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STUDY QUESTION Does increased daily energy intake lead to menstrual recovery in exercising women with oligomenorrhoea (Oligo) or amenorrhoea (Amen)? SUMMARY ANSWER A modest increase in daily energy intake (330 ± 65 kcal/day; 18 ± 4%) is sufficient to induce menstrual recovery in exercising women with Oligo/Amen. WHAT IS KNOWN ALREADY Optimal energy availability is critical for normal reproductive function, but the magnitude of increased energy intake necessary for menstrual recovery in exercising women, along with the associated metabolic changes, is not known. STUDY DESIGN, SIZE, DURATION The REFUEL study (trial # NCT00392873) is the first randomised controlled trial to assess the effectiveness of 12 months of increased energy intake on menstrual function in 76 exercising women with menstrual disturbances. Participants were randomised (block method) to increase energy intake 20–40% above baseline energy needs (Oligo/Amen + Cal, n = 40) or maintain energy intake (Oligo/Amen Control, n = 36). The study was performed from 2006 to 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were Amen and Oligo exercising women (age = 21.0 ± 0.3 years, BMI = 20.8 ± 0.2 kg/m2, body fat = 24.7 ± 0.6%) recruited from two universities. Detailed assessment of menstrual function was performed using logs and measures of daily urinary ovarian steroids. Body composition and metabolic outcomes were assessed every 3 months. MAIN RESULTS AND THE ROLE OF CHANCE Using an intent-to-treat analysis, the Oligo/Amen + Cal group was more likely to experience menses during the intervention than the Oligo/Amen Control group (P = 0.002; hazard ratio [CI] = 1.91 [1.27, 2.89]). In the intent-to-treat analysis, the Oligo/Amen + Cal group demonstrated a greater increase in energy intake, body weight, percent body fat and total triiodothyronine (TT3) compared to the Oligo/Amen Control group (P LIMITATIONS, REASONS FOR CAUTION While we had a greater than expected dropout rate for the 12-month intervention, it was comparable to other shorter interventions of 3–6 months in duration. Menstrual recovery defined herein does not account for quality of recovery. WIDER IMPLICATIONS OF THE FINDINGS Expanding upon findings in shorter, non-randomised studies, a modest increase in daily energy intake (330 ± 65 kcal/day; 18 ± 4%) is sufficient to induce menstrual recovery in exercising women with Oligo/Amen. Improved metabolism, as demonstrated by a modest increase in body weight (4.9%), percent body fat (13%) and TT3 (16%), was associated with menstrual recovery. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by the U.S. Department of Defense: U.S. Army Medical Research and Material Command (Grant PR054531). Additional research assistance provided by the Penn State Clinical Research Center was supported by the National Center for Advancing Translation Sciences, National Institutes of Health, through Grant UL1 TR002014. M.P.O. was supported in part by the Loretta Anne Rogers Chair in Eating Disorders at University of Toronto and University Health Network. All authors report no conflict of interest. TRIAL REGISTRATION NUMBER NCT00392873 TRIAL REGISTRATION DATE October 2006 DATE OF FIRST PATIENT’S ENROLMENT September 2006

Since the definition of secondary amenorrhea is cessation of regular menses for more than 3 months, it is likely that athletes with irregular menstrual cycles, including oligomenorrhea, do not consider the condition as serious. However, the consequences of untreated oligomenorrhea have not been investigated in elite track and field athletes. The cohort consisted of 91 elite-level track and field athletes. Body compositions, including bone parameters and bone turnover markers (BTMs), were measured. Among the 91 participants, 52 were eumenorrheic and 33 were oligomenorrheic. The eumenorrheic athletes had significantly higher bone mineral density (BMD) and bone mineral content (BMC) of the lumbar spine, lower extremities, and whole body than had the oligomenorrheic athletes (p

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

Context Anti-Müllerian hormone (AMH) measured in adolescence as biomarker for prediction of adult polycystic ovary syndrome (PCOS) is doubtful but not substantiated. Objective To investigate whether serum AMH levels and other PCOS-associated features in adolescence can predict the presence of PCOS in adulthood. Design and Setting A long-term follow-up study based on a unique adolescent study on menstrual irregularities performed between 1990 and 1997. Participants and interventions AMH was assayed in 271 adolescent girls. Data on PCOS features were combined with AMH levels. In 160 of the 271 (59%) participants, we collected information in adulthood about their menstrual cycle pattern and presence of PCOS (features) by questionnaire 2 decades after the initial study. Results AMH was higher in adolescent girls with oligomenorrhea compared with girls with regular cycles, median (interquartile range): 4.6 (3.1-7.5) versus 2.6 (1.7-3.8) μg/L (P Conclusions Adolescent AMH either alone or adjuvant to adolescent oligomenorrhea does not contribute as prognostic marker for PCOS in adulthood. Therefore, we do not recommend routine its use in clinical practice.

In this study, we aimed to investigate the relationship between body mass index (BMI), waist circumference (WC) or waist-to-hip ratio (WHR) and oligomenorrhea or irregular menstruation in Chinese women of childbearing age. A total of 1,423 Han women aged 19–39 years who were routinely examined at the Physical Examination Center of Peking University People's Hospital were enrolled by convenience sampling method. All participants were asked to fill up menstrual questionnaires. Binary logistic regression models were used to assess the odds ratio (OR) of different BMI, WC and WHR groups for the prevalence of oligomenorrhea and irregular menstruation. Moreover, we used the ROC curves to compare the predictive effects of BMI, WC and WHR on oligomenorrhea and irregular menstruation. Among the 1,423 participants, 93 women (6.5%) had BMI ≥ 30 kg/m2, 6.5% of the participants had oligomenorrhea, and 22.6% had irregular menstrual menstruation. Overall, those with BMI ≥30 kg/m2 (OR = 2.543; 95%CI 1.332–4.856; p = .005) or WC ≥ 90 cm (OR = 2.023; 95%CI 1.198–3.416; p = .008) were more likely to have long menstrual cycle. The prevalence of irregular menstruation was higher in the BMI ≥30 kg/m2 (OR = 2.509; 95%CI 1.591–3.958; p < .001), WC ≥ 90 cm (OR = 2.299; 95%CI 1.619–3.265; p < .001) and WHR ≥ 0.86 (OR = 1.739; 95%CI 1.293–2.339; p < .001) groups. The ROC curve showed that all three anthropometric indices had predictive effect, while there was no significant difference in predicting oligomenorrhea. WC was a better predictor for irregular menstruation compared with BMI. Obesity, oligomenorrhea and irregular menstruation were common in Chinese women of childbearing age, and obesity was associated with oligomenorrhea and irregular menstruation. Abdominal obesity might have a stronger predictive effect on irregular menstruation.

Aim: to study the peculiarities of the formation of secondary sexual characteristics and menstrual function in girls with hyperandrogenism (HA) during puberty.Materials and methods. We examined 137 adolescent girls with HA aged 12–17 years. All examined girls were divided into 3 groups: 12–13 years (Group I, n = 27); 14–15 years (Group II, n = 63); 16–17 years (Group III, n = 47). The intensity of secondary sexual characteristics was determined by Tanner scale; the severity of hirsutism was assessed by Ferriman–Galway scale. The studied parameters were compared with previously published data from 42 girls without HA symptoms with normal indicators of physical and sexual development that were also divided into 3 age groups: 12–13 years (n = 16), 14–15 years (n = 14), 16–17 years (n = 12).Results. Girls with HA in puberty, starting from 14–15 years, had marked reduction of mammary glands and enhancement of axillary and suprapubic hair growth. In 32.8 % of girls with HA menstrual function was normal; in 67.1 % menses disorders and menstrual irregularities were observed that manifested by opsomenorrhea (31.5 %), juvenile bleedings (19.6 %), oligomenorrhea (18.5 %), amenorrhea (16.3 %), algodismenorrhea (14.1 %).Conclusion. HA in puberty, regardless of origin that caused this pathology, is a high risk factor for pathologies of sexual development and the formation of menstrual dysfunction.

Introduction. Gynecological morbidity in adolescents and young women is presented predominantly by functional disorders that do not have a distinct organic substrate and develop as response to stress factors. Objective: to evaluate the response of the menstrual cycle to the cyclic intake of vitamins and plant extracts in adolescents and young women with stress-dependent menstrual disorders. Materials and methods: The observational study included 40 women aged 16–28 years with anovulatory normogonadotropic ovarian dysfunction that clinically manifested as abnormal uterine bleeding (n = 7), oligomenorrhea (n = 29), or amenorrhea (n = 4). The subjects were recommended a 12-week administration of Time Factor vitamin-plant complex as a food supplement. The examination included the assessment of clinical parameters, hormonal blood profile and autonomic balance, ultrasound monitoring before use and in the 3rd cycle of Time-Factor complex administration. Results: the autonomic dysfunction symptoms reversed to an acceptable level in 62.5% of patients, the average score of autonomic dysfunction decreased from 33.8 ± 11.7 to 16.8 ± 3.87 points (p < 0.001) in 12 weeks’ time. The menstrual intervals reduced from 51.2 ± 11.5 to 32.5 ± 16.2 days (p < 0.01) in 65% of women. Ovulation in the final complex administration cycle was reported in 25% of women. Positive dynamics of folliculogenesis, endometrial thickness and hormone levels in plasma were also observed. Conclusion. The use of Time Factor biologically active complex in adolescents and young women with stress-dependent menstrual disorders improves autonomic balance, quality of life and has a positive effect on the menstrual cycle characteristics. The method is effective for oligomenorrhea-type menstrual disorders and should not be used as the only remedy in patients with amenorrhea or abnormal uterine bleeding.

