Ethnic differences in the duration and amount of menstrual bleeding during the postmenarcheal period

Moving from ethnic exclusions to cultural safety: how is athlete ethnicity discussed in research on menstrual health in sports? A scoping review

OBJECTIVE

This study aims to investigate how athlete ethnicity is discussed in the inclusion and exclusion criteria, methodology, findings, and conclusions of research focused on menstrual health in sports science and medicine.

DESIGN

A scoping review of sports-based research conducted on athletes related to (1) menstrual health and ethnicity, (2) how researchers include/exclude participants based on ethnicity and (3) how ethnicity is discussed.

DATA SOURCES

Electronic search of PubMed and ProQuest.

ELIGIBILITY CRITERIA

Articles were included if they met the following criteria: (1) published before September 2023, (2) published in peer-reviewed journals, (3) participants were women athletes, (4) published in English and (5) relating to menstrual health. Articles were assessed as good, fair or poor quality using the Inclusion of Participant Ethnicity Quality Assessment Criteria.

RESULTS

From the 1089 studies available from the initial database search, 55 studies considered ethnicity. Nine studies met the inclusion criteria and were assessed as either good (22%), fair (44%) or poor (33%) in quality in their consideration of athlete ethnicity. 81% of research articles on menstrual health in sports do not consider athlete ethnicity, and when ethnicity is discussed, it rarely meets the criteria for cultural safety in the research process. Most studies did not factor ethnicity into the analysis and lacked cultural considerations in the research design and interventions.

CONCLUSION

More careful inclusion of ethnicity in sports menstrual health-related research and recognition of social and cultural influences on health and research outcomes for indigenous and other ethnic minority groups is needed. Such research is required to support coaches, medical personnel and support staff in designing culturally safe environments for sportswomen from diverse cultural and ethnic backgrounds.

Assessment of COVID-19 impact on menstrual symptom variation among women in the United Arab Emirates

COVID-19 pandemic has resulted in short-term and long-term health, economic, and social repercussions since its outbreak in December 2019. More research is required to determine how the pandemic impacts various segments of the population. Preliminary research suggests that COVID-19 impacts menstrual cycles in different ways. The primary objective of this study was to assess alterations in menstrual cycles among women in the United Arab Emirates (UAE) following the pandemic. A cross-sectional online study was conducted between October 2022 and January 2023, enrolled 439 UAE women using the snowball technique. The Menstrual Symptom Questionnaire and Depression Anxiety Stress Scale were used to evaluate menstrual symptoms and assess depression and stress levels, respectively. The findings showed a significant increase in menstrual symptoms with both higher mean of pads usage per day and use of pain medication during menses after COVID-19 with a p-value <0.001. Moreover, women reported higher levels of psychological distress after COVID-19 (Beta = 1.47). The findings show that COVID-19 affected the menstrual symptoms in women, reflected by higher pads usage per day, bleeding days, and frequency of pain medication intake during menses. Furthermore, higher stress levels were reported in the post-COVID-19 period.

Determinants and Assessment of Menstrual Blood Flow

Purpose of review

a)The modifiable and non-modifiable determinants and the currently available methods of assessment of menstrual blood flow will be discussed, with the goal of helping healthcare providers, researchers, and those interested in public health.

Recent findings

b)Several factors can impact menstruation. The determinants include modifiable factors such as smoking, nutrition, exercise, stress, weight fluctuation, and benign gynecologic diseases, and non-modifiable factors such as age, race, and the individual's genes. The intertwined dynamic among these determinants needs more critical attention. Currently, the methods for the assessment of menstruation all have advantages and disadvantages, often with a tradeoff between practicality and accuracy.

Summary

c)Considered by many as the fifth vital, menstruation provides a window to an individual's general health. The discussion of its determinants and assessment can be more appropriate for individual contexts, especially from a public health perspective as it can improve the reproductive health of the population.

Gynecologic problems and healthcare behavior by shift patterns in Korean nursing staff

We aimed to evaluate the clinical impact of shift patterns at work on gynecologic problems and the healthcare behavior of Korean nursing staff. We conducted a web-based survey for over two weeks in September 2021, involving female nursing staff, including nurses, nurses' aides, and nursing assistants, working in five medical centers. The questionnaire included 40 questions on baseline characteristics, working information, and experiences with gynecologic problems and medical approaches. Overall, 885 nursing staffs participated in the survey, of the 1,904 who received the invitation with an online link of the survey. The response rate was 46.5%. Among the participants responding to all questions, 569 (64.4%) worked two or three shifts and 305 (34.5%) worked full-time. In women rotating two or three-shift patterns, irregular menstrual cycles (21.6% vs. 13.8%, p = 0.005), abnormal menstrual cycles (40.9% vs. 33.8%, p = 0.038), and dysmenorrhea (48.0% vs. 38.4%, p = 0.006) were more frequent than in those who worked full-time. The experience of visiting gynecologic clinics (47.5% vs. 44.1%, p = 0.332) and treating gynecologic conditions (33.4% vs. 29.3%, p = 0.211) did not differ according to the working patterns. However, diagnosis of gynecologic diseases was more frequent in women working full-time (36.4% vs. 29.7%, p = 0.043). The rates of screening (76.1% vs. 57.8%, p<0.001) and human papillomavirus vaccination (55.7% vs. 39.9%, p<0.001) for cervical cancer prevention were higher in women working full-time than in two-three shifts. This study showed that rotating shift work may be related to an increase in gynecologic problems and a decrease in cancer prevention activity among female nursing staff.

