse expression of CYP11B2 (aldosterone synthase) within the tumor, whereas 11β;-hydroxylase (CYP11B1, a steroidogenic enzyme for cortisol biosynthesis) was mostly negative. VSNL1, a marker for the zona glomerulosa where physiologic aldosterone biosynthesis occurs, was highly expressed within the tumor. CYP11B2 IHC-guided targeted NGS identified concurrent somatic CTNNB1 (p.D32Y) and GNA11 (p.Q209H) mutations with similar variant allele frequencies (29.5% and 29.7%, respectively). Conclusions: To best of our knowledge, this is the first Asian case of APA with CTNNB1 and GNA11 mutations. Detailed clinical and histologic examination would provide useful information for better characterization of patients with PA due to these rare mutations.

Sleep-related factors and circulating levels of sex hormones in premenopausal Japanese women.

Sleep disruption and circadian disruption have been proposed to be risk factors of breast cancer. The present study examined the associations of sleep-related factors, referring to night shift work, sleep habits, and sleep disturbances, with the plasma levels of sex hormones in premenopausal Japanese women. Study participants were 432 women who had regular menstrual cycles less than 40 days long. Information on their history of night shift work and sleep disturbances was obtained using a self-administered questionnaire. Information on their sleep habits, such as usual wake-up times, bedtimes, and ambient light level while sleeping, was obtained in an interview. The participants' height and weight were measured. Plasma concentrations of estradiol, testosterone, dehydroepiandrosterone sulfate, sex hormone-binding globulin (SHBG), FSH, and LH were also measured. After controlling for the phase of the menstrual cycle and other covariates, more years of night shift work ≥ once a week during the past 10 years was significantly associated with a lower SHBG and a higher free estradiol level. Shorter sleep duration was significantly associated with the higher total, bioavailable, and free testosterone levels. Sleep disturbance by awaking after sleep onset was significantly associated with a high free estradiol level. The data suggest that long-term night shift work, short sleep duration, and arousal during sleep are associated with higher estradiol or testosterone levels in premenopausal women.

НЕКОТОРЫЕ МОРФОФУНКЦИОНАЛЬНЫЕ ОСОБЕННОСТИ МИТОХОНДРИЙ, ИХ СВЯЗЬ С РЕПРОДУКТИВНОЙ ФУНКЦИЕЙ ЖЕНЩИН

Introduction. Mitochondrial morphology and metabolism can have a decisive influence on energy metabolism and reproductive function in women. The objective of this study is to characterize the metabolic and energy metabolism processes in women of reproductive age and those in perimenopause. Methods. The study involved 100 women divided into two equal groups: women of reproductive age and women in perimenopause. Results. All participants had regular menstrual cycles. The duration of menopause in the second group was 1-3 years, with an onset age of 45 years. In total, 64% of the women in group 2 had neurohumoral abnormalities and obesity. Moderate to severe menopause symptoms were detected in 56% of women. Group 2 had reduced activity of mitochondrial enzymes in lymphocytes, such as succinate dehydrogenase and α-glycerophosphate dehydrogenase, while protein, glucose, and uric acid were above normal. Conclusion. This finding suggests that mitochondrial enzymes in group 2 become less active with age. At the end of the reproductive age, the intensity of the energy processes decreases. Cell energy metabolism remains an important area as further research, as this process can shift the timing of reproductive aging in women.

Oxidant and antioxidant status of erythrocytes and plasma samples in polycystic ovary syndrome patients

Polycystic ovary syndrome (PCOS) is one of the most common types of endocrine syndromes in women, where the disease is described as chronic anovulation and hyperandrogenism, which characterized by the formation of small cysts (fluid-filled sacs) in the ovaries. This study was carried out to introduce knowledge when plasma and erythrocytes portions were chosen to compare the antioxidant and oxidant status of PCOS patients treated and without treatment with Metformin. Samples were included 75 women diagnostics with PCOS according to Rotterdam criteria. The control group included healthy volunteers with regular menstrual cycles and with no symptoms of hyperandrogenism. Total Antioxidants Capacity (TAC), total Oxidant Status (TOS), and CuZn SOD enzyme activity were examined in both plasma and erythrocytes. The activity of the CuZn SOD enzyme was determined based on the ability of the enzyme to inhibit the autoxidation of pyrogallol. TAC values were significantly decreased in PCOS patients and the content in plasma was significantly higher than in Erythrocytes. On the other hand, the TOS values were in the opposite pattern, they were significantly increased in patients and higher in erythrocytes than plasma. The activity of superoxide dismutase was significantly higher in patients’ samples than in controls. This enzyme displayed higher activity values in samples from erythrocytes than the plasma and the highest activity was 61.9±3 U/ml. As the data for both TOS and SOD1 activity introduces the same pattern in blood samples, TAC values introduce a different line of responses. In considering Metformin’s effect on previous criteria, this drug significantly decreased the TAC, TOS and SOD1, activity group. as this drug is responsible for the reduction of circulating insulin and increasing the glucose uptake by peripheral tissues

