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Despite the increased popularity of female elite road cycling, research to inform the fueling requirements of these endurance athletes is lacking. In this case study, we report for the first time the energetics of a female world-tour cyclist competing in the 2023 Tour de France Femmes, an 8-day race of the Union Cycliste Internationale. The 29-year-old athlete presented with oligomenorrhea and low T3 before the race. Total daily energy expenditure assessed with the doubly labeled water technique was 7,572 kcal/day (∼4.3 physical activity levels), among the highest reported in the literature to date for a female. Crank-based mean maximal power was consistent with female world-tour cyclists (5 min, mean 342 W, 4.8 W/kg; 20 min 289 W, 4.1 W/kg). The average daily energy intake measured with the remote food photography method (Stage Days 1–7) was 5,246 kcal and carbohydrate intake was 13.7 g/kg (range 9.7–15.9 g/kg), and 84 g/hr during stages, and an average fat intake of 15% of daily energy intake. An estimated 2,326 kcal/day energy deficit was evidenced in a 2.2 kg decrease in body mass. Notwithstanding the high carbohydrate intake, the athlete was unable to match the energy requirements of the competition. Despite signs of energy deficiency preexisting (oligomenorrhea and low T3), and other further developing during the race (weight loss), performance was in line with that of other world-tour cyclists and a best personal performance was recorded for the last stage. This case study emphasizes the need for further research to inform energy requirements for female athletes' optimal performance and health. [ABSTRACT FROM AUTHOR]

STUDY QUESTION What is the predictive value of oligomenorrhea and other PCOS diagnostic characteristics in adolescence (age 15–18 years) for future fertility and cardiovascular and metabolic health at adult age? SUMMARY ANSWER Adolescents with oligomenorrhea are more often treated to conceive but are as likely to have as much children as those with regular periods, while persisting oligomenorrhea may associate more often with cardiovascular or metabolic problems. WHAT IS KNOWN ALREADY Adolescents with oligomenorrhea have a high risk for adult PCOS associated with subfertility due to ovulatory disorders and long-term health risks. Longitudinal studies to estimate the extent of these risks with input starting at adolescence and covering the complete reproductive lifespan are lacking. STUDY DESIGN, SIZE, DURATION A 25-year prospective follow-up study based on a unique population-based adolescent study on menstrual irregularities performed between 1990 and 1997, the Pubertal Onset of Menstrual Cycle abnormalities, a Prospective study (POMP study). Of the 271 invited adults, 160 (59%) participated. PARTICIPANTS/MATERIALS, SETTING, METHODS We contacted stratified samples of the POMP study cohort two decades after the initial study for a questionnaire assessing PCOS features, fertility history, pregnancy outcome, metabolic, and cardiovascular health. One hundred and sixty subjects completed the questionnaire. The mean adolescent age was 15.3 years, and the women were 39.6 years at the time of follow-up. One hundred and eight subjects had a regular menstrual cycle as adolescents and 52 were oligomenorrheic. MAIN RESULTS AND THE ROLE OF CHANCE Of those with adolescent regular menstrual cycles 12 never tried to conceive, 4 tried but never conceived and 92 of 96 (96%) conceived, 89 of 96 (93%) delivering at least one living child. The median number of children was two. The mean time to pregnancy (TTP) was 8.4 months in the women with regular periods as adolescents and 13.2 months in case of oligomenorrhea (P  = 0.08) and subfertility was present in respectively 18% and 26%. 47 of 52 adolescents with oligomenorrhea tried to conceive and 45 succeeded to have at least one live birth. Twenty-eight per cent of the subjects reported a change over time of their menstruation pattern. Fifty per cent of the girls with adolescent oligomenorrhea developed a regular cycle and 16% of those with regular periods changed to oligomenorrhea with significantly more reported subfertility (40%, P  = 0.04). In case of persistent oligomenorrhea, a significant proportion (40%) underwent fertility treatment (P  = 0.04). Adult BMI did not differ between groups. The risk for pregnancy-induced hypertension or pre-eclampsia was comparable between the groups. Gestational diabetes developed in three subjects each with persistent oligo amenorrhea. Adult diabetes, hypertension, and hypercholesterolemia were also mostly reported in case of persistent oligomenorrhea. In this group, the prevalence of combined cardiovascular and metabolic problems was 14% compared to 7% in the case of regular menstrual cycles as adolescent. LIMITATIONS, REASONS FOR CAUTION The numbers in the study are small. However, the small difference between the percentage with a least one living child of those with adolescent oligomenorrhea versus those with adolescent regular menstrual cycles is reassuring. Time to pregnancy data may have been biased by early treatment of oligomenorrheic adults. WIDER IMPLICATIONS OF THE FINDINGS Oligomenorrheic adolescents may be reassured that their chance to have a live birth is comparable with those with a regular menstrual cycle. STUDY FUNDING/COMPETING INTEREST(S) This research received no external funding, J.S.E.L. received unrestricted research grants from the following companies (in alphabetical order): Ansh Labs, Ferring, Merck, and Roche Diagnostics. He received consultancy fees or royalties from Ansh Labs, Art pred, Ferring, Gedeon Richter, and Roche Diagnostics. He received presentation fees from Ferring and Roche Diagnostics as well as support for attending meetings and/or travel from Ferring and Roche Diagnostics and he participated in the advisory board of the LOCI Trial UK. TRIAL REGISTRATION NUMBER Dutch Trial Registry, NTR5871. [ABSTRACT FROM AUTHOR]

Objective: Polycystic Ovary Syndrome (PCOS) is diagnosed by a combination of three features: hyperandrogenism (biochemical and/or clinical), ovulatory dysfunction, and polycystic ovarian morphology, usually detected by ultrasonography. Our study aimed to determine the need for androgen measurements by using hirsutism to establish hyperandrogenism for diagnosing PCOS in a medically unbiased population. Materials and Methods: We utilized a pre-existing cohort of unselected (medically unbiased) females aged 18–45 years. All underwent a history and physical, including a modified Ferriman-Gallwey (mFG) hirsutism score. Subjects were categorized clinically as eumenorrheic non-hirsute (CONTROLS), menstrual dysfunction only (OLIGO-ONLY), hirsutism only (HIRSUTE-ONLY), or menstrual dysfunction and hirsutism (OLIGO + HIRSUTE). All subjects underwent measurements of androgens using high-quality assays. CONTROLS established the upper normal limit for androgen levels. We defined PCOS using the NIH 1990 criteria. Results: Of 462 individuals with complete evaluations, 311 (67.3%) were CONTROLS, 71 (15.4%) were OLIGO-ONLY, 64 (13.9%) were HIRSUTE-ONLY, and 16 (3.5%) were OLIGO + HIRSUTE. Neither HIRSUTE-ONLY nor OLIGO-HIRSUTE women required androgen measures to demonstrate hyperandrogenism. Among OLIGO-ONLY, 19 (26.8%) demonstrated hyperandrogenemia without hirsutism, with White women significantly more likely than Black women to demonstrate this. Conclusions: In our study of medically unbiased reproductive-aged women using the NIH 1990 criteria for PCOS, only 15.4% of women evaluated (those with menstrual dysfunction only) required androgen measurements. In these women only one-quarter demonstrated hyperandrogenemia. These data provide a strategy to minimize the need for androgen assays, including firstly categorizing subjects by clinical presentation and then assessing circulating androgens in the subgroup with menstrual dysfunction only. [ABSTRACT FROM AUTHOR]

Background: Menstrual irregularities significantly distress women living with HIV (WLHIV), impacting their reproductive health and quality of life. Although the underlying mechanism remains inconclusive, studies have outlined possible contributory factors. This narrative review explores the burden of menstrual irregularities and associated hormonal dysregulation among women living with HIV in Nigeria. It synthesises data from studies to present an overview of the prevalence, patterns, potential etiology, and impacts of menstrual irregularities among WLHIV. Main body: A literature search across electronic databases such as PubMed, Google Scholar, and Web of Science was conducted, and information was extracted and synthesized to delineate the burden of menstrual irregularities in WLHIV. Eligibility criteria included original studies assessing the prevalence, aetiology, and impact of menstrual abnormalities among WLHIV in Nigeria. A narrative data synthesis approach utilized common themes and key concept extraction, including identifying patterns in the literature to present specific trends such as prevalence, patterns, etiology, and determinants. Menstrual irregularities were found to be prevalent among Nigerian WLHIV, varying from 29 to 76% across different regions, exceeding reports of similar studies in developed nations. Similarly, menstrual disorders including amenorrhea, oligomenorrhea, and polymenorrhea, were attributed to factors like HIV acquisition, antiretroviral therapy, low body mass index, and hormonal imbalances. Low CD4 count and high viral load with associated complications have been identified as major contributing factors. Distortion of the hypogonadal-pituitary-ovarian axis by viral-induced pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), and interferon-gamma (IFN-γ) may disrupt the hormonal balance necessary for regular menstrual cycles. Fluctuating levels of follicle-stimulating hormone (FSH), luteinising hormone (LH), estradiol, and prolactin have been reported among WLHIV. Although adherence to antiretroviral therapy has offered immense relief, its direct therapeutic effects on menstrual irregularities are inconclusive.. Conclusions: This study highlights the burden of menstrual disorders among WLHIV. It underscores the interplay between clinical, therapeutic, and client-associated factors as determinants of these abnormalities. Exploring associated complications like secondary infertility, reduced bone mineral density, and resultant osteoporosis, mirrors the significant impact of menstrual and hormonal irregularities on the reproductive health and quality of life of WLHIV. [ABSTRACT FROM AUTHOR]

