A herbal treatment approach for the management of clinical, hormonal and ultrasound parameters in reproductive age group women with polycystic ovarian syndrome: A randomized clinical trial.

Around fifteen percent women of reproductive age have been effected by Polycystic Ovarian Syndrome (PCOS); a complicated disorder; and apparently there is no standard therapy available. Considering this lack, we design present work; for the assessment of a herbal medicine (Femitex-SP4) in managing PCOs. During 2016-17; this study was carried out at Abbasi Shaheed hospital, Karachi, Pakistan. A total of 150 patients aged between 18-44 years were included as per Rotterdam criteria. Patients received 500 mg of powdered herbs in capsule form twice daily. The primary outcomes were regular menstruation and ovulation plus change in fasting blood sugar levels. Changes in free testosterone levels and ovarian morphology was secondary outcome measures. Continuous outcomes before and after treatment were compared by Student's t-test (one tailed, independent). P = 0.05 was considered as significant. Women menstrual cycle was considerably improved. Fasting blood sugar levels did not change (p=0.103392). Progesterone levels were same at the starting point and after treatment (P=0.318322). With complete recovery in 6 patients; a notable change was found in ovarian size. Free testosterone levels were also dropped significantly (p<0.00001). Our main success was drastic improvement in normalizing menstrual cycle during therapy. Herbal treatment is proven to be clinically effective in most of the patients; particularly PCOs patients with menstrual irregularities. Hence, Femitex-SP4 can be taken as a better treatment for PCOs.

Dietary Supplementation of Lauric Acid Alleviates the Irregular Estrous Cycle and the Impaired Metabolism and Thermogenesis in Female Mice Fed with High-Fat Diet (HFD).

Lauric acid (LA) has been implicated in the prevention/treatment of obesity. However, the role of LA in modulating an obesity-related female reproductive disorder remains largely unknown. Here, female mice were fed a control diet, high-fat diet (HFD), or HFD supplemented with 1% LA. The results demonstrated that the HFD-induced estrous cycle irregularity and the reduction of serum follicle-stimulating hormone (FSH) were alleviated by LA supplementation. In possible mechanisms, LA supplementation led to significant increase in serum lipid metabolites such as sphingomyelin and lysophosphatidylcholine containing LA (C12:0) and the improvement of glucose metabolism in mice fed HFD. Moreover, impaired body energy metabolism and weakened brown adipose tissue (BAT) thermogenesis of HFD-fed mice were improved by LA supplementation. Together, these findings showed that LA supplementation alleviated HFD-induced estrous cycle irregularity, possibly associated with altered serum lipid metabolites, improved glucose metabolism, body energy metabolism, and BAT thermogenesis. These findings suggested the potential application of LA in alleviating obesity and its related reproductive disorders.

Crosstalk between gonadotropins and thyroid axis.

Gonadotropins and thyroid hormones are essential, respectively, for reproduction and metabolism. The classical endocrinological approach is based on the detection of axes that start from the hypothalamus and arrive at the final effector organ, in this case gonads and thyroid. However, several clues suggest that these axes do not work in parallel, but they dialogue with each other. In this article, we review evidences demonstrating crosstalk between gonadotropins and thyroid axis. Firstly, there is an undeniable structural similarity of both hormones and receptors, maybe due to a common ancient origin. This structural similarity leads to possible interaction at the receptor level, explaining the influence of thyroid stimulating hormone on gonadal development and vice versa. Indeed, altered levels of thyroid hormones could lead to different disorders of gonadal development and function throughout entire life, especially during puberty and fertile life. We here report the current knowledge on this item both in males and in females. In particular, we deepen the interaction between thyroid and gonads in two situations in females: polycystic ovary syndrome, the most frequent cause of menstrual alteration, and pregnancy.

Efficacy of acupuncture on menstrual frequency in women with polycystic ovary syndrome: Protocol for a randomized, controlled trial.