The efficiency of traditional Chinese medicine theory and acupoints shows once more its accurate regulatory capacity by improving women biological cycles with the use of electroacupuncture (EA). Results presented in a research study that preformed ovulation induction in women with anovulation due to polycystic ovary syndrome (PCOS), successfully provided data supporting acupuncture as a natural treatment for infertile women, with no significant side effects. The purpose of this study is to demonstrate how EA treatment can induce ovulation related to the hormonal and neuronal system in women affected by PCOS. This study introduces proof of effectivity and improvement based on the research of the University of Gothenburg, Sweden, that presents a study on how EA can be an alternative to ovulation-inducing drugs, to be considered as a possible holistic regulator of PCOS and symptoms. The study covered 24 women with PCOS and oligo-/amenorrhea who received EA in a low frequency of 2 Hz with a total of 14 treatments applied for 3 months. Samples were taken three times during the study to see fluctuations in hormonal, ovulatory, and symptomatic behavior of PCOS. Results demonstrated effective regular ovulatory inductions in more than a third of women.

Background: Polycystic Ovary Syndrome is one of the most common cause of anovulation in women of reproductive age, with a prevalence of upto 10%. Oligomenorrhea, hirsutism and obesity together with enlarged polycystic ovaries are the diagnostic criteria of PCOS. These women are vulnerable to type II diabetes, dyslipidemia, premature arteriosclerosis, and endometrial carcinoma. Aims and Objectives: The aim and objective of this study was to see the various clinical profile of PCOS patients at a Medical College in Nepal and to make patients aware about the long term sequalae associated with it. Materials and Methods: This was a retrospective study conducted in the outpatient department of Obstetrics and Gynaecology at Manipal Teaching Hospital from January 2018 till June 2019. A total of 90 patients presenting with oligomenorrhoea, obesity, acne, infertility and hirsutism were included in the study. The exclusion criteria were young women who had their menarche less than 2 years back, women older than 45 years, and patients on exogenous estrogen or progesterone therapy. Results: Out of 90 patients studied, 37(41%) were married and 53(59%) were unmarried. There were many patients from urban compared to rural areas (67% vs 33%). Many patients were either overweight (22%) or obese (61%) and 6% of the patients were underweight. Mean age at the time of presentation was 31.66 years with many patients (37%) between 30-35 years age group. Majority of the patients were either oligomenorrhoeic or amenorrhoeic (78 %). Weight gain was present in 83% of the patients. Infertility was present in 81% of the married patients. Fifteen women (17%) had hypothyroidism and were receiving treatment for the same. Ultrasonography was done in all the patients and typical necklace pattern of follicular arrangement was seen in 70 (78%) patients. Conclusion: The diagnosis of PCOS can be reliably predicted with the help of clinical features and sonography in women according to Rotterdam criteria. Oligomenorrhoea or amenorrhea and weight gain were main symptoms in our patients. It is important to educate and make unmarried PCOS patients aware of its association with infertility and long-term medical problems.

In 1982, oral isotretinoin was first licensed as a treatment option for severe recalcitrant cystic acne in the United States. Since its introduction into the pharmaceutical market, several instances of amenorrhea in women of child-bearing age taking isotretinoin have been reported. In each documented instance, amenorrhea spontaneously resolved once the medication was discontinued. The Patient Introductory Brochure for iPLEDGE, the risk management distribution program mandated by the U.S. Food and Drug Administration for isotretinoin, does not currently include menstrual irregularities as a side effect of treatment; thus, patients who experience this side effect may also experience the unnecessary stress of a possible pregnancy, or, if a minor, explaining a lack of menses to their parent/guardian. This review synthesizes the limited literature available on this subject to advocate for more widespread acknowledgment of menstrual irregularities as a side effect of isotretinoin therapy. To perform the literature review, the search was conducted on June 13, 2020 on PubMed using the following search terms: (((isotretinoin) AND (oligomenorrhea))) OR ((isotretinoin) AND (amenorrhea)) OR ((isotretinoin) AND (PCOS)) OR ((isotretinoin) AND (menstrual irregularities)) OR ((isotretinoin) AND (polycystic ovary syndrome)). All years available were included. Articles were excluded if they were not published in English or did not address the topic of menstrual irregularities in the setting of isotretinoin, with or without the presence of polycystic ovary syndrome. A total of six articles met our criteria and are described.

Background: Adiposity rebound (AR), the second BMI rise in childhood at around the age of 6 years, is associated with obesity and metabolic alteration in later life. Given that polycystic ovary syndrome (PCOS) has a strong metabolic component, early life growth patterns could reveal a risk of PCOS. Thus, we aimed to investigate the associations between age at AR and PCOS diagnosis and BMI later in life. Materials and methods: This study is part of a prospective, population-based longitudinal study, where women with PCOS diagnosis by age 46 (n = 280) were compared with asymptomatic women (CTRLs, n = 1573). Weight and height data from birth to age 13 years, at age at menarche, and at ages 31 and 46 years were analyzed Results: Women with PCOS had lower birth weight (3357 +/- 477 vs. 3 445 +/- 505 g, p

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.

To explore the independent role of age at menarche on menstrual abnormalities among adolescents. The present study was a multicenter cross-sectional study on a large sample (n = 3782) of Italian girls aged 13–21 y attending secondary school who already had menarche. Girls were asked to fill in a questionnaire on menarcheal age and menstrual features during the latest three menses. The gynecological age was computed as the difference between age at the survey and the age at menarche. Main outcome measures were: prevalence of oligomenorrhea, polymenorrhea, menstrual cycle irregularity, abnormal bleeding length and dysmenorrhea. Irregularity in the recent past and since menarche was also studied. Multiple logistic models were used to identify any independent association between each abnormal feature and age at menarche or gynecological age. Adjusted ORs and 95%CI were performed. After adjusting for covariates, menarcheal age was not independently associated with polymenorrhea (OR = 0.81; 95%CI 0.63–1.04), oligomenorrhea (OR = 1.16; 95%CI 0.94–1.43), menstrual cycle irregularity (OR = 0.99; 95%CI 0.86–1.14), abnormal bleeding length (OR = 0.96; 95%CI 0.87–1.06) and dysmenorrhea (OR = 1.03; 95%CI 0.85–1.24). The multivariate analysis suggests that the higher prevalence of oligomenorrhea and menstrual cycle irregularity among the girls who were older at menarche might be purely explained by their younger gynecological age. No evidence of any independent influence of age at menarche on menstrual abnormalities among young girls was shown by the investigation. The findings suggest that, after menarche, adolescent girls’ menstrual health should be checked to monitor the endocrine system maturation and to early intercept latent disorders becoming symptomatic.

BACKGROUND We undertook the study to assess the clinical profile of adolescent girls in the age group of 10-19 years attending our gynaecology clinic at GMC Kottayam. The objective was to evaluate various clinical presentations and different modalities of management required for the girls in this group. MATERIALS AND METHODS We analysed 100 consecutive adolescent girls who visited our clinic at GMC Kottayam for a period of two years. They were evaluated prospectively for various clinical presentations at each visit. Specific proforma was filled for each patient which included their personal details, gynaecological problems with associated complaints, menstrual history, examination findings including height, weight and secondary sexual characteristics. Investigations such as haemogram, hormonal assay and USG were carried out as and when required. Counseling for good nutrition, physical fitness, exercise, responsible sexual behaviour and immunization was undertaken as per the need of the patient. RESULTS The commonest complaint was menstrual disorders 54% followed by ovarian tumours 25%. Other complaints included teenage pregnancy, sexual assault, leucorrhoea, vulval injury, Bartholin’s abscess etc. The incidence of severe anaemia was 7.4% in our study. Few suffered from hypothyroidism. There was one case of ITP and one case of CAH. 24% of girls had features of PCOD. CONCLUSION Over the last few years, Adolescent Gynaecology has emerged as a subspecialty in developing countries. Health professionals dealing with adolescent age group should have empathy, friendliness and non-judgemental attitude towards their parents. Confidentiality of young people should be maintained. We need to give special attention to adolescent population as they will be citizens and parents of tomorrow.

Athletes in weight-bearing sports may benefit from higher bone mineral density (BMD). However, some athletes are at risk for impaired BMD with female athlete triad (Triad). The purpose of this study is to understand the influence of sports participation and Triad on BMD. We hypothesize that athletes in high-impact and multidirectional loading sports will have highest BMD, whereas nonimpact and low-impact sports will have lowest BMD. Triad risk factors are expected to reduce BMD values independent of sports participation.Two hundred thirty-nine female athletes participating in 16 collegiate sports completed dual-energy x-ray absorptiometry (DXA) scans to measure BMD z-scores of the lumbar spine (LS) and total body (TB). Height and weight were measured to calculate body mass index (BMI). Triad risk assessment variables were obtained from preparticipation examination. Mean BMD z-scores were compared between sports and by sport category (high-impact, multidirectional, low-impact, and nonimpact). Multivariable regression analyses were performed to identify differences of BMD z-scores accounting for Triad and body size/composition.Athlete populations with lowest average BMD z-scores included synchronized swimming (LS, -0.34; TB, 0.21) swimming/diving (LS, 0.34; TB, -0.06), crew/rowing (LS, 0.27; TB, 0.62), and cross-country (LS, 0.29; TB, 0.91). Highest values were in gymnastics (LS, 1.96; TB, 1.37), volleyball (LS, 1.90; TB, 1.74), basketball (LS, 1.73; TB, 1.99), and softball (LS, 1.68; TB, 1.78). All Triad risk factors were associated with lower BMD z-scores in univariable analyses; only low BMI and oligomenorrhea/amenorrhea were associated in multivariable analyses (all P0.05). Accounting for Triad risk factors and body size/composition, high-impact sports were associated with higher LS and TB BMD z-scores and nonimpact sports with lower LS and TB BMD z-scores compared to low-impact sport (all P0.05).Both sport type and Triad risk factors influence BMD. Athletes in low-impact and nonimpact sports and athletes with low BMI and oligomenorrhea/amenorrhea are at highest risk for reduced BMD.