Background: The influence of menstrual cycle phases (MCPs), menstrual irregularities (MI) and hormonal contraceptive (HC) use on injury among female athletes has been scrutinised. Existing systematic reviews investigating the effect of exposures affecting the endogenous reproductive hormone status on sporting injuries are limited in terms of the types of studies included and injuries investigated. Objective: This scoping review aims to summarise the coverage of the literature related to the extent, nature and characteristics of the influence of MCP, MI and HC use on musculoskeletal injuries among athletes. It also aims to summarise key concepts and definitions in the relevant literature. Observational and experimental studies investigating the effect of MCP, MI, and HC on musculoskeletal injuries among female individuals of reproductive age were included. Studies specifically stating pregnant women, perimenopausal/postmenopausal athletes, or those using medication (other than HC) that affects reproductive hormone profiles or the musculoskeletal system were excluded. Methods: This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping reviews and JBI scoping review guidelines. Published and unpublished studies were sourced from several databases and resources. Initial keywords used included terms related to "menstrual cycle", "hormonal contraception" and "injury." Titles and abstracts of identified citations were screened independently and assessed for eligibility by two independent reviewers. Data from the included studies were extracted using a standard data extraction form. Results: The search yielded 10,696 articles, of which 96 met the eligibility criteria. Most studies investigated MI (77%), and 49% included MCP as a contributing injury risk factor. Publications have increased over the last two decades. Collectively, only 16% of research has been conducted in Africa, Asia and Oceania. There were no studies from South America. Seventy-five percent of the studies investigated individual versus team (25%) sport athletes. Most studies only investigated elite or professional (n = 24; 25%) level athletes. The definitions of injury, eumenorrhea and MI differ vastly among studies. Regarding MI, most studies (69%) investigated secondary amenorrhea, followed by oligomenorrhea (51%) and primary amenorrhea (43%). Concerning HC, the influence of oral contraceptive pills was mainly investigated. Conclusions: Research related to MCP, MI and HC as contributing musculoskeletal injury risk factors is increasing; however, several gaps have been identified, including research from countries other than North America and Europe, the study population being non-professional/elite level athletes, athletes participating in team sports and specific injuries related to MCP, MI and HC, respectively. Differences in methodology and terminology of injury, MCP and MI hinder comparative summative research, and future research should consider current published guidelines during the study design. Identifying barriers to following standard guidelines or research investigating the most practical yet accurate methods to investigate the influence of MCP on musculoskeletal health might yield valuable insights for future research designs. Clinical Trial Registration: Scoping review registration number: Open Science Framework (https://doi.org/10.17605/OSF.IO/5GWBV). [ABSTRACT FROM AUTHOR]

Data on gonadotoxicity of chemotherapies are essential to better counsel young females and males about the risk of infertility and to better indicate fertility preservation measures before cancer therapies. However, such data have not recently been reviewed for bone cancer. Therefore, a systematic literature search was conducted considering papers published since 2000. This study is part of the FertiTOX® project, which aims to improve the lack of data regarding gonadotoxicity of cancer therapies to enable more accurate counseling regarding fertility preservation. Only relapse-free women and men were included. Gonadotoxic therapy-induced suspected infertility was defined as very low anti-mullerian hormone, high gonadotropin concentration, amenorrhea, oligomenorrhea, azoospermia, or oligozoospermia. The quality of the individual studies was assessed using the Newcastle–Ottawa Scale (NOS). In total, 11 out of 831 studies were included in the review. Suspected infertility was found in 10/190 (5.1%, range 0%–66%) of female patients with osteosarcoma (six studies), in 24/46 (52.2%, range 46%–100%) of male patients with osteosarcoma (three studies), in 18/138 (13.0%, range 3%–18%) of female patients with Ewing's sarcoma (three studies), and in 34/38 (89.5%) of male patients with Ewing's sarcoma (one study). A risk calculation in relation to specific chemotherapies was not possible. Risk of suspected infertility tends to be higher in Ewing's sarcoma in which all patients received chemotherapies with alkylating agents. Two of the 11 included studies received a high NOS quality score, whereas the remaining nine studies received a low quality score, mainly because of the lack of a comparator group. Published data are too limited for precise estimation of the gonadotoxicity. However, data indicate clinically relevant risk for infertility, supporting counseling patients before chemotherapy about fertility preservation measures. [ABSTRACT FROM AUTHOR]

Background: Growth hormone (GH) positive pituitary neuroendocrine tumors do not always cause acromegaly. Approximately one-third of GH-positive pituitary tumors are classified as non-functioning pituitary tumors in clinical practice. They typically have GH and serum insulin-like growth factor 1 (IGF-1) levels in the reference range and no acromegaly-like symptoms. However, normal hormone levels might not exclude the underlying hypersecretion of GH. This is a rare and paradoxical case of pituitary tumor causing acromegaly-associated symptoms despite normal GH and IGF-1 levels. Case presentation: We report a case of a 35-year-old woman with suspicious acromegaly-associated presentations, including facial changes, headache, oligomenorrhea, and new-onset diabetes mellitus and dyslipidemia. Imaging found a 19 × 12 × 8 mm pituitary tumor, but her serum IGF-1 was within the reference, and nadir GH was 0.7ng/ml after glucose load at diagnosis. A thickened skull base, increased uptake in cranial bones in bone scan, and elevated bone turnover markers indicated abnormal bone metabolism. We considered the pituitary tumor, possibly a rare subtype in subtle or clinically silent GH pituitary tumor, likely contributed to her discomforts. After the transsphenoidal surgery, the IGF-1 and nadir GH decreased immediately. A GH and prolactin-positive pituitary neuroendocrine tumor was confirmed in the histopathologic study. No tumor remnant was observed three months after the operation, and her discomforts, glucose, and bone metabolism were partially relieved. Conclusions: GH-positive pituitary neuroendocrine tumors with hormonal tests that do not meet the diagnostic criteria for acromegaly may also cause GH hypersecretion presentations. Patients with pituitary tumors and suspicious acromegaly symptoms may require more proactive treatment than non-functioning tumors of similar size and invasiveness. [ABSTRACT FROM AUTHOR]

Background: PCOS is a complex genetic condition that is heterogeneous and multifactorial. It primarily affects females who are of reproductive age. One of the most common illnesses in the world, neglected treatment for this one can lead to infertility and possibly uterine cancer. Objectives: This study aimed to determine the prevalence and phenotypes of PCOS among women attending a teaching hospital of eastern India. Methods: The present cross sectional observation study of 50 PCOS patients was carried out from April 2023 to December 2023 in gynecology out-patient department of Gynae and Obstetrics, Calcutta National Medical College, Kolkata, West Bengal, India. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results: The prevalence of PCOS was 5.42% in the gynecology out-patient visits and 38.46% among infertile women. The mean age group of the patients was 24.3±5.16 SD. The mean BMI was 23.2±5.32 SD. The mean duration of infertility was 5.68 years. In present study among 50 PCOS patients, hirsutism was present in 28 (56%). Androgenic features like acne were present in 20 (40%) of the patients, acanthosis nigricans in 10 (20%) of the patients and androgenic alopecia was present in 26 (52%) of patients. The prevalence of metabolic syndrome in our study was 18.0%. In this study menstrual irregularity was the most common complaint. Conclusions: According to the study, oligomenorrhea was evident in the majority of our participants with polycystic ovarian syndrome. Central obesity and hirsutism were also frequent presentations. Because of their more severe ovulatory dysfunction, obese women with PCOS require additional care to ensure proper management. [ABSTRACT FROM AUTHOR]