BACKGROUND: Acupuncture may improve the menstrual frequency of women with polycystic ovary syndrome (PCOS). However, more sufficient data are needed to improve the efficacy of acupuncture. METHODS: A total of 172 participants diagnosed with PCOS would be randomly assigned to either the acupuncture group or sham-acupuncture group, at a ratio of 1:1. Participants in both groups will receive treatment for 12 weeks, 3 times a week. The primary outcome will be the proportion of participants with at least a 50% increase from baseline in the monthly menstrual frequency from baseline after 12 weeks intervention, while secondary outcomes will be the difference in anthropometrics, serum hormone level, ovarian morphology, anxiety and depression, and quality of life from baseline to after 12 weeks intervention and to 12 weeks postintervention follow-up between groups. DISCUSSION: The aim of this study is to evaluate the efficacy and safety of acupuncture for improving menstrual frequency and other symptoms of patients with PCOS. The limitation of this trial is that it would be difficult to blind the acupuncturists. In addition, these findings may not be suitable for women with PCOS who are seeking pregnancy.

[Considerations about Acupuncture Treatment during Menstruation].

A dispute about whether women are suitable to receive acupuncture treatment in the period of menstruation has existed for many years. There are some reports about acupuncture treatment induced abnormal menstruation in women experiencing menstruation. However, according to long-term clinical practice and current development of acupuncture therapy, the authors of the present paper hold that there are no absolute contradictions for acupuncture treatment of women during menstruation. Additionally, acupuncture induced menstrual disorder has no enough data support of large size example clinical trials. The key points of acupuncture administration for women during menstruation are: (1) reasonable selection of acupoints prescriptions, and (2) appropriate acupuncture needle manipulations, particularly avoiding strong stimulation.

[Artificial cycle therapy of acupuncture and moxibustion for irregular menstruation].

Through the discussion on TCM physiological characters of females in follicular, ovulatory, luteal and menstrual phases and treatment principles, the clinical application of artificial cycle therapy of acupuncture and moxibustion was introduced for irregular menstruation and the typical cases were attached. It is suggested that the menstrual cycle follows the growth-consumption rule of yin, yang, qi and blood. The corresponding treatment principles should be applied in accordance with the change rule of menstrual cycle. Hence, it is worth to adopt the artificial cycle therapy of acupuncture and moxibustion for irregular menstruation in clinical application.

A randomized trial of Chinese medicine Lirukang Granule combined with psychological intervention for cyclomastopathy and menoxenia.

OBJECTIVE: To observe the influence of therapy with Chinese medicine Lirukang Granule (, LRKG) combined with psychological intervention on anxiety states and sex hormones in patients with cyclomastopathy and menoxenia. METHODS: A total of 470 subjects were randomly assigned to three groups by the net-central randomization system, the treatment group (161 patients, treated with LRKG and psychological intervention), the Chinese medicine group (157 patients, treated with LRKG), and the psychological intervention group (152 patients, treated with psychological intervention). The dose of LRKG was 12 g three times per day; psychological intervention included establishing relations, cognitive intervention and psychological persuasion, 30-40 min per session, once a week. The therapy duration for all groups was three months. The efficacy was compared and anxiety state/State-Trait Anxiety Invertory (STAI) scoring was measured before and after treatment. The serum estradiol (E2), progesterone (P), prolactin (PRL) and follicle stimulating hormone (FSH) levels of 60 patients selected randomly from each group during the luteal phase were measured before and after treatment, and a group of 20 healthy women were evaluated for comparison. A follow-up was arranged for one year after treatment. RESULTS: Thirty subjects were lost to follow-up. (1) Comparison of efficacy: the markedly effective rate and the total effective rate of the treatment group were 86.67% (131/150) and 98.00% (147/150), respectively; of the Chinese medicine group, 64.58% (93/144) and 90.27% (130/144), respectively; and of the psychological intervention group, 0% (0/146) and 3.42% (5/146), respectively. The markedly effective rate and the total effective rate in the treatment group were significantly higher than those in the Chinese medicine and psychological intervention groups (P < 0.05). (2) Comparison of STAI scoring: STAI scoring was decreased dramatically in the treatment group after treatment compared with that of the Chinese medicine group (P < 0.01), but there was no significant difference compared with the psychological intervention group. (3) Comparison of levels of sex hormones: E2, P, PRL and FSH of the three patient groups were disordered before treatment, and significantly different from healthy women (P < 0.01). After treatment, the levels of P and FSH of the treatment group were significantly increased (P < 0.01), E2 and PRL were significantly reduced, which were also significantly decreased compared with the psychological intervention groups (P < 0.01). (4) FOLLOW-UP: the markedly effective rate and the total effective rate of the treatment group remained higher than those of the other two groups after one year of treatment (P < 0.05). (5) Adverse reactions: no obvious adverse reactions were found among the three groups. CONCLUSIONS: Therapy with Chinese medicine combined with psychological intervention was effective for short-term and long-term treatment of cyclomastopathy and menoxenia. The mechanism might be related to the regulation of sex hormones.

