Etiology and Secular Trends in Primary Amenorrhea in 856 Patients: A 17-Year Retrospective Multicenter Study in Korea

BackgroundThis study was performed to evaluate etiologies and secular trends in primary amenorrhea in South Korea.MethodsThis retrospective multi-center study analyzed 856 women who were diagnosed with primary amenorrhea between 2000 and 2016. Clinical characteristics were compared according to categories of amenorrhea (hypergonadotropic/hypogonadotropic hypogonadism, eugonadism, disorders of sex development) or specific causes of primary amenorrhea. In addition, we assessed secular trends of etiology and developmental status based on the year of diagnosis.ResultsThe most frequent etiology was eugonadism (39.8%). Among specific causes, Müllerian agenesis was most common (26.2%), followed by gonadal dysgenesis (22.4%). Women with hypergonadotropic hypogonadism were more likely to have lower height and weight, compared to other categories. In addition, the proportion of cases with iatrogenic or unknown causes increased significantly in hypergonadotropic hypogonadism category, but overall, no significant secular trends were detected according to etiology. The proportion of anovulation including polycystic ovarian syndrome increased with time, but the change did not reach statistical significance.ConclusionThe results of this study provide useful clinical insight on the etiology and secular trends of primary amenorrhea. Further large-scale, prospective studies are necessary.     

Cognitive dietary restraint: impact on bone, menstrual and metabolic status in young women

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

Genetic analysis of Turner syndrome: 89 cases in Tunisia

Turner's syndrome (TS) affects about 1/2500 female infants born alive. The syndrome results from total or partial absence of one of the two X chromosomes normally present in females. We report the results of a retrospective analysis of 89 cases of TS observed during a six-year period (2000-2005). The patients’ age ranged from two days to 51 years at the time of this analysis. Most patients were adults (48%). The aim of this study is to ascertain the principal clinical features leading to a request for a karyotype, searching for a possible relationship between chromosomal anomalies and clinical expression of TS. Pediatric patients were referred for statural retardation or dysmorphic features, while reproduction anomalies were the main indication for karyotyping in patients aged over 20 years. Mosaicism was prevalent (47%), whereas the homogeneous karyotype 45,X was found in only 32% of the patients; structural anomalies were found in 21%. Regarding the advanced age of our patients, we established a relationship between chromosome anomalies and the clinical expression of TS, based on an analysis of stature and reproduction disorders. Short stature and primary amenorrhea were correlated with total deletion of one chromosome X or imbalanced gene dosage due to structural X anomalies. Whereas cases of infertility, recurrent miscarriages and secondary amenorrhea were associated with a mosaic karyotype pattern (45,X/46,XX or 45,X/46,XX/47,XXX …), with a slight mosaicism in most cases. Thus, chromosome investigations should be performed in cases of reproduction failure even for women with normal stature.     

Menses Requires Energy: A Review of How Disordered Eating,Excessive Exercise,and High Stress Lead to Menstrual Irregularities

PurposeFunctional hypothalamic amenorrhea secondary to low weight, excessive exercise, and/or high levels of stress is common among young women. Adolescence is a time in development that a positive energy balance is crucial for puberty, menarche, and regular menstruation. Disordered eating and eating disorders are the third most common chronic illness and tend to start during puberty. High-level athletes, specifically young girls participating in ballet, running, gymnastics, and figure skating, are at risk of developing hypothalamic amenorrhea from excessive exercise and inability to meet the energy needs of the body. Dysfunction of the hypothalamic–pituitary–ovarian axis leads to a hypoestrogenic state. Low levels of estrogen have a negative effect on bone health, sexual maturation, sexual function, and fertility. Puberty has the highest rate of bone accrual in a female's life. Adequate nutrition, physical activity, and estrogen are crucial for bone development and prevention of osteoporosis. Recognition and early intervention are necessary to limit the irreversibility of some of these effects.MethodsA review of literature was completed to gather epidemiologic data, pathophysiology, diagnostic criteria, recommended laboratory/imaging, and approaches to treatment.FindingsAccording to the American College of Obstetricians and Gynecologists, 16% to 47% of slender female athletes have disordered eating, which makes them at risk for functional hypothalamic amenorrhea (FHA). Most women present with previously regular menstrual cycles until there was a change in one or multiple factors, including weight, stress, and/or exercise. Athletes have a higher incidence, stemming from the synergistic relationship that exercise and low weight have on puberty and the menstrual cycle. FHA is a diagnosis of exclusion; therefore, eating disorders and other etiologies of menstrual irregularity need to be ruled out first.ImplicationsHypothalamic dysfunction leads to a hypoestrogenic state within the body. Low levels of estrogen manifest in multiple ways: amenorrhea, low bone mineral density, vaginal and breast atrophy, infertility, and dyspareunia. The goal of treatment of FHA and these downstream symptoms is weight gain with spontaneous resumption of menses, as this is the best indicator that the hypothalamic dysfunction and hypoestrogenic state have been resolved. In refractory cases of FHA, it may be necessary to replace hormones with physiologic dosing of transdermal estrogen and cyclic progesterone for the benefit of the young woman’s bone health (Clin Ther. 2020;42:XXX–XXX) © 2020 Elsevier HS Journals, Inc.     