The knowledge of polycystic ovary syndrome (PCOS) natural history is limited. Our objective was to assess the effect of aging on clinical, hormonal and sonographic ovarian PCOS features and additionally to identify parameters that impact the course of PCOS. A secondary aim was to supply additional information on the reproductive outcome in women with previously diagnosed PCOS. A longitudinal cohort study with a median follow-up of 120.9 months was conducted, and 31 Caucasian women previously diagnosed with PCOS according to the Rotterdam criteria were re-examined at a median age of 35. Clinical examinations, transvaginal ultrasound scans, and lipid, E-selectin and sex hormone assessments were performed at the beginning and at the end of the follow-up. It was observed that menstrual cycles became regular and sonographic morphology of ovaries was normalized in 55% and 49% of the participants, respectively (all p &lt, 0.05). At the final assessment, 55% of the women no longer met the criteria for PCOS (p &lt, 0.05). The age, follicle-stimulating hormone (FSH) and E-selectin assessed at the baseline were the most important predictors of the PCOS persistence into later years (respectively, OR = 0.84, OR = 0.39, OR = 1.08, all p &lt, 0.05). Ninety-five percent of the patients who had ever been trying to conceive became pregnant a minimum of once. The women with persistent PCOS had worse metabolic and reproductive parameters compared to the women with resolved PCOS. Positive correlations were found between the number of miscarriages and ovarian volume, LH, androstenedione, 17-hydroxyprogesterone and an increase in E-selectin during the follow-up (R = 0.46, R = 0.59, R = 0.54, R = 0.49, R = 0.47, all p &lt, 0.05). In conclusion, progressing from the third to the fourth decade is connected with a reduction in PCOS features, which seems to have a great impact on fertility of women with a previous diagnosis of PCOS. FSH and E-selectin, as determined at the initial PCOS diagnosis, had an impact on the disappearance of the syndrome years after.

Leydig cell tumors are rare ovarian neoplasms. Affected individuals typically present with amenorrhea/oligomenorrhea and rapidly progressive features of virilization. Erythrocytosis can also occur as a result of high testosterone levels.

The objective:to study the features of the pathological state of the mammary glands, depending on the nature of the menstrual cycle, the characteristics of the hormonal and immunological status in women with menstrual disorders of endocrine genesis. Materials and methods.For the study, a group of 130 patients (n=130) of reproductive age (mean age 27±2,3 years) was selected, who were divided into 2 subgroups by the nature of menstrual dysfunction: 1 subgroup (n=73) – women with secondary amenorrhea and oligomenorrhea background of chronic anovulation, 2 subgroup (n=57) – women with a regular rhythm of the menstrual cycle and insufficiency of the luteal phase (ILP). All patients complained about the absence of pregnancy for an average of 4±1,2 years. To assess the state of the reproductive system and hormone-dependent organs, women underwent complex clinical-hormonal, ultrasound, radiothermometric, X-ray and immunological examinations. Results.Menstrual irregularities in all patients are caused by endocrine pathology: secondary amenorrhea and oligomenorrhea against the background of chronic anovulation – 56,2%, regular rhythm in combination with ILP – 43,8%. When examining the mammary glands, 88,9% of patients were diagnosed with various variants of fibrocystic disease (FCD), underdevelopment of structural elements, involutive changes that do not correspond to age, focal formations. Thus, the frequency of FCD with anovulation is 1,3 times higher than with ILP (43,9% and 35,1%, respectively), while focal formations in the mammary glands of the type of fibroadenoma are 4 times more likely to be detected in patients with ILP than with amenorrhea (5,3% and 1,4%, respectively). With radiothermometry, in 13,4% of cases FCD was additionally diagnosed, which was not detected by ultrasound, while the coincidence of the results of both diagnostics was noted in 49,2%. In 1 subgroup, every 2nd patient (52,0%) was diagnosed with hyperprolactinemia. The hormonal parameters were characterized by a decrease in the level of FSH, LH, estradiol, and the degree of inhibition of the secretion of these hormones increased depending on the increase in the level of prolactin. In patients with hyperprolactinemia, different forms of FCD were detected 2,4 times more often. Hormonal and immunological examination revealed a decrease in the activity of T-helpers, immunoregulatory index, circulating immune complexes in both groups, while no significant differences were found between the groups. Conclusion.When studying the characteristics of the nature of the menstrual function of the patients, it was found that the majority of the subjects had latent disorders of the hypothalamic-pituitary-ovarian system, which were compensated until a certain point and manifested themselves under the influence of unfavorable factors. With ILP more often than with anovulation, mixed forms of FCD and diffuse forms with a predominance of the cystic component were diagnosed. Probably, these changes in the mammary glands can be explained by the insufficient effect of progesterone and a relative increase in the level of estrogens, which support the proliferation of the connective tissue and epithelial components of the mammary gland. As a result, obstruction of the ducts develops, which in some patients leads to an increase in alveoli and the formation of cystic cavities. Progesterone deficiency is also largely associated with changes in the immune status in patients with endocrine infertility, but immune disorders develop secondarily and are not specific for a particular pathology.

