Ovarian dysfunction in adolescent girls with autoimmune rheumatic diseases

OBJECTIVE

To explore the different menstrual and pubertal abnormalities in adolescent females with systemic autoimmune rheumatic diseases (ARD).

METHODS

The study included adolescent girls aged 13-18 years with juvenile idiopathic arthritis (JIA), juvenile systemic lupus erythematosus (JSLE), and juvenile dermatomyositis (JDM) classified according to their international classification criteria. Data were collected from our patients' files and interpreted with respect to the demographic, clinical, disease assessment parameters, medications used, and the hormonal profile. The aspects of puberty and menstruation were assessed by a gynaecologist with ultrasound evaluation as well. The girls were classified according to their menstrual pattern into those with regular cycles versus abnormal ones. The subgroups were compared and significant variables entered into a logistic regression model to detect the independent predictors.

RESULTS

Twenty-one girls with JSLE were included, besides 23 JIA and 8 JDM cases. Ten patients with JSLE (47.6%) had menstrual abnormalities, whereas only four JIA (17.4%) and 1 JDM girls had these alterations without significant difference between the three groups. The median of the SLICC/ACR damage index was statistically higher in JSLE with abnormal menstrual cycles, similarly were the cumulative steroid dose and puberty onset. No difference was observed between JIA or JDM subgroups concerning the disease parameters, hormonal profile, ultrasound assessment or the treatment lines. The most significant predictor for menstrual abnormalities in JSLE was the SLICC/ACR damage index.

CONCLUSION

Menstrual abnormalities is a common disturbance among adolescent girls with ARDs. The SLICC/ACR damage index is the main determinant for menstrual abnormalities rather than the cumulative steroid use or disease duration in JSLE.

Chromosomal polymorphisms and susceptibility to menstrual disorders: a retrospective analysis of 24,578 women

PURPOSE

To evaluate the association between the polymorphic variants of chromosomes and menstrual disorders.

METHODS

The data from our previous retrospective, single-center cohort study were re-analyzed. Women with regular menstruation were included as controls. Women with menstrual cycle abnormalities were subgrouped according to reproductive causes. The frequency of chromosomal polymorphisms was compared between groups. Regression analysis was used to adjust for potential confounding variables.

RESULT

A total of 24,578 women composed of 8062 women with regular cycles as the control group and 16,516 women as the menstrual cycle irregularity group were included. When compared with the control group, the incidence of chromosomal polymorphisms in the total menstrual cycle irregularity group, Polycystic ovary syndrome group, and Primary ovarian insufficiency group were significantly higher (4.49% versus 5.34%, P = 0.004, 4.49% versus 5.35%, P = 0.018 and 4.49% versus 5.94%, P = 0.002, respectively). The incidences of inv(9) in the Primary ovarian insufficiency group were significantly higher than that in the control individuals (1.0% versus 1.6%, P = 0.024). Logistic regression analysis showed an effect of chromosomal polymorphisms on menstrual cycle irregularity (OR: 1.62, 95% CI: 1.234-2.187, P = 0.007; adjusted OR: 1.46, 95% CI: 1.153-1.819, P < 0.001). The result demonstrated an effect of chromosomal polymorphisms on the Primary ovarian insufficiency group (OR: 2.52, 95% CI: 1.307-5.177, P < 0.001; adjusted OR: 2.61, 95% CI: 1.371-4.605, P < 0.001).

CONCLUSION

The study suggests chromosomal polymorphisms adversely affect female menstrual cycle irregularity.

Hormonal changes and reproductive health issues in females with tuberculosis

BACKGROUND/AIMS

The association between tuberculosis (TB) and female reproductive health issues usually remains unaddressed. TB is considered as one of the major causes of infertility in India. Because of the associated stigma, the suffering females do not discuss the problems they are facing. This may lead to disturbances in serum hormone levels also. Hence, a study was planned to find abnormalities in menstrual patterns and fertility in women in childbearing age, who were suffering from TB, and evaluate disturbances in serum hormone levels of LH, FSH, Prolactin and testosterone, if any. It also aimed to evaluate if hormone levels, or some early disturbances in menstrual cycle, can serve as a predictor for infertility in future lives.

MATERIALS AND METHODS

25 female patients each of child bearing age group from OPD/IPD: of pulmonary TB (PTB), extra pulmonary non genital TB (EPTB), extra pulmonary genital TB (GTB) and healthy controls were enrolled. Thus, a total of 75 patients with TB and 25 healthy controls were taken into the study. Patients were questioned for any abnormalities of menstrual cycle. If married, fertility status, total number of live children, abortions etc and previous history of any reproductive health issues was asked. Serum FSH, LH, Prolactin and testosterone levels on the 3rd day of the menstrual cycle were done. Data so obtained was tabulated and statistically analyzed.

RESULTS

TB patients (75/100) and healthy controls (25/100) were matched with respect to age, marital status and rural/urban background. Menstrual abnormalities, infertility and adverse events related to pregnancy were higher in patients with TB than healthy controls (p = 0.176, 0.571 and 0.005 respectively). TB patients had significantly higher levels of Testosterone and significantly lower levels of Prolactin than healthy controls (p=<0.001). Levels of FSH and LH were lower in TB patients than healthy controls (p = 0.428 and 0.274 respectively). On categorization into different types of TB, the sub-groups were matched with respect to rural/urban background. GTB was significantly higher in patients who were married (p = 0.020). Significantly higher GTB patients (10/25) reported menstrual abnormalities (p < 0.001). All the 3 infertile patients reported in the study belonged to GTB sub-group (p = 0.044). GTB had higher number of adverse events related to pregnancy followed by EPTB and PTB. Levels of FSH, LH, Testosterone and Prolactin in the three sub-groups of TB patients did not show any significant difference (p = 0.683, 0.817, 0.781, and 0.187). Since the total number of infertile patients in our study was only 3, relationship of menstrual abnormalities or serum hormone levels as a predictor of infertility could not be assessed.