Effect of Yoga Nidra on physiological variables in patients of menstrual disturbances of reproductive age group.

Aim of this study was to see any effect on autonomic functions in menstrual disturbances patients after Yoga Nidra practice. The subjects for the study were 150 females with menstrual irregularities, 28.08 +/- 7.43 years of mean age, referred from department of Obstetrics and Gynecology CSMMU, UP, Lucknow. Subjects were divided randomly in to two groups' intervention and in control groups -seventy five (75) in each group. Out of these, one hundred twenty six (126) completed the study protocol. The yogic intervention consisted of 35-40 minutes/day, five days in a week till six months. An autonomic function testing was done in both the groups at zero time and after six months. A significant positive effect was observed when yoga therapy was used as an adjunct in the patients of menstrual disturbances. There were significant improvements in the blood pressure, postural hypotension and sustained hand grip, heart rate expiration inspiration ratio and 30:15 beat ratios of the subjects after yogic practice.

Menstrual psychosis: a bipolar disorder with a link to the hypothalamus.

The literature on menstrual psychosis is briefly reviewed in this article. There are about 80 cases with substantial evidence, and about 200 other possible cases. The clinical features are generally those of manic depressive (bipolar) disorder. The diagnosis requires the accurate dating of the onsets of episodes and of menstrual bleeding. Obtaining a baseline of several carefully dated episodes is also important in finding the best way to arrest the periodic illness. Although conventional psychotropic drugs can shorten episodes, they do not prevent recurrences. For this, unconventional treatments appear to be more effective, especially thyroid hormone and clomiphene. Patients with menstrual psychosis usually have abnormal menstruation, such as anovulatory cycles, luteal defects, or periods of amenorrhea. This, and the occurrence of episodes before the menarche, suggests that the interaction between the bipolar diathesis and menstruation is in the hypothalamus.

Exacerbated attention orienting to auditory stimulation in migraine patients.

OBJECTIVE: To investigate long-term (LTH) and short-term (STH) habituation of auditory event-related potentials (ERPs) during a migraine cycle, using a classic habituation paradigm. METHODS: In 22 patients suffering from menstrually-related migraine and in 20 age-matched control subjects, auditory ERPs were recorded in 3 sessions: in the middle of the menstrual cycle, before menses, and during menses. In 12 patients, a migraine attack occurred during one of the peri-menses sessions. In each session, 200 trains of stimuli were presented, with an average of 10 stimuli per train. RESULTS: In response to the first stimuli of the trains, migraineurs exhibited in all sessions a larger orienting component of N1 than matched controls and a larger P3a in the interictal session, which normalized during attacks. They also showed a residual orienting component in response to the subsequent stimuli inside the trains. In contrast, the sensory component of N1 showed no difference between the two groups, with similar STH and LTH. CONCLUSIONS: Migraineurs show an exacerbated attention orienting to auditory stimulation, without any habituation deficit. SIGNIFICANCE: Previous migraine studies reported interictal habituation deficits of ERPs, but demonstrated in the auditory modality only in paradigms testing intensity dependence. Previous and current results can be interpreted as an increased attention orienting, possibly relying on an abnormal involvement of frontal cortex in auditory processing.