COVID-19 pandemisi ve COVID-19 aşısının menstrüel siklusa etkisi

Effect of COVID-19 pandemic and COVID-19 vaccine on menstrual cycle Menstrual cycle irregularities include changes in menstrual cycle frequency, regularity, duration or intensity, as well as breakthrough bleeding. The global prevalence of irregular menstrual cycle ranges from 5% to 34% during reproductive years, and related problems constitute one of the most common reasons for referral to a gynecologist. It has been stated that during the Covid-19 pandemic and after the covid-19 vaccines, menstrual irregularities increased and the number of pads decreased in women. If these changes are related to the vaccine, it is thought that it may be a result of the immune response to the vaccine rather than a specific vaccine component. While reported changes in menstrual cycle after vaccination are short-lived, robust research on this potential adverse reaction remains critical to the overall success of the vaccination program. While Covid-19 affects social life, women cause hormonal imbalances, especially during the sexually active period. As a result, menstrual cycle irregularities may result in a decrease in the number of pads used and result in a decrease in the number of population that will threaten future generations. The aim of this study was to investigate the effects of mRNA vaccine and adenovirus vectored vaccines developed as Covid-19 pandemic and Covid-19 vaccine between December 2019–2022, the beginning of the pandemic process, on hormonal disorders and menstrual cycle irregularities. Resources were accessed from the literatures PUBmed, Web of Science, Google Academic using the keywords “Covid-19 pandemic, Covid-19 vaccine, menstruation, menstrual cycle irregularity” and 14400 references were identified. The number of retrospective studies and case reports were excluded, and the number decreased to 30, and 20 of the appropriate scientific publications were included in the study by scanning the rest. Keywords: Covid-19 pandemic, Covid-19 vaccine, menstruation, menstrüel cycle irregularity

Effects of Menstrual Cycle on Working Memory and its Correlation with Menstrual Distress Score: A Cross-sectional Study

Introduction: The menstrual cycle is a well known physiological model to study the ovarian steroid hormones, influencing cognitive functions like Working Memory (WM). Hormonal fluctuation during the menstrual cycle also affects menstrual distress-related symptoms, which indecently could the cognitive functions. However, the data were inconclusive regarding the change in WM functions during different phases of the menstrual cycle and the correlation of various WM functions with menstrual distress-related symptoms. Aim: To examine the verbal and visuospatial WM functions during the proliferative (day 10-14) and secretory phase (day 21-25) of the menstrual cycle and to correlate various WM functions with menstrual distress symptoms scores. Materials and Methods: A cross-sectional, observational study was carried out in the Department of Physiology at VMMC and Safdarjung Hospital, New Delhi, India, over a period of 18 months, from November 2020 to May 2022. A total of 40 young adult females with a history of regular menstrual cycles were selected for the study. Computerised software-based dual-task n-back WM tasks were given twice in the same menstrual cycle: first, the proliferative (day 10-14) and second, the secretory phase (day 21-25). In addition, a standardised Menstrual Distress Questionnaire (MDQ) based on various menstrual distress symptoms was also administered to each subject after completion of the WM task, first in the proliferative (day 10-14) and second, in the secretory phase (day 21-25). Based on MDQ, a score was calculated, a Menstrual Distress Score (MDS). Descriptive statistics such as mean, median, standard deviation, and mode were calculated and Pearson’s coefficient/ Spearman’s rank correlation coefficient was used to assess the correlation WM parameters with MDS. Data was compiled and analysed using the statistical software Graph PadPrism. Results: The mean age of the study population was 23.4 years with an average menstrual cycle length of 30 days. In the WM task, the ‘overall proportion of correct’ responses across all the tasks were significantly better in the secretory phase of the menstrual cycle than in the proliferative phase (p-value=0.040). Similarly, significantly improved performance in WM tasks during the secretory phase was also seen in the overall ‘hit rate’ of the visual target (p-value=0.020) and auditory targets (p-value=0.044). On the other hand, the correlation of WM parameters with MDS did not show any statistical significance except a significant negative correlation (r-value -0.369; p-value=0.019) between the ‘parametric sensitivity’ (subject’s ability to correctly distinguishing a target from a non target) of auditory WM of secretory phase and MDS of the proliferative phase. Conclusion: The visual and auditory WM skills were significantly improved during the secretory phase compared to the menstrual cycle’s proliferative phases in terms of the target ‘hit rate’. However, increased MDS had no significant detrimental effect on the performance of WM tasks during the normal menstrual cycle.