The hormonal changes in women influence creatine dynamics, emphasizing its potential importance during menstruation, pregnancy, postpartum, menopause, and postmenopause. Yet, limited research explores creatine's impact on female reproductive health at the population level. Our study investigated the relationship between dietary creatine intake and reproductive health indices in US women using data from the 2017–2020 National Health and Nutrition Examination Survey (NHANES). We extracted a dataset containing females aged 12 years and above who provided details about their reproductive health and dietary habits. Daily creatine intake was quantified as a relative amount (mg per kg body mass) and did not include creatine from dietary supplements and pharmacological agents. A daily requirement for dietary creatine for healthy women was employed to classify respondents into two separate subpopulations: (1) suboptimal intake of creatine (<13 mg per kg body mass per day) or (2) recommended intake (dietary creatine ≥ 13 mg per kg body mass per day). A total of 4522 female participants from the NHANES study (age 44.5 ± 20.5 years) provided data on their reproductive health and dietary intake. The average daily creatine intake for the group was 10.5 ± 10.8 mg per kg body mass. The odds ratio for having irregular periods in women consuming ≥13 mg of creatine per kg body mass daily (recommended intake) compared to those with suboptimal intake was 0.75 (95% CI, from 0.66 to 0.86), indicating a significant association between higher intake of dietary creatine and lower risk of oligomenorrhea (p <.001). Moreover, women consuming less than 13 mg of creatine per kg body mass faced an increased risk of fetal macrosomia (OR 1.26; p =.04), pelvic infection (OR 1.68; p =.01), hysterectomy (OR 1.42; p <.001), oophorectomy (OR 1.54; p <.001), and receiving hormone replacement therapy (OR 1.26; p =.02). Consuming a creatine‐rich diet has been linked to lower risks of reproductive issues in US women aged 12 and above. Those consuming ≥13 mg of creatine per kg body mass daily showed notably lower risks of irregular menstrual periods, obstetric conditions, and pelvic pathology. Further studies are needed to confirm these potential benefits. [ABSTRACT FROM AUTHOR]

Background: Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine–metabolic disorder in women of reproductive age. Diagnosis is based on the evidence-based international guideline 2018 and the Rotterdam Consensus to classify PCOS phenotypes. This study aims to characterize the biodemographic, clinical, metabolic, and reproductive variables and their relationship with PCOS phenotypes in a population from the Ecuadorian Andes. Methodology: A cross-sectional study was conducted with a non-random consecutive sample of 92 women who attended the outpatient gynecology and endocrinology clinic at the Hospital of the Technical University of Loja (UTPL)—Santa Inés, Loja, Ecuador, between January 2022 and July 2023. Descriptive statistics, mean calculations, standard deviation, parametric and nonparametric tests, odds ratios (OR), confidence intervals (CI), and p-values were employed. Results: The average age was 22 ± 3.4 years, with a predominantly mestizo, urban, single, highly educated, and medium–high socioeconomic level population. It was identified that phenotypes A + B are at a higher risk of developing oligomenorrhea and hypertriglyceridemia compared to phenotypes C + D, with statistically significant differences (p < 0.05). Furthermore, in terms of reproductive variables, phenotypes A + B exhibit a significantly higher frequency of elevated anti-Müllerian hormone (AMH) compared to phenotypes C + D, also with statistical significance (p < 0.05). Conclusions: The classical phenotypes A and B of PCOS are the most common in Ecuadorian Andean women and carry a higher risk of insulin resistance, anovulation, metabolic disorders, and elevated triglyceride levels compared to phenotypes C and D. Ethnic diversity and sociocultural habits influence the prevalence and clinical manifestations of these phenotypes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Congenital adrenal hyperplasia is an autosomal recessive disorder caused by a defect in adrenal steroidogenesis. The non-classical variant begins at puberty and is manifested by menstrual irregularities, hirsutism, genital hyperpigmentation, clitoral hypertrophy, accelerated growth, and elevated levels of testosterone and other androgens. Individuals with these non-classical forms of the disease are born with normal-appearing genitalia and begin clinical manifestations with the steroidogenic stimulus characteristic of adolescence. CLINICAL CASE: A 16-year-old female patient seen at the endocrinology clinic for menstrual irregularities and hirsutism, menarche at 13 years of age with menstrual irregularities (oligomenorrhea) and recession of the frontal hairline, breast and pubic hair development grade 4 on the Tanner scale for both features. The diagnosis of late-onset 21-hydroxylase blockade (non-classical form) was established. Initial treatment consisted of metformin and cyproterone, with marked relieve of hyperandrogenism and correction of menstrual irregularities. CONCLUSIONS: Late-onset non-classical congenital adrenal hyperplasia is due to a homozygous point mutation of the CYP21A2 gene, which in turn is due to a coding error at position 281 of the 21-hydroxylase protein, consisting of a substitution of the amino acid valine for leucine and resulting in complete inactivation of both alleles of the enzyme. [ABSTRACT FROM AUTHOR]

Objective: The primary aim of this study was to investigate the effects of autologous intrauterine platelet-rich plasma (IU-PRP) infusion during ovulation induction with clomiphene citrate (CC) on endometrial thickness (EMT) and clinical pregnancy in patients with polycystic ovary syndrome (PCOS) and thin endometrium. The secondary outcome was to detect possible transformations in oligomenorrheic cycles after PRP. Methods: This study was conducted on 35 anovulatory PCOS patients aged between 22 and 29 years who applied for infertility treatment. The patients had a thin endometrium in their past history. EMT 7 mm was considered thin endometrium. The diagnosis of PCOS was made according to the revised Rotterdam criteria. A total of 35 patients were divided into two groups according to whether they received PRP or not. Twenty patients received CC plus PRP treatment, whereas 15 patients received CC treatment alone. Patients in both groups were administered CC at a dose of 100 mg/day for 5 days, starting from the 3rd day of progesterone-related withdrawal bleeding. Follicular development and EMT were recorded using transvaginal ultrasonography. In cases with EMT <7 mm, approximately 0.5-1 mL of autologous PRP was infused with the IUI catheter, four days after CC treatment, i.e., on the ninth day of the cycle. EMT was measured and recorded again 3 and 6 days after PRP. Timed intercourse was recommended for cases with a follicle with a mean diameter of at least 16-18 mm. The biochemical and clinical pregnancy rates of both groups were recorded. Results: Both groups were similar in terms of participant age and body mass index. All participants in the CC plus PRP group were successfully infused with autologous PRP on the ninth day of the cycle. The serum estradiol, testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and LH/FSH ratios of both groups were similar. Biochemical pregnancy and clinical pregnancy rates of the CC plus PRP group were significantly higher than those of the CC alone group (p<0.03 and p<0.02, respectively). Although clinical pregnancy was detected in 5 individuals in the PRP group (25%), clinical pregnancy was recorded in 2 individuals in the CC alone group (13.3%). There was no significant change in the oligo/anovulatory cycle patterns of patients with and without PRP. EMT values on the sixth (4.96±2.11 mm vs. 4.68±2.47 mm, p<0.37) and eighth days were similar between the two groups (5.11±3.10 mm vs. 5.29±3.01 mm, p<0.51). Compared with the CC alone group, the EMT values measured both at day 12 (6.34±1.09 mm vs. 5.47±3.90 mm, p<0.02) and at day 15 (7.44±2.60 mm vs. 6.23±2.70 mm, p<0.01) in the PRP group were found to be significantly higher. Conclusion: IU-PRP infusion in PCOS patients with thin endometrium who underwent ovulation stimulation with CC significantly increased both EMT and clinical pregnancy rates. [ABSTRACT FROM AUTHOR]

Background and Objective: Polycystic ovary syndrome is one of the most common endocrine disorders, whose symptoms usually begin immediately after the first menstrual period. Previous studies found a significant relationship between dysmenorrhea, premenstrual syndrome and polycystic ovary syndrome. The aim of this study is to investigate the effect of chamomile on dysmenorrhea and premenstrual syndrome in patients with polycystic ovary syndrome. Methods: This clinical trial was conducted on 70 patients diagnosed with polycystic ovary syndrome based on Rotterdam criteria referring to a clinic in Mashhad. Patients were randomly assigned to two groups. The first group received two 500 mg chamomile capsules per day and the second group received two placebo capsules per day for three months. The response to treatment in premenstrual syndrome, dysmenorrhea and oligomenorrhea was evaluated using the Visual Analogue Scale and DSM-IV premenstrual syndrome diagnosis questionnaire. Findings: The mean age of the patients in the intervention group was 25.43±5.58 and in the placebo group was 28.06±5.71 years. The rate of improvement in women with premenstrual syndrome (16.6%), dysmenorrhea (50%) and oligomenorrhea (26.7%) was higher in chamomile group compared to placebo. There was no statistically significant difference in body mass index between the chamomile group (25.17±4.95) and the control group (25.57±6.7). Conclusion: Based on the results of this study, chamomile improved the symptoms of oligomenorrhea in patients with polycystic ovary syndrome and showed positive effects on dysmenorrhea and premenstrual syndrome. Therefore, chamomile can be used as a simple, low-cost therapy in the treatment of polycystic ovary syndrome patients. [ABSTRACT FROM AUTHOR]