Light exposure, melatonin secretion, and menstrual cycle parameters: an integrative review.

Dysfunction in menstrual physiology has pronounced effects on quality of life, involving mood changes, body image, infertility, and pregnancy complications. Light exposure may affect menstrual cycles and symptoms through the influence of melatonin secretion. The purpose of this systematic review is to determine the current state of knowledge about the effects of light and melatonin secretion on menstrual phase and cycle alterations. A brief overview of the influence of melatonin on human physiology is included. There is evidence of a relationship between light exposure and melatonin secretion and irregular menstrual cycles, menstrual cycle symptoms, and disordered ovarian function. In women with a psychopathology such as bipolar disorder or an endocrinopathy such as polycystic ovary syndrome, there seems to be greater vulnerability to the influence of light-dark exposure. Research on the complex role of light-dark exposure in menstrual physiology has implications for treatment of menstrual-associated disorders.

The hypothalamus-pituitary-ovary axis and type 1 diabetes mellitus: a mini review.

A high prevalence of menstrual cycle and fertility disturbances has long been associated with diabetes mellitus. However, rationalization of the intrinsic mechanisms of these alterations is controversial and even contradictory. This review considers (i) the relationship between diabetes mellitus, especially type 1 diabetes mellitus (T1DM), and the hypothalamus-pituitary-ovary (HPO) axis, (ii) the state of our knowledge concerning neuroendocrine control and its relationship with dopaminergic and opioid tonus, and (iii) the influence of the hypothalamus-pituitary-adrenal axis on ovarian function. Functional disturbances that occur as a consequence of diabetes are also discussed, but some T1DM-related diseases of autoimmune origin, such as oophoritis, are not further analysed. Although there are clear indications of a relationship between menstrual and fertility alterations and glycaemic control, in many instances the improvement of the latter is not sufficient to reverse such alterations. It appears that the oligoamenorrhoea and amenorrhoea associated with T1DM is mainly of hypothalamic origin (i.e. failure of the GnRH pulse generator) and may be reversible. The importance of the evaluation of the HPO axis in T1DM women with menstrual irregularities, even in the presence of adequate metabolic control, is emphasized.

Epilepsy in women.

Epilepsy in women raises special reproductive and general health concerns. Seizure frequency and severity may change at puberty, over the menstrual cycle, with pregnancy, and at menopause. Estrogen is known to increase the risk of seizures, while progesterone has an inhibitory effect. Many antiepileptic drugs induce liver enzymes and decrease oral contraceptive efficacy. Women with epilepsy also have lower fertility rates and are more likely to have anovulatory menstrual cycles, polycystic ovaries, and sexual dysfunction. Irregular menstrual cycles, hirsutism, acne, and obesity should prompt an evaluation for reproductive dysfunction. Children who are born to women with epilepsy are at greater risk of birth defects, in part related to maternal use of antiepileptic drugs. This risk is reduced by using a single antiepileptic drug at the lowest effective dose and by providing preconceptional folic acid supplementation. Breastfeeding is generally thought to be safe for women using antiepileptic medications.

[The perimenopause. Problems and therapeutic changes]. / La perimenopausa. Problematiche e opportunità terapeutiche.