Determination of Biphasic Menstrual Cycle Based on the Fluctuation of Abdominal Skin Temperature during Sleep

In this study, we focused on the fluctuation of the abdominal skin temperature (AST) during sleep as a second marker for determining the biphasic menstrual cycle, alongside the basal body temperature. The nocturnal AST was measured every 10 min using a wearable device mounted on the abdominal wall. With this system, the AST time-series data were recorded for a total of 1667, 1035, and 1690 days from seven participants for the menstrual/follicular, ovulatory, and luteal phases, respectively. First, the AST fluctuation was evaluated by plotting the cumulative probability distribution (CPD) of changes in AST every 10 min from 0 to 0.7℃. The results showed that the CPD fitted well with an exponential attenuation curve. Second, the mean attenuation coefficients obtained by exponential regression from the CPD data were compared among the three phases. For regular menstrual cycles, the attenuation coefficient was the highest in the menstrual/follicular phase (8.57; 95% confidence interval 8.44–8.70; R2 = 0.983; P < 0.001), followed by the ovulatory phase (7.80; 95% confidence interval 7.65–7.96; R2 = 0.985; P < 0.001) and then the luteal phase (7.24; 95% confidence interval 7.12–7.36; R2 = 0.985; P < 0.001). Finally, we examined whether the attenuation coefficients can be used as an index to classify the three phases by long short-term memory (LSTM)-based deep learning. Consequently, the attenuation coefficient affected the prediction of the menstrual/follicular, ovulatory, and luteal phases with significantly higher F-measures of 0.603, 0.328, and 0.660, respectively. These results suggest that the thermoregulatory system may increase the AST fluctuation in healthy women during the transition from the follicular phase to the ovulatory phase and then to the luteal phase.

Impact of lifestyle and dietary habits on menstrual cycle among female medical students

Background and Aim: Menstrual patterns are influenced by a wide variety of factors which can be responsible for menstrual disorders, among them are lifestyle and dietary habits play a major role. So, the present study is effect of life style and dietary habits on the menstrual cycle among female medical college students and suggest them to adopt healthy life style and dietary habits accordingly. Materials and Methods: A cross-sectional study was conducted among 200 students of all semesters in a tertiary care institute using simple random sampling method. A pre-tested and pre-designed, semi-structured and self-administered questionnaire was used to collect data. Data collected was analysed using SPSS trail version 24 and chi-square test was used wherever applicable. Results: It was found that 29.1% had irregular menstrual cycle. 79.4% respondents took sugary food for more than 3 days/week. 43% did not have sleep duration of more than 7 hours/day. 52% did not regularly exercises for more than 5 times/week. Conclusion: There was a significant association between consumption of junk food, physical activity, and sleep habits on menstrual cycle of the respondents. Regular exercise, more healthy food, good sleep, less stress is responsible to maintain a healthy regular menstrual cycle.

