Psychological assessment of patients with premature ovarian failure

Possible association between subclinical hypothyroidism and age at menopause in Colombian women

OBJECTIVE

To evaluate the association between subclinical hypothyroidism with early menopause, premature menopause, and last menstrual bleeding before the natural age of menopause.

METHODS

This was a cross-sectional study conducted in 643 postmenopausal women aged 40-69 years. Groups were formed according to last menstrual episode: ≥45 [Natural age at menopause], 40-44 and [Early menopause], <40 [Premature menopause], and <45 [last menstrual episode before the natural age of menopause]. The Zulewski scale was applied to identify manifestations related to hypothyroidism and subclinical hypothyroidism, diagnosed with a serum TSH > 4.5 µIU/mL plus T4-free between 0.7 and 1.9 ng/dL.

RESULTS

It was found that 24.4% had the last menstrual episode before the natural age of menopause, 18.6% had early menopause, and 5.7% had premature menopause. Subclinical hypothyroidism was diagnosed in 4.5% of patients. Among women with subclinical hypothyroidism, there was a higher frequency of early menopause, premature menopause, and last menstrual episode before the natural age of menopause, than in women without subclinical hypothyroidism (p < 0.05). Paresthesia (50%) and dry skin (40.7%) were the most reported hypothyroidism-related manifestations. Early menopause, premature menopause, and last menstrual episode before the natural age of menopause were associated with subclinical hypothyroidism, OR: 3.37 [95% CI: 1.40-8.10], OR: 4.31 [95% CI: 1.24-14.97], and OR: 3.57 [95% CI: 1.57-8.10], respectively.

CONCLUSIONS

The last menstrual episode before the natural age of menopause, early menopause, and premature menopause were significantly associated with a higher chance of subclinical hypothyroidism.

Appropriateness of premature ovarian insufficiency recommendations provided by ChatGPT

OBJECTIVE

This study aimed to evaluate the appropriateness of ChatGPT's responses to frequently asked queries regarding the prevention and treatment of premature ovarian insufficiency (POI).

METHODS

A set of 25 questions covering topics related to disease risk factors, screening, symptoms, treatment, and treatment adverse effects were posed to ChatGPT, and the responses were evaluated by two experienced obstetrician/gynecologists.

RESULTS

Of the responses given by ChatGPT, 19 of 25 (76%) were deemed appropriate, five (20%) were rated as inappropriate, and the remaining one (4%) was considered unreliable. There was no question that ChatGPT answered completely incorrectly; answers that were considered inappropriate included partially correct information.

CONCLUSIONS

The study's findings suggest that ChatGPT provides patients with mostly accurate information about the POI but might present significantly inaccurate information. However, it is important to note that further research is needed to validate the use of artificial intelligence chatbots in the context of reproductive health, especially for individuals who may be highly impacted by the emotional and psychological effects of POI. In addition, given the complexity and individuality of medical care, AI chatbots should not be considered a replacement for medical professionals but rather a supplementary tool that can help patients access reliable information and support. Overall, this study contributes to the growing body of research on AI chatbots and their potential use in reproductive health, highlighting both the benefits and limitations of these technologies.

Characterizing the Adolescent Premature Ovarian Insufficiency Phenotype: A Case Control Study

