RESUMO
Objective: To investigate the effects of eating and emotions on reproductive axis function in patients with functional hypothalamic amenorrhea (FHA).Methods: A retrospective cohort study was conducted to summarize the clinical and endocrine characteristics of 58 patients with FHA at initial diagnosis and to follow up the recovery of ovulation and spontaneous menstruation in the patients to investigate these biochemical indicators and their effects on recovery outcomes.Results: Among patients with FHA, 13.8% (8/58) and 15.5% (9/58) had above moderately severe depressive and severe anxiety symptoms respectively, and 25.9% (15/58) were at high risk for eating disorders. 34.5% (20/58) were included assessed as having recovered. The non-recovered group had higher scores on the Patient Health Questionnaire (PHQ-9) (p = .022) and higher scores on the Eating Attitude Test-26 (EAT-26) (p = .03) as well as bulimia and food preoccupation (p = .041). Follicle diameter >5 mm at initial diagnosis was an independent factor influencing recovery of reproductive axis function (odds ratio = 7.532; 95% confidence interval, 1.321-42.930; p = .023).Conculsions: Mood disorders and a certain risk of eating disorders were present in FHA.These, together with weight loss, endocrine and follicle size, could influence the outcome.
Assuntos
Amenorreia , Doenças Hipotalâmicas , Humanos , Feminino , Amenorreia/fisiopatologia , Amenorreia/psicologia , Adulto , Estudos Retrospectivos , Doenças Hipotalâmicas/fisiopatologia , Doenças Hipotalâmicas/complicações , Doenças Hipotalâmicas/psicologia , Adulto Jovem , Emoções/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Depressão/psicologia , Depressão/fisiopatologia , Ansiedade/fisiopatologia , Ansiedade/psicologia , Ingestão de Alimentos/psicologia , Ingestão de Alimentos/fisiologia , AdolescenteRESUMO
Functional hypothalamic amenorrhoea (FHA) can occur due to the independent or combined effects of psychogenic and energetic stressors. In exercising women, research has primarily focused on energy deficiency as the cause of FHA while psychological stressors have been ignored. To assess both psychological and metabolic factors associated with FHA in exercising women, we performed across-sectional comparison of 61 exercising women (≥2 hours/week, age 18-35 years, BMI 16-25kg/m2), who were eumenorrheic or amenorrhoeic confirmed by daily urine samples assayed for reproductive hormone metabolites. Psychological factors and eating behaviours were assessed by self-report questionnaires. Exercising women with FHA had lower resting metabolic rate (p=0.023), T3 (p<0.001), T4 (p=0.013), leptin (p=0.002), higher peptide YY (p<0.001), greater drive for thinness (p=0.017), greater dietary cognitive restraint (p<0.001), and displayed dysfunctional attitudes, i.e., need for social approval (p=0.047) compared to eumenorrheic women. Amenorrhoeic women displayed asignificant positive correlation between the need for social approval and drive for thinness with indicators of stress, depression, and mood, which was not apparent in eumenorrheic women. In exercising women with FHA, eating behaviours are positively related to indicators of psychological stress and depression.
Assuntos
Amenorreia/metabolismo , Amenorreia/psicologia , Exercício Físico/psicologia , Comportamento Alimentar/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/metabolismo , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Estresse Psicológico , Adolescente , Adulto , Amenorreia/fisiopatologia , Metabolismo Basal , Índice de Massa Corporal , Estudos Transversais , Depressão/psicologia , Dieta , Exercício Físico/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Feminino , Humanos , Hipotálamo/fisiologia , Ciclo Menstrual , Magreza/psicologia , Adulto JovemRESUMO
OBJECTIVE: To determine the aetiological factors of amenorrhea. METHODS: The pilot cross-sectional study was conducted in Government Naserullah Khan Babar Memorial Hospital, Peshawar, Pakistan, from January 2015 to December 2017, and comprised amenorrhea cases. Cases were analysed according to their clinical profile, ultrasound findings and biochemical tests. Data was analysed using SPSS 20. RESULTS: There were 100 patients with a mean age of 22.17±5.52 years (range: 14-36 years). Anatomical defects were the most common cause in 60(60%) patients. Imperforate hymen and transverse vaginal septum were found in 7(7%), 7(7%) patients each, while mullerian abnormalities were found in 46(46%) patients. Hypergonadotropic hypogonadism and polycystic ovarian syndrome were found in 17(17%) patients each. CONCLUSIONS: Anatomical defects were found to be the most common cause among amenorrhea patients.