Menstrual symptoms variation among Lebanese women before and after the COVID-19 pandemic

Objectives

Pandemic diseases and the confinement measures due to COVID-19 infection have introduced acute and persistent psychosocial stressors for different individuals with a greater influence on females manifested through changes in the menstrual cycle. The objective of this study was to assess Lebanese female of reproductive age about their menstrual cycle, their mental health, and their lifestyle, throughout the COVID-19 pandemic, Beirut blast, and the economic crises.

Methods

A cross-sectional online study conducted between October and December 2021, enrolled 398 Lebanese women using the snowball technique. The Menstrual Symptom Questionnaire (MSQ) was used to assess menstrual symptoms. A repeated measures ANOVA was used to assess factors associated with the variation in MSQ scores after vs before the pandemic.

Results

Our results showed that a significantly higher number of days of menses, number of pads per day and total MSQ score were significantly found after the pandemic compared to before it. More distress (Beta=0.68), more post-traumatic stress disorder due to COVID-19 (Beta=0.19), a higher number of waterpipes smoked per week (Beta=1.20) and being infected by COVID-19 compared to not (Beta=3.98) were significantly associated with an increase in the MSQ score after the pandemic compared to before it.

Conclusion

Our main findings indicate that females had irregular menstrual cycles, unpredictable bleeding pattern, and intense symptoms severity post COVID-19 pandemic. Furthermore, stress post COVID-19 and Beirut blast tended to be associated with increased menstrual symptoms. Thus, vulnerable women should be identified and offered appropriate care, information, and awareness regarding their menstrual period during a pandemic.

Dysmenorrhea Symptom-Based Phenotypes: A Replication and Extension Study

BACKGROUND

Dysmenorrhea is a prevalent pain condition among women and a risk factor for other chronic pain conditions. Individuals vary in dysmenorrhea pain severity, the number of painful sites, and co-occurring gastrointestinal symptoms. Three dysmenorrhea symptom-based phenotypes were previously identified using latent class analysis; however, there is a need to validate these in an independent sample, so they can be used in mechanistic and interventional research. There is also a need to further characterize dysmenorrhea symptom-based phenotypes in terms of demographic, clinical, and psychobehavioral characteristics so they can be used to inform precision dysmenorrhea treatment.

OBJECTIVES

The study objectives were to (a) determine whether the same dysmenorrhea symptom-based phenotypes would be found in a new sample; (b) determine whether including demographic, clinical, and psychobehavioral covariates in latent class analyses would change individuals' phenotype memberships; and (c) investigate relationships between dysmenorrhea symptom-based phenotypes and demographic, clinical, and psychobehavioral characteristics.

METHODS

This cross-sectional survey study included 678 women (aged 14-42 years) with dysmenorrhea. Participants reported dysmenorrhea symptom severity, demographic, clinical (comorbid chronic pain and gynecological conditions), and psychobehavioral characteristics (perceived stress, anxiety, depression, sleep disturbance, and pain catastrophizing). We used latent class analysis to identify symptom-based phenotypes. We compared analyses with and without covariates (i.e., demographic, clinical, and psychobehavioral characteristics) to determine if individuals' phenotype memberships changed. We then examined associations between phenotypes and demographic, clinical, and psychobehavioral characteristics.

RESULTS

We reproduced three dysmenorrhea symptom-based phenotypes: the "mild localized pain" phenotype (characterized by mild abdominal cramps), the "severe localized pain" phenotype (characterized by severe abdominal cramps), and the "multiple severe symptoms" phenotype (characterized by severe pain at multiple locations and gastrointestinal symptoms). Analyses with and without covariates had little effect on individuals' phenotype membership. Race, comorbid chronic pain condition, endometriosis, and pain catastrophizing were significantly associated with the dysmenorrhea phenotypes.

DISCUSSION

Findings provide a foundation to further study mechanisms of dysmenorrhea symptom heterogeneity and develop dysmenorrhea precision treatments. The three dysmenorrhea symptom-based phenotypes were validated in a second sample. Demographic, clinical, and psychobehavioral factors were associated with dysmenorrhea symptom-based phenotypes.

Prevalence of iron deficiency in 62,685 women of seven race/ethnicity groups: The HEIRS Study

Background

Few cross-sectional studies report iron deficiency (ID) prevalence in women of different race/ethnicity and ages in US or Canada.

Materials and methods

We evaluated screening observations on women who participated between 2001–2003 in a cross-sectional, primary care-based sample of adults ages ≥25 y whose observations were complete: race/ethnicity; age; transferrin saturation; serum ferritin; and HFE p.C282Y and p.H63D alleles. We defined ID using a stringent criterion: combined transferrin saturation <10% and serum ferritin <33.7 pmol/L (<15 μg/L). We compared ID prevalence in women of different race/ethnicity subgrouped by age and determined associations of p.C282Y and p.H63D to ID overall, and to ID in women ages 25–44 y with or without self-reported pregnancy.

Results

These 62,685 women included 27,079 whites, 17,272 blacks, 8,566 Hispanics, 7,615 Asians, 449 Pacific Islanders, 441 Native Americans, and 1,263 participants of other race/ethnicity. Proportions of women with ID were higher in Hispanics and blacks than whites and Asians. Prevalence of ID was significantly greater in women ages 25–54 y of all race/ethnicity groups than women ages ≥55 y of corresponding race/ethnicity. In women ages ≥55 y, ID prevalence did not differ significantly across race/ethnicity. p.C282Y and p.H63D prevalence did not differ significantly in women with or without ID, regardless of race/ethnicity, age subgroup, or pregnancy.

