Reduced bone mineral density in adult women diagnosed with menstrual disorders during adolescence.

OBJECTIVE: To evaluate the long-term effects on bone mineral density (BMD) in women diagnosed with menstrual disorders in their adolescence. DESIGN: Prospective follow-up study six years after the initial investigation. SETTING: A youth clinic that is part of the school health system in Stockholm. POPULATION: Eighty-seven women diagnosed with secondary amenorrhea or oligomenorrhea in adolescence. METHODS: Subjects underwent gynecological examination, evaluation of eating behavior and physical activity. Whole body Dual Energy X-ray Absorptiometry was used for measurement of BMD. MAIN OUTCOME MEASURES: BMD. RESULTS: The overall frequency of osteopenia/osteoporosis was 52%, and three girls had osteoporosis. Women with previous secondary amenorrhea had significantly lower BMD in the pelvis and lumbar spine than those with previous oligomenorrhea. The strongest predictor of low BMD was a restrictive eating disorder in adolescence and the most important counteraction was high physical activity at follow-up and a body mass index (BMI) > or = 22. Persistent menstrual dysfunction at follow-up was associated with polycystic ovary syndrome and lower frequency of osteopenia. CONCLUSIONS: This clinical follow-up study has demonstrated a high frequency of osteopenia in women diagnosed with menstrual disorders in adolescence. Previous anorectic behavior was the strongest negative predictor of BMD. It is important to pay attention to an underlying eating disorder in young women with menstrual dysfunction in order to promote bone health.

Gender differences in sexuality and life quality among young people visiting a Swedish youth clinic.

UNLABELLED: A survey was performed in the spring of 2004 to investigate aspects of life quality and sexuality in young girls and boys visiting a youth clinic in the centre of Stockholm, Sweden. METHODS: Girls and boys coming for treatment, as well as accompanying persons, were over a period of three months asked to complete a questionnaire covering physical, mental, and social matters, including sexuality and lifestyle. RESULTS: The questionnaire was answered by 480 girls and 108 boys. The response rate was 87%. The mean age of the girls was 18.7 +/- 2.1 years and of the boys 19.8 +/- 2.9 years. Significantly more girls than boys felt depressed, suffered stress, and had physical pain. More girls than boys were dissatisfied with their bodies and consciously tried to control their weight. Girls had been forced to have sex to a higher degree than boys. Boys, more than girls, appreciated casual sex, enjoyed masturbating and watching pornography and had an orgasm during intercourse. CONCLUSION: We found that girls were less satisfied than boys with life, their bodies, and sexuality. Weight-control behavior was notably common among teenage girls and could indicate eating disorder problems. These gender differences should be taken into account for the adequate care and treatment of young people and important when designing youth-friendly clinics and the help they can provide.

Prospective follow-up of menstrual disorders in adolescence and prognostic factors.

OBJECTIVE: Clinical follow-up of menstrual status and eating behavior in grown-up women diagnosed with menstrual disturbance in adolescence. DESIGN: Prospective follow-up study six years after the initial study. SETTING: A youth clinic that is part of the school health system in Stockholm. POPULATION: Eighty-seven women diagnosed with secondary amenorrhea or oligomenorrhea in adolescence. METHODS: Subjects underwent gynecological examination, evaluation of eating behavior and endocrine status. MAIN OUTCOME MEASURES: Menstrual status and eating behavior changes. RESULTS: Menstrual disturbances were still present in 62% of the subjects not using hormonal contraception, 59% of which fulfilled the criteria for polycystic ovary syndrome (PCOS). The frequency of persistent menstrual disturbance was significantly more common in women with previous oligomenorrhea than secondary amenorrhea. The occurrence of eating disorders was decreased by half to 31% in women diagnosed with secondary amenorrhea at the initial study, whereas it was unchanged (40%) in women with previous oligomenorrhea. Recovery from anorectic behavior, primarily in the group of secondary amenorrhea, significantly predicted resumption with menses. CONCLUSION: Menstrual disturbances and eating disorders were still frequent after six years in a follow-up of women who had menstrual disturbance in adolescence. PCOS was the main cause explaining persistent menstrual disorder, whereas recovery of anorectic eating disorders predicted resumption of menses. The findings call for a continued follow-up of women diagnosed with menstrual disturbance in their teens.

Menstrual disorders and associated factors among adolescent girls visiting a youth clinic.

BACKGROUND: Menstrual disturbances are common among teenagers and are often explained by immaturity of the hypothalamic-pituitary-gonadal axis. However, little is known about the underlying causes. The aim of this study was to evaluate endocrine mechanisms of menstrual disturbances and associated factors among adolescent girls visiting a Swedish youth clinic. METHODS. All adolescent girls visiting the youth clinic during a five-year period due to menstrual disturbances, except those with primary amenorrhea, were included in this retrospective study. These 203 girls were evaluated in a standardized manner by the same gynecologist. One third also met a psychologist and/or a dietician at the clinic. RESULTS: Secondary amenorrhea was diagnosed in 117 girls (58%) and oligomenorrhea in 86 girls (42%). Menarcheal age was 13 in both groups. Hypothalamic inhibition of the gonadal axis was more frequent in the girls with secondary amenorrhea, whereas a hyperandrogenic hormonal pattern as a feature of polycystic ovary syndrome was more common in the oligomenorrheic girls. Different types of eating disorders were diagnosed in 68% of the amenorrheic girls and in 38% of the oligomenorrheic girls. CONCLUSIONS: We found hypothalamic amenorrhea and hyperandrogenism to be frequent endocrine mechanisms of menstrual disorders in teenagers. Concomitant eating disorder was highly frequent and secondary amenorrhea was associated with anorectic behavior. It is important to evaluate endocrine patterns and eating behavior in adolescents with menstrual disturbances to ensure adequate medical care and treatment.