Introduction: Polycystic ovary syndrome is one of the common diseases during the reproductive period that the common treatments are mostly symptomatic and their long-term use has many complications. According to previous studies that showed the effect of wet cupping on calf muscles on oligomenorrhea pattern, this study was performed with aim to investigate the effect of wet cupping on calf muscles on clinical and laboratory symptoms and quality of life in patients with this syndrome. Methods: In this randomized clinical trial study which was performed in 2019-2021, 60 PCOS women with minimum 60 days menstrual cycle entered the study and randomly divided to cupping and control groups (n=30 per group). At the 26th day menstrual cycle, after blood sampling for two groups, wet-cupping on calf muscles was done for intervention group. Menstrual period, insulin resistance and quality of life were measured using Cronin PCOS Questionnaire. Data analysis was done using SPSS statistical software (version 20) and student t and chi-square tests. P<0.05 was considered significant. Results: In this study, 21 members of cupping group and 6 members of control group menstruated after the intervention, the difference was statistically significant (p<0.001). Insulin resistance changed significantly in the intervention group (p=0.03). Quality of life was significantly improved in the cupping group (p=0.01), but no significant statistical difference was observed in the control group. Conclusion: Calf muscles wet-cupping can be considered as one of the options for causing bleeding in people with PCOS. Obviously, more studies are necessary to compare different protocols and investigate its mechanism. [ABSTRACT FROM AUTHOR]

The female athlete triad is a condition where low energy availability is typically observed together with menstrual dysfunction and/or low bone mineral density. How this condition affects maximal work capacity in endurance athletes is not clear, and the recovery time course of menses with increased energy availability with concomitant high training load is unknown. This case study of an amenorrheic elite road cyclist reports resumption of normal menstrual function after weight gain during a 5-year period (2014-2019), while engaged in high training load and competition. The athlete (...O2max 3.54 L/min, 64ml⋅min-1⋅kg-1, aerobic peak power output 300 W, 5.4 W/kg) reported amenorrhea (2013-2015) and oligomenorrhea (2015-2018). Training load increased from 2014 to 2019 (584-818 hr/year and 26,707-41,945 training stress score/year). Regular menses (every 23-35 days) resumed in June 2018, ~5-6 months after a weight gain episode. During the period of menstrual dysfunction, body mass was 51.3 ± 2.25 kg (mean ± 95% confidence limit) and fat percentage was 19% (dual-energy X-ray absorptiometry, 2016), and after weight gain, body mass was 56.8 ± 2.63 kg and fat percentage was 25% (dual-energy X-ray absorptiometry, 2019). Crank-based power meter data showed absolute mean maximal power (in watts) improvement over the 5 s to 4 hr range through the 2014--2019 period, while relative mean maximal power (in watts per kilogram) likely peaked in the 2015--2016 season for 5 min, 20 min, and 30 min, but remained mostly unchanged across seasons. Results suggest that (a) the best relative power output associated with aerobic capacity (5 min to 1 hr) can be achieved during menstrual dysfunction, (b) high performance achieved despite an increase in body mass, and (c) resumption of menses is achievable while maintaining high training loads when coupled with high energy availability. [ABSTRACT FROM AUTHOR]

Background: Menstrual problems and infertility are best understood and treated with knowledge of gynecological endocrinology. Serum prolactin levels in infertile individuals with menstrual disorder are the focus of this study. Materials and Methods: Patients between the ages of 20 and 40 (the reproductive age range) were split into two groups for a year-long prospective case-control research. Fifty fertile women with normal periods served as the control group, while 150 infertile women with menstrual dysfunctions made up the research group. Serum prolactin levels were checked in addition to other relevant laboratory and radiographic tests to get a full picture of the obstetric history. Results: In this analysis, hyperprolactinemia was shown to occur in 24.6% of participants. Hyperprolactinemia was more common in those with polycystic ovary syndrome (33.3%), oligomenorrhea (27.27%), secondary amenorrhea (30.2%), primary amenorrhea (5.5%), irregular menstruation (9.09%), and 25% of those with regular ovulatory cycles and 40% of those with regular anovulatory cycles. Oligomenorrhea was the most common presenting symptom among hyperprolactinemic patients (48.7%), followed by secondary amenorrhea (35.1%). Patients with secondary amenorrhea had a substantially higher mean blood prolactin level (111.42 ng/mL) compared to those with oligomenorrhea (69.3 ng/mL). Seventy-five point six percent of hyperprolactinemic individuals experienced primary infertility, but only twenty-seven point zero seven percent experienced secondary infertility. (p0.01). Blood prolactin levels were significantly different (p 0.01) between cases with and without galactorrhea, and 66.6% of patients with galactorrhea had hyperprolactinemia. Although 13.5 percent of hyperprolactinemic individuals experienced galactorrhea, this symptom was not consistently present. Conclusion: Regular blood prolactin testing is required for the diagnosis of hyperprolactinemia, a major cause of infertility and menstrual disruption. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate associations between menstrual function, eating disorders, and risk of low energy availability with musculoskeletal injuries in British servicewomen. Methods: All women younger than 45 yr in the UK Armed Forces were invited to complete a survey about menstrual function, eating behaviors, exercise behaviors, and injury history. Results: A total of 3022 women participated; 2% had a bone stress injury in the last 12 months, 20% had ever had a bone stress injury, 40% had a time-loss musculoskeletal injury in the last 12 months, and 11% were medically downgraded for a musculoskeletal injury. Menstrual disturbances (oligomenorrhea/amenorrhea, history of amenorrhea, and delayed menarche) were not associated with injury. Women at high risk of disordered eating (Female Athlete Screening Tool score >94) were at higher risk of history of a bone stress injury (odds ratio (OR; 95% confidence interval (CI)), 2.29 (1.67–3.14); P < 0.001) and time-loss injury in the last 12 months (OR (95% CI), 1.56 (1.21–2.03); P < 0.001) than women at low risk of disordered eating. Women at high risk of low energy availability (Low Energy Availability in Females Questionnaire score ≥8) were at higher risk of bone stress injury in the last 12 months (OR (95% CI), 3.62 (2.07–6.49); P < 0.001), history of a bone stress injury (OR (95% CI), 2.08 (1.66–2.59); P < 0.001), a time-loss injury in the last 12 months (OR (95% CI), 9.69 (7.90–11.9); P < 0.001), and being medically downgraded with an injury (OR (95% CI), 3.78 (2.84–5.04); P < 0.001) than women at low risk of low energy availability. Conclusions: Eating disorders and risk of low energy availability provide targets for protecting against musculoskeletal injuries in servicewomen. [ABSTRACT FROM AUTHOR]

Hereditary angioedema (HAE) is characterized by recurrent angioedema attacks with no urticaria. This disease has a high mortality due to asphyxia. Level of complement component 4 (C4), C1 esterase inhibitor (C1-INH) level and function, and genetic mutations determine different endotypes of HAE. Clinical presentation and the triggers of vasogenic edema may change according to the endotypes. An adolescent girl with oligomenorrhea, obesity, hirsutism, and acanthosis nigricans was diagnosed with polycystic ovary syndrome and prescribed ethinyl estradiol and cyproterone acetate containing oral contraceptive (OC). On the sixteenth day of treatment, she developed angioedema of the face, neck, and chest leading to dyspnea. Adrenaline, antihistamine, and corticosteroid treatments were ineffective. In the family history, the patient’s mother and two cousins had a history of angioedema. C1-INH concentrate was administered with a diagnosis of HAE. C4 and C1-INH level and activity were normal. Genetic analysis identified a mutation in the factor 12 (F12) gene, and the diagnosis of F12-related HAE was made. OC treatment was discontinued. She has had no additional angioedema attacks in the follow-up period of two years. OC containing estrogen may induce the life-threatening first attack of F12-related HAE even in children. Recurring angioedema attacks in the family should be asked before prescribing estrogen-containing OC pills. [ABSTRACT FROM AUTHOR]

