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Endometriosis: Clinical Manifestation and Differential Diagnosis
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
In a recent cross-sectional survey of 50,000 women concluded in 2014, Heitmann et al. noted menstrual abnormalities were worse in cases with endometriosis than non-endometriosis, including heavy bleeding, irregular bleeding, passing clots, and irregular cycles. Premenstrual spotting also correlates with endometriosis in infertile women (49). Although these disorders are common in women with endometriosis, ironically, most women with endometriosis have regular cycles without abnormal bleeding (50). Menstrual irregularity is reported by only 10–20% of the patients. This symptom has a big list of differential diagnoses and could be mostly managed even improved through conservative measures like the Mirena coil.
The practical management of hormonal treatment in adults with gender dysphoria
Published in James Barrett, Transsexual and Other Disorders of Gender Identity, 2017
Hirsuitism and menstrual irregularity can be controlled using the oral contraceptive pill. These medication induce SHBG production whilst suppressing ovarian androgen production and effectively reducing hirsuitism. Dianette is especially effective as it contains a combination of the ethinylestradiol with the anti-androgenic progestin cyproterone acetate, which helps to control the effects of androgens on the hair follicle. An alternative approach is to use a topical preparation eflornithine (Vaniqa 11.5%), which inhibits the enzyme ornithine decarboxylase in the hair follicle and so reduces hair growth. Local measures such as waxing, sugaring, laser and electrolysis are also extremely effective in controlling excess body hair.
Polycystic Ovary Syndrome
Published in Steven R. Bayer, Michael M. Alper, Alan S. Penzias, The Boston IVF Handbook of Infertility, 2017
Rita M. Sneeringer, Kristen Page Wright
The symptoms of menstrual irregularity and hyperandrogenism can be improved through use of the oral contraceptive pill (OCP). The maximal benefit is achieved with combined estrogen-progestin pills, since these formulations take advantage of the first pass effect in the liver. As a result, levels of hepatic proteins, including SHBG, are significantly increased, thus reducing free circulating androgen concentrations. After initiation of OCP therapy, the regulation of the menstrual abnormality is usually immediate, but improvement in hyperandrogenic symptoms may not be appreciated for 4–6 months. Additionally, OCPs protect the endometrium from hyperplasia by providing progesterone exposure. For all patients who have prolonged anovulation, some form of progesterone exposure is needed. For most, OCPs offer the most convenient solution. For patients with contraindications to oral estrogen, progesterone administration alone for at least 10 days per month can be prescribed. Alternative routes of administration of progesterone such as the progestin-containing IUD, progesterone implant, and Depo-Provera injection will effectively protect the endometrium from hyperplasia but are less useful for improving symptoms of hyperandrogenism.
Age at menarche: risk factor for gestational diabetes
Published in Journal of Obstetrics and Gynaecology, 2022
Ayla Ergin, Ünal Türkay, Suzi Özdemir, Ayşe Taşkın, Hasan Terzi, Mehmet Özsürmeli
The number of patients with a cycle duration >31 days was statistically higher in the GDM group than in the control group. Because the study was based on a retrospective cohort design, polycystic ovary syndrome (PCOS) screening was not performed. Oligomenorrhoea and BMI are more common in patients with PCOS than in the normal population. In the GDM group, some patients with oligomenorrhoea and a BMI >25 might have been afflicted with PCOS. Thus, their long cycle durations might be related to PCOS or other endocrine pathologies (Dishi et al. 2011; Liu et al. 2017). However, in this retrospective study, only the patients’ verbal statements were considered in defining menstrual irregularity. The presence of PCOS was not questioned or diagnosed. Further studies are necessary to investigate menstrual irregularity, its relationship to PCOS and GDM, and the underlying mechanisms involved.
Relation of aerobic fitness, eating behavior and physical activity to body composition in college-age women: A path analysis
Published in Journal of American College Health, 2021
Chaise Murphy, Shinya Takahashi, Jim Bovaird, Karsten Koehler
Higher levels of cognitive restraint in college-aged women have been associated with more frequent exercise, higher incidence of disordered eating, reduced energy availability25 and menstrual irregularity.18 Chronic dieting can lead to an absence of menstruation, or amenorrhea, which impairs reproductive potential and has been linked to reduced bone health.26 However, menstrual irregularity may also result from weight gain. Polycystic Ovarian Syndrome affects between 6 and 15 percent of women,27 making it the most common endocrine disorder; it is commonly associated with abdominal weight gain and may result in amenorrhea17 and the loss of peak reproductive years.28 Because significant numbers of college women put themselves at risk for lasting health consequences with significant changes in weight status, this population’s causal lifestyle habits warrant further investigation. By understanding the relationship between eating behaviors, physical activity and dietary intake, we hope to inform the creation of targeted interventions for at-risk college women in order to maximize the development of optimal health during college years.
Long-term use of mTORC1 inhibitors in tuberous sclerosis complex associated neurological aspects
Published in Expert Opinion on Orphan Drugs, 2020
Romina Moavero, Paolo Curatolo
The increasing use of mTORC1 inhibitors in always younger children obviously raised several concerns about possible specific adverse events in infancy and early childhood. Data on the use of mTORC1 inhibitors in children in the first 3 years of life have been gathered in two different studies. The main reasons for administration appeared to be refractory epilepsy, cardiac rhabdomyomas, and SEGAs, and although also in this specific age range adverse events were very common, they were not life-threatening, and no death or disability has been reported [78,79]. Another common concern, above all for use in pre-puberal age, was the possible effect of Everolimus on growth and sexual maturation. As far as the actual medical literature allows to discern, normal puberal progression and normal growth are usually observed; however, as already observed in previous studies, amenorrhea is not a rare event [34]. Indeed, a pooled analysis of three prospective trials, also including a long-term follow-up study, revealed that 43 out of 112 patients (38.4%) presented at least 1 menstrual irregularity, the most common being amenorrhea (24.1%), which was grade 3/4 in 6.3% of patients, and irregular menstruation (17%) [80].