流产后月经异常患者用药方法探讨与效果评价

目的：探讨流产后月经异常患者临床治疗方法评价效果。方法：回顾性总结我站收治的人工流产术后月经减少或闭经患者50例资料。结果：B超诊断发现异常者16例（诊断率为32．0％）,所有患者在手术治疗基础上使用宫血宁胶囊后三个月时随访调查,痊愈26例,显效15例,失败9例,总有效率82．0％。结论：流产后月经异常患者在手术治疗基础上应用宫血宁胶囊药物治疗具有满意的临床效果。     

神经性厌食的临床分析

目的　提高对神经性厌食 (AN)患者的临床特点、内分泌功能改变及其预后情况的认识。方法　分析 2 8例AN患者的临床资料、内分泌激素水平的变化 ,并进行随访 ;研究 13例不同治疗阶段的AN患者瘦素水平变化。结果　 (1)大多数AN患者为年轻女性 (92 .9% ,2 6/2 8) ,发病年龄 (19.4± 3 .8)岁 ,病程4个月～ 7年 ;(2 )临床特点主要为厌食、消瘦和闭经 ;(3 ) 2 4例患者下丘脑 垂体 性腺轴 (HPG)功能显著下降 ,12例患者下丘脑 垂体 肾上腺轴 (HPA)功能亢进 ,9例患者甲状腺功能减退 ;(4 )AN患者 (n =9)血清瘦素水平较正常对照组 (n =2 6)显著降低〔(1.2 1± 0 .3 6vs 7.70± 4.15 ) μg/L ,P <0 .0 0 1〕 ;(5 )接受随访的患者共 2 2例 ,其中痊愈 9例 ,好转 5例 ,无效 7例 ,死亡 1例。结论　显著的体重减轻和闭经是AN患者的主要临床特征 ,伴有严重的下丘脑 垂体功能紊乱 ,瘦素水平明显下降 ,在治疗后有所上升 ,仅 40 .9%的患者经综合治疗后痊愈。     

Female adolescent athletes' awareness of the connection between menstrual status and bone health

Study Objective

The aims of this study are to determine among female high school track athletes: (1) knowledge of the association between menstrual irregularity and bone health; (2) attitudes toward amenorrhea, specifically if amenorrhea is seen as a sign of athletic success; (3) the association between knowledge and attitudes based on athlete menstrual status.

Design

Cross-sectional survey.

Setting

Five public high schools in Texas.

Participants

103 female high school track athletes ages 14–18 years.

Intervention

Participants completed a questionnaire that addressed menstrual history, details of track participation, knowledge of bone mineral density (BMD)/ menstrual status connection, and attitudes about the desirability of oligo/amenorrhea.

Outcome Measures

Frequencies of attitude and knowledge replies, summative knowledge score, and correlations between attitudes, knowledge, and menstrual status.

Results

Sixteen subjects (16.7%) met criteria for amenorrhea, 16 for oligomenorrhea (16.7%). Median summative knowledge score was one of six. Menstrual irregularity was associated with lower knowledge (P = 0.035). Incorrect answers about consequences of bone loss and the link to menstrual irregularity were given by ≥90% of respondents. Lower knowledge was associated with a greater number of “don’t know” replies to attitude questions (P = 0.002). Among more knowledgeable participants endorsing opinions, menstrual irregularity was not seen as a sign of athletic success.

Conclusions

The prevalence of irregular menses is high among adolescent track athletes and a larger-scale inquiry to clarify adolescent athletes’ knowledge of and attitudes about the link between menstrual patterns and BMD is indicated. Education may provide one key to improved health behavior among this at-risk population.     

青春期多囊卵巢综合征诊断标准的现状分析

多囊卵巢综合征是育龄妇女中最常见的内分泌疾病,在青春期表现尤其明显.目前,成年多囊卵巢综合征的诊断标准已经明确.随着近年青春期多囊卵巢综合征发病率的逐渐提高,急需建立适合青春期多囊卵巢综合征的诊断标准.现讨论高雄激素血症、闭经和卵巢呈多囊性改变等在青春期多囊卵巢综合征诊断中的重要意义.