Conclusions

ID prevalence was greater in Hispanic and black than white and Asian women ages 25–54 y. p.C282Y and p.H63D prevalence did not differ significantly in women with or without ID, regardless of race/ethnicity, age subgroup, or pregnancy.

Menstrual Cycle Changes as Women Approach the Final Menses: What Matters?

Increased variability in menstrual cycle length marks the onset of the menopausal transition, with the likelihood of long cycles increasing as women approach menopause. This article describes the STRAW+10 bleeding criteria for recognizing onset of the early and late menopausal transition, as well as the specific bleeding changes a woman may experience during this life stage, including how women's bleeding experiences differ. The high probability of episodes of excessive and prolonged bleeding as women approach their final menstrual period is documented, as is the continuing probability of ovulation as women reach their final menstrual period.

Sociodemographic differences in symptom severity and duration among women referred to secondary care for menorrhagia in England and Wales: a cohort study from the National Heavy Menstrual Bleeding Audit

OBJECTIVE

To examine symptom severity and duration at time of referral to secondary care for heavy menstrual bleeding (HMB) by socioeconomic deprivation, age and ethnicity DESIGN: Cohort analysis of data from the National HMB Audit linked to Hospital Episode Statistics data.

SETTING

English and Welsh National Health Services (secondary care): February 2011 to January 2012.

PARTICIPANTS

15 325 women aged 18-60 years in England and Wales who had a new referral for HMB to a gynaecology outpatient department METHODS: Multivariable linear regression to calculate adjusted differences in mean symptom severity and quality of life scores at first outpatient visit. Multivariable logistic regression to calculate adjusted ORs. Adjustment for body mass index, parity and comorbidities.

PRIMARY OUTCOME MEASURES

Mean symptom severity score (0=best, 100=worst), mean condition-specific quality of life score (0=worst, 100=best) and symptom duration (≥1 year).

RESULTS

Women were on average 42 years old and 12% reported minority ethnic backgrounds. Mean symptom severity and condition-specific quality of life scores were 61.8 and 34.7. Almost three-quarters of women (74%) reported having had symptoms for ≥1 year. Women from more deprived areas had more severe symptoms at their first outpatient visit (difference -6.1; 95% CI-7.2 to -4.9, between least and most deprived quintiles) and worse condition-specific quality of life (difference 6.3; 95% CI 5.1 to 7.5). Symptom severity declined with age while quality of life improved.

CONCLUSIONS

Women living in more deprived areas reported more severe HMB symptoms and poorer quality of life at the start of treatment in secondary care. Providers should examine referral practices to explore if these differences reflect women's health-seeking behaviour or how providers decide whether or not to refer.

Symptoms-Based Phenotypes Among Women With Dysmenorrhea: A Latent Class Analysis

Dysmenorrhea is highly prevalent and may increase women's risk for developing other chronic pain conditions. Although it is highly variable, symptom-based dysmenorrhea phenotypes have not been identified. The aims of the study were to identify symptom-based dysmenorrhea phenotypes and examine their relationships with demographic and clinical characteristics. In a cross-sectional study, 762 women with dysmenorrhea rated severity of 14 dysmenorrhea-related symptoms. Using latent class analysis, we identified three distinctive phenotypes. Women in the "mild localized pain" phenotype ( n = 202, 26.51%) had mild abdominal cramps and dull abdominal pain/discomfort. Women in the "severe localized pain" phenotype ( n = 412, 54.07%) had severe abdominal cramps. Women in the "multiple severe symptoms" phenotype ( n = 148, 19.42%) had severe pain at multiple locations and multiple gastrointestinal symptoms. Race, ethnicity, age, and comorbid chronic pain conditions were significantly associated with phenotypes. Identification of these symptom-based phenotypes provides a foundation for research examining genotype-phenotype associations, etiologic mechanisms, and/or variability in treatment responses.

Preeclampsia and future cardiovascular risk: A point of view from the clearance of plasma vasoactive amines

OBJECTIVE

To summarize the reported evidence on the relationship between vasoactive amines and preeclampsia.

METHODS

A literature search was conducted in MEDLINE/PubMed and EMBASE.

RESULTS

The summarized results are as follows: (1) Menstruation can effectively eliminate vasoactive amines norepinephrine, serotonin and histamine. (2) Pregnancy increases norepinephrine production due to fetal brain development and decreases vasoactive-amine elimination due to amenorrhea. (3) Preeclampsia is associated with a low renal and/or sweating capacity, or in rare cases, with increased norepinephrine production due to maternal pheochromocytoma and fetal neuroblastoma.

CONCLUSION

Preeclampsia is mainly due to decreased excretion of norepinephrine and other vasoactive amines.

Ethnicity or environment: effects of migration on ovarian reserve among Bangladeshi women in the United Kingdom

OBJECTIVE

To assess whether the quality of early childhood environments among different groups of Bangladeshi women, including migrants to the United Kingdom (UK), contributes to variation in ovarian reserve and the rate of reproductive aging in later life.

DESIGN

Cross-sectional study.

SETTING

Not applicable.

PATIENT(S)

A total of 179 healthy women volunteers aged 35-59 years were divided into four groups: [1] 36 Bangladeshis living in Sylhet, Bangladesh; [2] 53 Bangladeshis who migrated to the UK as adults; [3] 40 Bangladeshis who migrated to the UK as children aged 0-16 years; and [4] a reference group of 50 women of European origin living in London.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Levels of serum antimüllerian hormone, inhibin B, FSH, and E2, and anthropometrics derived from biomarkers; reproductive, demographic, and health variables from structured questionnaires.

