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• Polycystic ovary syndrome (PCOS) is common worldwide. The syndrome refers to a group of disorders with multiple reproductive, metabolic, and endocrine elements. • PCOS affects women from fetal life throughout their lifespan, often decreasing reproductive ability and quality of life, and increasing other types of morbidity and mortality. It is often undiagnosed and untreated. • Management traditionally focuses on the treatment of hyperandrogenism and oligomenorrhea. Women with PCOS often have dyslipidemia, hypertension, obesity, and metabolic syndrome. Management plans should incorporate diagnosis and management of these factors, if present, because of the strong contribution to risk for atherosclerotic cardiovascular disease. • Understanding that the disease extends throughout life emphasizes the importance of continued screening for and treatment of risk factors to prevent cardiovascular disease throughout a woman's lifespan. • Given the complexities of the syndrome and heterogeneous manifestations, optimal management often requires a multi-disciplinary approach to provide counseling and support for lifestyle modification and addressing the full range of any reproductive, endocrine, and cardiometabolic abnormalities. Polycystic ovary syndrome (PCOS) is a common endocrinopathy worldwide with a heterogeneous clinical presentation including reproductive, metabolic, and endocrine elements. However, the assessment and management of PCOS remains inconsistent, with many women undiagnosed and untreated. We now also understand that the management of PCOS should extend throughout a woman's lifespan as many elements of the syndrome persist after menopause. Management has traditionally focused on the treatment of hyperandrogenism and oligomenorrhea. Women with PCOS often have dyslipidemia, hypertension, obesity, and metabolic syndrome, which may be worsened by the hormonal abnormalities, and are therefore at higher risk for cardiovascular disease morbidity and mortality, a risk that increases after menopause. While treatment with hormonal therapy, in particular combined oral contraceptives, may improve cardiovascular risk factors, management plans should incorporate specific diagnosis and management of these factors, if present, because of the strong contribution to the risk for atherosclerotic cardiovascular disease. Given the complexities of the syndrome, optimal management often requires a multi-disciplinary approach including the lipid and cardiometabolic specialist to provide counseling and support for lifestyle modification along with pharmacologic therapy as indicated to address the full range of any reproductive, endocrine, and cardiometabolic abnormalities. [ABSTRACT FROM AUTHOR]

Regular menstruation is a key indicator of general health and irregular menstrual parameters have been associated with elevated risk of adverse health outcomes. While psychological stress is believed to contribute to abnormal menstruation, little is known of the effects of discrete psychological stressors, including the COVID-19 pandemic, on menstrual function. A systematic database search was performed and studies investigating the relation between psychological stress and menstrual cycle irregularity in otherwise healthy adults were included. Two independent investigators completed abstract and full-text screening, data extraction, and risk of bias assessment. In the 41 included studies, a variety of stressors were assessed, namely COVID-19 pandemic stress, academic stress, and occupational stress. Our review found most studies report an association between psychological stress and menstrual dysfunction, with the most common disruptions being irregular menstruation and abnormal menstrual flow. Our findings also underlined notable discrepancies in the operational definitions used in the study of menstrual disorders. These observations emphasize the importance of psychological stress as a modifiable risk factor associated with irregular menstruation. • Most reviewed studies report elevated stress to be linked to abnormal menstruation. • Irregular menstruation and menorrhagia are commonly associated with high stress. • No consistent relation was observed between stress and abnormal cycle length. • Many inconsistencies were noted in the definitions used for abnormal menstruation. [ABSTRACT FROM AUTHOR]

Background Energy deficiency can result in menstrual disturbances and compromised bone health in women, a condition known as the Female Athlete Triad. Objectives The REFUEL randomized controlled trial assessed the impact of increased energy intake on bone health and menstrual function in exercising women with menstrual disturbances. Methods Exercising women with oligomenorrhea/amenorrhea (Oligo/Amen) were randomly assigned to an intervention group (Oligo/Amen + Cal, n  = 40, mean ± SEM age: 21.3 ± 0.5 y; weight: 55.0 ± 1.0 kg; BMI: 20.4 ± 0.3 kg/m2) who increased energy intake 20%–40% above baseline energy needs for 12 mo or a control group (Oligo/Amen Control, n  = 36; mean ± SEM age: 20.7 ± 0.5 y; weight: 59.1 ± 1.3 kg; BMI: 21.3 ± 0.4 kg/m2). Energy intake and expenditure, metabolic and reproductive hormones, body composition, and areal bone mineral density (aBMD) were assessed. Results Oligo/Amen + Cal improved energy status [increased body mass (2.6 ± 0.4 kg), BMI (0.9 ± 0.2 kg/m2), fat mass (2.0 ± 0.3 kg), body fat percentage (2.7% ± 0.4%), and insulin-like growth factor 1 (37.4 ± 14.6 ng/mL)] compared with Oligo/Amen Control and experienced a greater likelihood of menses (P  < 0.05). Total body and spine aBMD remained unchanged (P  > 0.05). Both groups demonstrated decreased femoral neck aBMD at month 6 (−0.006 g/cm2; 95% CI: −0.011, −0.0002 g/cm2 ; time main effect P  = 0.043) and month 12 (−0.011 g/cm2; 95% CI: −0.021, −0.001 g/cm2; time main effect P  = 0.023). Both groups demonstrated a decrease in total hip aBMD at month 6 (−0.006 g/cm2; 95% CI: −0.011, −0.002 g/cm2; time main effect P  = 0.004). Conclusions Although higher dietary energy intake increased weight, body fat, and menstrual frequency, bone mineral density was not improved, compared with the control group. The 12-mo intervention may have been too short and the increase in energy intake (∼352 kcal/d), although sufficient to increase menstrual frequency, was insufficient to increase estrogen or improve aBMD. Future research should refine the optimal nutritional and/or pharmacological interventions for the recovery of bone health in athletes and exercising women with Oligo/Amen. This trial was registered at clinicaltrials.gov as NCT00392873. [ABSTRACT FROM AUTHOR]

To identify polycystic ovarian syndrome (PCOS) in a population of female patients with McCune−Albright syndrome (MAS) by retrospective chart review. Retrospective study. Academic setting. All female patients with a prior diagnosis of MAS who were more than 12 years of age at the time of chart review. Only complete medical records from January 2009 to January 2020 were included in the analysis. None. Diagnosis of PCOS based on the Rotterdam 2003 criteria. Seventeen female patients with MAS were included in the analysis. PCOS appeared to be more prevalent in MAS patients than expected based on population estimates (exact binomial test = 0.353; CI = 0.142-0.617, P =.01). The average body mass index was not significantly different between MAS patients with and without PCOS (23.38 kg/m2 vs 23.44 kg/m2, 2-sample Wilcoxon rank-sum test with continuity correction, W = 29, P = 0.733). The majority of patients (71%) were treated with an aromatase inhibitor and/or a gonadotropin-releasing hormone (GnRH) agonist. The results of this study suggest that female individuals with MAS have a statistically higher prevalence of PCOS. These findings warrant further studies to determine whether the increased risk of PCOS may be associated with precocious puberty, treatment of precocious puberty, or other factors. [ABSTRACT FROM AUTHOR]