Choice Reaction Time in Different Phases of the Menstrual Cycle in Healthy Females: A Cross-sectional Study

Introduction: The gonadal hormone output of females fluctuates monthly, and the endometrium, ovaries, and other genital organs undergo physical changes. It is known that women experience fluctuations in mood, energy, and cognitive abilities during different phases of their Menstrual Cycle (MC). Reaction Time (RT) is utilised to measure the ability of brain processing. The present study analysed the effect of various phases occurring in the MC on choice RT. Aim: To determine whether hormonal changes that occur throughout the MC and its phases may have any effect on cognition. Materials and Methods: An observational analytical crosssectional study was conducted in the Department of Physiology at Jawaharlal Nehru Medical College, Wardha, Maharashtra, India. The study duration was six months, from August 2021 to April 2022. A total of 50 apparently healthy females aged 18-25 years were included in the study. The subjects with a history of normal and regular MC for the last six months were included. The Choice Reaction Time (CRT) with visual and auditory stimuli was analysed using an RT apparatus developed by Anand Agencies, Pune, India. In CRT, random auditory and visual stimuli were given to the subjects, and they had to react accordingly. The RT apparatus timer started when the stimuli were given, and it automatically stopped when the subject reacted, providing the RT. RT was noted in the subjects on four occasions: two days prior to menstrual bleeding (premenstrual), the 2nd day during menstruation, the 8th day (follicular phase), and the 18th day after menstrual bleeding (luteal phase). The average value of each type of Visual Reaction Time (VRT) and Auditory Reaction Time (ART) in the various menstrual phases was noted and analysed. The level of significance in the various menstrual phases was analysed with inferential statistical study using one-way Analysis of Variance (ANOVA) and multiple comparison Tukey’s post-hoc test. Results: In the present study, prolongation of visual and ART was seen in the luteal phase. There was prolongation of VRT when the luteal phase was compared to the menstrual and follicular phase, but the difference was not statistically significant (p&lt;0.05). While in ART, there was prolongation when the luteal phase was compared with the premenstrual, menstrual, and follicular phase, but the difference was not statistically significant (p&lt;0.05). Conclusion: The current study reveals that there was a non significant prolongation of visual and ART in the luteal phase of MC when CRT was analysed. Thus, it was observed that there was no influence of fluctuating levels of ovarian hormones on ART and VRT in various phases of the MC while conducting CRT.

Role of Vitamin E in the Treatment of Primary Dysmenorrhea

Background: Primary dysmenorrhea is the common gynecologic problems, particularly among adolescent girls. The pain is severe during the first and/or second day of bleeding &amp; usually lasts up to 72 hours. More than 55 to 80% of post-menarche women are thought to experience primary dysmenorrhea. Both vitamin E and a placebo may lessen dysmenorrhea-related pelvic pain, although vitamin E appears to do more significantly Objective: To find the role of vitamin E in the treatment of Primary dysmenorrhea Methodology: This randomized placebo-controlled trial was conducted at JankiDevi Jamiat Singh Maternity Hospital Lahore and Sir Syed Hospital Karachi from 1stJune 2021 to 31stMay 2022. Sample size 70 with age 16-28 years with unmarried women; regular menstrual cycles; no urogenital disorders; no previous history of abdominal or pelvic surgery. To check severity of pain we used Visual Analog Scale (VAS) &amp; Cox Menstrual Symptom Scale (CMSS) was used for grading the pain duration. Pain duration was categorized as follows: score 1: ≤0-0.5 hours of pain; score 2: 0.5-1 hours of pain; score 3:&gt;1 hour of pain; score 4: &gt;1 day of pain. Two groups were formed from the sample. Vitamin E 400 units/day in two divided doses was prescribed for the first group to begin the treatment course (5 days in a month,), and Placebo was given to the second. Data was entered and analyzed in SPSS. Result: Total 70 were enrolled. There were 35 women given Vitamin E and 35 were given placebo. In Group 1, the mean age was 21.57+ 3.35 and in Group 2, the mean age was 22.0+3.05.Before treatment, the mean of VAS pain score was 49.29 in Vitamin E group ad placebo group was 58.71mm and after treatment, the mean of Vas pain score was reduce to 34.60 in vitamin E group and placebo group was 44.48. A significant difference was found the severity of pain and duration between the pre- and post treatment in both groups. Table: 2,3 As the comparison indicates, no significant differences were found regarding severity of pain and duration between the groups. ( p &lt; 0.05). This study will help the practioners,gynecologist for in the treatement of primary dysmenorrheal further this will also open the doors for further researches in this field. Conclusion: Vitamin E helps to relieve pain in primary dysmenorrhea. It can be considered as a universal medicine in the treatment of primary dysmenorrhea since it is a very simple way for pain control with fewer side effects and is cost-effective. Keywords: Dysmenorrhoea, Vitamin-E, nausea, vomiting, gastrointestinal symptoms

CAN MANUAL THERAPY AND MASSAGE BE USED AS COMPLEMENTARY METHODS FOR FEMALE INFERTILITY IN DIFFERENT AGE GROUPS?