RESULT(S)

Bangladeshi migrants who moved to the UK as children and European women had a highly significantly larger, age-related ovarian reserve compared with migrant Bangladeshis who had moved to the UK as adults or Bangladeshi women still living in Bangladesh. There were no other significant covariates in the model aside from age and menopausal status.

CONCLUSION(S)

The study points to the importance of childhood development in considering variation in ovarian reserve across different ethnic groups. Clinical studies and research in assisted reproductive technology have emphasized the role of genes or race in determining inter-population variation in ovarian reserve. Early life developmental factors should be given due consideration when evaluating inter-group differences in response to assisted reproductive technology.

Bleeding patterns during the menopausal transition in the multi-ethnic Study of Women's Health Across the Nation (SWAN): a prospective cohort study

OBJECTIVE

Previous studies describing menses duration and heaviness of flow during the menopausal transition (MT) have been short in duration and limited to white women. We estimated the frequency of and risk factors for prolonged bleeding, spotting and heavy bleeding during the MT in an ethnically diverse population.

DESIGN

Prospective community-based cohort study.

SETTING USA

southeastern Michigan, northern California and Los Angeles, California.

POPULATION

A total of 1320 midlife women who participated in the Study of Women's Health Across the Nation (SWAN) Menstrual Calendar Substudy. Participants included African-American, white, Chinese, and Japanese women.

METHODS

Women completed daily menstrual calendars from 1996 to 2006, and provided information on hormone therapy, smoking and physical activity. Annual measures included height and weight. Kaplan-Meier survival analysis and multivariable regression were used to analyse the data.

MAIN OUTCOME MEASURES

Menses of 10+ days, spotting of 6+ days, heavy bleeding of 3+ days.

RESULTS

At least three occurrences of menses 10+ days was reported by 77.7% (95% confidence interval [95% CI] 56.7-93.2), of 6+ days of spotting by 66.8% (95% CI 55.2-78.0) and of 3+ days of heavy bleeding by 34.5% (95% CI 30.2-39.2) of women. Menses of 10+ days, 6+ days of spotting, and 3+ days of heavy bleeding were associated with MT stage, uterine fibroids, hormone use and ethnicity. Body mass index was associated with 3+ days of heavy bleeding.

CONCLUSIONS

These data provide clinicians and women with important information about the expected frequency of prolonged and heavy bleeding and spotting during the menopausal transition that may facilitate clinical decision making.

Menstrual bleeding patterns among regularly menstruating women

Menstrual bleeding patterns are considered relevant indicators of reproductive health, though few studies have evaluated patterns among regularly menstruating premenopausal women. The authors evaluated self-reported bleeding patterns, incidence of spotting, and associations with reproductive hormones among 201 women in the BioCycle Study (2005-2007) with 2 consecutive cycles. Bleeding patterns were assessed by using daily questionnaires and pictograms. Marginal structural models were used to evaluate associations between endogenous hormone concentrations and subsequent total reported blood loss and bleeding length by weighted linear mixed-effects models and weighted parametric survival analysis models. Women bled for a median of 5 days (standard deviation: 1.5) during menstruation, with heavier bleeding during the first 3 days. Only 4.8% of women experienced midcycle bleeding. Increased levels of follicle-stimulating hormone (β = 0.20, 95% confidence interval: 0.13, 0.27) and progesterone (β = 0.06, 95% confidence interval: 0.03, 0.09) throughout the cycle were associated with heavier menstrual bleeding, and higher follicle-stimulating hormone levels were associated with longer menses. Bleeding duration and volume were reduced after anovulatory compared with ovulatory cycles (geometric mean blood loss: 29.6 vs. 47.2 mL; P = 0.07). Study findings suggest that detailed characterizations of bleeding patterns may provide more insight than previously thought as noninvasive markers for endocrine status in a given cycle.

Menstruation and the menopausal transition

This paper characterizes changes in menstrual bleeding during perimenopause,including bleeding changes that represent markers of the menopausal transition. Recent results from the Study of Women's Health Across the Nation and other cohort studies are reviewed. Emerging data describing subpopulation differences in the transition experience are highlighted. When treating women in the midlife, clinicians should pay careful attention to medical factors, including both conditions and treatments, that may increase menstrual blood loss or alter menstrual cycle characteristics sufficiently to obscure the onset of the menopausal transition or the final menstrual period.

Working conditions associated with ovarian cycle in a medical center nurses: a Taiwan study

AIM

Decreased basal body temperature measurements predict ovulation with an accuracy of 74%. The anovulatory cycle exhibits an ovarian monophasic pattern. This study evaluated the relationship between ovarian cycle pattern and sociodemographic characteristics, menstrual history and work characteristics of nurses in a Taiwan medical center.

METHODS

Of 200 nurses recruited, 151 were analyzed. Each subject completed questionnaires and provided life recordings and daily basal body temperature measurements during the 14-week study.

RESULTS

The analytical results demonstrated that work place (P = 0.014) and work shift (P = 0.048) are significantly related to ovarian cycle pattern. Nurses who worked in emergent care units and wards had a higher prevalence of irregular ovarian cycle pattern. Approximately 53% of nurses who worked rotating shifts exhibited irregular ovarian cycle pattern.

CONCLUSIONS

Nurses who either had rotating shift work or worked in emergent care units and wards should be concerned with their own ovarian cycle pattern for their health.