The main function of a woman’s reproductive system is pregnancy and the birth of healthy offspring. In women with menstrual dysfunction in the pubertal period, more than 70% of pregnancy complications are observed, the most common of which are menacing miscarriage and placental insufficiency. Despite the medical and social significance, today there is not enough information about the reproductive potential of women with menstrual dysfunction in the puberty period, and their pregnancy and childbirth.The objective: аccording to laboratory and instrumental methods of research, to study the features of the course of pregnancy in women with menstrual dysfunction in the puberty.Materials and methods. According to the nature of the disorders, the main group of pregnant women (n=120) who had a menstrual pathology in the puberty were divided into 3 subgroups (n=40): the first – pregnant women with primary oligomenorrhea in the anamnesis, the second – with a late age menarche, the third - with puberty bleeding. The control group included pregnant women (n=40) with the correct rhythm of menstruation in puberty.Results. A clinical study found that women with menstrual irregularities in the puberty were significantly more likely than women with the right rhythm of menstruation, pregnancy was complicated by a threatening miscarriage in the early stages, threatening premature birth and chronic placental insufficiency.During the dynamic observation of pregnant women using modern diagnostic examination methods, placental dysfunction in the period of 11–14 weeks was detected in 15,0% of women, chronic placental insufficiency (compensated form) in 30–40 weeks – in 6,7%. At 36–40 weeks, chronic placental insufficiency was diagnosed in 59,2% of women, of which a subcompensated form with growth retardation of the first degree in 8,5% was diagnosed. A histological examination of the placenta revealed chronic placental insufficiency in 62,0% of women, of which 6,5% were in subcompensated form.Conclusion. In the course of a scientific search, an attempt was made to find a confirmation of the assumption that the basis of the genesis of placental dysfunction and related gestational complications in patients with disorders of the formation of menstrual function has a history of hormonal and metabolic imbalance, implantation endometrial insufficiency and vasculogenesis dysfunction, the premises of which are laid on stage of the pathological puberty.The results of the studies indicate the need to improve prognostic and diagnostic methods for the prevention of pregnancy complications in women with menstrual dysfunction in the puberty, based on new knowledge about the mechanisms of their development, and in the current demographic crisis are the requirement of the time., Основная функция репродуктивной системы женщины – наступление беременности и рождение здорового потомства. У женщин с нарушениями менструальной функции в пубертатный период наблюдается более 70% осложнений беременности, наиболее распространенными из которых являются угрожающий выкидыш и плацентарная недостаточность. Несмотря на медико-социальную значимость, на сегодня недостаточно информации о репродуктивном потенциале женщин с нарушениями менструальной функции в пубертатный период, об особенностях протекания у них беременности и родов.Цель исследования: изучение особенностей течения беременности у женщин с нарушениями менструальной функции в пубертатный период по данным лабораторных и инструментальных исследований.Материалы и методы. По характеру нарушений основную группу беременных (n=120), имевших патологию менструальной функции в пубертатный период, распределили на три подгруппы: 1-я – беременные с первичной олигоменореей в анамнезе (n=40), 2-я – с поздним возрастом менархе (n=40), 3-я – с пубертатными кровотечениями (n=40). В контрольную группу вошли беременные (n=40) с правильным ритмом менструаций в пубертате.Результаты. В ходе клинического исследования установлено, что у женщин с нарушениями менструальной функции в пубертатный период достоверно чаще, чем у женщин с правильным ритмом менструаций, беременность осложнялась угрожающим выкидышем в ранних сроках, угрожающими преждевременными родами и хронической плацентарной недостаточностью.При динамическом наблюдении беременных с применением современных диагностических методов обследования дисфункция плаценты в сроке 11–14 нед выявлена у 15,0% женщин, хроническая плацентарная недостаточность (компенсированная форма) в 30–40 нед – у 6,7%. В 36–40 нед хроническая плацентарная недостаточность была диагностирована у 59,2% женщин, из них – субкомпенсированная форма с задержкой роста плода 1-й степени – у 8,5%. При гистологическом исследовании плацент хроническая плацентарная недостаточность выявлена у 62,0% женщин, из которых у 6,5% – в субкомпенсированной форме.Заключение. В ходе научного поиска сделана попытка найти подтверждение предположению, согласно которому в основе генеза плацентарной дисфункции и связанных с ней гестационных осложнений у пациенток с нарушениями становления менструальной функции в анамнезе лежит гормональный и метаболический дисбаланс, имплантационная недостаточность эндометрия и дисфункция васкулогенеза, предпосылки для возникновения которых заложены на этапе патологического пубертатного периода.Результаты проведенных исследований свидетельствуют о необходимости усовершенствования прогностических и диагностических методов профилактики осложнений беременности у женщин с нарушениями менструальной функции в пубертатный период, основанных на новых знаниях о механизмах их развития и в условиях современного демографического кризиса являющихся требованием времени., Основна функція репродуктивної системи жінки – настання вагітності і народження здорового потомства. У жінок, які мали порушення менструальної функції у пубертатний період, спостерігається понад 70% ускладнень вагітності, найпоширенішими з яких є загрозливий викидень і плацентарна недостатність. Незважаючи на медико-соціальну значущість, на сьогодні бракує інформації щодо репродуктивного потенціалу жінок із порушеннями менструальної функції у пубертатний період, особливостей перебігу у них вагітності і пологів.Мета дослідження: вивчення особливостей перебігу вагітності у жінок, які мали порушення менструальної функції у пубертатний період, за даними лабораторних та інструментальних досліджень.Матеріали та методи. За характером порушень основну групу вагітних (n=120), які мали розлади менструальної функції у пубертатний період, було розподілено на три підгрупи: 1-а – вагітні з первинною олігоменореєю в анамнезі (n=40), 2-а – з пізнім віком менархе (n=40), 3-я – з пубертатними кровотечами (n=40). До контрольної групи увійшли вагітні (n=40) з правильним ритмом менструацій у пубертаті.Результати. У ході клінічного дослідження встановлено, що у жінок, які мали порушення менструальної функції у пубертатний період, достовірно частіше, ніж у жінок із правильним ритмом менструацій, вагітність ускладнювалась загрозливим викиднем у ранніх термінах, загрозливими передчасними пологами і хронічною плацентарною недостатністю.Під час динамічного спостереження вагітних із застосуванням сучасних діагностичних методів обстеження дисфункція плаценти у терміні 11–14 тиж виявлена у 15,0% жінок, хронічна плацентарна недостатність (компенсована форма) у 30–40 тиж – у 6,7%. У 36–40 тиж хронічну плацентарну недостатність діагностовано у 59,2% жінок, з них – субкомпенсовану форму із затримкою росту плода 1-го ступеня – у 8,5%. При гістологічному дослідженні плацент хронічна плацентарна недостатність виявлена у 62,0% жінок, з яких у 6,5% – у субкомпенсованій формі.Заключення. У ході наукового пошуку зроблена спроба знайти підтвердження припущенню, згідно з яким в основі генезу плацентарної дисфункції та пов’язаних з нею гестаційних ускладнень у пацієнток із порушенням становлення менструальної функції в анамнезі лежить гормональний та метаболічний дисбаланс, імплантаційна недостатність ендометрія та дисфункція васкулогенезу, передумови для виникнення яких закладено на етапі патологічного пубертатного періоду.Результати проведених досліджень свідчать про необхідність удосконалення прогностичних і діагностичних методів профілактики ускладнень вагітності у жінок, які мали порушення менструальної функції у пубертатний період, заснованих на нових знаннях щодо механізмів їхнього розвитку і в умовах сучасної демографічної кризи є вимогою часу.

Background Ovarian steroid cell tumors represent a rare category of sex cord-stromal tumors that constitute less than 0.1% of all ovarian tumors. These neoplasms are classified into three main subtypes according to the cell of origin: Leidyg cell tumors, stromal luteomas, and steroid cell tumors not otherwise specified (SCTs-NOS). The latter subtype is defined as a neoplasm of an uncertain lineage that mostly affects middle-aged women, whereas it’s rare in younger ages. Case presentation We report a case of a 21-year-old virgin female who presented to our hospital with complaints of mild abdominal pain, hirsutism, and oligomenorrhea for more than a year. Before her current admission, the patient had attended an external gynecologic clinic where she had been prescribed oral contraceptives to regulate her periods. Nevertheless, on presentation to our institution, physical examination revealed abdominal tenderness with a palpable pelvic mass and mild hirsutism in the thigh. Ultrasonography demonstrated a large left ovarian mass measuring 154 × 104 mm, and compressing the uterus. Therefore, a unilateral salpingo-oophorectomy was performed, and interestingly, pathologic examination of the large aforementioned mass alongside with immunohistochemical correlation revealed the diagnosis of a large ovarian steroid cell tumor-not otherwise specified with a unique combination of benign and malignant features. Conclusions Although ovarian steroid cell tumors represent a rare category, they must be considered in the differential diagnosis for mild virilization symptoms in young females due to the importance of early diagnosis and management. In this manuscript, we aimed to present the first case report from Syria that highlights the crucial role of detailed morphological examination for challenging cases despite the difficulties in differential diagnosis, and the absence of ancillary techniques. Furthermore, we managed to discuss a brief review of diagnostic methods, histological characteristics, and treatment recommendations.

PCOS is one of the most common endocrine disorders and NAFLD is one of its most dangerous metabolic consequences. The diagnosis of NAFLD is not a practical task and the condition is at risk of being overlooked. The use of simpler but still reliable surrogate markers is necessary to identify women with a high likelihood of NAFLD. The aim of this study was to evaluate the clinical correlates of NAFLD Liver Fat Score (NAFLD-LFS) in women with oligomenorrhea and/or hirsutism. Furthermore, the study aimed to evaluate whether, among the hormonal parameters evaluated in such women, possible hallmarks of NAFLD may be identified. To this purpose, 66 women who attended our Outpatient Clinic for oligomenorrhea and/or hyperandrogenism were included in the study. In order to validate the results obtained in the first cohort, a second independent sample of 233 women evaluated for female sexual dysfunction (FSD) was analyzed. In cohort 1, NAFLD-LFS positively correlated with metabolic and inflammatory parameters. Among the hormone parameters, NAFLD-LFS showed no significant relationships with androgens but a significant negative correlation with SHBG (p

The reproductive system is exposed to various adverse factors and harmful effects at all stages of functioning of an organism. Against the background of declining levels of women's reproductive health in recent years, there has been a clear tendency towards an increase in the number of patients with pathology of puberty. The low level of somatic and reproductive health before pregnancy causes a high incidence of complicated labors, which leads to a deterioration in the development of subsequent generations.The purpose of the study. To provide clinical characteristics of women who had menstrual dysfunction in puberty, which were based on the study of clinical and anamnestic data, laboratory and instrumental research methods, analysis of risk factors, clinical course, treatment effectiveness and dispensary observation.Materials and methods. According to the nature of the disfunctions, the main group of women (n = 210) who had menstrual disorders in puberty was divided into 3 subgroups (n = 70): the first - women with primary oligomenorrhea and timely average menarche, the second - with late menarche, the third - with pubertal bleeding. The control group included women (n = 70) with the correct rhythm of menstruation in puberty.Results. The clinical prospective study analyzed the social status of women with reproductive dysfunction in puberty, the frequency and structure of existing concomitant somatic diseases, the duration of the menstrual cycle, the nature of diseases of the female genital organs; the assessment of the comprehensive treatment of revealed disorders, which allowed to obtain a favorable reproductive prognosis. The majority of surveyed women (53.3%) planned a pregnancy, which occurred in 75.9% from among of planning ones.Conclusions. The conduction of clinical and anamnestic analysis of the reproductive function of women with menstrual dysfunction in puberty will increase the effectiveness of the treatment of identified disorders and will allow developing algorithms for management of such women during planning and during pregnancy.