Background: While increased risk of psychiatric burden in patients with polycystic ovarian syndrome (PCOS) is reported in the literature, there is dearth of reports from Saudi Arabia on occurrence of psychological burden in women with PCOS. This study aimed to compare the sociodemographic and clinical features of PCOS cases with non-PCOS control and explore the prevalence of depression, anxiety and stress in PCOS and non-PCOS women.Materials and Methods: This is a case-control study carried out in PSMMC, Riyadh, Saudi Arabia from March 2019 to June 2019. Samples were recruited by convenience sampling and simple random method in PCOS cases (82) and control group (85), respectively. Depression, Anxiety and Stress Scale-21 (DASS-21) was used to measure the presence of psychological burden.Results: High percentage of participants were in an age group of 26-35 years (51%) and university educated (64%). Significantly (P = 0.001) high proportion of PCOS cases found with irregular menses, hirsutism, infertility and presence of acne (P = 0.001) when compared to control group. The odds of developing depression (P = 0.006), anxiety (P = 0.028) and stress (P = 0.000) was significantly higher in PCOS cases compared to control participants. Further, among the three parameters, the occurrence of stress (odds ratio, OR=10.45) in women with PCOS was more common than depression (OR=2.675) and anxiety (OR=2.056).Limitations: Recall bias and inclusion of only one hospital.Conclusion: In conclusion, most of the PCOS cases had stress, depression and anxiety compared to control group. Meeting the psychological need of the PCOS women will help in improving their quality of life. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that the polycystic ovary syndrome (PCOS) phenotype, or its component features, is less severe in adolescents than in young adult patients, in a referred (clinical) population.Design: Cross-sectional study.Setting: Tertiary-care academic medical center.Patient(s): Two hundred seventy-four adolescents and young adults aged 13.0-24.9 years with PCOS according to the National Institute of Health 1990 criteria. Patients were categorized as adolescents (AD: 13.0-18.9 years; n = 91) and young adults (YA: 19.0-24.9 years; n = 183). Adolescents were further categorized as early adolescents (Early-AD: 13.0-15.9 years; n = 31) and late adolescents (Late-AD: 16.0-18.9 years; n = 60).Intervention(s): History, physical examination, hormonal assays with the use of standardized protocols.Main Outcome Measure(s): Unadjusted and adjusted odds ratios (ORs; adjusted for body mass index [BMI] when applicable) were calculated for biochemical hyperandrogenism (HA), hirsutism (HIR), acne, and degree of oligo/amenorrhea (OA). PCOS phenotypes were classified as HIR+HA+OA, HA+OA, and HIR+OA.Result(s): Our analysis demonstrated minimal significant difference in the prevalence of the three PCOS phenotypes, or component features, between AD and YA patients. The risks for obesity were higher for YA versus AD, and the risk of acne was lower for YA versus AD. There was no significant difference between Early-AD and Late-AD. BMI-adjusted models did not significantly modify the main findings.Conclusion(s): The present study suggests that the PCOS phenotype is established in early adolescence, remains constant into adulthood, and is not related to BMI. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) is a reproductive, endocrine, and metabolic disorder affecting millions of women worldwide. Women with PCOS are often identified in adolescence or early adulthood with symptoms of oligomenorrhea or hirsutism or when presenting for infertility care. The health risks associated out of PCOS, however, go far beyond management of these common presenting symptoms or fertility treatment and likely extend past the reproductive years through and beyond menopause. International surveys suggest that most patients are dissatisfied with long-term counseling related to medical and psychologic issues. We performed a review of comorbidities, including diabetes mellitus, dyslipidemia, obesity, hypertension, metabolic syndrome, depression, anxiety, obstructive sleep apnea, nonalcoholic fatty liver disease, endometrial cancer, and cardiovascular disease, in both reproductive-age and older women with PCOS. Most meta-analyses in reproductive-age women demonstrate increased risks independent from obesity. Longitudinal and cross-sectional studies including women with PCOS >40 years of age are limited in number and design, but many demonstrate that some of these comorbidities persist. All providers involved in the multidimensional care of women with PCOS should be aware of these long-term health risks to provide appropriate counseling, screening, and management options. We identify limitations that should be the focus of future studies designed to study health outcomes in postmenopausal women with PCOS. [ABSTRACT FROM AUTHOR]

Study Objective Polycystic ovarian syndrome (PCOS) is a common endocrine disorder characterized by hyperandrogenism and chronic anovulation, which affects 5%-10% of reproductive-age women. Diagnosis of adult patients with PCOS is made easily with clinical and laboratory methods and the anti-Müllerian hormone (AMH) level are accepted as a good indicator. However, there is still no complete consensus on the diagnosis of PCOS in adolescents. Design and Setting Prospective cohort study, December 2013 to November 2014. Participants The study was conducted on adolescent girls with oligomenorrhea, with at least 2 years since menarche. The study group consisted of adolescent girls with complete PCOS and incomplete PCOS. A control group was formed of healthy adolescent girls. Complete PCOS was diagnosed according to the Rotterdam criteria, as the presence of all the following characteristics: oligomenorrhea, hyperandrogenism, and polycystic ovarian morphology on ultrasound image. Incomplete PCOS was accepted as “oligomenorrhea and polycystic ovarian morphology,” or “oligomenorrhea and hyperandrogenism.” Interventions and Main Outcome Measures All patients underwent a physical examination and the anthropometric assessments, insulin resistance, and acanthosis nigricans were recorded. It was also noted whether or not the patient had an acne score. The Ferriman-Gallwey score was applied to evaluate hirsutism. Results The results of this study showed that no statistically significant difference was found between the PCOS and incomplete PCOS groups and the control group with respect to AMH levels. Conclusion The use of adult-specific diagnostic methods in adolescence might result in an incomplete diagnosis and inadequate treatment plan. Although the serum AMH level clearly facilitates the diagnosis of PCOS, the use of the AMH level in adolescence in PCOS diagnosis is still controversial and further studies are needed. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting young women. Even though the definition of PCOS has changed over the years, all diagnostic criteria include two or more of the following: oligomenorrhea/oligoovulation/anovulation, androgen excess and polycystic ovaries (PCO). Traditional method of assessing the ovarian morphology has been transvaginal pelvic ultrasound. Recent studies support that serum anti-Mullerian hormone (AMH) levels correlate with the number of ovarian follicles and cysts. Hence, measurement of AMH is adequate to make the diagnosis. Traditionally, hyperandrogenemia has been assessed by measuring total-testosterone. The literature stresses the importance of sex hormone binding globulin (SHBG) measurements and bioavailable-testosterone and free-testosterone calculations, because insulin resistance decreases SHBG, lowers total-testosterone, and leads to under-estimation of bioavailable- and free-testosterone. Since 50–60% of PCOS patients have metabolic syndrome, assessment of metabolic risk is also necessary. It is important to diagnose insulin resistance before development of glucose intolerance and diabetes. This requires measurements of not only plasma glucose but also insulin concentrations. Determination of HgBA1 can be informative as well. This review aims to present an accurate and cost-effective approach to diagnosis and management of PCOS. [ABSTRACT FROM AUTHOR]

Background: Menarche is the first menstrual cycle. Menstrual problems, such as dysmenorrheal menorrhagia, oligomenorrhea, and irregular cycle are common in female adolescents. This research aims to examine the associations between age at menarche and menstrual problems and suicidal behavior among Chinese female adolescents.Methods: An epidemiological survey of 5831 female adolescents from eight high schools of three counties of Shandong province, China, was conducted. A self-administered paper-and-pencil questionnaire was used to collect information. Logistic regression analyses were used to examine the association between menstruation and suicidality.Results: The mean age of the sample was 15.02 (SD=1.44) years. Of the sample, 5,231 (90.0%) had experienced their first menstrual cycle, and 23.2%, 10.4%, and 4.5% of the sample reported having had suicidal ideation, plan and attempt, respectively. In multivariate models, menarche at ≤11 years was associated with increased risk of suicidal ideation (OR=1.41, 95%CI: 1.10-1.81) and menarche at 12 years was associated with suicide plan (OR=1.23, 95%CI: 1.00-1.51). Irregular menstrual cycle was significantly associated with increased risk of suicidal ideation (OR=1.40, 95%CI: 1.05-1.86) and menstrual period less than or equal to 4 days was significantly associated with increased risk of suicide plan (OR=1.32, 95%CI: 1.06-1.66).Limitations: This cross-sectional study cannot establish the causal directions between menstrual problems and suicidality in adolescents.Conclusions: Our study suggests that earlier menarche, irregular menstrual cycle and short menstrual period are associated with suicidal behavior in female adolescents. Further research is warranted to examine the causal relationship between menstrual problems and suicidal behavior in adolescents. [ABSTRACT FROM AUTHOR]

Oligomenorrhea is a polyetiological disease, and in the adolescent population is most often considered as a physiological condition, due to the lack of a clear relationship with any particular somatic or gynecological pathology. Hormonal research, in most cases, is not informative. In this regard, it is relevant to search for molecular biological markers that allow diagnosing the disease in the early stages of its development. Modern studies have revealed the possibility of participation of the phragil X chromosome gene (FMR1), located on the long arm of the X chromosome in the Hq27.8 locus, in the pathology of folliculogenesis. The role of premutation – an increase in the number of CGG repeats ranging from 50 to 200 – in the genesis of PNA and infertility is represented by few scientific reports [1]. The least studied is the relationship of reducing the number of CGG repeats of less than 26 with the risk of ovarian dysfunction [2]. To date, there are no studies conducted in the adolescent population regarding the relationship of the abnormal number of CGG repeats in the FMR1 gene with ovarian dysfunction, manifested by various menstrual disorders. Studies of the FMR1 gene product, the FMR1 protein (FMR1P), have also not been conducted in adolescents. The purpose of the study is to improve the differential diagnosis of oligomenorrhea in adolescents based on the investigation of molecular genetic markers as predictive factors of ovarian dysfunction. Study Design: The study included 80 adolescent girls diagnosed primary and secondary oligomenorrhea. One of the objects of the study was the fragile X mental retardation-1 (FMR1) gene on the X chromosome and protein FMR1 (FMR1P). The determination of allele variants of FMR1 genes was carried out by PCR. In addition to the studies included in the standard of patient management with oligomenorrhea, the ELISA method defined the serum content of anti-ovarian antibodies, AMH, Inhibin-B. In retrospect, patients with oligomenorrhea were divided into 3 groups depending on the various heterozygous subgenotypes of the FMR1 gene: I group – heterozygous individuals with «het-norm / low» subgenotype - the number of CGG repeats of one allele within the normal range (26-34), and in the second allele - less than the lower limit of the norm (26); II group - heterozygous individuals with het-norm / high, whose number of CGG repeats of one allele - within the normal range, and in the second allele - exceeds the upper limit of standards (34); III group - unaffected individuals, the FMR1 gene contains 29 or 30 repeats of the sequence CGG. Results and Conclusion: Based on the results of our study [3], we have identified the clinical heterogeneity of the cohort of patients with oligomenorrhea, caused by various heterozygous subgenotypes of the FMR1 gene, formulated the clinical-laboratory characteristic of each subgenotype and developed a personalized algorithm for examination and therapy of adolescents with oligomenorrhea. 1. Heterozygous low - characterized by an increased titer of autoantibodies to TPO and ovarian antigens, increased production of AMH, FMR1P, hyperandrogenism and small cystic ovarian transformation and can be considered as an autoimmune phenotype of polycystic ovary syndrome. The incidence according to our study was 25%; 2. Heterozygous high - characterized by an decreased level of FMR1P, inhibin B, AMH relative to age-related standards, with moderately elevated gonadotropins, which can be considered as the initial signs of POI. The incidence was 13.75%. [ABSTRACT FROM AUTHOR]