Demographic correlates of low hemoglobin deferral among prospective whole blood donors

BACKGROUND

Approximately 10% of attempted blood donations are not allowed because of low hemoglobin (Hb) deferral.

STUDY DESIGN AND METHODS

Low Hb deferrals were tracked in more 715,000 whole blood donors at six blood centers across the United States. A multivariable logistic regression model was developed to comprehensively assess demographic correlates for low Hb deferral.

RESULTS

Demographic factors significantly associated with low Hb deferral include female sex (11 times greater odds than males), increasing age in men (men over 80 have 29 times greater odds than men under 20), African American race (2-2.5 times greater odds than Caucasians), Hispanic ethnicity in women (1.29 times greater odds than Caucasian women), and weight in men (men under 124 pounds have 2.5 times greater odds than men over 200 pounds). Interestingly, increasing donation frequency is associated with decreased odds for low Hb deferral (women with one donation in the previous 12 months have two times greater odds than those with six donations).

CONCLUSIONS

Low Hb deferral is associated with female sex, older age, African American race/ethnicity, and lower body weight in men. An inverse association with donation frequency suggests a selection bias in favor of donors able to give more frequently. These data provide useful information that can be utilized to manage blood donors to limit low Hb deferrals and assist in policy decisions such as changing the Hb cutoff or permissible frequency of donation. They also generate hypotheses for new research of the causes of anemia in defined groups of donors.

2d:4d, sex steroid hormones and human psychological sex differences

Studies on 2d:4d, the ratio between the second and the fourth digit, as a possible indicator of prenatal androgen exposure, have failed to produce consistent results. This paper analyzes the relation between 2d:4d, sex steroids and well-documented sex differences in characteristics such as depression, dominance, and aggressive (ART) and non-aggressive adolescent risk-taking (NART) in a comparatively large sample of adolescent boys (N=301, mean age: 14.4 years) and girls (N=298, mean age: 14.3 years). Boys had on average a lower 2d:4d than girls (F=42.15; p<0.001). With respect to boys, controlling for age and pubertal development (PD), a small but marginally significant positive association was found between 2d:4d and total testosterone (TT) (r=0.11; p<0.05). In girls a significant association was found between 2d:4d and SHBG (r=0.18; p<0.01). However, relationships between 2d:4d and hormones depended on the phase of the menstrual cycle, with 2d:4d being negatively associated with FT (B=-0.013; p<0.05) once a positive association between 2d:4d and FT for girls in the mid-cycle group (B=0.019; p<0.01) is taken into account. With respect to sex differences in characteristics, we found evidence of a relationship between 2d:4d and depression in boys (r=-0.14; p<0.05) but not between 2d:4d and dominance, ART or NART. No relationships were found between 2d:4d and any of these variables in girls.

Estradiol, testosterone, differential association and aggressive and non-aggressive risk-taking in adolescent girls

Although the relation between androgens and adolescent risk-taking has been relatively well documented in boys, little is known as to how sex steroid hormones relate to aggressive (ART) and/or non-aggressive adolescent risk-taking (NART) behavior in girls. On the basis of a sample of 298 adolescent girls (mean age: 14.3 years), we examined: (i) the relationship between serum levels of testosterone (T) and estradiol (E2) in relation to ART and NART and (ii) if differential association--having friends who are highly involved in risk-taking--moderates the relationship between relationships between hormones and risk-taking. The sample provided evidence of an association between free estradiol (FE2) and both NART (Beta=0.19; p<0.01) and ART (Beta=0.19; p<0.01), controlling for age and pubertal development. No relationship between T and ART or NART was found. The importance of the relationship between E2 and ART and NART differed between girls at different phases of their menstrual cycle and was significant only for girls in the mid-phase of the menstrual cycle. In addition, significant interactions between differential association and FE2 were found indicating that the relationship between FE2 and NART and ART was particularly strong in girls with high levels of differential association.

Effect of Native American ancestry on iron-related phenotypes of Alabama hemochromatosis probands with HFE C282Y homozygosity

BACKGROUND

In age-matched cohorts of screening study participants recruited from primary care clinics, mean serum transferrin saturation values were significantly lower and mean serum ferritin concentrations were significantly higher in Native Americans than in whites. Twenty-eight percent of 80 Alabama white hemochromatosis probands with HFE C282Y homozygosity previously reported having Native American ancestry, but the possible effect of this ancestry on hemochromatosis phenotypes was unknown.

METHODS

We compiled observations in these 80 probands and used univariate and multivariate methods to analyze associations of age, sex, Native American ancestry (as a dichotomous variable), report of ethanol consumption (as a dichotomous variable), percentage transferrin saturation and loge serum ferritin concentration at diagnosis, quantities of iron removed by phlebotomy to achieve iron depletion, and quantities of excess iron removed by phlebotomy.

RESULTS

In a univariate analysis in which probands were grouped by sex, there were no significant differences in reports of ethanol consumption, transferrin saturation, loge serum ferritin concentration, quantities of iron removed to achieve iron depletion, and quantities of excess iron removed by phlebotomy in probands who reported Native American ancestry than in those who did not. In multivariate analyses, transferrin saturation (as a dependent variable) was not significantly associated with any of the available variables, including reports of Native American ancestry and ethanol consumption. The independent variable quantities of excess iron removed by phlebotomy was significantly associated with loge serum ferritin used as a dependent variable (p < 0.0001), but not with reports of Native American ancestry or reports of ethanol consumption. Loge serum ferritin was the only independent variable significantly associated with quantities of excess iron removed by phlebotomy used as a dependent variable (p < 0.0001) (p < 0.0001; ANOVA of regression).