Purpose: The diagnosis of polycystic ovary syndrome (PCOS) remains a challenge to clinicians due to heterogeneous clinical presentation and diagnostic criteria. This study investigated the utilization of Anti-Müllerian hormone (AMH) alone or replacing polycystic ovarian morphology (PCOM) in the PCOS diagnostic criteria. Methods: A total of 401 women were categorised as PCOS (n:154), nonPCOS with polycystic ovarian morphology (PCOM) (n:105), and nonPCOS with normal ovarian morphology (NOM) (n:142). First, the diagnostic performance of AMH for PCOS diagnosis in Rotterdam, Androgen Excess Society, and National Institutes of Health (NIH) criteria was analyzed. Second, AMH was used instead of PCOM in Rotterdam criteria and we searched diagnostic performance for PCOS phenotypes. Results: AMH levels were positively correlated with LH, testosterone, hirsutism score, menstrual cycle length, and antral follicle count (p < 0.05). AMH alone had specificity and sensitivity for PCOS diagnosis were 84.9% and 72.4% in Rotterdam (AUC: 0.866); 84.4% and 72% in Androgen Excess Society (AUC: 0.857); 83.3% and 66.4% in National Institute of Health criteria (AUC: 0.825). AMH alone had satisfactory diagnostic potential for phenotype A, but not other phenotypes. The replacement of PCOM with AMH in Rotterdam criteria had a high diagnostic potential for PCOS (AUC: 0.934, sensitivity:97.4%, specificity: 90.67%). Phenotype A and phenotype D were diagnosed with 100% sensitivity and 94.5% specificity. Phenotype C was recognised with 96.15% sensitivity and 94.5% specificity. Conclusion: AMH may be used with high diagnostic accuracy instead of PCOM in the Rotterdam PCOS criteria. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) is a common endocrinological disorder in women with significant reproductive, metabolic, and psychological health implications. The lack of a specific diagnostic test poses challenges in making the diagnosis of PCOS, resulting in underdiagnosis and undertreatment. Anti-Mullerian hormone (AMH) synthesized by the pre-antral and small antral ovarian follicles appears to play an important role in the pathophysiology of PCOS, and serum AMH levels are often elevated in women with PCOS. The aim of this review is to inform the possibility of utilizing anti-Mullerian hormone either as a diagnostic test for PCOS or as an alternative diagnostic criterion in place of polycystic ovarian morphology, hyperandrogenism, and oligo-anovulation. Increased levels of serum AMH correlate highly with PCOS, polycystic ovarian morphology, hyperandrogenism, and oligo/amenorrhea. Additionally, serum AMH has high diagnostic accuracy as an isolated marker for PCOS or as a replacement for polycystic ovarian morphology. [ABSTRACT FROM AUTHOR]

The prolactin receptor gene (PRLR) may contribute to polycystic ovarian syndrome (PCOS) since it plays important roles in physiological ovarian functions. PRLR-knockout mice have irregular cycles and subfertility and variants in or around the PRLR gene were associated in humans with female testosterone levels and recurrent miscarriage. We tested 40 variants in the PRLR gene in 212 Italian families phenotyped by type 2 diabetes (T2D) and PCOS and found two intronic PRLR-variants (rs13436213 and rs1604428) significantly linked to and/or associated with the risk of PCOS. This is the first study to report PRLR as a novel risk gene in PCOS. Functional studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Background: Considering the high prevalence of polycystic ovary syndrome (PCOS) in women of reproductive age and the metabolic disorders associated with it, this study was conducted to determine the effects of curcumin on metabolic indices and androgen level (primary outcomes), and menstruation characteristics, and hirsutism (secondary outcomes) in women with PCOS. Methods: This triple-blind randomized controlled trial was conducted on women with PCOS who visited the health centers at Eslamshahr County (Tehran Province-Iran) from 2020 to 2022. The participants were allocated into two groups (curcumin and placebo) using block randomization method. The treatment group received two 500 mg edible curcumin tablets together at the same time per day for twelve weeks while the control group received placebo tablets similar to curcumin. Biochemical parameters such as Fasting Blood Insulin (FBI), Fasting Blood Sugar (FBS), triglyceride, total cholesterol, Low Density Lipoprotein- cholesterol (LDL-C), High Density Lipoprotein- cholesterol (HDL-C) were measured before intervention and then 3 months after the intervention. Sex Hormone Binding Globulin (SHBG) and testosterone serum levels were measured 3 months after the intervention. Questionnaires regarding the menstrual cycle characteristics and the Ferriman–Gallwey score were also filled for evaluating hirsutism before the intervention as well as 3 months after the intervention. The independent t-test, Mann-Whitney U test, and ANCOVA were used to analyze the data. Results: There was no statistically significant difference between the two groups in terms of socio-demographic and the baseline levels of measured outcomes. After 12 weeks of intervention, the mean serum FBS levels in the curcumin group were significantly lower than in the placebo group (mean difference: 6.24; 95%confidence interval: -11.73 to -0.76; P = 0.027) but there was no significant difference between the two groups in terms of triglyceride (P = 0.351), cholesterol (P = 0.528), LDL (P = 0.064), HDL (P = 0.306), FBI (p = 0.929), SHBG (p = 0.682), and testosterone (p = 0.133) serum levels. After the intervention, amenorrhea and oligomenorrhea frequency in the curcumin group was significantly lower than in the placebo group (13% vs. 22%, P = 0.038). There was no significant difference in terms of duration of menstruation (P = 0.286) and hirsutism (P = 0.630) between the two groups. Conclusion: Curcumin decreased FBS levels and improved menstruation characteristics (amenorrhea, oligomenorrhea, and menstrual irregularities) in women with PCOS but did not affect other metabolic, hormonal, and hirsutism indices. More studies using a larger sample size are required for a definitive conclusion. Trial registration: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N51 Date of registration: 30/11/2019. URL: https://en.irct.ir/user/trial/40597/view; Date of first registration: 30/11/2020. [ABSTRACT FROM AUTHOR]

Background: Polycystic ovary syndrome (PCOS) is currently considered to have a peri-adolescence onset and continuously influence the reproductive and metabolic health of the patients, while the diagnostic criteria among adolescent population haven't been universally unified till now. This survey seeks to preliminarily evaluate the prevalence of PCOS in the tenth grade schoolgirls in Guangzhou area under NIH criteria and analyze the clinical features of adolescents with PCOS. Methods: The cross-sectional epidemiological survey was carried out among the tenth grade schoolgirls in Guangzhou area by the method of cluster sampling. The contents of this survey included the questionnaire, physical exams and serum measurements. Until now, totally 1294 girls underwent this survey and 1095 serum samples were restored. 235 non-hirsute (mFG < 6), postmenarcheally 2-year girls were randomly selected as the control group, among which the cut-off value of biochemical hyperandrogenemia was set accordingly. The prevalence of PCOS among this population was preliminarily evaluated according to the NIH criteria. Results: Along with the increase of gynecological age, the menstruations of girls was becoming more regular and the incidence of oligomenorrhea or amenorrhea was declining. Even among those who were less than 2 years after menarche, those whose menstrual cycle were longer than 90 days accounted for lower than 5%. The 95th percentile of mFG score was 6 among the girls who were < 2 years after menarche, and 5 among the girls who were > 2 years after menarche. Among the 235 healthy girls, the 95th percentile values of Testosterone (T), Free androgen index (FAI) and Androstenedione (A2) were 2.28 nmol/mL, 4.37, and 5.20 nmol/mL respectively. Based on the NIH criteria, the prevalence of PCOS in this survey was 3.86%. The prevalence of adolescent PCOS tend to slightly increase with age and gynecological age, but the difference was not statistically significant. The prevalence of PCOS among obese girls was markedly higher than that in lean girls. Conclusion: Based on the NIH criteria, the prevalence of PCOS among the tenth grade schoolgirls in Guangzhou area was 3.86%. The diagnosis of hyperandrogenism among adolescents should also be based on both clinical and biochemical parameters. [ABSTRACT FROM AUTHOR]

Background: Recent studies reported possible concerns following long-lasting treatments with high doses of D-chiro-inositol in women. However, to date, no clinical trial has investigated or validated these concerns. We addressed this issue both retrospectively and with a prospective pilot study. Methods: For the retrospective analysis, we searched our databases for insulin-resistant women who took 1200 mg/day D-chiro-inositol for 6 months. In our prospective study, we enrolled 10 healthy women to supplement with the same therapeutic scheme. We performed statistical analyses through the Wilcoxon Signed-Rank Test. A p-value < 0.05 was considered significant. Results: Twenty women underwent 6 months of 1200 mg/day D-chiro-inositol. The treatment significantly decreased BMI, glycemia, insulinemia, HOMA-IR, serum levels of LH, total testosterone, and DHEAS. Serum estradiol rose and menstrual abnormalities occurred following the treatment. In our prospective study, we observed increases in serum levels of total testosterone and asprosin in healthy women. Conclusions: This is the first clinical evidence demonstrating that long-term treatments with high dosages of D-chiro-inositol can predispose women to hormonal and menstrual abnormalities. Moreover, the accumulation of D-chiro-inositol following such treatment regimen may lead to detrimental effects in non-reproductive tissues, as demonstrated by the increase in asprosin levels. [ABSTRACT FROM AUTHOR]