Infertility is the inability to conceive after one year of unprotected intercourse, and about one in six couples deal with this issue. Nearly half of the factors contributing to a couple’s infertility are female-related, and the underlying cause is variable. Many treatment options can be used depending on the underlying cause of infertility. The available treatments often include in vitro fertilization, intrauterine insemination, and fertility-inducing drugs. Numerous couples favor complementary medicine alongside conventional treatments to enhance treatment efficacy and reduce side effects. Manual therapy and massage are among these complementary treatment approaches. Manual therapy is defined in various ways. One of them is manipulating and mobilizing soft tissue structures and related joints using the hands. Manual therapy can alleviate pain, reduce inflammation, prevent contracture formation, manage existing contractures, increase range of motion, aid mobilization, and improve overall health. It contains a variety of massage treatments, stretching, and mobilization applications. Manual therapy and massage can be administered to manage various disorders, from pediatric to geriatric populations. These are safe interventions. Manual therapy and massage have beneficial effects on the management of female infertility. These methods reduce adhesions and mobilize organs in the pelvic region. They have positive effects on circulatory system disorders, including lymphatic drainage abnormalities. Overcoming reproductive system lymphatic drainage and circulation difficulties can result in balanced hormone levels, regular menstrual cycles, and pregnancies. In addition, manual therapy and massage improve the psychological state of individuals in a way that will benefit the management of female infertility.

Relationship between Hormonal Changes and Self-Perceived Halitosis in Females: A Cross-Sectional Study.

Halitosis is a growing concern for patients seeking dental treatment. Women experience hormonal changes throughout different phases of their life. These changes may affect volatile organic compound (VOC) production and can be linked to halitosis. The aim of this study was to evaluate the effect of hormonal changes on self-perceived halitosis in a sample of females using a self-administered questionnaire. This study used a cross-sectional observational design. The questionnaire was distributed electronically through Google forms. A total of 1089 participants completed the questionnaire. Almost 50% of participants were below the age of 25; and 12% were of menopausal age (defined as 45 years and older). Most participants reported having regular menstrual cycles (63.5%) while only 20% reported having hormonal disturbances. Almost 62% of the sample reported that they notice halitosis on themselves with 27.6% indicating their perception of halitosis occurred at different times of the month. Around 12% of the sample thought that a relationship between halitosis and their menstrual cycle existed with 4.6% reporting halitosis during menstruation. The present study found that regularity of menstrual cycle and hormonal disturbances can affect females' self-perceived halitosis and the prevalence of oral health symptoms.

Neighborhood disadvantage is associated with decreased ovarian reserve in women with overweight and obesity

To evaluate the association between neighborhood disadvantage and ovarian reserve stratified by body mass index (BMI). Cross-sectional cohort study. Single academic medical center. A total of 193 healthy reproductive-age women with regular menstrual cycles in the St. Louis, Missouri metropolitan area. Residence in a disadvantaged neighborhood. Ovarian reserve as assessed by ovarian antral follicle count (AFC) and serum anti-Müllerian hormone (AMH) concentration. Women (n = 193) ranged from 20 to 44 years. The majority had overweight or obesity (59%, n = 117) with mean BMI of 28±7 kg/m2. Forty-eight women lived in the most disadvantaged neighborhood quartile, of which 75% had overweight or obesity, compared with 54% of the 145 women living in the 3 less disadvantaged neighborhood quartiles. When controlling for age, race, and smoking status, women with overweight or obesity living in the most disadvantaged neighborhoods had significantly lower AMH compared with those living in the less disadvantaged neighborhoods. Antral follicle count did not differ among women with overweight or obesity by neighborhood of residence. Neighborhood disadvantage was not associated with ovarian reserve by AFC or AMH in women with normal weight or underweight status. Living in a socioeconomically deprived area is associated with lower markers of ovarian reserve among women with an elevated BMI.