CONCLUSION

We conclude that the iron-related phenotypes of hemochromatosis probands with HFE C282Y homozygosity are similar in those with and without Native American ancestry reports.

Initial screening transferrin saturation values, serum ferritin concentrations, and HFE genotypes in whites and blacks in the Hemochromatosis and Iron Overload Screening Study

We compared initial screening data of 44,082 white and 27,124 black Hemochromatosis and Iron Overload Screening (HEIRS) Study participants. Each underwent serum transferrin saturation (TfSat) and ferritin (SF) measurements without regard to fasting, and HFE C282Y and H63D genotyping. Elevated measurements were defined as: TfSat more than 50% (men), more than 45% (women); and SF more than 300 ng/ml (men), more than 200 ng/ml (women). Mean TfSat and percentages of participants with elevated TfSat were significantly greater in whites than in blacks. Mean SF and percentages of participants with elevated SF were significantly greater in blacks than in whites. TfSat and SF varied by gender and age in whites and blacks. Prevalences of genotypes that included either C282Y or H63D were significantly greater in whites than in blacks. The prevalence of elevated TfSat and SF plus genotypes C282Y/C282Y, C282Y/H63D, or H63D/H63D was 0.006 in whites and 0.0003 in blacks. Among whites with HFE C282Y homozygosity, 76.8% of men and 46.9% of women had elevated TfSat and SF values. Three black participants had HFE C282Y homozygosity; one had elevated TfSat and SF values. Possible explanations for differences in TfSat and SF in whites and blacks and pertinence to the detection of hemochromatosis, iron overload, and other disorders with similar phenotypes are discussed.

Initial screening transferrin saturation values, serum ferritin concentrations, and HFE genotypes in Native Americans and whites in the Hemochromatosis and Iron Overload Screening Study

We compared initial screening transferrin saturation (TfSat) and serum ferritin (SF) phenotypes and HFE C282Y and H63D genotypes of 645 Native American and 43,453 white Hemochromatosis and Iron Overload Screening Study participants who did not report a previous diagnosis of hemochromatosis or iron overload. Elevated measurements were defined as TfSat >50% in men and >45% in women and SF >300 ng/ml in men and >200 ng/ml in women. Mean TfSat was 31% in Native American men and 32% in white men (p = 0.0337) and 25% in Native American women and 27% in white women (p < 0.0001). Mean SF was 153 microg/l in Native American and 151 microg/l in white men (p = 0.8256); mean SF was 55 microg/l in Native American women and 63 microg/l in white women (p = 0.0015). The C282Y allele frequency was 0.0340 in Native Americans and 0.0683 in whites (p < 0.0001). The H63D allele frequency was 0.1150 in Native Americans and 0.1532 in whites (p = 0.0001). We conclude that the screening TfSat and SF phenotypes of Native Americans are similar to those of whites. The allele frequencies of HFE C282Y and H63D are significantly lower in Native Americans than in whites.

Polychlorinated biphenyls and menstrual cycle characteristics

BACKGROUND

Experimental studies in nonhuman primates provide evidence that low-level exposure to persistent organochlorine pollutants such as polychlorinated biphenyls (PCBs) may affect aspects of their menstrual cycle, including cycle length, regularity, and bleeding duration. Few studies have examined these associations in humans.

METHODS

We used data from 2314 pregnant women who participated in the Collaborative Perinatal Project, a cohort study that enrolled pregnant women in the 1960s in 12 centers in the United States. Information about usual (prepregnancy) menstrual cycle length, regularity, bleeding duration, and dysmenorrhea was collected at enrollment, and 11 PCBs and p,p'-DDE (1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) were measured in stored blood samples collected during the third trimester of pregnancy. We used multivariate linear and logistic regression to examine the association between organochlorine levels and menstrual cycles, adjusting for demographic factors, cholesterol, and triglycerides.

RESULTS

Total PCBs were positively associated with increasing menstrual cycle length (adjusted difference across 5 categories of PCB exposure = 0.7 days, trend-test P value = 0.02). Irregular cycles were slightly more frequent among those in the 2 highest categories of PCB exposure (odds ratio for highest category = 1.5; 95% confidence interval = 0.70-3.3), and there also was some evidence of an association with DDE. The strengths of these associations increased with various exclusions made to decrease potential misclassification of the outcome and the exposures. There was little evidence for associations between DDE or PCBs and bleeding duration, heavy bleeding, or dysmenorrhea.

CONCLUSIONS

This study supports experimental studies in monkeys showing an effect of low-dose PCB exposure on menstrual function.

The Associations between Menstrual Function and Life Style/Working Conditions among Nurses in Taiwan

This study was aimed at understanding the relationship among menstrual pattern, dysmenorrhea, life style and working conditions in nurses. The nurses were randomly selected from a medical center in Northern Taiwan. Each subject completed daily records including life and working conditions during the study period. The study showed that there were statistically significant differences in work years, daily working hours and type of work shift among nurses that worked at different units in the hospital. In the perceived regular cycle group, nurses that worked the night shift only exhibited the shortest menstrual cycles, less than 25 d. There was a significant difference (p<0.05) among the nurses' menstrual cycles. Many life factors (such as passive tobacco smoke exposure, perceived life satisfaction and perceived life stress) and working factors (such as work years, perceived work satisfaction and perceived work stress) were not significantly related to menstrual cycle regularity. In addition, 30% of the nurses complained of dysmenorrhea. Some factors including age, marital status and perceived life satisfaction were significantly related to dysmenorrhea. However, other life factors (such as passive tobacco smoke exposure, smoking, coffee, alcohol, cold drink habits, exercise and perceived life stress) and working factors (such as working places, type of work shift, daily work hours, perceived work satisfaction and perceived work stress) showed no correlation with dysmenorrhea. This study indicates that women should pay attention to their menstrual function and dysmenorrhea phenomenon.