STUDY OBJECTIVES

To characterize the skeletal, cardiometabolic, cognitive, and mental health phenotype of adolescents with idiopathic premature ovarian insufficiency (POI) DESIGN: Case control SETTING: Pediatric tertiary referral center in Cincinnati, Ohio PARTICIPANTS: Nine adolescents (ages 11-18.99 years) with newly diagnosed POI and 9 normally menstruating controls, matched by age and body mass index MAIN OUTCOME MEASURES: Between-group comparisons of bone characteristics assessed by dual energy x-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT), psychosocial health (anxiety, depression, and quality of life), and cognition and memory by questionnaire RESULTS: Adolescents with POI had lower bone density Z-scores by DXA (lumbar spine -1.93 vs 0.80; whole body less head -2.05 vs 0.00; total hip -1.03 vs 0.83; and femoral neck -1.23 vs 0.91; all P < .001), as well as lower trabecular volumetric bone mineral density (tibia 3% site 226 vs 288 mg/mm³, P < .001; radius 3% site 200 vs 251, P = .001), smaller cortical area (tibia 66% site 251 vs 292 mm², P = .028), and thickness (tibia 66% site 3.56 vs 4.30 mm, P = .001) than controls. No abnormalities in cardiometabolic biomarkers were detected in POI cases. Adolescents with POI were also more likely to report low energy (78% vs 22%, P = .02).

CONCLUSION

Estrogen deficiency adversely affects bone health in adolescents with POI. However, we did not find associations with cardiometabolic, mental health, or cognitive outcomes in this small sample.

The effect of cognitive-behavioral therapy on stress and anxiety of women with premature ovarian insufficiency: A randomized controlled trial

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N64. Date of registration: 14/02/2021. URL: https://en.irct.ir/user/trial/52024/view; date of first registration: 17/02/2021.

Folic Acid Preconditioning Alleviated Radiation-Induced Ovarian Dysfunction in Female Mice

Radiological therapy/examination is the primary source of artificial radiation exposure in humans. While its application has contributed to major advances in disease diagnosis and treatment, ionizing radiation exposure is associated with ovarian damage. The use of natural products, either alone or as an adjunct, has become increasingly common for reducing the side effects of radiological therapy during disease treatment. Herein, we explored the protective effect of folic acid (FA), a widely used B vitamin, against radiation-induced ovarian injury and its mechanism of action. Female mice with normal ovarian function were randomly divided into control, FA, radiation, and radiation + FA groups. The intervention strategy included daily intragastric administration of FA (5 mg/kg) for 3 weeks prior to radiation exposure. Mice in the radiation and radiation + FA groups received a single dose of 5 Gy X-ray irradiation. Changes in the estrous cycle were then recorded, and ovarian tissues were collected. Pathophysiological changes as well as reproductive and endocrine-related indexes were determined via H&E staining, immunohistochemistry, Western blot, and ELISA. The reproductive performance and emotional symptoms of animals were also monitored. Our results indicated that FA intervention effectively alleviated ovarian damage, leading to more regular estrous cycles, lesser impairment of follicular morphology and endocrine status, as well as greater germ cell preservation. Reduced levels of oxidative stress, inflammation, and enhanced DNA repair were associated these changes. FA pre-administration improved the reproductive performance, leading to higher pregnancy rates and greater litter sizes. Further, the anxiety levels of animals were significantly reduced. Our results indicate that FA pre-administration significantly alleviates radiation-induced ovarian damage in rodents, highlighting its potential as a protective strategy against radiation exposure in the female population.

Women with premature ovarian failure using hormone therapy do not experience increased levels of depression, anxiety and stress compared to controls

OBJECTIVE

To evaluate anxiety, depression and stress of POI women using hormone therapy.

METHODS

A quantitative cross-sectional study included 61 women diagnosed with POI receiving HT, and 61 women with preserved ovarian function, matched 1:1 for age (control group). Instruments used to evaluate depression, anxiety and stress were Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Lipp's Stress Symptom Inventory (LSSI). The chi-square or Fisher's exact tests, Mann-Whitney test, Spearman's correlation coefficient or logistic regression analysis with stepwise criteria were used for analysis.