• Gestational diabetes (GDM) is the highest risk factor for diabetes in young women. • The association of pre-pregnancy hyperandrogenism and GDM is inconsistent. • In this study, polycystic ovary syndrome (PCOS) was positively associated with GDM. • Hyperandrogenism or oligomenorrhea in the absence of PCOS was not associated with GDM. In this 28-year prospective study of 455 women (mean age: 26 years), polycystic ovary syndrome (PCOS) was associated with a 2.6-fold elevated risk of gestational diabetes (GDM). However, hyperandrogenism or oligomenorrhea in the absence of PCOS was not associated with GDM. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the prevalence of fracture in women aged >55 years with self-reported premenopausal hirsutism and/or oligomenorrhea.Study Design: A cross-sectional study including 1057 post-menopausal women aged >55 years who were treated in a primary care facility in Santa Maria, South Brazil, from March 2013 through August 2013. Data were collected using a standardized questionnaire for characteristics including fracture history, medication use, and reproductive history (oligomenorrhea, hirsutism, miscarriage, the diagnosis or treatment of hypothyroidism, hyperprolactinemia, or infertility).Results: A non-significant trend towards an increased prevalence of all fragility fractures was observed in women with premenopausal hirsutism and/or oligomenorrhea when compared to those without (20.4% vs. 15.7%). After correction for age, falls, and comorbidities, fracture prevalence was significantly higher in the lower leg (OR 3.1 [CI 1.1-8.6]; P=0.029), and humerus (OR 2.6 [CI 1.2-5.4]; P=0.015) in the women with hirsutism and/or oligomenorrhea.Conclusion: This is a hypothesis-generating study which evaluated the association between hirsutism and/or oligomenorrhea and fractures in postmenopausal women. Our results suggest that premenopausal hirsutism and/or oligomenorrhea may be associated with an increased risk of fracture postmenopause, particularly in the humerus and lower leg. [ABSTRACT FROM AUTHOR]

Objective: The present study aims to determine the effects of a history of adolescent pregnancy (AP) on the bone mineral density (BMD) of perimenopausal women.Methods: Overall, 240 women aged between 40 and 55 years, with a complaint of oligomenorrhea or amenorrhea not exceeding 1 year in duration, were evaluated. Evaluation included a DEXA scan and a detailed demographic survey for bone health. Comparison was made between women with a history of AP and those without.Results: In total, 87 women who had a history of AP were compared with 153 women who did not have a history of AP. The study groups did not differ significantly for most of the evaluated demographic factors. Women with a history of AP had higher gravidity and parity. Comparison of T-scores revealed lumbar BMD to be unaffected by AP (P=0.184), whereas femoral BMD was positively influenced by a history of AP (0.78±0.65 vs -1.06±0.67; P=0.042). In covariance regression models, after adjusting for parity and age of first menarche, AP still positively influenced femoral BMD. Without a history of AP, women were at increased risk for osteoporosis of femoral neck (odds ratio, 2.8, 95% CI 1.75-4.8).Conclusions: The effects of AP on BMD are not well elucidated. Women with a history of AP had better femoral BMD scores, indicating a possible protective influence of AP on bone health.Brief Summary: Pregnancy during adolescence is associated with a better femoral bone mineral density than pregnancy at an older age. However, the effects did not extend to lumbar spine bone mineral density. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study is to evaluate the effect of polycystic ovarian syndrome (PCOS) on the prevalence of metabolic syndrome (MBS) in adolescent girls with normal BMI. Materials and Methods Our study group consisted of 63 pubertal girls with a BMI less than 25 kg/m 2 who were referred to our center with signs of hirsutism or oligomenorrhea. The diagnosis of PCOS was based on the recent ESHRE/ASRM proposal and required that all 3 of the Rotterdam criteria for diagnosing PCOS in adolescents be met. The control group consisted of 159 pubertal girls matched for age and BMI. Glucose, insulin, testosterone, and sex hormone-binding globulin, free testosterone and all lipid parameters measured. For to diagnose the cases with MBS, modified Cook criteria were used and cases who had at least 3 of 5 criteria's were diagnosed as MBS. Results Girls with PCOS had higher blood pressure parameters (systolic/diastolic) ( P < .01), fasting insulin ( P = .007), low-density lipoprotein ( P = .017), triglyceride ( P = .045), total ( P < .001) and free testosterone ( P = .001) levels compared to control group. There were more cases who had at least 1 Cook criterion in girls with PCOS compared to the control group but the difference was not significant. However, there were more cases who had MBS in girls with PCOS compared to the control group ( P = .02). Conclusion MBS prevalence is higher in normal BMI adolescent girls with PCOS compared to age and BMI matched control group. So as clinicians, we must search for the MBS criteria's in girls with PCOS even if they have a normal BMI. [ABSTRACT FROM AUTHOR]

Melasma is a facial hyperpigmentation in the upper lips, cheeks, forehead and chin. It is mostly seen in women. Melasma treatments include topical methods that are not only costly, but also temporary. Melasma recurs shortly after cessation of the treatment. Considering the relationship between melasma and elevated estrogen levels in patients with oligomenorrhea, systemic anti-estrogen therapies are not used for melasma. In this study, by searching in the scientific databases such as Scopus, Pubmed and the authentic books of traditional medicine such as the Canon of medicine, melasma treatment was evaluated based on oligomenorrhea systemic therapy. The results of this study showed that if melasma is due to oligomenorrhea, the use of systemic anti-estrogenic therapies can improve melasma by reducing of Melanogenesis due to decreasing α msh (alpha-Melanocyte-stimulating hormone) in addition to oligomenorrhea improvement. However, because of the extreme attention to the advertising cosmetic creams, attention to systemic therapies has been faded. According to traditional medicine, the use of menstruation-inducing systemic therapies can be more effective in melasma than topical treatments because of removing of the disease agent. Given the important role of oligomenorrhea in creating of melasma, it is suggested conducting more studies on the effect of systemic therapy of oligomenorrhea on melasma treatment. If proven, to be considered as the treatment strategies for this disease. [ABSTRACT FROM AUTHOR]

Study Objective This study aimed to determine awareness/knowledge of the Triad and its health implications among female high school athletes and their coaches, and to evaluate coaches' Triad screening/intervention practices. Design Cross-sectional survey. Setting Two high schools in the western United States. Participants Female athletes from a variety of sports (N = 240) ages 14-18 years and their coaches (N = 10). Intervention Participants completed surveys that assessed Triad knowledge and athlete Triad risk factors. Main Outcome Measures Frequency of responses to Triad knowledge, Triad risk factor, and Triad education/screening procedures questions; athlete summative knowledge score. Results Half (N = 120) of participants reported menstrual irregularity, and 42% (N = 101) had 2 or more Triad risk factors: past amenorrhea (N = 39), past stress fracture (N = 41), self-reported not eating enough (N = 53), underweight (BMI-for-age < 5 th percentile) (N = 10), pressure to be a certain weight (N = 143), and wanting to lose >10 pounds when self-reported weight was in a healthy range (N = 34). Average athlete Triad knowledge score was 2.97 ± 1.61 out of 8. Coach Triad knowledge was limited; however, most (9/10) were comfortable discussing menstruation with their athletes. Barriers to Triad screening/education were coaches' insufficient time, knowledge, and educational resources. Conclusion Triad risk factors were prevalent among athletes and coach and athlete Triad knowledge was low. Providing coaches with Triad screening/education training may increase Triad knowledge and decrease Triad risk among high school athletes. [ABSTRACT FROM AUTHOR]