The study of hemodynamic features of the pelvic organs in women is of great clinical importance, since it allows assessing the degree of recovery of endometrial regeneration after menstruation, the possibility of implantating a fertilized egg and placental development. Women who have had menstrual dysfunction in puberty, the determination of qualitative and quantitative parameters of uterine hemodynamics can be useful while choosing treatment tactics, evaluating its effectiveness, and will also provide significant assistance in predicting the prospects for their reproductive health. The purpose of the study. To examine the hemodynamics of uterus and assess the ability of endometrium to implant in women with menstrual dysfunction in puberty with the help of ultrasound and dopplerometry.Materials and methods. To achieve the set goals, 120 women of reproductive age from 19 to 32 years old were examined. By the nature of the disorders, the main group of women (n = 90) with menstrual dysfunction in puberty were divided into 3 subgroups (n = 30): the first group - women with primary oligomenorrhea, the second one - with late menarche, the third one - with pubertal bleeding. The control group consisted of women (n = 30) with the correct rhythm of menstruation in puberty. Results. On the basis of a comparative analysis of the echographic parameters of the size of the uterus in women with menstrual dysfunctions in puberty (main group) and women with the correct rhythm of menstruation (control group), it was found that, on the average stage of endometrial secretion, the volume of the uterus is 1, 2 times smaller in women of the main group (p˂0.05) due to the width of the body of the uterus (p˂0.001). The ratio between the length of the body and cervix in the examined groups did not differ significantly. The thickness of the anterior wall of the uterus is less than the control values in women with late menarche (p˂0.05) and pubertal bleeding (p˂0.01), which was a predictor of the absence of combined uterine pathology. Echographic examination of the thickness of the endometrium at a late stage of the proliferation phase in the examined women did not reveal significant differences with the control group. In the middle stage of the secretion phase, the thickness of the endometrium was less in women, who had menstrual dysfunction in puberty - 9.50 ± 0.27 mm versus 11.38 ± 0.48 mm in the group with the correct menstruation rhythm (p

Polycystic ovarian syndrome is the most common endocrinological disorder in women of reproductive age and has a considerable metabolic, reproductive, and cardiovascular consequences. This study was designed to provide an overview of the presentation of he clinical profile and hormonal presentation of the patients with polycystic ovarian syndrome attending a tertiary care hospital.A descriptive cross-sectional study was conducted between September 14, 2019 to October 16, 2019 on patients presenting to a tertiary care hospital, after obtaining ethical clearance from Institutional Review Committee (Dated 03/09/2019) and informed consent from the patient or patient relatives. Data entry and analysis were done in Microsoft Excel 10. The data was statistically analysed using Statistical Package for the Social Sciences (SPSS) version 20.0.The study included 100 PCOS patients. The mean age of the patients was 24.9±4.52 years and the most common group was 26-34 years. The most common presenting symptom was menstrual irregularity which was seen in 86 (86%) of the patients, followed by weight gain in 55 (55%) of the patients. Thirty percent (30 in number) of the patients were overweight, while eleven (11%) of the patients had grade I obesity. LH/FSH ratio was more than or equal to 2 in eighty-three percent 83 (83%) of the patients.Polycystic ovarian syndrome has varying clinical manifestations, most commonly affecting the young women of reproductive age group. The commonest presenting complaint in the current study was menstrual abnormality. Majority of the patients had deranged hormonal profile which can lead to an increased risk of cardiovascular disease and type 2 DM. Thus, awareness regarding PCOS is important for early diagnosis and to prevent its sequalae to various complications.

Eating Disorders (ED) are associated with multiple physical complications that strongly affect the physical health of these young and fragile patients and can also cause significant mortality, the highest among psychiatric pathologies. Among the various organic complications, albeit still little known, the gynecological implications, up to infertility, are very widespread. Both among adolescent and adult patients, gynecological symptoms can be very widespread and range from menstrual irregularities to amenorrhea, from vaginitis to ovarian polycystosis, up to complications during the gestational phase and in postpartum, in addition to the possible consequences on the unborn child. Among the most frequent and significant gynecological disorders in women with ED, there are menstrual irregularities that may occur with oligomenorrhea or even amenorrhea. This symptom, although no longer part of the DSM-5 diagnostic criteria for defining Anorexia Nervosa (AN), must be considered a very relevant event in the overall evaluation of young women and adolescents with eating disorders. Functional Hypothalamic Amenorrhea in ED patients is related to psychological distress, excessive exercise, disordered eating, or a combination of these factors which results in suppression of the hypothalamic- pituitary-ovarian axis, resulting in hypoestrogenism. The objective of this paper is to summarize the causes and the mechanism underlying the menstrual disorders and to provide a better understanding of the correlation between the reproductive system and the mechanisms that regulate food intake and eating habits. In addition, early recognition of risk factors for eating disorders for gynecological implications can help put more accurate assessments of patients to prevent potentially fatal complications. The importance of the involvement of specialist gynecologists in the multidisciplinary team that has to follow patients with eating disorders is also discussed.

CapsuleOligo/amenorrhea is an independent risk factor of low ovarian response but not high ovarian response, particularly in women with low AMH levels.ObjectiveTo investigate the association of menstrual cycle length (MCL) with anti-Müllerian hormone (AMH) and ovarian response.MethodsThis was a retrospective cohort study. A total of 7471 women who underwent ovarian stimulation and oocyte retrieval were enrolled. The main outcome was the number of oocytes retrieved.Main ResultsA total of 5734 patients were eligible for analysis. In women without polycystic ovary syndrome (PCOS), serum AMH levels and antral follicle count were significantly lower in women with short cycles and higher in women with oligo/amenorrhea than those with a normal menstrual cycle. In women with PCOS, compared to women with a normal menstrual cycle, women with short cycles and women with oligo/amenorrhea showed higher antral follicle count and higher serum AMH levels. Compared with the 0-25th range group of AMH levels, 75-100th percentile groups showed a significantly increased rate of oligo/amenorrhea in women with and without PCOS [adjusted odds ratio (OR) =1.9 (1.04, 3.46), 2.4 (1.70, 3.35)]. In women without PCOS, the low ovarian response was more common in women with short cycles and less common in women with oligo/amenorrhea compared to women with normal cycles [OR=3.0 (2.38, 3.78), 0.7 (0.55, 0.96), respectively]. When adjusted for AMH levels, both short cycles and oligo/amenorrhea were associated with an increased risk of low response [adjusted OR=1.3 (1.02, 1.75), 1.3 (0.93, 1.86), respectively]. In women without PCOS and with low AMH levels, the low ovarian response was more common in women with short cycles as well as in women with oligo/amenorrhea [OR=1.5 (1.08, 1.98), 1.7 (1.08, 2.69), adjusted OR=1.2 (0.86, 1.74), 2.2 (1.31, 3.82), respectively].ConclusionAMH levels are significantly associated with increased risk of oligo/amenorrhea in women with and without PCOS. AMH is an indispensable confounder in the association between MCL and ovarian response in women without PCOS. Oligo/amenorrhea is an independent risk factor associated with a low ovarian response in women without PCOS, particularly those with low AMH levels.

Objective: To investigate the prevalence and the related characteristics of oligomenorrhea among women within childbearing age in China. Study design: A large-scale community-based investigation was conducted from 2013 to 2015. A total of 12,964 women aged 18–49 years from 9 provinces/municipalities in China were recruited for healthcare screening in local community health centers. Outcome measures include clinical history, ultrasonographic exam, and hormonal and metabolic parameters. Results: Among women within childbearing age in China, the prevalence of oligomenorrhea was 12.2% (1,579/12,964). Both sociodemographic factors and medical history were significantly associated with oligomenorrhea ( P Conclusions: Obesity, acne, seborrhea, acanthosis, larger ovarian size, and polycystic ovarian morphology were significantly associated with oligomenorrhea. The increase of anti-Mullerian hormone, total testosterone, and androstenedione level was also demonstrated in the oligomenorrhea group. Higher prevalence of infertility and medical treatment rate was observed in women with oligomenorrhea.

To date, there is insufficient information in the literature on studies of the regulatory system of angiogenesis represented by vascular growth factors in women with menstrual dysfunction in the pubertal period. The objective: using the clinical material using clinical, laboratory and instrumental methods to study the state of angiogenic growth factors (VEGF and its receptors VEGF-R1, VEGF-R2) and ovarian hemodynamics, as well as expand the understanding of the mechanisms of development of luteal phase deficiency (LPD) in women with menstrual dysfunction in the puberty. Materials and methods. Studies were conducted among women of reproductive age from 19 to 32 years. According to the nature of the violations, the main group of women (n=90) who had a pathology of menstrual function in the puberty period was divided into 3 subgroups (n=30): the first – women with primary oligomenorrhea in the anamnesis, the second – with a late age menarche, the third – with puberty bleeding. The control group included women (n=30) with the correct rhythm of menstruation in puberty. Biochemical and ultrasound markers of angiogenesis were studied. Results. In women with menstrual dysfunction in the puberty, a decrease in the maximum systolytic blood flow velocity (Vmax) in the ovarian artery in the ovary with a preovulatory follicle was found compared with women in the control group (p Conclusion. Studies have shown that the formation of a full-fledged preovulatory follicle and corpus luteum in the ovary is affected by microcirculation in the ovarian tissue, the state of which depends on the activity of the angiogenic system represented by VEGF and its receptors VEGF-R1 and VEGF-R2. The establishment of a correlation between VEGF and vascular resistance indices indicates the participation of angiogenic growth factors in ovarian hemodynamics during the formation of the preovulatory follicle in women with menstrual dysfunction in the pubertal period.

Background: Polycystic ovary syndrome (PCOS), the most prevalent hormonal disorder in females, is characterized by low levels of progesterone, which causes increased estrogen levels leading to production of various anti and auto-antibodies. This study aimed to estimate and compare levels of anti-nuclear antibodies (ANA), anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG), and anti-islet cell antibodies (anti-ICAb) in patients with PCOS and healthy controls. Methods: The present comparative study included 82 subjects divided into two groups with 41 individuals in each group. Group I included healthy subjects, while Group II included patients diagnosed with PCOS. Blood samples were collected to determine serum levels of ANA, anti-TPO, anti-TG, and anti-ICAb using commercially available ELISA kits. Data were analyzed by using SPSS 20.0. Results: Two (4.8%) subjects in Group II had ANA, but none of the other healthy individuals had these auto-antibodies. Levels of anti-TPO were higher in Group II (6.01 IU/ml) than in Group I (5.98 IU/ml). Levels of anti-TG and anti-ICAb were higher in Group I (19.86 and 32.49 IU/ml, respectively) than in Group II (19.78 and 26.07 IU/ml, respectively). Conclusion: Levels of ANA and anti-TPO were higher in patients with PCOS than in controls. By contrast, levels of anti-TG and anti-ICAb were higher in controls than in patients with PCOS.