Hematologic differences between African-Americans and whites: the roles of iron deficiency and alpha-thalassemia on hemoglobin levels and mean corpuscular volume

The average results of some laboratory measurements, including the hemoglobin, mean corpuscular volume (MCV), serum transferrin saturation (TS), serum ferritin, and white blood cell count of African-Americans differ from those of whites. Anonymized samples and laboratory data from 1491 African-American and 31 005 white subjects, approximately equally divided between men and women, were analyzed. The hematocrit, hemoglobin, MCV, TS, and white blood cell counts of African-Americans were lower than those of whites; serum ferritin levels were higher. When iron-deficient patients were eliminated from consideration the differences in hematocrit, hemoglobin, and MCV among women were slightly less. The -3.7-kilobase alpha-thalassemia deletion accounted for about one third of the difference in the hemoglobin levels of African-Americans and whites and neither sickle trait nor elevated creatinine levels had an effect. Among all subjects, 19.8% of African-American women would have been classified as "anemic" compared with 5.3% of whites. Among men, the figures were 17.7% and 7.6%. Without iron-deficient or thalassemic subjects, the difference had narrowed to 6.1% and 2.77% and to 4.29% and 3.6%, respectively. Physicians need to take into account that the same reference standards for hemoglobin, hematocrit, MCV, and TS and the white blood cell count do not apply to all ethnic groups.

A new statistical approach demonstrated menstrual patterns during the menopausal transition did not vary by age at menopause

OBJECTIVE

To describe population mean, variance, and correlation of cycle length across the life span and by age at menopause and age at menarche using a new statistical approach.

STUDY DESIGN AND SETTING

Data from the Tremin Trust (n=997), a prospective menstrual diary study, was analyzed. Marginal models with generalized estimating equations were used to describe changes in menstrual parameters across the reproductive life span.

RESULTS

During the menopausal transition, the increase in standard deviation preceded that in mean by 2 to 6 years. Although beginning earlier in women with earlier menopause, increases in mean and variance for women with different ages at menopause were parallel. Women with later menopause had longer cycles throughout life and longer, more variable cycles during the transition.

CONCLUSION

The transition from late reproductive life to early menopausal transition appears to begin in the late thirties when variability of cycle length increases. Patterns of change in menstrual function during the menopausal transition do not differ by age at menopause; thus, differences in age at menopause are likely to reflect changes in the timing and not changes in the process of ovarian senescence, at least for the normative ages of menopause.

Risk factors for low iron intake and poor iron status in a national sample of British young people aged 4-18 years

OBJECTIVE

To examine the prevalence and dietary, sociodemographic and lifestyle risk factors of low iron intake and poor iron status in British young people.

DESIGN

National Diet and Nutrition Survey of young people aged 4-18 years.

SETTING

Great Britain, 1997.

SUBJECTS

In total, 1699 young people provided 7-day weighed dietary records, of which 11% were excluded because the participant reported being unwell with eating habits affected. Blood was obtained from 1193 participants, with iron status indicated by haemoglobin, serum ferritin and transferrin saturation.

RESULTS

Iron intakes were generally adequate in most young people aged 4-18 years. However, low iron intakes (below the Lower Reference Nutrient Intake) occurred in 44% of adolescent girls (11-18 years), being less prevalent with high consumption of breakfast cereals. Low haemoglobin concentration (<115 g l-1, 4-12 years; <120 or <130 g l-1, 13+ years for girls and boys, respectively) was observed in 9% of children aged 4-6 years, pubertal boys (11-14 years) and older girls (15-18 years). Adolescent girls who were non-Caucasians or vegetarians had significantly poorer iron status than Caucasians or meat eaters, independent of other risk factors. The three iron status indices were correlated significantly with haem, but not non-haem, iron intake.

CONCLUSIONS

Adolescent girls showed the highest prevalence of low iron intake and poor iron status, with the latter independently associated with non-Caucasian ethnicity and vegetarianism. Risk of poor iron status may be reduced by consuming (particularly lean red) meat or enhancers of non-haem iron absorption (e.g. fruit or fruit juice) in vegetarians.

Blood lead concentration and delayed puberty in girls

BACKGROUND

Environmental lead exposure has been linked to alterations in growth and endocrine function. It is not known whether such exposure affects pubertal development.

METHODS

We analyzed the relations between blood lead concentration and pubertal development among girls (defined as females 8 to 18 years of age) who were enrolled in a cross-sectional study (the third National Health and Nutrition Examination Survey) in which race was self-reported or proxy-reported: 600 were non-Hispanic white, 805 were non-Hispanic African-American, and 781 were Mexican-American girls. Puberty was measured on the basis of the age at menarche and Tanner stage for pubic-hair and breast development.