CONCLUSION

Females suffering from TB experience significantly higher adverse events related to pregnancy than healthy controls. Menstrual abnormalities, infertility and adverse events related to pregnancy were more pronounced in females suffering from GTB than PTB/EPTB. Female patients suffering from any form of TB need to be comprehensively managed. Because of highly sensitive issues related to infertility and reproductive health in today's era, it is imperative that any future complications of the same are kept into consideration in female patients with TB.

Relugolix for the treatment of uterine fibroids

Uterine leiomyomas represent the most common form of benign gynecological tumors affecting 20-40% of women during their life. Several therapeutic options are available for treating these patients. The use of medical treatment for myomas has largely grown in the last years, in particular for women who would refuse, postpone or are not candidates for surgery. In the last years, the clinical investigation of gonadotropin-releasing hormone (GnRH) antagonists (GnRH-ants) has emerged. This class of drugs exerts pure competitive antagonistic activity on the GnRH receptor at the pituitary gland, producing an immediate stop in the release of gonadotropins and sex steroids. Relugolix is an orally active nonpeptide GnRH-ant, recently licensed for marketing in Japan for the treatment of symptoms related to uterine myomas. Currently, several phase III clinical trials are ongoing to evaluate this molecule in this setting in the U.S. and Europe.

[Effects of Workload on Reproductive Health Status of Female Workers in Mechanical Manufacturing Industry]

Objective: To investigate the reproductive health status of female workers in the machinery industry and to analysis the effect of workload on their reproductive health. Methods: 5 732 female mechanical workers were selected and investigated by the Female Workers' Reproductive Health Questionnaire, which was printed by the occupational health and poisoning control institute of China CDC to collect the information about the reproductive health status of from March to December in 2016. Results: The rate of abnormal menstruation was 27.15%, and the rate of gynecological diseases of female workers was 34.39%. The menstruation abnormality and gynecological diseases rate of female workers with high workload was higher than that female workers with low workload (both P<0.01) . High workload was the independent the risk factor associated with the menstruation abnormality (OR=1.88, 95%CI: 1.54~2.31, P<0.01) and gynecological diseases (OR=1.97, 95% CI: 1.61~2.40, P<0.01) . Conclusion: The workload has a large impact on the reproductive health status of female workers.

Ectopic Paratubal Adrenal Cell Rest Associated with Mucinous Cystadenoma of Ovary

Ectopic adrenal cortex is a rare entity. Usually found in male children; commonly located around kidney, retroperitoneum, spermatic cord and para-testicular region. Rarely, adults with heterotopic adrenal glands are described. Incidence in females is very less; though sometimes detected accidentally in hysterectomy specimens. We describe a case of ectopic adrenal cortical cell in paratubal region in a patient with mucinous cyst adenoma of ovary. A 26-year-old female presented with complains of menstrual irregularities and abdominal discomfort for 6 months. Investigations suggested a right ovarian cyst. Right ovarian cystectomy with partial salpingectomy was performed; histopathology revealed mucinous cyst adenoma. Sections from tube showed presence of ectopic adrenal cortical rest in the paratubal region, incidentally discovered on microscopy. We present this case because of its rarity in females, interesting presentation with another unrelated gynaecological pathology, its potentiality for malignant transformation and possible complications.

Menstrual abnormalities in school going girls - are they related to dietary and exercise pattern?

CONTEXT

Adolescence is the transitional phase of physical and mental development between childhood and adulthood and is characterized by immense hormonal changes.75% of girls experience some problems associated with menstruation.

AIM

We tried to find out the prevalence of menstrual abnormalities in school going girls in Pondicherry and their association with dietary and exercise habits.

SETTING AND DESIGN

A cross-sectional questionnaire based study was conducted in adolescent girls who attained menarche in four secondary schools of Pondicherry, India.

MATERIAL AND METHODS

All students who attained menarche and willing to participate in the study were invited to answer the questionnaire, which dealt with anthropometric data, socioeconomic data, menstrual history, and diet and exercise pattern.

STATISTICAL ANALYSIS

Chi-square test and Fisher's exact test was used to compare the dietary and exercise patterns among students having menstrual abnormalities and those who do not have menstrual abnormalities.

RESULTS

A total of 853 students participated in the study. Dysmenorrhea and premenstrual symptoms were the most frequent problems encountered. Premenstrual symptoms were significantly more common among girls who were overweight, in girls who were eating junk food regularly, in girls who were eating less food (dieting) in order to lose weight and in those who were not doing regular physical activity. Dysmenorrhea was significantly more common in the girls who were dieting to lose weight. Passage of clots was also significantly high in the girls who were dieting.

CONCLUSION

Lifestyle modifications like regular physical activity, decreasing the intake of junk food and promoting healthy eating habits should be emphasised in school health education programs to improve their menstrual health.