BACKGROUND Oligomenorrhea is one of the most frequent gynecologic complaints that interferes with women's life quality. Treatment using traditional Chinese medicine (TCM) is a preferred alternative therapy for oligomenorrhea. However, systematic reviews (SRs) evaluating the efficacy of TCM treatments for oligomenorrhea remain absent. The present SR and meta-analysis aimed to evaluate the efficacy and safety of TCM treatment for oligomenorrhea. METHODS Randomized controlled trials (RCTs) published in English and Chinese were retrieved by searching in the databases in October 2019, including PubMed, Cochrane Library, EMBASE, Sinomed, CNKI, VIP, and WanFang databases. Quantitative analyses and quality assessments were then conducted based on abstracted data. This study protocol is registered PROSPERO, number CRD42018095660. RESULTS A total of 26 eligible RCTs involving 2,389 patients were included in our analysis. Overall, we observed an effect of increasing menstrual blood volumes owing to using TCM treatments plus bio-medicine (BM) (n=649; MD, 12.05; 95% CI: 5.23 to 18.87; P

Objective To assess the safety of the levonorgestrel 52-mg intrauterine system (LNG-IUS) in women with a history of thrombosis or coagulopathy and to evaluate bleeding patterns. Methods A retrospective chart review was conducted of 117 women attending a clinic between 2007 and 2019. Their sociodemographic characteristics, hematologic status, reasons for using LNG-IUS, duration of use, use of oral anticoagulants, complications, and bleeding patterns were analyzed. Results Ninety-nine women had a history of thrombosis (71.7% in use of oral anticoagulants) and 18 had coagulopathies. No bleeding or any other complications occurred during placement of the LNG-IUS. Around two-thirds of the women reported amenorrhea or oligomenorrhea at 12, 24, and 54 months of follow-up, with no difference between the groups using the IUS for contraception or to treat heavy menstrual bleeding (HMB) (P=0.07), those with a history of thrombosis or coagulopathy (P=0.53), and users or non-users of oral anticoagulants (P=0.59). Conclusion The LNG-IUS is safe for women with hematologic disorders. It was associated with amenorrhea or oligomenorrhea in a large proportion of users up to 54 months of follow-up regardless of use of oral anticoagulants, reason for use of LNG-IUS (contraception or HMB), or history of coagulopathy or thrombosis.

Stress fractures are common among elite ballet dancers whereby musculoskeletal health may be affected by energy balance and overtraining.This study aimed to characterize bone health in relation to stress fracture history, body composition, eating disorder risk, and blood biomarkers in professional male and female ballet dancers.A single cohort of 112 dancers (male: 55, 25 ± 6 yr; female: 57, 24 ± 6 yr) was recruited. All participants underwent bone and body composition measures using dual-energy x-ray absorptiometry. In a subset of our cohort (male: 30, 24 ± 6 yr; female, 29, 23 ± 5 yr), a blood panel, disordered eating screen, menstrual history, and stress fracture history were also collected. Age-matched Z scores and young-adult T scores were calculated for bone mineral density (BMD) and body composition. Independent-samples t-tests and Fisher's exact tests were used to compare BMD, Z-scores, T scores, and those with and without history of stress fractures. A 1 × 3 ANOVA was used to compare BMD for those scoring 0-1, 2-6, and 7+ using the EAT26 questionnaire for eating disorder risk. Regression was used to predict BMD from demographic and body composition measures.Female dancers demonstrated reduced spinal (42nd percentile, 10%T-1) and pelvic (16th percentile, 76%T-1) BMD. Several anthropometric measures were predictive of BMD (P0.05, r = 0.65-0.81, standard error of estimate = 0.08-0.10 g·cm, percent error = 6.3-8.5). Those scoring1 on EAT26 had lower BMD than did those with a score of 0-1 (P0.05).Professional female ballet dancers exhibit reduced BMD, fat mass, and lean mass compared with the general population whereby low BMD and stress fractures tend to be more prevalent in those with a higher risk of disordered eating. Anthropometric and demographic measures are predictive of BMD in this population.

Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age. It is a complex disease in which genetic, endocrine, environmental, and behavioral factors are intertwined, giving rise to a heterogeneous phenotype with reproductive, metabolic, and psychological characteristics. Polycystic ovary syndrome affects women’s health and their quality of life across the life course. During different life stages, the polycystic ovary syndrome phenotype can change, which requires a personalized diagnostic approach and treatment. Polycystic ovary syndrome is a major cause of anovulatory infertility; this disorder is also associated with hirsutism and acne. Diagnosing polycystic ovary syndrome during adolescence is challenging because the polycystic ovary syndrome criteria include normal physiological events that occur during puberty. With increasing age, the syndrome evolves from a reproductive disease to a more metabolic disorder. Along with metabolic disturbances, including insulin resistance and abnormalities of energy expenditure, polycystic ovary syndrome is recognized as a major risk factor for the development of type 2 diabetes and cardiovascular disease in later life. Moreover, there is evidence for familial clustering of endocrine and metabolic features of polycystic ovary syndrome. Environmental factors such as diet and obesity appear to contribute to the phenotype. Treatment should be tailored to the specific concerns and needs of the individual patient and involves restoring fertility, treatment of the metabolic complaints, treatment of androgen excess, and providing endometrial protection. The complexity of the disorder, and the impact on quality of life, requires a timely diagnosis, screening for complications, and management strategies for the long-term health issues associated with polycystic ovary syndrome. The syndrome remains underdiagnosed, and women experience significant delays to diagnosis.

BackgroundPolycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age. Previous studies have identified genetic variants associated with PCOS identified by different diagnostic criteria. The Rotterdam Criteria is the broadest and able to identify the most PCOS cases.ObjectivesTo identify novel associated genetic variants, we extracted PCOS cases and controls from the electronic health records (EHR) based on the Rotterdam Criteria and performed a genome-wide association study (GWAS).Study DesignWe developed a PCOS phenotyping algorithm based on the Rotterdam criteria and applied it to three EHR-linked biobanks to identify cases and controls for genetic study. In discovery phase, we performed individual GWAS using the Geisinger’s MyCode and the eMERGE cohorts, which were then meta-analyzed. We attempted validation of the significantly association loci (P−6) in the BioVU cohort. All association analyses used logistic regression, assuming an additive genetic model, and adjusted for principal components to control for population stratification. An inverse-variance fixed effect model was adopted for meta-analyses. Additionally, we examined the top variants to evaluate their associations with each criterion in the phenotyping algorithm. We used STRING to identify protein-protein interaction network.ResultsWe identified 2,995 PCOS cases and 53,599 controls in total (2,742cases and 51,438 controls from the discovery phase; 253 cases and 2,161 controls in the validation phase). GWAS identified one novel genome-wide significant variant rs17186366 (OR=1.37 [1.23,1.54], P=2.8×10−8) located nearSOD2. Additionally, two loci with suggestive association were also identified: rs113168128 (OR=1.72 [1.42,2.10], P=5.2 x10−8), an intronic variant ofERBB4that is independent from the previously published variants, and rs144248326 (OR=2.13 [1.52,2.86], P=8.45×10−7), a novel intronic variant inWWTR1. In the further association tests of the top 3 SNPs with each criterion in the PCOS algorithm, we found that rs17186366 was associated with polycystic and hyperandrogenism, while rs11316812 and rs144248326 were mainly associated with oligomenorrhea or infertility. Besides ERBB4, we also validated the association withDENND1A1.ConclusionThrough a discovery-validation GWAS on PCOS cases and controls identified from EHR using an algorithm based on Rotterdam criteria, we identified and validated a novel association with variants withinERBB4. We also identified novel associations nearbySOD2andWWTR1. These results suggest the eGFR and Hippo pathways in the disease etiology. With previously identified PCOS-associated lociYAP1, theERBB4-YAP1-WWTR1network implicates the epidermal growth factor receptor and the Hippo pathway in the multifactorial etiology of PCOS.

The mechanism underlying oligo/amenorrhea in exercising women is often presumed as hypothalamic inhibition secondary to energy deficiency; however, hyperandrogenism may provide an alternative mechanism in some exercising women. Our purpose was to compare reproductive, metabolic, and androgen profiles of exercising women with eumenorrheic, ovulatory menstrual cycles (n = 91), oligo/amenorrhea without evidence of hyperandrogenism (Oligo/Amen; n = 83), and oligo/amenorrhea with evidence of hyperandrogenism (Oligo/Amen-HA; n = 17), and determine the prevalence of oligo/amenorrhea with evidence of hyperandrogenism in exercising women. Self-reported menstrual history and quantification of daily estrogen and progesterone urinary metabolites determined reproductive status. Resting energy expenditure, body composition, and metabolic hormone concentrations determined metabolic status. Serum androgens and calculated free androgen index (FAI) determined androgen status. Groups were similar in age (22.4 ± 0.3 years), height (165.1 ± 0.5 cm), resting energy expenditure (1198.4 ± 12.0 kcal/day), and total triiodothyronine (85.0 ± 1.5 ng/dL) concentration. Oligo/Amen-HA had greater weight (60.0 ± 1.6, 56.1 ± 0.7 kg), body mass index (22.3 ± 0.4, 20.6 ± 0.2 kg/m2), percentage body fat (27.3% ± 1.4%, 24.4% ± 0.6%), fat mass (16.2 ± 1.0, 13.8 ± 0.4 kg), insulin (5.8 ± 0.7, 4.2 ± 0.3 μIU/mL), leptin (12.2 ± 2.3, 6.6 ± 0.7 ng/mL), FAI (6.1 ± 0.3, 1.7 ± 0.1), and luteinizing hormone/follicle-stimulating hormone (1.9 ± 0.3, 1.3 ± 0.2) compared with Oligo/Amen, respectively. In our sample, 17% of those with oligo/amenorrhea had concurrent hyperandrogenism. This study supports that oligo/amenorrhea in some exercising women is related to hyperandrogenism. Novelty Caution must be utilized when discriminating hypothalamic oligo/amenorrhea from hyperandrogenic oligo/amenorrhea. In our sample, 17% of those with presumed hypothalamic oligo/amenorrhea had concurrent hyperandrogenism. Exercise and/or mild energy deficiency may be protective against developing severe hyperandrogenic symptoms.