Objective To estimate the prevalence of uterine müllerian duct anomalies in a general population. Design Cross-sectional study. Setting University hospital in collaboration with the Danish Civil Registry. Patient(s) A total of 1,654 women randomly recruited from a general population; 686 women were eligible and accepted inclusion (429 pre- and 257 postmenopausal). Saline contrast sonohysterography (SCSH) was finally performed in 622 women (aged 20-74 years) (the procedure was impossible owing to cervical stenosis in 58, contraindicated in 2, other patient-related factors in 4). Intervention(s) The shape of the uterus was dynamically evaluated in the transversal and longitudinal planes during SCSH and classified in accordance with American Fertility Society as normal, arcuate, septate (partial, complete), bicorn (partial, complete), or unicorn. History of previous miscarriage and menstrual cycle was obtained by a questionnaire. Main Outcome Measure(s) Prevalence of müllerian anomalies, miscarriage, and oligomenorrhea. Result(s) The overall prevalence of müllerian anomalies was 9.8% (61 of 622) (95% confidence interval [CI] 7.5-12.1). The majority had arcuate uteri (n = 42, 6.8%), 17 partial septate (2.7%), 1 complete septate (1.6%), and 1 unicorn uterus (1.6%). Müllerian anomalies were significantly more frequently diagnosed in nulliparous (20% [26 of 128]) compared with parous women (7% [35 of 494]). Müllerian anomalies were more frequent in women with oligomenorrhea compared with women with normal menstrual periods (19% [15 of 79] vs. 10% [34 of 339]). One first-trimester miscarriage or multiple miscarriages (more than one) were not significantly more frequent in premenopausal women with müllerian anomalies compared with women with normal-shaped uteri (24% [6 of 25] vs. 22% [57 of 265]). Conclusion(s) In a general population examined by SCSH the prevalence of Müllerian anomalies is estimated at 9.8%. Müllerian anomalies were more frequent in nulliparous women. Both impaired fertility and a pregnancy-associated modulation of the uterine corpus are among explanations. Müllerian anomalies were associated with oligomenorrhea in premenopausal women. In this general population there was no association between miscarriage and müllerian anomalies; however, the number of cases was limited. [ABSTRACT FROM AUTHOR]

Polycystic ovarian syndrome (PCOS) is the leading cause for anovulatory infertility. It is diagnosed by two of the following three clinical criteria: oligomenorrhoea, hyperandrogenism and polycystic appearance of the ovaries. Weight loss and physical activity can lead to ovulation and conception. Lowering of serum insulin normalizes androgen concentrations whereas ovulation induction often causes ovarian hyperstimulation. Theca cells from PCOS ovaries may be more responsive to insulin than cells from non-PCOS ovaries. Herein we review the research efforts at the genomic and cell function levels, as well as animal models, which have been made to elucidate the underlying mechanism that leads to PCOS. It appears that, despite the impressive amount of data that have been generated in these studies, the mechanism of this syndrome is still only partially understood. [ABSTRACT FROM AUTHOR]

Abstract: Background: An oral dose of 0.75 mg levonorgestrel (LNG) taken shortly after sex was marketed as a routine, nonemergency contraceptive method until the 1990s. Because a hormonal method used only at the time of intercourse may be desirable for women who have infrequent sex, we conducted a study to reevaluate the potential of pericoital LNG as a primary means of contraception. Methods: We enrolled women aged 18–45 years in Brazil and the USA who expected to have sex 1–4 days per month for 6.5 months. Participants were instructed to take one tablet 0.75 mg LNG within 24 h before or after sex, with no more than one dose in any 24-h period. The primary efficacy measure was the Pearl Index among women aged 18–35 years. Results: The study was stopped after 72 of the planned 300 participants were enrolled due to slow recruitment and related feasibility considerations. In the primary analysis, three pregnancies occurred during 13.4 woman-years of follow-up, resulting in a Pearl Index of 22.4 (95% confidence interval, 4.6–65.4). No serious adverse events were reported, and vaginal bleeding patterns were generally acceptable. Conclusions: Our estimated Pearl Index was noticeably higher than expected from previous research of LNG for pericoital contraception. Although the regimen was safe and generally acceptable, the study was challenged by slow enrollment and curtailed person-years of follow-up, resulting in poor precision for the estimated treatment effect. Future research may inform whether our results are symptomatic of the regimen, study design or characteristics of the populations from which we recruited. Implications: Our study failed to confirm prior data suggesting that 0.75 mg LNG for pericoital contraception could be more effective than typical use of barrier methods among women having infrequent sex. Characterizing populations most likely to adhere to, and benefit from, pericoital regimens is essential to future research on these methods. [Copyright &y& Elsevier]

Objective: To determine the features of polycystic ovary syndrome (PCOS) that are implicated in the associated reproductive and metabolic morbidities. Design: Cross-sectional case–control study. Setting: Academic medical setting. Patient(s): A total of 1,062 women with PCOS and 1,887 women without PCOS. Intervention(s): None. Main Outcome Measure(s): Physical examination including hirsutism scoring, biochemical and hormone measurements, ovarian ultrasound, and a 75-g oral glucose tolerance test to measure glucose and insulin levels. Result(s): A factor analysis identified four dominant factors in women with PCOS. These factors were interpreted as follows: [1] metabolic and hyperandrogenemia factor, [2] oligomenorrhea and hyperandrogenemia factor, [3] blood pressure factor, and [4] ovarian morphology factor. In women with PCOS, hyperandrogenemia was a significant predictor of metabolic syndrome after adjusting for age, body mass index, and insulin resistance in the regression analysis. Conclusion(s): A factor analysis identified multiple factors that are responsible for the abnormalities associated with PCOS. Hyperandrogenemia was a common underlying feature of the metabolic and reproductive abnormalities in women with PCOS but not in women without PCOS. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The relation between eating disorders and menstrual function has been widely studied, but it is unknown whether the behavior of binge eating itself is related to menstrual dysfunction. Methods: The 11,503 women included in this study were from the Swedish Twin study of Adults: Genes and Environment. The associations between menstrual dysfunction and binge eating were analyzed using logistic regression or multiple linear regression models with generalized estimation equations. Results: Women who reported lifetime binge eating were more likely to report either amenorrhea or oligomenorrhea than women who reported no binge eating. These results persisted when controlling for compensatory behaviors including self-induced vomiting, laxative use, and diuretic use. No differences between women with and without a history of binge eating were observed for age at menarche. Conclusion: Even when controlling for the effect of compensatory behaviors, the behavior of binge eating is associated with menstrual dysfunction. Metabolic and endocrinological factors could underlie this association. Careful evaluation of menstrual status is warranted for women with all eating disorders, not just anorexia nervosa. [Copyright &y& Elsevier]

Objective: We determined whether simple, clinical information on late and early menarche could help identify adult women with metabolic syndrome (MetS) and oligomenorrhea. Materials/Methods: We carried out a 26-year prospective follow-up of 272 suburban schoolgirls from ages 5–22 to 30–46. Results: Early menarche (≤10years, 5.2% of girls) and late menarche (≥16years, 6.7% of girls) were both associated with oligomenorrhea (≥42days) in adulthood, 29% and 11%, vs. 5% for normal menarche (11–15years), p=.004. Early menarche was characterized by high childhood BMI (LS mean±SE: 21.2 ±1.0kg/m2) and by high childhood and adult MetS (15%, 36%). Girls with late menarche had the lowest childhood BMI (18.1±1.0), no childhood MetS, and the highest adult MetS (47%). Increasing age at menarche was associated with uniformly decreasing childhood BMI and MetS, but with a U-shaped pattern of BMI (p = .05), MetS (p=.008), and oligomenorrhea (p=.02) in adulthood. Change to MetS from median ages 13 to 38 was associated with early–late menarche (OR=3.11, 95% CI 1.37–7.07, p=.007). MetS in adulthood was associated with childhood MetS (OR=8.03, 95% CI 2.57–25.08, p=.0003) and with early–late menarche (OR =3.43, 95% CI 1.44–8.15, p=.005). Conclusions: Menarche age had a curvilinear (‘U’ shaped) relationship with MetS and oligomenorrhea in adulthood. Late menarche and early menarche are risk factors for adult oligomenorrhea, MetS, and cardiometabolic abnormalities. Girls with early (≤ age 10) and with late menarche (≥ 16) represent a group at high risk for adult cardiometabolic abnormalities and oligomenorrhea that is easily identifiable by physicians. [ABSTRACT FROM AUTHOR]

Highlights: [•] The prevalence of hyperandrogenism and oligomenorrhea in PCOS decrease with age. [•] The age-related changes affect the incidence and complications of PCOS. [•] Hyperandrogenism and oligomenorrhea are predominant in younger women with PCOS. [•] Obesity and metabolic disturbances are predominant in older women with PCOS. [•] Increased body weight might contribute to the complications of PCOS in later life. [Copyright &y& Elsevier]