RESULTS

The mean age of POI women and control group was 35.03±7.68 and 34.49±7.55 years old (p = 0.63). POI group and control group had a mean of 0.44±0.92 and 1.28±1.38 children (p = 0,001); the total BDI, BAI and LSSI scores were 15.72±11.68 and 13.66±8.44 (p = 0.64); 17.54±13.16 and 17.25±11.05 (p = 0.90), 19.39±12.08 and 18.93±11.21 (p = 0.945). The majority of women did not have depression or presented mild depression, but approximately one-third had moderate-severe undiagnosed depressive or anxiety symptoms. In POI group, depression was positively correlated with the number of children and anxiety. Anxiety and stress were also positively correlated. It was observed that for each point in the BDI, the risk of stress above 20 increased 19.6%, while for each point in the BAI, the risk of greater stress increased 32.4%.

LIMITATIONS

This is a cross-sectional study, which made it impossible to draw cause and effect conclusions CONCLUSION: Women with POI receiving HT have indexes of depression, anxiety and stress similar to the population of women with preserved ovarian function.

Emotional indicators in young patients with Idiopathic Scoliosis: a study through the drawing of Human Figure

Background

Investigating Health Related Quality of Life (HRQL) is considered determinant in patients with Adolescent Idiopathic Scoliosis (AIS) in clinical as in research field. The aim of the present study is to explore the most relevant aspects of personality of the patients with AIS and its relationship with HRQL.

Method

50 patients (mean age = 16 years) were given a socio-demographic data questionnaire, the Human Figure Drawing (HFD) and SRS (Scoliosis Research Society) -22.

Results

In Subtotal SRS-22, patients presented a mean value of 3.9. In HFD, half of these patients presented physical and/or emotional tensions with reference to the shoulders and almost all of them did not show any expression of aggressiveness. No relationship between personality and HRQL was confirmed. The older the patients were, the more body tension was discovered as well as the more concerns about their bodies they showed to have. There was also a correlation between growing old and a decreasing in Mental Health. Previous conservative treatment did not show any impact on personality or on HRQL.

Conclusions

Patients with AIS suffer stress and general concern more frequently with the increase of age. We suggest an appropriate supportive treatment for this type of patients.

Adolescent Premature Ovarian Insufficiency Following Human Papillomavirus Vaccination: A Case Series Seen in General Practice

Three young women who developed premature ovarian insufficiency following quadrivalent human papillomavirus (HPV) vaccination presented to a general practitioner in rural New South Wales, Australia. The unrelated girls were aged 16, 16, and 18 years at diagnosis. Each had received HPV vaccinations prior to the onset of ovarian decline. Vaccinations had been administered in different regions of the state of New South Wales and the 3 girls lived in different towns in that state. Each had been prescribed the oral contraceptive pill to treat menstrual cycle abnormalities prior to investigation and diagnosis. Vaccine research does not present an ovary histology report of tested rats but does present a testicular histology report. Enduring ovarian capacity and duration of function following vaccination is unresearched in preclinical studies, clinical and postlicensure studies. Postmarketing surveillance does not accurately represent diagnoses in adverse event notifications and can neither represent unnotified cases nor compare incident statistics with vaccine course administration rates. The potential significance of a case series of adolescents with idiopathic premature ovarian insufficiency following HPV vaccination presenting to a general practice warrants further research. Preservation of reproductive health is a primary concern in the recipient target group. Since this group includes all prepubertal and pubertal young women, demonstration of ongoing, uncompromised safety for the ovary is urgently required. This matter needs to be resolved for the purposes of population health and public vaccine confidence.

Dyspareunia and lubrication in premature ovarian failure using hormonal therapy and vaginal health

OBJECTIVE

To evaluate vaginal microbiological and functional aspects in women with and without premature ovarian failure (POF) and the relationship with sexual function.

METHODS

A cross-sectional study of 36 women with POF under hormonal therapy who were age-matched with 36 women with normal gonadal function. The vaginal tropism was assessed through hormonal vaginal cytology, vaginal pH and vaginal health index (VHI). Vaginal flora were assessed by the amine test, bacterioscopy and culture for fungi. Sexual function was evaluated through the questionnaire Female Sexual Function Index (FSFI).