Menstrual irregularities are one of the main clinical symptoms caused by polycystic ovary syndrome (PCOS). Pharmacological treatment options for non-fertility indications to restore menstrual frequency play an important role in the management of PCOS. Oral contraceptive pills are commonly prescribed for adolescents with menstrual irregularities, however, when contraindicated or poorly tolerated, further pharmacological therapy is required. This systematic literature research aims to provide an overview concerning the effects of non-hormonal pharmacological treatment options on menstrual irregularities in adolescents suffering from PCOS. A systematic literature search in PubMed, Cochrane, Embase, Bio-SISS and Web of Science was performed, including literature from January 1998 to September 2022, using specific keywords in order to find related studies. n = 265 studies were identified of which n = 164 were eligible for further evaluation. Only four placebo-controlled studies were identified, with diverging inclusion and exclusion criteria. Available data on specific non-hormonal off-label use medication primarily consisted of metformin, Glucagon-like peptide 1 receptor agonists, thiazolidinediones, anti-androgen agents (spironolactone, finasteride, flutamide) and supplements (chromium picolinate, myo-inositol). However, only a few have partly pointed out beneficial effects on improving menstrual frequency in patients diagnosed with PCOS. In summary, metformin in dosages of 1500–2550 g/day, GLP-1—analogues and supplements were effective in regulation of menstrual cycles in adolescents diagnosed with PCOS. Menstrual frequency in adolescents with PCOS is essential to prevent hypoestrogenism with long-term consequences. In this context, MET is the most effective and cost- efficient in overweight adolescent girls, also showing beneficial effects in the regulation of insulin sensitivity, especially if COCs are contraindicated or not well-tolerated. Further studies are needed to evaluate therapies in lean and normal-weight girls with PCOS. [ABSTRACT FROM AUTHOR]

Study Question: Does maternal polycystic ovarian syndrome (PCOS) affect the timing of pubertal development in daughters and sons?Summary Answer: Maternal PCOS was associated with earlier adrenarche in daughters.What Is Known Already: Female adolescents with PCOS often experience earlier adrenarche compared to adolescents without PCOS, due to hyperandrogenism. Likewise, they usually have hyperandrogenism during pregnancy, which might potentially affect the development of the foetus, including its future reproductive health.Study Design, Size, Duration: In this population-based cohort study, we included 15 596 mothers-child pairs from the Danish National Birth Cohort (DNBC) Puberty Cohort, who were followed from foetal life until full sexual maturation or 18 years of age.Participants/materials, Setting, Methods: Using register-based and self-reported information on maternal PCOS and menstrual irregularities, collected during pregnancy, we categorized the mothers as having PCOS (n = 251), oligomenorhoea (n = 134), 'other menstrual irregularities' (n = 2411) or no menstrual abnormalities (reference group, n = 12 800). The children provided self-reported information on pubertal development every 6 months from the age of 11 years. The main outcome measures were adjusted mean age differences (in months) at attaining several individual pubertal milestones using an interval-censored regression model, as well as the average difference in age at attaining all pubertal milestones combined into a single estimate using Huber-White robust variance estimation.Main Results and the Role Of Chance: We found that maternal PCOS was associated with an accelerated pubertal development in daughters with an overall average difference of -3.3 (95% CI: -6.3; -0.4) months based on all pubertal milestones compared to the reference group. When further looking into the average difference for adrenarche only (pubarche, axillary hair and acne), the average difference was -5.4 (95% CI: -8.7; -2.1) months compared to the reference group; whereas thelarche and menarche did not occur earlier in daughters of mothers with PCOS (average difference: -0.8 (95% CI: -3.9; 2.4) months). Oligomenorrhoea and 'other menstrual irregularities' were not associated with pubertal development in daughters. Neither PCOS, oligomenorrhoea nor 'other menstrual irregularities' were associated with pubertal development in sons.Limitations, Reasons For Caution: We expect some degree of non-differential misclassification of maternal PCOS and menstrual irregularities as well as pubertal development in the children.Wider Implications Of the Findings: Maternal PCOS might accelerate adrenarche in daughters. Whether this is due to genetics, epigenetics or prenatal programming by hyperandrogenism in foetal life remains unsolved. The results from the present study can be generalized to Caucasian populations.Study Funding/competing Interest(s): The study is funded by the Faculty of Health at Aarhus University. The authors have no financial relationships or competing interests to disclose.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Objective: To compare the anthropometric indexes, sex hormones and metabolism of infertile patients with polycystic ovary syndrome (PCOS) at different degrees of oligomenorrhea, and to analyze the pregnancy outcomes after the ovulation induction with acupuncture-assisted clomiphene protocol. Methods: 948 participants with oligomenorrhea in PCOSAct clinical trial were selected. According to the days of menstrual cycle, they were divided into 4 groups: 423 cases in the group A (36-59 days), 311 cases in the group B (60-89 days), 167 cases in the group C (90-179 days) and 47 cases in the group D (≥180 days). The anthropometric indexes, sex hormones, glucose and lipid metabolism were compared, and the pregnancy outcomes were analyzed. Results: The longer the menstrual cycle, the higher the body mass index, waist-hip ratio, black acanthosis score, right ovarian volume, luteinizing hormone, luteinizing hormone/follicle-stimulating hormone, total testosterone, free testosterone, free androgen index, fasting plasma glucose, fasting insulin, homeostatic model assessment values for insulin resistance, triglyceride and apolipoprotein B (all P＜0.05). The incidences of insulin resistance and metabolic syndrome were also increased with the extension of menstrual cycle (both P＜0.05), while the sex hormone-binding globulin, ovulation rate and biochemical pregnancy rate were decreased (all P＜0.05). There were no significant differences in the clinical pregnancy rate, live birth rate and the incidence of perinatal adverse events among the groups (all P＞0.05). Multivariate binary logistic regression analysis showed that the menstrual cycle was an independent influencing factor for ovulation and biochemical pregnancy in PCOS patients. Conclusions: The more severe the degree of oligomenorrhea (especially more than 90 days), the more prone to endocrine, glucose and lipid metabolism disorders. Oligomenorrhea may affect adversely the pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Diet plays a role in the pathophysiology and treatment of women with hyperandrogenic menstrual disturbances; however, limited research exists examining components of dietary intake in women with subclinical menstrual disturbances. The aim of this investigation was to evaluate the relationship between diet quality and hormonal status in exercising women with menstrual disturbances. Eighty exercising women with ovulatory menstrual cycles (OV; n = 32), women with oligo/amenorrhea without evidence of hyperandrogenism (Oligo/Amen-LowFAI; n = 28), and women with oligo/amenorrhea and evidence of subclinical hyperandrogenism (Oligo/Amen-HighFAI; n = 32) participated in the cross-sectional observational study (Clinical Trial Number: NCT00392873). Self-reported menstrual history, resting energy expenditure, body composition, hormonal and metabolic hormone concentrations determined reproductive and metabolic status. Serum androgens and calculated free androgen index (FAI) determined androgen status. The Diet Quality Index International (DQI-I) and the Dietary Inflammatory Index (DII) evaluated quality of diet. Oligo/Amen-HighFAI group had the highest androgen concentrations (P < 0.05) and lower DQI-I score compared to OV group and Oligo/Amen-LowFAI (P < 0.05). The Oligo/Amen-HighFAI group consumed less of vitamin A, B2, B6, B12, magnesium, and potassium compared to the Oligo/Amen-LowFAI group (all P < 0.05). In the women with menstrual disturbances with subclinically elevated androgens, poor diet quality is related to altered hormonal parameters which may have implications for future nutritional treatment strategies. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate risk factors for endometrial intraepithelial neoplasia/malignancy in premenopausal women with abnormal uterine bleeding or oligomenorrhea. Specifically, we aimed to elucidate whether body mass index (BMI) or age confers a higher risk. A retrospective cohort study was performed at a large academic center examining risk factors for endometrial hyperplasia/malignancy in premenopausal women undergoing endometrial sampling. Of the 4170 women ages 18–51 who underwent endometrial sampling from 1987 to 2019, 77 (1.85%) were found to have endometrial intraepithelial neoplasia or malignancy. Clinical predictors of EIN/malignancy in this population included obesity (OR: 3.84, 95%, p <.001), Body mass index [(OR30 vs. 25:2.11, p <.001) and OR35 vs. 30: 1.65, p <.001], Diabetes (OR: 3.6, p-value <.001), hormonal therapy use (OR: 2.93, p <.001), personal history of colon cancer (OR: 9.90, p =.003), family history of breast cancer (OR: 2.65, p <.001), family history of colon cancer (OR: 3.81, p <.001), and family history of endometrial cancer (OR: 4.92, p =.033). Age was not significantly associated with an increased risk of disease. Adjusting for other factors, a model using BMI to predict the risk of EIN/malignancy was more discriminative than a model based on age. Increased BMI, may be more predictive of endometrial hyperplasia/malignancy than age in premenopausal women with abnormal uterine bleeding. Modification of evaluation guidelines in a contemporary demographic setting could be considered. [ABSTRACT FROM AUTHOR]