Abstract: Study Objective: To determine the prevalence, characteristics and effects on the activities of daily living of menstruation disturbances among adolescent girls. Design: Descriptive, cross-sectional study. Setting: A public school in the city of Petrolina, Brazil. Participants: 218 female adolescents of ages between 12 and 17 years. Main Outcome Measure: We used a structured questionnaire addressing the socio-demographic and menstrual characteristics of the adolescents. The intensity of menstrual pain and its effect on the activities of daily living were measured using an 11-point numeric rating scale. Results: The mean age of adolescent girls was 13.7 ± 1.5 years. The menstrual cycles of 67% were regular, while 33% were irregular. Dysmenorrhea had a prevalence of 73%, and school absenteeism was observed among 31% of the adolescents. In addition, 66% of the participants considered that dysmenorrhea affected their activities of daily living. Associations were found between the intensity of pain and the variables: school absenteeism; affected activities of daily living; need to use medications; and between affected activities of daily living and school absenteeism (P < .05). Conclusions: Among the menstrual disturbances observed dysmenorrhea stood out due to its high prevalence among adolescents with a negative effect on adolescents’ activities of daily living. Early diagnosis and knowledge about menstrual disturbances are essential because in addition to reiterating the importance of implementing health education actions, they also help to choose appropriate treatments, thus minimizing the negative effects of these disturbances on the lives of adolescents. [Copyright &y& Elsevier]

Abstract: Objective: To date, very few publications have examined the health related quality of life (HRQL) in the younger population with menstrual problems, despite their high prevalence in adolescent girls. We describe the health-related quality of life (HRQL) among adolescents with menstrual problems and identified factors that have an impact on it. Methods: The study was a questionnaire study (using PedsQL 4.0) of adolescents aged 13–18 referred to a tertiary gynecology center for menstrual problems between June 2009 and August 2010. Results: One hundred eighty-four adolescents completed the questionnaires. The mean age was 15.10 ± 1.49 with the mean body mass index (BMI) of 22.83 ± 4.82 kg/m2. The most common menstrual problems seen in the clinic were dysmenorrhea (38.6%) followed by heavy bleeding (33.6%), oligomenorrhea (19.6%), and amenorrhea (8.2%). The mean overall score was 70.40 ± 16.36 with 42.3% having a score below 1 standard deviation (SD) from the norms. Adolescents with dysmenorrhea had the poorest score in physical function, whereas those with amenorrhea had the lowest score in psychosocial function. Maternal parenting style, parental anxiety, adolescents'' ill-health behavior, and BMI have been found to have impact on the girls'' quality of life (QoL). Conclusion: Although menstrual problems are not life threatening, they can pose a significant impact on the quality of life of these patients. Identification of these impacts might lead to the recognition of potential services or education to improve this. Understanding the characteristics that predict QoL may help a clinician identify patients who are risk for poor QoL. [Copyright &y& Elsevier]

Objective: To compare differences in endocrine and metabolic characteristics and response to induced ovulation treatment between oligomenorrheic and amenorrheic women with polycystic ovary syndrome (PCOS). Methods: A total of 154 infertile PCOS patients presenting with oligomenorrhea or amenorrhea were retrospectively analysed, the differences in endocrine and metabolic characteristics and induced ovulation outcome parameters between oligomenorrheic and amenorrheic women were compared. Results: Total follicle count, serum levels of total testosterone (TT), luteotropic hormone (LH) and insulin resistant index (HOMA-IR) were significantly higher in amenorrheic patients compared with oligomenorrheic patients (P<0.05). There were no differences in age, body mass index (BMI), follicle stimulating hormone (FSH), glucose, insulin levels and lipid level between the two groups. During clomiphene citrate (CC) and hMG induced ovulation (203 cycles), the ovulation rate in amenorrheic group was significantly lower than that of oligomenorrheic group (84.62% vs 96.80%, P<0.01). The duration to reach a dominant follicle, the cycles need to add hMG and the total dose of hMG were higher in women with amenorrhea compared with those with oligomenorrhea. No significant differences were found between the two groups in the total number of mature follicles, estradiol level and endometrial thickness on the day of hCG administration and pregnancy rate. Conclusions: The degree of cycle irregularity might be a simple and effective clinical parameter to estimate the degree of metabolic and endocrine disorders and response to induced ovulation. [Copyright &y& Elsevier]

Objective: To evaluate the performance of antimullerian hormone (AMH) and inhibin B as ovarian function markers for differentiating common causes of secondary oligoamenorrhea, namely hypogonadotrophic hypogonadism (HH), polycystic ovary syndrome (PCOS), premature ovarian failure (POF), and hyperprolactinemia (HPRL).Design: Retrospective analysis.Setting: Two university hospitals.Patient(s): A total of 124 women with secondary oligoamenorrhea and 26 women with normal ovulation.Intervention(s): Serum samples from the subjects were analyzed for AMH and inhibin B.Main Outcome Measure(s): Serum AMH and inhibin B concentrations.Result(s): Serum AMH concentration was significantly raised in women having World Health Organization group 2 anovulation, either with or without PCOS, and was significantly decreased to very low levels in POF; the diagnostic accuracy in both conditions was excellent, with areas under the receiver operating characteristic curve (AUC) of 0.913 and 0.977, respectively. The discriminatory performance between HH and PCOS was also good, with AUC 0.861. AMH remained unchanged in HH and HPRL compared with ovulatory control subjects. There were large overlap of serum inhibin B levels in the different conditions, and a significant difference from control subjects existed only in the POF group.Conclusion(s): Serum AMH, but not inhibin B concentration, serves as a useful diagnostic tool in the differential diagnosis of secondary oligoamenorrhea. [ABSTRACT FROM AUTHOR]

Abstract: We hypothesized that adolescent oligomenorrhea (ages 14-19) would independently predict impaired fasting glucose (IFG; ≥110 to <126 mg/dL) plus type 2 diabetes mellitus (T2DM; ≥126 mg/dL), insulin and glucose levels, and insulin resistance (IR) in young adulthood (ages 19-25). A prospective 15-year follow-up of 370 schoolgirls starting at age 10 was performed. Age 14 waist circumference was the most important explanatory variable for IFG + T2DM during ages 19 to 24 (P = .002; odds ratio, 1.06; 95% confidence interval, 1.02-1.10), along with oligomenorrhea category from ages 14 to 19 (0, 1, 2, ≥3 reports over 6 years; P = .032; odds ratio, 1.82; 95% confidence interval, 1.05-3.14). Impaired fasting glucose + T2DM at ages 19 to 24 were more common in girls having 1 (6%), 2 (11%), and ≥3 (38%) oligomenorrhea reports from ages 14 to 19 than in girls without oligomenorrhea (3%; P = .0003). Positive explanatory variables (all Ps ≤ .05) for homeostasis model assessment of IR at ages 19 to 24 included age 14 waist (partial R 2 = 30.1%), oligomenorrhea with hyperandrogenism (polycystic ovary syndrome; partial R 2 = 4.1%), black race (3.8%), and oligomenorrhea frequency during ages 14 to 19 (0.8%); sex hormone binding globulin was a negative explanatory variable (0.7%). This is the first prospective study to report an independent association of adolescent oligomenorrhea with young adult IFG + T2DM, with insulin and glucose levels, and with IR. Age 14 waist circumference, oligomenorrhea with hyperandrogenism (polycystic ovary syndrome), black race, oligomenorrhea frequency at ages 14 to 19, and age 14 sex hormone binding globulin were independently associated with IR at ages 19 to 24, potentially facilitating primary prevention of IFG, T2DM, and hyperinsulinemia. [Copyright &y& Elsevier]

Abstract: Background: PCOS is a common female endocrine disorder with prevalence ranging from 2.2% to 26%. Most reports have studied adult women with age ranged from 18 to 45 years. The aim of this study was to find the prevalence of PCOS in Indian adolescents. Method: We prospectively studied 460 girls aged 15 to 18 years from a residential college in Andhra Pradesh, South India, who underwent clinical examination. Out of which 72 girls with oligomenorrhea and/or hirsutism were invited for biochemical, hormonal, and ultrasonographic evaluation for diagnosis of PCOS by Rotterdam criteria. PCOS was defined as the presence of any two of the three features: (1) Oligo/amenorrhea: absence of menstruation for 45 days or more and/or ≤8 menses per year. (2) Clinical hyperandrogenism: Modified Ferriman and Gallway (mFG) score of 6 or higher. (3) Polycystic ovaries: presence of >10 cysts, 2–8 mm in diameter, usually combined with increased ovarian volume of >10 cm3, and an echo-dense stroma in pelvic ultrasound scan. Results: Out of 460 girls, one (0.22%) had oligo/amenorrhea with clinical hyperandrogenism, 29 (6.30%) had oligomenorrhea with polycystic ovaries, one (0.22%) had polycystic ovaries with clinical hyperandrogenism and 11 (2.39%) had oligomenorrhea with polycystic ovaries in the presence of clinical hyperandrogenism. Thus 42 (9.13%) girls satisfied Rotterdam’s criteria for PCOS, which increased to 50.46 (10.97%) when imputed data were included. Conclusion: Prevalence of PCOS in Indian adolescents is 9.13%.This draws attention to the issue of early diagnosis in adolescent girls. [Copyright &y& Elsevier]