RESULTS

Women in both groups were of similar age and showed similar marital status. The two groups presented vaginal tropic scores according to the VHI but the tropism was worse among women in the POF group. No difference was observed with respect to hormonal cytology and pH. Vaginal flora was similar in both groups. Women with POF showed worse sexual performance with more pain and poorer lubrication than women in the control group. The VHI, the only parameter evaluated showing statistical difference between the groups, did not correlate with the domains of pain and lubrication in the FSFI questionnaire.

CONCLUSION

These findings suggest that the use of systemic estrogen among women with POF is not enough to improve complaints of lubrication and pain despite conferring similar tropism and vaginal flora. Other therapeutic options need to be evaluated.

Quality of life in women with premature ovarian failure

A cross-sectional and case-control study with a matching for age was performed to evaluate quality of life in 58 women with a diagnosis of premature ovarian failure (POF) and 58 women with normal ovarian function paired for age (± 2 years) (control group). In both groups were excluded women with chronic diseases and iatrogenic or genetic causes. Quality of life was evaluated using the WHOQOL-BREF. Although there were no statistically significant differences in quality of life in general between the two groups, there were statistically significant differences in mean scores in the physical health [61.3 ± 18.0 and 72.8 ± 16.4 for the POF and control groups, respectively (p < 0.0001)] and psychological domains [64.2 ± 16.7 and 69.3 ± 14.1, respectively (p = 0.0455)]. Having POF represented an approximately 2.5-fold greater risk of scoring poorly in the physical health and psychological domains. No statistically significant differences were found between the groups with respect to the social relationships or environment domains or for overall health. Women with POF have more difficulty with respect to their physical health and psychological aspects, indicating a need to provide adequate psychosocial and clinical support for these women to minimize the repercussion of this diagnosis on their activities and quality of life.

Premature ovarian failure in mice with oocytes lacking core 1-derived O-glycans and complex N-glycans

Premature ovarian failure (POF) affects up to 1.4% of women under the age of 40 yr and less than 30% of cases have a known cause. Here we describe a new mouse model of POF resulting from oocyte-specific ablation of core 1-derived (mucin) O-glycans and complex and hybrid N-glycans. Females carrying floxed alleles of both the C1galt1 (T-syn) and Mgat1 glycosyltransferase genes and a ZP3Cre transgene, generate oocytes lacking complex O- and N-glycans following oocyte-specific deletion at the primary follicle stage. We previously showed that few double-mutant females are fertile, and those produce only a single small litter. Here we show that ovarian function declined rapidly in double-mutant females with less than 1% ovulating at 11 wk of age after superovulation with exogenous gonadotropins. Ovary weight was significantly decreased in double-mutant females by 3 months of age, consistent with a decrease in the number of developing follicles. FSH levels in double-mutant females were elevated at 3 months of age, and testosterone and inhibin A were decreased, showing that the loss of complex N- and O-glycans from oocyte glycoproteins affected hypothalamic-pituitary-gonadal feedback loops. The absence of developing follicles, ovary dysfunction, reduced testosterone and inhibin A, and elevated FSH in double-mutant females lacking C1galt1 and Mgat1 in oocytes represents a new mouse model for the study of follicular POF.

Premature ovarian failure from current perspective

Premature ovarian failure (POF) is a syndrome characterised by amenorrhoea, hypoestrogenism and hypergonadotropinism before the age of 40. It is a disorder affecting approximately 1% of women <40 years, 1/1,000 women by the age of 30 and 1/10,000 women by the age of 20. POF is not merely an early menopause. Up to 50% of the patients with POF will have intermittent and unpredictable ovarian function which may persist for some years. Heterogeneity of POF is also reflected by the variety of possible causes, including autoimmunity, toxics, drugs, radiation, infectious as well as genetic defects. HRT remains the cornerstone of treatment and the only proven method of achieving pregnancy in these patients is by ovum donation.