Efficacy of Cannabidiol Versus Ibuprofen in the Relief of Menstrual Pain in Females Living with Primary Dysmenorrhea A phase II, Non-Inferiority trial

Introduction: Pain is the cardinal symptom in women living with primary dysmenorrhea (PDM), resulting in a relentless negative effect on their quality of life.&nbsp; Women with PDM have higher levels of prostaglandin in their endometrial fluid, which correlates with the degree of pain. The standard of care treatment for pain associated with PDM starts with nonsteroidal anti-inflammatory drugs (NSAIDs) that block prostaglandin-triggering enzymes. Although NSAIDs present as a feasible option, they are also associated with a significant risk of side effects. Around 20 to 25% of patients will experience pain refractory to NSAIDs and will then seek alternative therapies. Cannabidiol (CBD) is a well-tolerated potential therapy for several chronic diseases, including pain, and acts by blocking prostaglandin-triggering enzymes, similarly to NSAIDs. The safety of CBD is well established, with the advantage of it acting via central and peripheral mechanisms. To date, no previous trials assessing CBD alone for dysmenorrhea have been conducted. Objective: To evaluate the effect of CBD alone in the reduction of acute menstrual pain compared to ibuprofen, as assessed by the total pain relief (TOTPAR) scale. Design: Randomized (with random block sizes), triple-blinded, multicenter, parallel-group, non-inferiority clinical trial. Setting: St. George, Scarborough, and Mississauga campuses at the University of Toronto, Ontario, Canada. Participants: PDM patients aged 18 to 40 years, regular menstrual cycles (ranging from 21 to 35 days), and a visual analog scale (VAS) score of ≥ 5. Intervention: 108 patients will be randomized with an allocation ratio of 1:1 to either CBD 200 mg/day or ibuprofen 800mg/day. The sample size is based on a mean expected pain relief for ibuprofen of 16.49 and CBD of 14.02, as assessed by the TOTPAR scale and on a 30% estimated dropout rate. Main Outcome Measures: The primary outcome will be the mean difference in the TOTPAR scale (range, 0-4) after taking the study drugs over four menstrual cycles. TOTPAR will be assessed after 1, 2, 3, 4, 5, and 6 hours after taking the study drugs. Secondary outcomes include pain VAS, adverse events, the need for breakthrough medications, and quality of life (QoL). Discussion: NSAIDs may cause troubling side effects, and CBD is well tolerated in clinical trials, with acceptable adverse event profiles. Numerous randomized clinical trials have demonstrated the safety and efficacy of CBD in alleviating central and peripheral pain of other disorders. The results of this trial aim to provide much-needed evidence that oral CBD alone is an alternative for the treatment of menstrual pain in women with PDM. CBD presents as an important promise for women with PDM who do not respond or who have contraindications to NSAIDs. Keywords: Cannabidiol, CBD, menstrual pain, ibuprofen, pain relief, non-inferiority, dysmenorrhea

Serum uric acid/creatinine ratio and free androgen index are synergistically associated with increased risk of polycystic ovary syndrome in obese women

BackgroundFeatures of metabolic syndrome such as abdominal obesity, insulin resistance, hypertension and dyslipidemia are commonly encountered in polycystic ovary syndrome (PCOS). Recent evidence has suggested an association between high serum uric acid/creatinine (UA/Cr) ratio and metabolic syndrome however, no studies have investigated this association in PCOS. The current study was conducted to investigate the relationship between UA/Cr ratio and PCOS and to identify whether UA/Cr ratio and free androgen index (FAI) have an additive interaction for detection of PCOS risk in obese women.MethodsThis study enrolled 40 obese women with PCOS and 40 control women with regular menstrual cycles matched for age and body mass index (BMI). Anthropometric measurements, fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), lipids profile, luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, dehydroepiandrosterone sulfate (DHEAS), sex hormone binding globulin (SHBG), total testosterone, free androgen index (FAI), UA/Cr ratio were assessed.ResultsSerum UA/Cr ratio was significantly higher in obese women with PCOS than in non-PCOS women. UA/Cr ratio was correlated with BMI, waist and neck circumferences, blood pressure, fasting insulin, HOMA-IR, lipids, LH/FSH, estradiol, DHEAS, total testosterone, FAI and SHBG. UA/Cr ratio and FAI were independent risk factors for PCOS in obese women however, the addictive interaction between UA/Cr ratio and FAI had a higher fold risk (OR: 4.3, 95% CI, 3.4–7.58) and a more significance (P = 0.002) for determination of PCOS.ConclusionSerum UA/Cr ratio combined with FAI can exert an additive or synergistic impact on prediction of PCOS in obese women.