Abstract: Thyroid disorders have a great impact on fertility in both sexes. Hyperthyroidism and hypothyroidism cause changes in sex hormone-binding globulin (SHBG), prolactin, gonadotropin-releasing hormone, and sex steroid serum levels. In females, thyroid hormones may also have a direct effect on oocytes, because it is known that specific binding sites for thyroxin are found on mouse and human oocytes. There is also an association between thyroid dysfunction in women and morbidity and outcome in pregnancy. In males, hyperthyroidism causes a reduction in sperm motility. The numbers of morphologically abnormal sperm are increased by hypothyroidism. When euthyroidism is restored, both abnormalities improve or normalize. In women, the alterations in fertility caused by thyroid disorders are more complex. Hyper- and hypothyroidism are the main thyroid diseases that have an adverse effect on female reproduction and cause menstrual disturbances—mainly hypomenorrhea and polymenorrhea in hyperthyroidism, and oligomenorrhea in hypothyroidism. In recent studies, it has become evident that it is not only changes in serum levels of SHBG and sex steroids that are responsible for these disorders, but also alterations in the metabolic pathway. Adequate levels of circulating thyroid hormones are of primary importance for normal reproductive function. This review presents an overview of the impact of thyroid disorders on reproduction. [Copyright &y& Elsevier]

Abstract: PCOS is not only the most frequent cause of oligomenorrhea in young women, but also a metabolic disorder characterized by insulin resistance, glucose intolerance, dyslipidemia, and obesity, especially the visceral phenotype. PCOS represents a broad spectrum of endocrine and metabolic alterations which change with age and with increasing adiposity. In fact, during adolescence and youth the predominant clinical manifestations of PCOS are menstrual abnormalities, hirsutism and acne, whereas in peri-menopausal and post-menopausal periods metabolic disorders and an increased risk for cardiovascular diseases prevail. The pathogenetic links between PCOS and metabolic or cardiovascular complications are still debated. However, recent evidence has been focused on a condition of low-grade chronic inflammation as a potential cause of the long-term consequence of the syndrome. In this review we describe the state of low-grade inflammation observed in PCOS. In addition, we hypothesize the potential mechanisms responsible for the generation of this inflammatory state and the role played by low-grade inflammation in linking hyperandrogenism and insulin resistance with the metabolic and cardiovascular long-term complications of the syndrome. [Copyright &y& Elsevier]

Abstract: Objective: To investigate oligomenorrhoea in adolescents with type 1 diabetes and the possible relationship with glycaemic control. Study design: The study group consisted of 81 female adolescents with type 1 diabetes whose mean age was 15.0 years (range 12–18). The control group consisted of 205 healthy adolescents with a mean age of 15.5 years (range 12–18). Data on menstruation were collected by two parallel self-administered questionnaires. Oligomenorrhoea was defined as having a menstrual cycle longer than 36 days throughout the past year (5–6/year). The metabolic control of diabetes was evaluated by calculating the mean value of HbA1c during the past year. Results: Age of menarche was greater for adolescents with type 1 diabetes (12.2±1.4 vs. 11.7±1.2, p <0.000) compared to healthy age-matched controls. Logistic regression analysis with oligomenorrhoea as the dependent binary variable revealed an odds ratio equal to 7.8 (95% CI 3.411–17.853) for adolescents with type 1 diabetes (p <0.000). Finally, a second logistic regression analysis, concerning only adolescents with type 1 diabetes and with the same binary variable, estimated an odds ratio of 4.8 (95% CI 1.784–13.057, p <0.002) for HbA1c, and an odds ratio of 5.3 (95% CI 1.821–15.130, p <0.002) for the frequency of hypoglycaemia. Conclusion: In adolescents with type 1 diabetes, menarche occurs later and oligomenorrhoea is more frequent. The relative risk of having oligomenorrhoea is greater when there is an increased value of HbA1c or when hypoglycaemia is more frequent. [ABSTRACT FROM AUTHOR]

Abstract: The menstrual cycle is a physiological process beginning at menarche and ending at menopause in which the endometrium is shed at regular intervals. The length of cycle ranges from 21 to 35 days; and only 10–15% of women are they 28 days. At the extremes of reproductive life dysfunctional bleeding is usually due to anovulation. However, dysfunctional bleeding is a diagnosis made after pathology such as fibroids, polyps, infection and malignancy have been excluded. Management is determined on an individual case-by-case basis according to age, reproductive status, hormonal profile, family planning intentions, ultrasound findings, diagnosis and ultimately patient choice. A variety of medical options and recently developed minimally invasive surgical techniques have revolutionized the treatment of menstrual irregularities. [Copyright &y& Elsevier]

Objective: To evaluate the prevalence and risk factors of menstrual cycle irregularities in adolescents with type 1 diabetes mellitus. Design: Prospective diary of menstrual cycle. Setting: Pediatric diabetes clinics and nearby schools. Patient(s): Adolescents with type 1 diabetes mellitus treated with multiple daily insulin doses (n = 56) and 56 healthy adolescents. Main Outcome Measure(s): Duration and variability of menstrual cycle. Result(s): Duration of the menstrual cycle was 48 ± 39 and 32 ± 7 days in girls with type 1 diabetes mellitus and controls, respectively. Oligomenorrhea (58.9% vs. 19.6%) and amenorrhea (10.7% vs. 1.8%) were more prevalent in girls with type 1 diabetes mellitus than in controls. Oligomenorrhea was observed in 53.3% of the girls with type 1 diabetes mellitus with optimal metabolic control. Girls with an HbA1c level of 7.6% to 8.9% exhibited increased cycle duration, menstrual cycle variability, and prevalence of oligomenorrhea compared with controls. Regression analysis showed that, for each point of increase in HbA1c, the menstrual cycle duration increased by 5.1 days. Cycle variability was associated with a higher daily insulin dose. Conclusion(s): Despite optimal metabolic control, a higher prevalence of oligomenorrhea was observed in girls with type 1 diabetes mellitus compared with controls. This is the first report to describe the high variability of the menstrual cycle in type 1 diabetes mellitus. HbA1c and insulin dose are important factors related to menstrual irregularities in type 1 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To compare the health-related quality of life (HRQOL) of women at surgical menopause with that of women at natural menopause, utilizing the Menopause Rating Scale (MRS-II). Study design: An institution-based cross-sectional study design was used, with 32 participants in each of two groups: women who had undergone surgical menopause of 9–12 months previously; and women who were more than 40 years of age and had had oligomenorrhoea for at least 1 year. The MRS-II was used to assess HRQOL. None of the women had received any hormonal therapy before assessment. Main outcome measures: Total MRS-II scores along with the scores on the somato-vegetative, psychological and urogenital sub-scales were compared between the two groups. Results: HRQOL was rated as worse by the surgical menopause group than by the natural menopause group: the total MRS-II scores were much higher for the surgical menopause group (mean=29.4, SD=6.7) than for natural menopause group (mean=20.7, SD=6.5), and this difference was significant (p <0.0001). Similar results were obtained on the three sub-scales—somato-vegetative (p =0.030), psychological (p <0.0001) and urogenital (p <0.0001). Conclusion: HRQOL is worse after surgical than in natural menopause. Routine surgical castration at hysterectomy should be avoided because of adverse short-term effects and, potentially, long-term consequences. [Copyright &y& Elsevier]