RESULTS

Geometric mean lead concentrations were less than 3 microg per deciliter (0.144 micromol per liter) in all three groups. As compared with concentrations of 1 microg per deciliter (0.048 micromol per liter), lead concentrations of 3 microg per deciliter were associated with decreased height (P<0.001), after adjustment for age, race, and other factors, but not with body-mass index or weight. Blood lead concentrations of 3 microg per deciliter were associated with significant delays in breast and pubic-hair development in African-American and Mexican-American girls. The delays were most marked among African-American girls; in this group, the delays in reaching Tanner stages 2, 3, 4, and 5 associated with a lead concentration of 3 microg per deciliter as compared with 1 microg per deciliter were 3.8, 5.3, 5.8, and 2.1 months, respectively, for breast development and 4.0, 5.5, 6.0, and 2.2 months, respectively, for pubic-hair development; the associated delay in age at menarche was 3.6 months. In white girls, there were nonsignificant delays in all pubertal measures in association with a lead concentration of 3 microg per deciliter.

CONCLUSIONS

These data suggest that environmental exposure to lead may delay growth and pubertal development in girls, although confirmation is warranted in prospective studies.

Dietary intake does not account for differences in low iron stores among Mexican American and non-Hispanic white women: Third National Health and Nutrition Examination Survey, 1988-1994

We used nationally representative data from the third National Health and Nutrition Examination Survey (NHANES III) to examine the relationship between low iron stores (serum ferritin < 12 microg/L) and dietary patterns that might affect iron status among Mexican American (MA) and non-Hispanic white (NHW) girls and women of reproductive age (12-39 y). Dietary data from the qualitative food-frequency questionnaire were used to classify subjects into three categories (using the 25th and 75th quartile values for NHW) for intake of heme iron, nonheme iron, iron absorption enhancers, and iron absorption inhibitors. The prevalence of low iron stores was 17.4% among MA (n = 1368) and 7.9% among NHW (n = 1473). Compared with high intake, the adjusted odds ratio (OR) for low iron stores was 1.80 [95% confidence interval (CI), 1.24-2.62] for medium intake of heme iron and 0.48 (95% CI, 0.25-0.91) for low intake of nonheme iron (plus iron supplement). Compared with no use, use of vitamin C supplements was associated with half the risk of low iron stores (OR = 0.50; 95% CI, 0.29-0.87). Similar results were found after income and parity were controlled for, except that the protective effect of vitamin C supplements was no longer significant. Even after adjustment for sociodemographic and dietary factors, MA women remained at increased risk for low iron stores (OR = 1.80; 95% CI, 1.30-2.49) indicating that the reasons for the higher prevalence of iron deficiency in MA women warrants further investigation.

Evolution of age at menarche and at onset of regular cycling in a large cohort of French women

BACKGROUND

Early exposure to ovarian hormones is considered to increase breast cancer incidence. The age at which the ovaries become functional is thus important.

METHODS

We explored the evolution of age at first menstruation and at onset of regular cycling in 86 031 women participating in the E3N-EPIC cohort study, part of the European Prospective Investigation into Cancer.

RESULTS

We observed an increase in mean age at menarche among women born between 1925 and 1930, followed by a steady decrease in the youngest birth cohorts. In contrast, age at onset of regular cycling increased gradually from 1925 onwards. There was thus a steady increase in the interval between age at menarche and at onset of regular cycling, mainly due to an increase in the percentage of women in whom regular cycling started at least 5 years after menarche (from 9.0% among women born in 1925-1929 to 20.8% in those born in 1945-1950). The increase in the interval between menarche and onset of regular cycling was even greater among women with a late menarche.

CONCLUSIONS

This increase might be due to a change in dietary intake and/or physical exercise aimed at achieving the slim silhouette desired by the younger generations.

Menstrual disorders and occupational, stress, and racial factors among military personnel

Few studies have assessed multiple stress factors as a potential risk for menstrual disorders. This study evaluated whether work-related stress or life event stress was associated with alterations in menstrual function of military personnel. The study is unique in that it evaluated the association between race and three job factors--job stress, handling chemical mixtures, and being a military or civilian employee of the US Air Force. A comprehensive questionnaire was administered to 170 healthy, premenopausal employed women to examine the relationship between work-related or life event stress and menstrual disorders. Multiple logistic regression analyses showed no statistically significant association between work-related stress and menstrual disorders, whereas life event stress was significantly associated with dysmenorrhea (odds ratio [OR], 2.20; 95% confidence interval [CI], 1.08 to 4.50) abnormal cycle length (OR, 3.42; CI, 1.12 to 10.50), and hypermenorrhea (OR, 2.99; 95% CI, 1.20 to 7.42). Having one or more menstrual disorders was significantly associated with life events by race interaction (OR, 6.52; 95% CI, 2.45 to 17.36). Non-Caucasians had significantly increased risks of hypermenorrhea (OR, 4.99; 95% CI, 2.07 to 12.05) and abnormal cycle length (OR, 4.12; 95% CI, 1.47 to 11.55). The prevalence of menstrual disorders in this military population was 31.2% for dysmenorrhea, 17.9% for hypermenorrhea, and 12.0% for abnormal cycle length. This study suggests that women in the military report less day-to-day job stress but more atypical life events, including those related to their jobs, and that these life events are associated with adverse menstrual consequences.

Epidemiologic correlates with menstrual cycle length in middle aged women

While irregular menstruations have been associated with lower cumulative exposure to the ovarian steroids, shorter regular cycles have been postulated to increase the cumulative exposure. Epidemiological correlates with menstrual patterns were analyzed among 4900 premenopausal women aged 45 or younger from the New York University Women's Health Study. The length of regular menstrual cycles increased with increasing age at menarche, body mass index and parity, but decreased with age, nonwhite racial background and current smoking. The likelihood of irregular cycles increased with increasing age, body mass index and number of cigarettes smoked per day. With adjustment for age, body mass index and number of cigarettes smoked per day, the risk of irregular cycles was marginally positively associated with total fat intake.