The Relationship between Physical Activity and Menstrual Cycle 11th Grade Student of Kharisma Bangsa High School and its Review According to Islamic Views

Introduction: Mentruation is a sign that a woman has entered puberty. Menstrual cycle disorders are a problem that is quite often experienced by adolescents. Irregular menstrual cycles can be caused by various factors, one of which is physical activity. This study aims to find out whether there is a relationship between physical activity and menstrual cycle in 11th grade students of Kharisma Bangsa High School and its review according to islamic views. Method: This type of research is analytical with a cross-sectional approach and the way of determining the sample is total sampling. The sample in this study was a 11th grade student of Kharisma Bangsa High School with a total of 44 students. Data collection is carried out by questionnaires. Results: In this study, only 32 respondents fit the research inclusion criteria. From the results of statistical analysis, 5 (15.6%) respondents with light physical activity had a regular menstrual cycle. Meanwhile, 13 (40.6%) respondents with moderate physical activity and 3 (9.4%) respondents with heavy physical activity had irregular menstrual cycles. The results of the Chi-Square test obtained a p-value of 0.045 (&lt;0.05) which showed a significant relationship between physical activity and the menstrual cycle in 11th grade students of Kharisma Bangsa High School.Conclusion: There is a significant relationship between physical activity and the menstrual cycle. Physical activity can affect menstrual cycle irregularities. Therefore, it is recommended to pay attention to the type and duration of physical activity to be carried out.

Magnitude and associated factors of menstrual irregularity among young girls: A cross-sectional study during COVID-19 second wave in India.

Several symptoms are typically experienced after a coronavirus disease 2019 (COVID-19) infection. Worldwide, a lot of women are reporting irregularities in their menstrual cycles post-COVID-19 infection. The purpose of this study is to investigate the prevalence of menstrual pattern among young girls during the second wave of COVID-19 pandemic and to determine the risk factors related to lifestyle among young girls. A cross-sectional study was conducted using a self-designed questionnaire encompassing details of the menstrual pattern, features of hyperandrogenism, lifestyle, and comorbidity among young girls aged 16-24 years. The data from 508 girls fulfilling the inclusion criteria were analyzed. The prevalence of irregular menstrual cycle was found to be 29.1%. Further analysis revealed that a significant percentage of girls with irregular menstrual cycle suffer from depression (14.9%) and are often staying stressed (40.5%) in comparison to the girls having regular menstrual cycle. Also, a total of 58 girls out of 508 were diagnosed with polycystic ovary syndrome (PCOS). Among various comorbid conditions, obesity was found in 60% of girls having PCOS followed by an eating disorder. A significant increase in irregular menstrual cycle in young girls was found during the second wave of COVID-19. The risk factors for causing the irregular menstrual cycle were found to be insomnia, stress, and depression.

P059Pharmacodynamic evaluation of the etonogestrel contraceptive implant initiated midcycle with and without ulipristal acetate: A pilot randomized controlled trial

<h3>Objectives</h3> To determine the incidence of ovulation within five days of etonogestrel (ENG) implant insertion in the presence of a dominant follicle with and without same-day oral ulipristal acetate (UPA) administration. <h3>Methods</h3> This single site trial recruited people aged 18–35 with regular menstrual cycles and interest in an ENG implant without pregnancy risk. We initiated transvaginal ultrasounds on day 7–9 of menses and randomized participants 1:1 to ENG implant alone or with concurrent oral UPA when a dominant follicle reached ≥14 mm in diameter. We completed daily transvaginal ultrasounds and serum hormone levels for up to seven days post-insertion or transitioned to labs alone if we observed follicular collapse on ultrasound prior to the end of seven days. We defined ovulation as follicular rupture followed by a progesterone level ≥3ng/mL. <h3>Results</h3> We enrolled 35 people: 17 with ENG implant alone (mean enrollment follicular size: 15.2 mm ± 0.9 mm) and 18 with ENG implant and UPA (mean enrollment follicular size: 15.4 mm ± 1.2 mm, p=0.6). Ovulation occurred in 35.3% (n=6) of ENG implant–alone participants and in 61.1% (n=11) of ENG implant and were given UPA(Risk ratio (RR), 0.6; 95% CI, 0.3–1.2; p=0.1). <h3>Conclusions</h3> Although not powered to detect statistically significant differences, mid-cycle ovulation suppression was more common when the ENG implant was inserted alone than with same-day UPA administration, supporting concerns for drug-drug interactions between oral UPA and ENG. Ovulation suppression with the implant exceeds prior reports of oral levonorgestrel. Thus, the ENG implant is worth testing as emergency contraception.