Objective: To test the hypothesis that women with polycystic ovary syndrome (PCOS) are distinguishable from those with 21-hydroxylase-deficient nonclassic adrenal hyperplasia on the basis of having polycystic ovaries and metabolic dysfunction.Design: Prospective observational.Setting: Tertiary care center.Patient(s): Fifty-two lean and 54 obese women with PCOS according to the 1990 National Institutes of Health criteria, 23 women with nonclassic adrenal hyperplasia, and 27 controls.Intervention(s): History and physical examination, blood sampling, ovarian sonography, oral glucose tolerance, and acute adrenocorticotropin stimulation testing.Main Outcome Measure(s): The frequency of clinical, biochemical, and metabolic features.Result(s): Women with PCOS had a higher frequency of oligomenorrhea or amenorrhea than those with nonclassic adrenal hyperplasia. Mean androstenedione and DHEAS levels were highest in nonclassic adrenal hyperplasia. The degree of metabolic dysfunction was greatest in obese women with PCOS; women with nonclassic adrenal hyperplasia and lean women with PCOS did not differ in degree of metabolic dysfunction. Women with nonclassic adrenal hyperplasia had a lower prevalence of polycystic ovaries than those with PCOS. The proportion of patients with an LH/FSH ratio >2 was greater in women with PCOS, compared with those with nonclassic adrenal hyperplasia. Basal 17-hydroxyprogesterone levels >2 ng/mL were found in 87%, 25%, 20%, and 7% of women with nonclassic adrenal hyperplasia, lean women with PCOS, obese women with PCOS, and controls, respectively.Conclusion(s): Nonclassic adrenal hyperplasia should be excluded in all women presenting with hirsutism, with use of a basal follicular phase 17-hydroxyprogesterone level, regardless of the presence of polycystic ovaries or metabolic dysfunction; however, women with nonclassic adrenal hyperplasia have a higher prevalence of normal ovulation and lower likelihood of having an LH/FSH ratio >2 or polycystic ovaries. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: Oligomenorrhea in active adolescent females of normal weight is presumed to be related to hypoestrogenism secondary to physical activity and decreased fat mass. We hypothesized that active adolescents with oligomenorrhea would have lower estrogen levels than normal controls with similar levels of cardiovascular fitness. Design/Participants: Twenty healthy participants between the ages of 16 and 20 years were recruited at least 2 years postmenarche. Adolescents reporting fewer than 9 cycles a year (n = 6) were compared to 14 controls with monthly menstrual cycles. Histories of eating disorder, hirsutism, severe acne, depression, or amenorrhea were cause for exclusion. Main Outcome Measures: Body composition and bone density were measured by total body dual x-ray absorpitometry. Cardiovascular fitness was evaluated by measuring oxygen consumption during exercise. Control subjects were matched by age, body mass index (BMI), and fitness level. Serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, progesterone, and estradiol were obtained. Statistical analysis was performed using SAS 9.1. Results: Cardiovascular fitness in both groups was within normal limits for age. No significant differences in BMI, estradiol concentrations, or bone density were found, but trunk fat mass was lower in adolescents with oligomenorrhea who also reported more frequent exercise. Testosterone concentrations and LH/FSH ratios were significantly higher in participants with irregular menstrual cycles (P = 0.0018 and <0.001, respectively). Conclusion: Adolescents with oligomenorrhea were leaner, yet they had higher testosterone levels and a greater LH/FSH ratio than their BMI-matched, cyclic counterparts. We hypothesize that, in active adolescents of normal weight, elevated androgen and LH concentrations are linked to ovarian dysfunction, which can masquerade as exercise-induced oligomenorrhea. [Copyright &y& Elsevier]

Objective: To evaluate the metabolic profiles of adolescents with different phenotypes of polycystic ovary syndrome (PCOS). Design: Observational study. Setting: University outpatient clinic. Patient(s): Adolescents with PCOS (n = 120) were divided into four groups: oligomenorrhea and hirsutism (O-H, n = 50), oligomenorrhea, hirsutism, and polycystic ovaries (PCO-O-H, n = 22), oligomenorrhea, hirsutism, and hyperandrogenemia (A-O-H, n = 28), oligomenorrhea, and hirsutism, hyperandrogenemia, and polycystic ovaries (PCO-A-O-H, n = 20). A control group of age-matched adolescents (n = 30) was included. Intervention(s): Subjects underwent physical and ultrasound evaluations; fasting blood samples were taken for the measurement of endocrine and metabolic parameters. Main Outcome Measure(s): The endocrine and metabolic profiles were evaluated. Result(s): Adolescents with PCOS showed reduced insulin sensitivity and dyslipidemia. Triglycerides, and total and low-density lipoprotein cholesterol were higher in the phenotypes with hyperandrogenemia. Insulin resistance and body mass index were not significantly different between PCOS phenotypes. Triglyceride positively and high-density lipoportein cholesterol levels negatively correlated with free testosterone and free androgen index. Conclusion(s): The risk of metabolic alterations may vary in adolescent PCOS patients with different phenotypes. Hyperandrogenemia is a risk factor for dyslipidemia. This information may be of relevance in counseling adolescents with PCOS. [Copyright &y& Elsevier]

Objective: To evaluate inappropriate gonadotropin secretion in women with polycystic ovary syndrome (PCOS). Design: Retrospective study. Setting: Academic tertiary center. Patient(s): A total of 373 women were classified into three groups: [1] healthy control women (n = 48); [2] women who were positive for PCOS risk factor; and [3] women with PCOS (n = 251). Intervention(s): None. Main Outcome Measure(s): Gonadotropin levels, LH-FSH ratio, body mass index, and clinical and/or biochemical presentations of PCOS. Result(s): The area under the receiver operating characteristic curve, used to predict PCOS for the LH-FSH ratio, showed similar diagnostic performance to total T and average ovarian volume. The LH-FSH ratio exhibits greater observed accuracy than total T and average ovarian volume for evaluation of women with oligomenorrhea or anovulation. An LH-FSH ratio of >1 presented the best combination of sensitivity and specificity. Body mass index was positively correlated with total T in non-PCOS and PCOS groups; however, body mass index was negatively correlated with LH in PCOS but showed no correlation in non-PCOS subjects. Conclusion(s): The LH-FSH ratio is a valuable diagnostic tool in evaluating women with PCOS and oligomenorrhea or anovulation, and an LH-FSH ratio of >1 may be used as a decision threshold. The link between body mass index and LH may provide clues for further understanding the pathological milieu of PCOS. [Copyright &y& Elsevier]

Abstract: We compared bone mineral density (BMD) and content (BMC), menstrual and metabolic status between physically active women with 1) high cognitive dietary restraint (High-CDR) (score≥9, n =38) and Normal-CDR (score<9, n =46) and 2) across quartiles of CDR scores. Eighty-four physically active (500±35 min wk−1) premenopausal women participated and were categorized according to their CDR score. Primary outcomes included, BMD, BMC, menstrual status, estrone-3-glucuronide (E1G) and pregnanediol-3-glucuronide (PdG) area under the curve (AUC). Secondary outcomes included resting energy expenditure (REE), total triiodothyronine, and ghrelin. Measures of body mass (59.2±1.1 vs. 58.5±1.0 kg) and percent body fat (24.7±1.2 vs. 23.7±0.7%) were similar between women with Normal-CDR and High-CDR, however the High-CDR group had lower total body (1.140±0.011 vs. 1.179±0.010 g cm−2; p =0.015) and lumbar spine (1.114±0.019 vs. 1.223±0.022 g cm−2; p =0.001) BMD. The prevalence of oligo-amenorrhea was higher in the High-CDR group and became increasingly greater across the CDR quartiles. There were no differences in metabolic characteristics between the High-CDR and Normal-CDR groups, however REE and the ratio of measured to predicted REE were lower in the fourth quartile (CDR scores≥13) compared to the second and third quartiles. Our results provide evidence that high CDR scores are associated with reduced lumbar spine and total body BMD in physically active premenopausal women. A greater frequency of menstrual disturbances in women with higher CDR scores likely played a role in the reduced total body and lumbar spine BMD. [Copyright &y& Elsevier]

Objective: To determine whether infertile oligomenorrheic women are insulin resistant, using an oral glucose tolerance test (OGTT). Design: Retrospective study. Setting: National Center for Child Health and Development. Patient(s): One hundred twenty-seven infertile women with oligomenorrhea (oligomenorrheal group) and 177 infertile eumenorrheic women (normal menstrual group) were recruited. Intervention(s): All women underwent an OGTT (75 g glucose). Main Outcome Measure(s): A homeostasis model assessment of insulin resistance (HOMA-IR), area under the curve (AUC) of insulin after the glucose load, and plasma insulin level at 120 minutes after glucose loading (IRI 120) were used as an index of insulin resistance. Result(s): The prevalence of insulin resistance (HOMA-IR ≥1.73) among oligomenorrheic women was 23.8%, which was significantly higher than that of eumenorrheic women, at 14.1%. The glucose AUCs (mean ± SE) in the oligomenorrheal group (13,609 ± 259 mg/min/dL) were similar to those for the normal menstrual groups (13,054 ± 196 mg/min/dL), but the insulin AUCs of the oligomenorrheal group (5333 ± 376 mU·min/L) were significantly higher than those of the normal menstrual groups (4517 ± 266 mU·min/L). Conclusion(s): The prevalence of insulin resistance assessed using an OGTT was significantly higher among infertile oligomenorrheic women with non-polycystic ovary syndrome than it was among women with normal menstrual cycles. [Copyright &y& Elsevier]

Abstract: Introduction: Gestational diabetes mellitus (GDM) is the most common metabolic disorder that occurs during pregnancy. Knowing the risk factors for GDM is thus particularly important. Objective: To evaluate the relationship between GDM and a history of polycystic ovarian syndrome (PCOS). Methods: A case-control study was conducted involving 188 pregnant women. Ninety-four cases had GDM based on an impaired glucose tolerance test (GTT) and the other 94 cases (control group) were pregnant women without GDM. The subjects in each group were questioned regarding a history of PCOS (i.e., a history of oligomenorrhea and hyperandrogenism) and then their health documentation''s were reviewed and those women whose documentation''s were complete (sonologic and hormonal evidences for PCOS) entered the study. The relationship between GDM and a history of PCOS was then evaluated. Results: The women with GDM had a history of PCOS more often than the control group of women (15 cases of PCOS in GDM group vs. 6 cases of PCOS in the control group, P =0.03), but regarding body mass index, a history of PCOS were not shown to have a significant relationship with GDM. Regarding the number of pregnancies, a history of PCOS had a significant relationship with GDM (P =0.05). Conclusions: GDM has a relationship with a history of PCOS, therefore in women with a history of PCOS, the risk of GDM should be considered. [Copyright &y& Elsevier]