The female life period in which hormonal share begins to drop and the first menopausal clinical symptoms occur, is called perimenopausal period. During this female life phase, frequently, time of regular function and time of ovarian dysfunctions occur, with a limited luteal phase and an estrogen production fall. So, perimenopausal clinical symptoms begin: hot flushes, tiredness and libido decrease; to these problems, others can be connected to inadequate luteal phase, as breast pain, nervousness and body increase. Therefore, it's possible to affirm that the perimenopause is a particularly delicate period, either because it represents a transient moment to climateric phase, or because it's possible to detect a great hormonal instability, fundamental step for clinical problems. In our investigation we discuss this problem, explain the causes and the possible remedies to delay the onset of symptoms or to treat hormonal perimenopausal modifications.

Evolución y pronostico de los trastornos menstruales en la adolescencia / Evolution and prognosis of menstrual disorders in adolescence

Los trastornos menstruales son muy frecuentes en los primeros 5 años de edad ginecológica, evolucionando desde un alto porcentaje de ciclos anovulatorios en el primer año postmenárquica a una mayoría de ciclos ovulatorios a los 6 años de edad ginecológica. Estas irregularidades menstruales pueden corresponder a un proceso de maduración del eje hipotálamo-hipófisis-gonadal, o señalar la aparición de cuadros como el síndrome de ovario poliquístico. Otra gran causa de amenorrea y oligoamenorrea desde la pubertad, es el trastorno funcional hipotalámico, en que excluidos todo otro trastorno endocrino, enfermedad sistémica y cuadro orgánico, una alteración funcional en las neuronas del GNRH produce insuficiencia o disfunción hipotalámica de acuerdo al grado de compromiso de la pulsatilidad del GNRH. Se presenta las características clínicas y evolución de un grupo de pacientes con disfunción hipotalámica diagnosticada en la adolescencia, y reevaluadas en la vida adulta.

Menstrual disturbances are very cycles frecuent during the first 5 years after menarche. High prevalence of anovulatory cycles occur in the first year. In contrast high prevalence of ovulatory cycles occur at 6 years postmenarchal. Menstrual disturbances have been associated with hypothalamic-pituitary-ovarian axis madurative phenomenon or pathology of pubertal root as polycystic ovary syndrome. Hypothalamic dysfunction is other cause of menstrual disturbances when other diseases have been discarded. This condition is caracterized by a alteration of the GNRH pulse generation system. We report the natural history of reproductive and menstrual evolution in women with hypothalamic dysfunction developed in adolescence.

The effects of intense exercise on the female reproductive system.

Women have become increasingly physically active in recent decades. While exercise provides substantial health benefits, intensive exercise is also associated with a unique set of risks for the female athlete. Hypothalamic dysfunction associated with strenuous exercise, and the resulting disturbance of GnRH pulsatility, can result in delayed menarche and disruption of menstrual cyclicity. Specific mechanisms triggering reproductive dysfunction may vary across athletic disciplines. An energy drain incurred by women whose energy expenditure exceeds dietary energy intake appears to be the primary factor effecting GnRH suppression in athletes engaged in sports emphasizing leanness; nutritional restriction may be an important causal factor in the hypoestrogenism observed in these athletes. A distinct hormonal profile characterized by hyperandrogenism rather than hypoestrogenism is associated with athletes engaged in sports emphasizing strength over leanness. Complications associated with suppression of GnRH include infertility and compromised bone density. Failure to attain peak bone mass and bone loss predispose hypoestrogenic athletes to osteopenia and osteoporosis. Metabolic aberrations associated with nutritional insult may be the primary factors effecting low bone density in hypoestrogenic athletes, thus diagnosis should include careful screening for abnormal eating behavior. Increasing caloric intake to offset high energy demand may be sufficient to reverse menstrual dysfunction and stimulate bone accretion. Treatment with exogenous estrogen may help to curb further bone loss in the hypoestrogenic amenorrheic athlete, but may not be sufficient to stimulate bone growth. Treatment aimed at correcting metabolic abnormalities may in fact prove more effective than that aimed at correcting estrogen deficiencies.