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-Mullerian 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.

Prolactin-related adverse effects contribute to nonadherence and adverse health consequences, particularly in women with severe mental illness. Treating these adverse effects may improve treatment acceptability, adherence, and long-term outcomes.Premenopausal women with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder were recruited for a randomized, double-blind, placebo-controlled 16-week trial of adjunct aripiprazole (5-15 mg/d). Participants had elevated prolactin (24 ng/mL) and were experiencing galactorrhea, amenorrhea, oligomenorrhea, or sexual dysfunction on a prolactin-elevating antipsychotic. Participants were evaluated biweekly for prolactin elevation and galactorrhea and completed a menstrual diary review. Psychiatric symptoms and adverse effects were closely monitored.Forty-six women were randomized (n = 25 aripiprazole, n = 21 placebo). Thirty-seven completed at least 8 weeks of the study (n = 20 [80%] aripiprazole and n = 17 [81%] placebo). Aripiprazole (mean dose, 11.7 ± 2.4 mg/d) was effective for lowering prolactin relative to placebo (P = 0.04). In addition, 45% (9/20) of the aripiprazole group had a normalized prolactin (24 mg/mL) compared with 12% (2/17) of the placebo group (P = 0.028). Galactorrhea resolved in 77% (10/13) of the aripiprazole-treated participants compared with 33% (4/12) in the placebo group (P = 0.028). Normalization of sexual function (16 on the Arizona Sexual Experience Scale) occurred in 50% on aripiprazole (7/14) versus 9% (1/11) on placebo (P = 0.030). No differences between groups in symptoms or adverse effects were noted. Overall, women rated a mean score of 4.6 ± 0.6 on a 5-point Likert scale for sexual function improvement, suggesting their particular satisfaction with improvement in this domain.Building upon prior studies, this rigorous evaluation confirms the utility of adjunctive aripiprazole as a strategy for improving prolactin and managing prolactin-related adverse effects in premenopausal women with psychosis.

Study Objective Although early diagnosis of polycystic ovary syndrome (PCOS) in adolescents might allow for earlier treatment and prevention of chronic disorders, incorrect or premature diagnosis carries risks of unnecessary treatment and psychological distress. There is no consensus concerning which diagnostic criteria to use for adolescents and current criteria vary. The objective of this study was to determine whether using different diagnostic criteria will affect PCOS diagnosis in adolescents. Design, Setting, and Participants Fifty-two patients aged 13-18 years with at least 2 of the following criteria were included in the study: (1) oligomenorrhea or amenorrhea; (2) Clinical or biochemical hyperandrogenism; and (3) polycystic ovaries on ultrasonography. Patients were then categorized according to the 6 different criteria for PCOS. National Institutes of Health, Rotterdam criteria, Androgen Excess Society, Amsterdam criteria, Endocrine Society criteria, and the Pediatric Endocrine Society criteria. The characteristics of adolescents who were diagnosed with PCOS were also evaluated. Interventions and Main Outcome Measures Forty-one patients out of 52 (78.8%) received diagnosis with National Institutes of Health and Endocrine Society criteria, all with Rotterdam criteria, 45/52 (86.5%) with Androgen Excess Society criteria, 36/52 (69.2%) with Amsterdam criteria and 34/52 (65.4%) with the Pediatric Endocrine Society criteria. Results and Conclusion This study shows that the choice of guideline used does have a great effect on whether an adolescent received the PCOS diagnosis or not. For physicians using the broader criteria, care should be taken to ensure the patient does not receive diagnosis because of the physiological changes seen during puberty, which might mimic PCOS. For those using stricter criteria, close monitoring of patients who do not receive diagnosis is necessary to prevent chronic complications.

Background Adolescents often experience menstrual irregularity in the first few years after menarche. Abnormal menstrual cycles may increase the risk of polycystic ovary syndrome. Objective To determine the menstrual cycle patterns of adolescent females in Indonesia and associated factors. Methods This cross-sectional study was conducted at two senior high schools in Surakarta, Central Java, from September to October 2016. Subjects were healthy female students whose parents have given written informed consent. Girls taking hormonal drugs or with chronic diseases were excluded. Subjects filled questionnaires on menstrual cycle, diet, ethnicity, and physical activity. All subjects underwent anthropometric measurements (height and weight). Kruskal-Wallis test was used for data analysis. Results Four hundred and forty-four subjects met the inclusion criteria. Mean age at menarche was 12.27 (SD 1.08) years. Mean menstrual cycle length was 31.1 (SD 6.5) days. Abnormal menstrual cycle occurred in 30.6% of subjects (24.5% oligomenorrhea, 5.9% polymenorrhea, and 0.2% amenorrhea). Ethnicity (Javanese, Chinese, or Arab) was significantly associated with menstrual cycle category (P

Background: Polycystic ovary syndrome (PCOS), and one of its distinguishing characteristics, oligomenorrhea, have both been associated with ovarian cancer risk in some but not all studies. However, these associations have been rarely examined by ovarian cancer histotypes, which may explain the lack of clear associations reported in previous studies. Methods: We analyzed data from 14 case–control studies including 16,594 women with invasive ovarian cancer (n = 13,719) or borderline ovarian disease (n = 2,875) and 17,718 controls. Adjusted study-specific ORs were calculated using logistic regression and combined using random-effects meta-analysis. Pooled histotype-specific ORs were calculated using polytomous logistic regression. Results: Women reporting menstrual cycle length >35 days had decreased risk of invasive ovarian cancer compared with women reporting cycle length ≤35 days [OR = 0.70; 95% confidence interval (CI) = 0.58–0.84]. Decreased risk of invasive ovarian cancer was also observed among women who reported irregular menstrual cycles compared with women with regular cycles (OR = 0.83; 95% CI = 0.76–0.89). No significant association was observed between self-reported PCOS and invasive ovarian cancer risk (OR = 0.87; 95% CI = 0.65–1.15). There was a decreased risk of all individual invasive histotypes for women with menstrual cycle length >35 days, but no association with serous borderline tumors (Pheterogeneity = 0.006). Similarly, we observed decreased risks of most invasive histotypes among women with irregular cycles, but an increased risk of borderline serous and mucinous tumors (Pheterogeneity < 0.0001). Conclusions: Our results suggest that menstrual cycle characteristics influence ovarian cancer risk differentially based on histotype. Impact: These results highlight the importance of examining ovarian cancer risk factors associations by histologic subtype. Cancer Epidemiol Biomarkers Prev; 27(2); 174–82. ©2017 AACR.

BACKGROUND The major Problems occurring during the adolescent period is related to menstrual cycle. Data regarding the burden of menstrual disturbances in school going children of South India is lacking. Assessing the burden in such children may aid in revealing the current state of menstrual health and hence aiding the policy makes to take appropriate measures. Hence, we assessed the prevalence of menstrual disturbances in school going adolescent girls of South India. The primary aim of this study is to assess the burden of menstrual disorders in school going adolescent girls. The secondary objective were to assess individual menstrual disturbance in the study group and to assess the various factors influencing the menstrual health. MATERIALS AND METHODS This cross-sectional study was conducted in two government girl’s higher secondary school in the state of Tamil Nadu, India. After receiving approval, a structured questionnaire in the regional language (Tamil) was distributed to the school going children between the age of 10 and 19 years. Demographic data and details regarding menstrual health were collected. Frequency of medical assistance and school absenteeism were also analysed in patients with dysmenorrhea. Data were analysed using the SPSS 13.0.1. RESULTS Data of 340 girls who have attained menarche and who have completed the questionnaire was analysed. The median age of menarche in the study group was 13 years. (IQR; 12, 14)) and 13.2% attained early menarche(before12 years). There was a higher prevalence of menstrual disturbances; (46.2%) with polymenorrhea and (12%) with oligomenorrhea. there was a significantly higher usage of sanitary pads in our study population in our study group (98%). In addition, (41.5%) had premenstrual symptoms and (36.8%) had dysmenorrhea. With a higher prevalence of dysmenorrhea (n=125), 35 had school absenteeism. But, only 8/35 consulted a physician and took treatment. Five of these patients were told to have PCOS and 2 were diagnosed to have hypothyroidism. Factors associated with early menarche included overweight (p