Abstract: Polycystic ovary syndrome (PCOS) is an extremely common endocrine disorder affecting young women, with the potential for both reproductive and non-reproductive adverse outcomes. While oligomenorrhea, hyperandrogenism, and cystic ovarian morphology are recognized characteristics of this syndrome, the origin of these disturbances is not always apparent. During normal growth and development, adrenarche, the prepubertal onset of adrenal androgen secretion, results phenotypically in pubarche. Gonadarche, which is the ovarian response to gonadotropin releasing hormone-mediated gonadotropin secretion, also occurs, leading to reproductive competence, namely the establishment of ovulatory cycles, repeatedly. In this mini-review, an overview of adrenarche and gonadarche are presented, followed by two hypotheses. The first describes an evolutionary role for adrenarche: an advantage in the attainment of reproductive competence. The second proposes that the path to PCOS be viewed from a developmental perspective, namely, that PCOS is a maladaptation of the processes that lead to reproductive competence in women. Its defining characteristics of oligomenorrhea, hyperandrogenism, and cystic ovarian morphology are the final common pathway of multiple possible derangements. Elucidating and understanding these maladaptive processes will be the key to future endeavors at prevention and treatment of this common reproductive disorder. [Copyright &y& Elsevier]

Objective: To determine the risk of metabolic complications, primarily metabolic syndrome, in all polycystic ovary syndrome (PCOS) phenotypes compared with control subjects. Design: Retrospective chart review. Setting: University practice. Patient(s): Women with PCOS (Rotterdam definition; n = 258) and women without PCOS seen during the same time period for an annual exam used as controls (n = 110). Intervention(s): None. Main Outcome Measure(s): Metabolic syndrome. Result(s): Three PCOS phenotypes had a significantly higher prevalence of metabolic syndrome compared with the control subjects: oligomenorrhea/oligo-ovulation (O) + hyperandrogenism (H) + polycystic ovaries (P), age-adjusted odds ratio [OR] 6.3 (95% confidence interval 2.1–18.9); O+H, OR 7.8 (2.2–27.5); and H+P, OR 8.2 (2.3–29.3). There was no significant difference in the prevalence of metabolic syndrome between women with O+P and control subjects, even in obese women. The prevalence of insulin resistance and glucose intolerance was not significantly different between POCS phenotypes Conclusion(s): The risk of metabolic syndrome may vary among the four phenotypes of PCOS based on the Rotterdam criteria. This new information may be of relevance in counseling women with PCOS although larger studies may be needed to validate our findings. [Copyright &y& Elsevier]

Background: Oligomenorrhea was associated with more asthma (Respiratory Health in Northern Europe study), but a possible association with lung function has not been investigated previously. Objective: To investigate whether oligomenorrhea was related to lung function and asthma, and whether body mass index and physical activity modified associations. Methods: Women age 28 to 44 years (n = 1631) participating in the European Community Respiratory Health Survey were included. Women who were taking exogenous sex hormones, were pregnant, or had recently given birth were excluded. Results: Long or irregular menstrual cycles were reported by 313 women (19%). Oligomenorrhea was significantly associated with more asthma symptoms (odds ratio [OR], 1.76; 95% CI, 1.29-2.40), allergic asthma (OR, 2.46; 95% CI, 1.43-4.23), and lower forced vital capacity (FVC; adjusted difference, 63 mL; 95% CI, −124 to −1). When excluding women using asthma medication, very lean women, or women exercising daily, these associations remained significant. Effects of oligomenorrhea were additive to those of body mass index (BMI) on asthma and FVC. Asthma symptoms increased significantly with BMI. FVC and FEV1 increased with BMI until 25 kg/m2 and thereafter decreased with increasing BMI. Excluding women exercising daily, asthma symptoms increased significantly with decreasing physical activity (OR, 1.09; 95% CI, 1.001-1.19) per category of physical activity) independently of oligomenorrhea. Among women exercising daily, oligomenorrhea predicted very high risk for asthma symptoms (OR, 12.6; 95% CI, 3.7-43). Conclusion: Women with oligomenorrhea have reduced lung function and more asthma, particularly allergic asthma, independent of BMI and physical activity. Airways pathology may have not only a hormonal but also a metabolic component. Clinical implications: Women with oligomenorrhea should be investigated with regard to asthma and lung function. Underlying metabolic disturbance should be considered in asthma. [Copyright &y& Elsevier]

Abstract: Study Objective: To evaluate whether oligomenorrhea and amenorrhea in adolescent females would have a negative effect on the standard quality of life (QOL) scores as compared to eumenorrheic adolescents, and whether such scoring would differ between those with exercise related oligo/amenorrhea or those with hypothalamic/ovarian causes. Design: Prospective cross-sectional observational survey. Methods: Young dancers were recruited from the Sports Clinic of a collegial School of Dance, and non-dancers were recruited from a hospital-based adolescent gynecology clinic. All subjects completed a structured self-answering questionnaire recording epidemiological data and a 36-item Short Form Health Survey (SF-36). All subjects had a full hormonal profile and pelvic ultrasound to study ovarian morphology. Results: Sixty-six dancers (19 with exercise-related oligo/amenorrhea and 47 eumenorrhoeic) and 90 non-dancers (45 eumenorrhoeic and 45 oligo/amenorrheic) were analyzed, all 16–20 years of age. There was no difference in the scoring between eumenorrheic dancers and non-dancers. Oligo/amenorrheic dancers did not score lower than eumenorrheic dancers. Compared with eumenorrheic subjects or to oligo/amenorrheic dancers, oligo/amenorrheic non-dancers had significantly lower QOL scores in the domains of physical functioning (PF) and general health (GH) and vitality (VT). Conclusion: Compared with eumenorrheic adolescents, QOL scores were lower in non-exercising adolescents with oligo-amenorrhea, but not those with exercise related oligo/amenorrhea. The negative effects of oligomenorrhea and amenorrhea on quality of life were apparently attenuated if the menstrual dysfunction was related to physical training. [Copyright &y& Elsevier]

Objective: To determine which first-line medication is more effective in polycystic ovary syndrome (PCOS) patients for ovulation induction and pregnancy achievement and to verify whether any patient characteristic is associated with a better response to therapy. Design: Observational comparative study. Setting: Fertility clinic. Patient(s): One hundred fifty-four infertile women with oligomenorrhea and hyperandrogenism. Intervention(s): Group 1 (56 patients) received clomiphene citrate (CC) 50 mg from days 5–9 of the cycle. Group 2 (57 patients) received 500 mg of metformin 3 times a day. Group 3 (41 patients) received both medications. Main Outcome Measure(s): Ovulation and pregnancy. Result(s): Patients receiving metformin alone had an increased ovulation rate compared with those receiving CC alone (75.4% vs. 50%). Patients on metformin had similar ovulation rates compared with those in the combination group (75.4% vs. 63.4%). Pregnancy rates were equivalent in the 3 groups. Response to metformin was independent of body weight and dose. Finally, nonsmoking predicted better ovulatory response overall as well as lower fasting glucose for CC and lower androgens for metformin. Conclusion(s): Metformin is better for ovulation induction than CC alone and equivalent for pregnancy achievement. We suggest that metformin can be used first for ovulation induction in patients with PCOS regardless of their weight and insulin levels because of its efficacy and known safety profile. [Copyright &y& Elsevier]

Objective: To determine whether obese, nonhirsute adolescents with oligomenorrhea exhibit similar increased LH pulse secretion patterns compared with obese girls with polycystic ovary syndrome (PCOS). Design: Prospective, observational study. Setting: Tertiary university hospital. Patient(s): Nine obese girls with oligomenorrhea, 15 with PCOS, and 10 controls. Intervention(s): Twenty-four-hour IV blood sampling for LH (every 10 minutes); measurement of steroid hormones (every 12 hours); and injection of leuprolide acetate (10 μgm/kg SC). Main Outcome Measure(s): Twenty-four-hour, wake, and sleep LH mean serum concentration, pulse frequency, amplitude; steroid hormones, including free androgen index (FAI); and pre- and post-leuprolide acetate 17-hydroxyprogesterone measurements. Result(s): Twenty-four-hour LH pulse frequency in oligomenorrheic girls (18.6 ± 1.2) (mean ± SE) was comparable to that in girls with PCOS (20.9 ± 0.7) and greater than in normal girls (13.4 ± 0.8). The pulse number during both sleep and wake was identical in oligomenorrheic and PCOS girls and significantly greater than that of normal girls. Mean 24-hour LH level, serum androgen levels, and FAI in oligomenorrheic girls were equivalent to those of normal controls and lower than those of PCOS girls. Conclusion(s): These preliminary results indicate that obese girls with oligomenorrhea exhibit increased LH pulse frequency in the absence of clinical and/or biochemical evidence of hyperandrogenism. [Copyright &y& Elsevier]