Study Question: Is the severity of menstrual cyclicity related to hyperinsulinemia and dysglycemia in women with hyperandrogenic polycystic ovary syndrome (PCOS)?Summary Answer: Hyperandrogenic PCOS women with amenorrhea, compared to those with oligomenorrhea or eumenorrhea, had a greater risk of post-challenge hyperinsulinemia, which may explain their higher prevalence of dysglycemia.What Is Known Already: PCOS is associated with metabolic dysregulation including insulin resistance (IR) and hyperinsulinemia, risk factors for type 2 diabetes mellitus (T2DM) and other vascular-metabolic morbidities. Although the severity of menstrual cyclicity is associated with IR in PCOS, it is unclear whether, and to what extent, it is related to hyperinsulinemia and glycemic abnormalities.Study Design, Size, Duration: We prospectively compared the degree of menstrual cyclicity with the presence of dysglycemia (elevated 1-h plasma glucose ≥155 mg/dl; abnormal glucose tolerance [AGT], including prediabetes and T2DM; and AUC for glucose [G-AUC]) or dynamic state hyperinsulinemia (peak insulin levels either at 1 or 2 h of the oral glucose tolerance test (oGTT) and AUC for insulin [I-AUC]) in 333 hyperandrogenic PCOS women.Participants/materials, Setting, Methods: In a tertiary care setting, hyperandrogenic PCOS participants with ovulatory eumenorrhea (Ov-Eumeno, n = 25), anovulatory eumenorrhea (Anov-Eumeno, n = 33), oligomenorrhea (Oligo, n = 150) and amenorrhea (Ameno, n = 125) underwent comprehensive phenotyping and a 2-h 75 g oGTT.Main Results and the Role Of Chance: Mean BMI was greater among Ameno women than among Oligo, Anov-Eumeno or Ov-Eumeno women. Adjusting for BMI, the Ameno group demonstrated higher mean 1- and 2-h insulin and glucose, peak insulin and I-AUC and G-AUC, and either had a higher, or tended toward having a higher, prevalence of elevated 1-h glucose level and prevalence of AGT than the Oligo, Anov-Eumeno or Ov-Eumeno groups. In logistic regression, adjusting for BMI, Ameno women were more likely to have: AGT than Oligo women (odds ratio [OR]: 2.3; 95% CI: 1.3 to 4.2); elevated 1-h glucose (OR: 10.2; CI: 1.3-79.7) than those with Ov-Eumeno; and both AGT (OR: 1.7; CI: 1.1-2.6) and elevated 1-h glucose (OR: 1.8; CI: 1.1-2.8) than those with Anov-Eumeno or Ov-Eumeno when combined. Race/ethnicity, age, waist-to-hip ratio, fasting insulin and glucose, and biochemical or clinical measures of hyperandrogenism were similar across the four menstrual categories.Limitations, Reasons For Caution: Our study was limited by its cross-sectional nature and by studying women affected by PCOS as defined by the Androgen Excess & PCOS Society criteria (i.e. Rotterdam Phenotypes A, B and C) who were identified in the clinical setting. Consequently, extrapolation of the present data to other PCOS phenotypes (e.g. PCOS Phenotype D) should be made with caution.Wider Implications Of the Findings: In hyperandrogenic PCOS phenotypes, a history of amenorrhea, compared to oligomenorrhea or eumenorrhea, suggests a more severe cardiometabolic risk, including a higher degree of hyperinsulinemia and greater prevalence of glycemic abnormalities. These findings may assist in refining the treatment and screening guidelines for glycemic abnormalities in PCOS.Study Funding/competing Interest(s): This work was supported in part by grants R01-DK073632 and R01-HD29364 from the NIH and an endowment of the Helping Hand of Los Angeles, Inc. (to R.A.). M.D.P. has no competing interests to declare. U.E. is an investor in Concentric Analgesics, Inc. R.A. serves as a consultant for Spruce Biosciences and Fortress Biotech and an advisor for Aurora Forge.Trial Registration Number: N/A. [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]

Aims: To analyze the clinical and hormonal profile of patients presenting with oligomenorrhoea in outdoor consultation. Methods: This is an observational descriptive study conducted between January to April 2022 in Bhaktapur Hospital. Data were collected in outpatient clinic of Department of Obstetrics and Gynecology. Descriptive parameters were analyzed. Results: There were 80 patients enrolled in the study. Cause of oligomenorrhoea was identified in only one-third of cases. Common diagnosed cause of oligomenorrhea was Polycystic Ovary Syndrome (16;20%) followed by thyroid disorder (8;10%) and hyperprolactinemia (2;2.5%). Conclusions: The most common identified causes of oligomenorrhea were polycystic ovarian syndrome and thyroid disorder but two-third of cases had no any identifiable cause. [ABSTRACT FROM AUTHOR]

Bone stress injury (BSI) is prevalent in female distance runners. Menstrual disturbances are associated with impaired bone health in endurance athletes. This study aimed to investigate the association between menstrual function and BSI and explore whether plyometric training may protect against BSI in individuals with menstrual disturbances. Competitive female distance runners (n = 183) aged 18–40 years were surveyed for training habits, menstrual function, and BSI, during the previous 12 months. Oligo/amenorrhoea during the previous 12 months (<9 menses) was deemed to indicate menstrual disturbance; hormonal contraceptive users and those previously diagnosed with a pathology that impacted menstrual function were excluded. BSI incidence rate was 2.25 (p = 0.02, 95% CI: 1.14–4.41) times greater in oligo/amenorrhoeic than eumenorrhoeic runners. BSI incidence rate was similar in oligo/amenorrhoeic and eumenorrhoeic runners that did plyometric training, but 3.78 (p = 0.001, 95% CI: 1.68–8.5) times greater in oligo/amenorrhoeic versus eumenorrhoeic runners that did not. However, the effect of plyometrics was non-significant (menstrual function × plyometric training interaction, p = 0.06; main effect, p = 0.89). Conventional plyometric training may not reduce BSI incidence in female distance runners, but menstrual disturbances and prolonged periods of low energy availability should be avoided. [ABSTRACT FROM AUTHOR]

Introduction: 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. Materials and methods: The cohort consisted of 91 elite-level track and field athletes. Body compositions, including bone parameters and bone turnover markers (BTMs), were measured. Results: 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 < 0.01). There were no significant differences in BTMs between the two groups, but oligomenorrheic athletes had significantly lower percent body fat. Conclusion: More than 40% of the elite-level female track and field athletes in this study reported menstrual disorders with oligomenorrhea as the most common. However, none sought medical attention. As compared to the eumenorrheic athletes, the oligomenorrheic athletes had lower BMC and BMD. Hence, if an athlete is oligomenorrheic, bone parameter measurements are considerably important. [ABSTRACT FROM AUTHOR]

Aim: To examine the outcomes of prenatally diagnosed lower urinary tract obstruction (LUTO) with current management using vesicoamniotic shunting (VAS). Methods: A retrospective study of prenatally diagnosed LUTO before 26 weeks of gestation at two tertiary centers in Japan between March 2002 and September 2017. LUTO was diagnosed by ultrasound demonstration of an enlarged fetal bladder associated with hydronephrosis and/or hydroureters. VAS was offered for fetuses with LUTO at ≤26 weeks of gestational age, in the presence of oligohydramnios or decreasing amniotic fluid and a favorable fetal urinary analysis. Results: Among 87 fetuses with LUTO, 46 (53%) were terminated before 22 weeks of gestation. Eight cases (9%) underwent VAS and one underwent fetoscopic urethrotomy. The live birth rates in the VAS and expectant groups were 100% (8/8) and 56% (18/32), respectively (p = 0.034), and the survival rates at 6 months old with a normal renal function were 38% (3/8) and 16% (5/32), respectively (p = 0.608). The etiology varied with six cases of associated anomalies among 23 diagnosed cases. Among the nine cases of posterior urethral valve (PUV), only one fetus underwent VAS at 25 weeks of gestation, ultimately surviving with mild renal dysfunction. Among the other eight cases of PUV that were managed expectantly, two died, and only one of the six survivors showed a normal renal function. Conclusions: More than half of the prenatally diagnosed LUTO cases were terminated. VAS seemed effective for achieving a perinatal survival, regardless of etiology. The outcomes were poor in cases of expectantly managed PUV. [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]

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 < 0.05). In a subgroup analysis where n = 22 participants were excluded (ambiguous baseline menstrual cycle, insufficient time in intervention for menstrual recovery classification), 64% of the Oligo/Amen + Cal group exhibited improved menstrual function compared with 19% in the Oligo/Amen Control group (χ2, P = 0.001).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. [ABSTRACT FROM AUTHOR]