Eighty-four subjects, premenopausal female patients (n=42, mean (SD) age: 26.4 (4.2) years) diagnosed with polycystic ovary syndrome (PCOS) and age-matched healthy volunteers (n=42, mean (SD) age: 27.6(3.4) years), were included in this study. Data on physical examination, anthropometric measurements and blood biochemistry analysis were recorded for each subject along with analysis for SOCS1-1478 CA/del polymorphism by polymerase chain reaction-restriction fragment length polymorphism. The relation of SOCS1-1478 CA/del polymorphism to PCOS status and insulin resistance was analysed via logistic regression analysis. Mean (SD) levels for BMI (28.5(6.5) vs.22.5 (4.9) kg/m(2), p

Background: Polycystic ovary syndrome (PCOS) is more frequently observed in type 1 diabetes mellitus (T1DM) adult women than in nondiabetic women. No such prevalence has yet been studied in adolescent girls with T1DM. Aim: The aim of this study was to evaluate the prevalence of PCOS in adolescent girls with T1DM and to determine the clinical and hormonal features associated with the disorder. Methods: A cross-sectional study of 53 adolescent girls (gynecological age >2 years) referred for routine evaluation for T1DM was conducted. We diagnosed PCOS using the National Institutes of Health (NIH) and Rotterdam criteria. Results: 26.4 and 47.9% of adolescents had PCOS according to NIH (NIH-PCOS) and Rotterdam (Rotterdam-PCOS) criteria. 66.7% of NIH-PCOS adolescents had a complete phenotype associated with hyperandrogenism, oligomenorrhea, and polycystic ovarian morphology, unlike only 33.3% of the Rotterdam-PCOS adolescents. A family history of type 2 diabetes mellitus (T2DM) was more frequent in PCOS than in non-PCOS girls, whichever criteria were used. Late pubertal development and a T1DM diagnosis close to puberty were factors associated with NIH-PCOS. Conclusion: Adolescents with T1DM had a high prevalence of PCOS. More differences between PCOS and non-PCOS patients were found using the NIH criteria, suggesting that clinical characteristics might be more accurate for diagnosing PCOS in girls with T1DM. A family history of T2DM is associated with a high risk of PCOS.

The article presents the current data of history of polycystic ovary syndrome (PCOS) study. It contains studies of genetic susceptibility of PCOS, PCOS symptoms and connection with development of anxiety and depressive disorders. The article covers ethnic differences in the phenotypic manifestations of PCOS. The papers describes the study of endocrine causes of infertility in Russian and Buryat women. Several theories of PCOS, including the theory of PCOS connection with intestinal bacterial flora disorders (“dysbiotic intestinal microbiota”) are being discussed. The article also provides an overview of various scientific research in this area and the data of the relationship of PCOS and the risk of cardiometa-bolic disorders, insulin resistance, metabolic syndrome, obesity and sleep apnea. It highlights modern aspects in the study of PCOS etiology – studies of adipose tissue as an endocrine organ. The article reflects study of PCOS relationship with the level of the gastrointestinal tract hormones: leptin, insulin, ghrelin, cholecystokinin, peptide YY. The effect of short-term low-dose hormonal contraceptives on appetite levels in PCOS is covered. The scientific articles on the severity of hypertension in menopausal women with PCOS history and the presence of overweight are reviewed. The scientific work determines molecular genetic markers of PCOS in the aspect of the influence of environmental factors on the expression of genes.

Obesity has adverse effects on ovulation, menstrual cyclicity and oocyte development leading to clinical symptoms such as infertility and menstrual disorders. The Roux-en-Y gastric bypass (RYGB) leads to weight loss, improved insulin sensitivity and may improve ovarian function. In 31 premenopausal women, 18 eu- and 13 oligo-/amenorrhoic, we followed the changes in follicular phase sex hormones 3, 6 and 12 month after RYGB. The average weight loss during the first postoperative year was 39.6 kg. The insulin sensitivity and serum insulin improved markedly especially within the first three postoperative months. SHBG increased progressively and was doubled after 12 months. In contrast, total and free androgens and DHEA declined about 50% during the first three postoperative months and remained fairly constant hereafter. One year after surgery, 85% (11/13) of the women with oligo-/amenorrhea gained regular menstrual cycles. Our results indicate that some of the endocrine changes related to regulation of ovarian function occur very early after bariatric surgery.

To determine the prevalence of menstrual dysfunction (MD; i.e. oligomenorrhea or amenorrhea) and attitudes towards body weight among athletes and non‐athletes, we studied a cohort of athletes and non‐athletes, in adolescence (14–16 years) and subsequently in young adulthood (18–20 years). We further studied the differences between athletes reporting MD and eumenorrheic athletes at both time periods and identified physical and behavioural characteristicsthat might predict MD in young adulthood. Data were collected using questionnaires, accelerometers, and a pre‐participation screening. In adolescence, the athletes reported current primary amenorrhea more often than the non‐athletes (4.7% vs. 0%, p=0.03). In young adulthood, athletes reported MD more frequently than non‐athletes (38.7% vs. 5.6%, p

Funding: funded by grants from the MRC, BBSRC, and NIHR and supported by the NIHR/Wellcome Trust Imperial Clinical Research Facility and Imperial Biomedical Research Centre. The Section of Endocrinology and Investigative Medicine is funded by grants from the MRC, BBSRC, and NIHR and is supported by the NIHR Biomedical Research Centre Funding Scheme. Introduction : Polycystic ovarian syndrome (PCOS) is a leading cause of female subfertility worldwide, however due to the heterogeneity of the disorder, the criteria for diagnosis remains subject to conjecture. In the present study, we evaluate the utility of serum Anti-Müllerian Hormone (AMH) in the diagnosis of menstrual disturbance due to PCOS. Method : Menstrual cycle length, serum AMH, gonadotropin and sex-hormone levels, total antral follicle count (AFC), body mass index (BMI) and ovarian morphology on ultrasound were analyzed in a cohort of 187 non-obese women, aged 18–35 years, screened for participation in a clinical trial of fertility treatment between 2013 and 2016 at a tertiary reproductive endocrine center. Results : Serum AMH was higher in women with menstrual disturbance when compared to those with regular cycles (65.6 vs. 34.8 pmol/L; P < 0.0001). The odds of menstrual disturbance was increased 28.5-fold (95% CI 3.6–227.3) in women with serum AMH >60 pmol/L, in comparison to those with an AMH < 15 pmol/L. AMH better discriminated women with menstrual disturbance (area under ROC 0.77) from those with regular menstrual cycles than AFC (area under ROC 0.67), however the combination of the two markers increased discrimination than either measure alone (0.83; 95% CI 0.77–0.89). Serum AMH was higher in women with all three cardinal features of PCOS (menstrual disturbance, hyperandrogenism, polycystic ovarian morphology) when compared to women with none of these features (65.6 vs. 14.6 pmol/L; P < 0.0001). The odds of menstrual disturbance were increased by 10.7-fold (95% CI 2.4–47.1) in women with bilateral polycystic morphology ovaries than those with normal ovarian morphology. BMI was a stronger predictor of free androgen index (FAI) than either AMH or AFC. Conclusion : Serum AMH could serve as a useful biomarker to indicate the risk of menstrual disturbance due to PCOS. Women with higher AMH levels had increased rates of menstrual disturbance and an increased number of features of PCOS. Publisher PDF

BACKGROUND: Data documenting BMD in pre-professional adolescent ballet dancers is limited. This cross-sectional study assesses hone mineral density (BMD) in young adolescent elite ballet dancers and compares BMD values between males and females (with and without normal menarche) and body composition between dancers with and without low Z-score. METHODS: Cross-sectional study of third year ballet students (female=23; male=15; mean age 14.7 years; SD: 0.5) of The Royal Ballet School of Antwerp (Belgium) training 22 hours a week. They completed questionnaires and underwent dual energy X-ray absorptiometry (DXA) to measure BMD and body composition. Each female participant completed questionnaires assessing menstrual status. RESULTS: DXA revealed that 12 out of 38 (32%) of the dancers had Z-score

Aims To demonstrate a new laparoscopic sign “Sharma's Parachute sign” in abdominopelvic tuberculosis in women with infertility. Methods A total of 104 women who were diagnosed to have abdominopelvic tuberculosis, on endometrial sampling or on laparoscopy were enrolled in this ongoing study on tuberculosis in infertility. A new laparoscopic “Sharma's parachute sign” was looked for in these cases on laparoscopy. Results The mean age, pairty and duration of infertility was 27.6 years, 0.58 and 4.1 years respectively. Menstrual dysfuction were common especially hypomenorrhoea (34.61%), oligomenorrhoea (36.53%) along with constitutional symptoms and abdomino pelvic pain or lump. Diagnosis of abdominopelvic tuberculosis was made by identification of acid fast bacilli (AFB) on microscopy or culture of endometrial aspirate or peritoneal biopsy or positive gene Xpert or positive polymerase chain reaction (PCR) or histopathological demonstration of epithelioid granuloma on endometrial or peritoneal biopsy, various laparoscopic findings on pelvic and abdominal organs were tubercles and shaggy areas (white deposits, caseous nodules encysted ascites, abdominal and pelvic adhesions, tubal findings (hydrosalpinx, pyosalpinx, beaded or calcified tubes). A new “Sharma's parachute sign”in which ascending colon was totally adherent to anterior abdominal wall with its mesocolon looking like an open parachute with small caseous nodule was seen in 11 (10.5%) cases. Conclusion Diagnostic laparoscopy is an important investigation for abdominopelvic tuberculosis showing various adhesions including new parachute sign.