Comparing Metformin, Inositol, and Lifestyle Modifications to Improve Symptomatology of Polycystic Ovary Syndrome (PCOS): A Research Protocol

Introduction: Polycystic ovary syndrome (PCOS), a common endocrinological disorder of women of reproductive age, affects about 5-20% of women globally. It is diagnosed through the Rotterdam criteria with the presence of two out of three clinical features of oligo-anovulation, hyperandrogenism, and/or polycystic ovaries. Hyperinsulinemia and insulin resistance are central features of PCOS , along with obesity. This study aims to compare three treatment interventions: metformin, inositol, and lifestyle modifications to improve symptoms of PCOS. Methods: In this four-arm randomized study, 48 women of reproductive age (25-36 years) will be recruited over a 12-week period. Impacts of treatment types (metformin, inositol and lifestyle modifications) will be determined in improving symptoms of PCOS. Control group, “Group A” (N=12) will not be going through any treatment; “Group B” (N=12) will be taking 500 mg of metformin daily, with close assessment of side effects; “Group C” will take 2 g of inositol supplements twice daily with a 40:1 myo-inositol and D-chiro-inositol ratio; and “Group D” will undergo lifestyle modifications, closely monitored by personal trainers, nutritionists, and dietitians, to facilitate weight loss. ANOVA, Pearson’s correlation, and Kruskal-Wallis H test will be conducted to determine significance. Anticipated Results: PCOS patients of group C, inositol intake, may be seen to have greatest improvements in PCOS symptomatology due to its insulin sensitizing, metabolic, and hormonal influences, with minimal adverse effects. Discussion: Previous studies have shown inositol consumption to result in significant improvements in insulin resistance, menstrual cycle regularity, Acne score, Ferriman-Gallwey score, endocrine and metabolic parameters, reduced serum levels of total testosterone, and elevated sex hormone binding globulin in women with PCOS. Metformin may yield similar effects to inositol, but greater adverse effects may be present. Through a reduced BMI, lifestyle modifications have shown to significantly reduce total androgen profile, waist circumference, and lipid profile while increasing clinical pregnancy rate by 20%. Conclusion: The comparison of three treatment modalities may be beneficial for PCOS patients to provide optimal treatment. It may be beneficial to compare a combination of treatment interventions in the future for additive or synergistic effects.

The Effects of Isotretinoin on The Menstrual Cycle: A Cross-Sectional Study.

Menstrual irregularities during isotretinoin therapy, including amenorrhea, can cause a great deal of health-status uncertainty such as the possibility of pregnancy. This study aimed to evaluate the effects of isotretinoin treatment on the menstrual cycle. This cross-sectional study was conducted among females aged between 15-45 years taking isotretinoin for acne. Descriptive statistics were used in the form of frequencies and percentages to represent categorical variables. Pearson's chi-squared test was performed to assess the relationship between some of the variables with menstrual irregularities. A logistic regression model was performed to assess the risk factors for developing menstrual irregularities during isotretinoin therapy. Of participants with a known regular menstrual cycle, 10.4% were found to have irregularity in their cycle after starting the drug (p &lt; 0.001). Amenorrhea was the most commonly reported menstrual irregularity in isotretinoin-treated females. Our results showed that single females, those who took isotretinoin for 10-12 months and who were concurrently taking hormonal contraceptives all have a statistically significant higher risk of developing menstrual irregularities than others. In conclusion, we found that a statistically significant number of participants with a regular menstrual cycle pre-isotretinoin intake developed irregularity in their cycle after starting the drug. The mechanism of how isotretinoin influences female hormonal imbalances, thereby affecting menstrual irregularities is still poorly understood and needs to be clarified in further clinical studies.