Background: PCOS is among the most common endocrinopathy in women of reproductive age group with increasing prevalence worldwide either due to dietary or lifestyle changes or due to the involvement of genetic background. It is diagnosed in a woman with 1. Oligomenorrhoea/amenorrhea 2. Clinical/Biomedical signs of Hyperandrogenism, Hirsutism, Acne, Alopecia, elevated androgen levels (testosterone) 3. Presence of polycystic ovaries on ultrasound scans. This study is planned to assess the biochemical parameters, fasting glucose, fasting insulin, uric acid and lipid profile in women with PCOD. The parameters will be reported to see the risk of development of CVDs. Method: The study was conducted at Krishna hospital, Krishna Institute of Medical Sciences, Karad- a tertiary care teaching institute. A total of 39 samples were studied of ultrasound diagnosed cases of PCOD and analysed in biochemistry laboratory, Krishna hospital. The statistical software SPSS versions were used for the analysis of collected data from PCOS patients and control group and Pearson correlation between the study variable was performed to find out the relationships. Result: The present study showed increased fasting blood glucose in 23% cases and hyperinsulinemia in 28% cases suggestive of increased risk of developing diabetes in PCOS patients. A significant deviation of serum uric acid towards the higher range of reference value and an increase in the Cholesterol, LDL, VLDL, TGL and a slight deviation of HDL towards the lower range of the reference value indicate dyslipidemia. The above result may predict CVD risk in PCOS patients. Conclusion: The study revealed hyperinsulinemia and an increase in FBS along with dyslipidemia to be a risk factor for developing CVD and diabetes among PCOS patients. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Oral tranexamic acid (TXA) 250 mg twice daily has been used effectively for 4 weeks to 6 months to treat melasma. As relapses are frequent on discontinuation, a minimum effective dose of TXA that can be used safely for long time remains unknown. We compared the efficacy of oral TXA 250 mg once daily and 500 mg twice daily given for 16 weeks in 132 (m:f 23:109) adults with melasma. 42 patients in Group-A (TXA 250 mg/d) and 46 patients in Group-B (TXA 500 mg twice/d) completed the study. They were followed up at 4-week interval for percentage reduction in baseline Melasma Area Severity Index (MASI) and at 24 and 28 weeks for relapse. Therapeutic response, for both as per-protocol and intention-to-treat analysis, was scored as very good (> 75% reduction), good (51–75% reduction), moderate (25–50% reduction), mild (< 25% reduction) or no improvement. Reduction in mean MASI score at 4 weeks was not statistically significant in Group-A but it decreased significantly 8 weeks onwards and was comparable with that in Group-B. The relapse rate was higher in Group-B (10.8%) than Group-A (4.7%) at the end of 28 weeks. Oligomenorrhoea and abdominal discomfort in few patients did not necessitate treatment discontinuation. TXA 500 mg twice daily showed early reduction in mean MASI score compared to 250 mg given once daily with comparable safety and therapeutic efficacy at 16 weeks. Open-label cross-sectional design, no control arm, small number of patients in each group, MASI score being subjective assessment tool, short duration of treatment and follow-up are study limitations. [ABSTRACT FROM AUTHOR]

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 < 0.05.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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The diagnosis of polycystic ovary syndrome (PCOS) in adolescents is complicated by the overlap of normal puberty with features of PCOS. To address this difficulty, recent diagnostic guidelines have worked to modify adult diagnostic criteria for use in adolescents. These guidelines stress that a definitive diagnosis of PCOS is not needed to initiate treatment. Deferring diagnosis, while providing symptom treatment and regular follow-up, is one recommended option. Treatment options for PCOS should be individualized to the presentation, needs, and preferences of each patient. The goals of treatment are to improve the quality of life and long-term health outcomes. [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]

A high drive-for-thinness (DT) score obtained from the Eating Disorder Inventory-2 is associated with surrogate markers of energy deficiency in exercising women. The purposes of this study were to confirm the association between DT and energy deficiency in a larger population of exercising women that was previously published and to compare the distribution of menstrual status in exercising women when categorized as high vs. normal DT. A high DT was defined as a score ≥7, corresponding to the 75th percentile for college-age women. Exercising women age 22.9 ± 4.3 yr with a BMI of 21.2 ± 2.2 kg/m2 were retrospectively grouped as high DT (n = 27) or normal DT (n = 90) to compare psychometric, energetic, and reproductive characteristics. Chi-square analyses were performed to compare the distribution of menstrual disturbances between groups. Measures of resting energy expenditure (REE) (4,949 ± 494 kJ/day vs. 5,406 ± 560 kJ/day, p < .001) and adjusted REE (123 ± 16 kJ/LBM vs. 130 ± 9 kJ/LBM, p = .027) were suppressed in exercising women with high DT vs. normal DT, respectively. Ratio of measured REE to predicted REE (pREE) in the high-DT group was 0.85 ± 0.10, meeting the authors' operational definition for an energy deficiency (REE:pREE <0.90). A greater prevalence of severe menstrual disturbances such as amenorrhea and oligomenorrhea was observed in the high-DT group χ2 = 9.3, p = .003) than in the normal-DT group. The current study confirms the association between a high DT score and energy deficiency in exercising women and demonstrates a greater prevalence of severe menstrual disturbances in exercising women with high DT. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study was to evaluate the effects of a long-term treatment with α-lipoic acid (ALA) combined with myo-inositol (MI) on clinical and metabolic features of women with polycystic ovary syndrome (PCOS). Fifty-seven women with PCOS and a history of oligoamenorrhea were treated with MI and ALA (800 mg + 2000 mg per day). Forty-four of them had complete clinical charts and were considered eligible for the study. Information about cycle length and body mass index (BMI) was checked after 6, 12, and 24 months. After 12 months ovarian volume, total testosterone plasma levels and changes in hirsutism were also evaluated. The metabolic parameters were evaluated in 16 women after 6 and 18 months of the treatment. Cycle length was significantly reduced at 6 (p <.001), 12, and 24 months of treatment (p <.01). BMI showed a reduction only at 6 months (p <.05), thereafter returning similar to the basal values. No changes of testosterone and ovarian volume were observed. HOMA-IR and fasting insulin were unchanged, but the insulin response to a 3 h OGTT was improved after 6 (p <.01) and 18 months (p <.05) of treatment. No individual suffered from any adverse event. In conclusion, the combination of ALA and MI showed to be useful as long-term therapy in PCOS women, providing a normalization of the menstrual cycle and an amelioration of insulin levels with a high tolerability. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of polycystic ovarian syndrome in female medical students and the risk factors associated with polycystic ovarian syndrome. Study Design: A cross-sectional analytical study. Place and Duration of Study: Combined Military Hospital Lahore Medical College, from Apr to Dec 2017. Methodology: All female medical students studying MBBS in Combined Military Hospital Lahore Medical College in 2017 were included in the study. A structured questionnaire was administered to all female medical students and polycystic ovarian syndrome was diagnosed through Rotterdam criteria. An interview was scheduled with the students diagnosed with polycystic ovarian syndrome to assess the risk factors associated with this condition. Results: Two hundred and forty two students participated in the study with a mean age of 21 ± 1.6 years. The frequency of polycystic ovarian syndrome in female medical students in year 2017 was 19.4% as 47 female students out of 242 fit the rotterdam consensus criteria for polycystic ovarian syndrome. Mean age of the students diagnosed with polycystic ovarian syndrome was 20 ± 1.4 years. Six out of 47 patients (13%) had BMI >30. 37 out of 47 students (78%) used fats/oils/sweets daily or more than once a day. Family history of diabetes mellitus was positive in 34 out of 47 students (72%). Conclusion: Our study showed a high frequency of polycystic ovarian syndrome in female medical students, which calls for a national study to look at its prevalence in our young female population, as it has long-term consequences for their reproductive and metabolic health. [ABSTRACT FROM AUTHOR]

Background: Youth-onset type 2 diabetes (T2D) is increasing in many countries, creating large personal and societal burdens. While many primary health-care professionals (HCPs) are aware of the classic symptoms of T2D, there are several other manifestations that could indicate its presence. Summary: This narrative review summarizes information on these symptoms and indicators, focusing on those less well known. The classic symptoms and comorbidities include frequent urination, excessive thirst, metabolic syndrome, and obesity. In addition to these, the presence of dermatological (e.g., acanthosis nigricans, granuloma annulare, necrobiosis lipoidica diabeticorum, and scleredema), gynecological (e.g., polycystic ovary syndrome, oligomenorrhea, and vulvovaginitis), hepatological (e.g., nonalcoholic fatty liver disease), and psychiatric diseases (e.g., psychosis, depression, and autism) could indicate that a patient has T2D or is at increased risk of T2D. Other less well-known indicators include abnormal blood tests (e.g., oxidized lipids, inflammation markers, hepatokines, and adipokines), prescriptions for antipsychotic medications or statins, and disrupted sleep patterns. Key Message: Due to the diversity of T2D manifestations in young people, primary HCPs need to remain alert to its possible presence. [ABSTRACT FROM AUTHOR]

Metformin is an oral glucose-lowering drug that has been widely used for more than half a century. Both the American Diabetes Association and the European Association for the study of Diabetes recommend metformin as the first line therapy for the treatment of type II diabetes mellitus. Metformin has considerably evolved from being an antidiabetic into a drug with a wider potential of therapeutic uses such as anticancer, antiaging, treatment of gestational hypertension, preeclampsia and weight loss. In addition to the in-label use of metformin as an anti-hyperglycemic medication, it is widely prescribed as an off label therapy for young women with Poly Cystic Ovary Syndrome for the treatment of symptoms associated with the disorder. This article is a brief summary that lists and briefly discusses current and potential non-hyperglycemic uses and effects of metformin. [ABSTRACT FROM AUTHOR]