Assuntos
Amenorreia , Genitália Feminina/diagnóstico por imagem , Hipogonadismo , Síndrome do Ovário Policístico , Anormalidades Urogenitais , Adolescente , Adulto , Amenorreia/diagnóstico , Amenorreia/epidemiologia , Amenorreia/etiologia , Amenorreia/psicologia , Estudos Transversais , Feminino , Ginecologia/métodos , Humanos , Hipogonadismo/complicações , Hipogonadismo/diagnóstico , Hipogonadismo/epidemiologia , Paquistão/epidemiologia , Papel do Médico , Projetos Piloto , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/diagnóstico , Síndrome do Ovário Policístico/epidemiologia , Sistemas de Apoio Psicossocial , Centros de Atenção Terciária , Anormalidades Urogenitais/classificação , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/diagnóstico , Anormalidades Urogenitais/epidemiologiaRESUMO
Energy deficiency in exercising women can lead to physiological consequences. No gold standard exists to accurately estimate energy deficiency, but measured-to-predicted resting metabolic rate (RMR) ratio has been used to categorize women as energy deficient. The purpose of the study was to (a) evaluate the accuracy of RMR prediction methods, (b) determine the relationships with physiological consequences of energy deficiency, and (c) evaluate ratio thresholds in a cross-sectional comparison of ovulatory, amenorrheic, or subclinical menstrual disturbances in exercising women (n = 217). Dual-energy X-ray absorptiometry (DXA) and indirect calorimetry provided data on anthropometrics and energy expenditure. Harris-Benedict, DXA, and Cunningham (1980 and 1991) equations were used to estimate RMR and RMR ratio. Group differences were assessed (analysis of variance and Kruskal-Wallis tests); logistic regression and Spearman correlations related ratios with consequences of energy deficiency (i.e., low total triiodothyronine; TT3). Sensitivity and specificity calculations evaluated ratio thresholds. Amenorrheic women had lower RMR (p < .05), DXA ratio (p < .01), Cunningham1980 (p < .05) and Cunningham1991 (p < .05) ratio, and TT3 (p < .01) compared with the ovulatory group. Each prediction equation overestimated measured RMR (p < .001), but predicted (p < .001) and positively correlated with TT3 (r = .329-.453). A 0.90 ratio threshold yielded highest sensitivity for Cunningham1980 (0.90) and Harris-Benedict (0.87) methods, but a higher ratio threshold was best for DXA (0.94) and Cunningham1991 (0.92) methods to yield a sensitivity of 0.80. In conclusion, each ratio predicted and correlated with TT3, supporting the use of RMR ratio as an alternative assessment of energetic status in exercising women. However, a 0.90 ratio cutoff is not universal across RMR estimation methods.
Assuntos
Metabolismo Basal , Exercício Físico/fisiologia , Deficiência Energética Relativa no Esporte/fisiopatologia , Absorciometria de Fóton , Adolescente , Adulto , Amenorreia/fisiopatologia , Amenorreia/psicologia , Biomarcadores/sangue , Índice de Massa Corporal , Calorimetria Indireta , Estudos Transversais , Metabolismo Energético , Exercício Físico/psicologia , Feminino , Humanos , Distúrbios Menstruais/fisiopatologia , Distúrbios Menstruais/psicologia , Ovulação , Tri-Iodotironina/sangue , Adulto JovemRESUMO
BACKGROUND: Disorders of sex development (DSD) affect the quality of life of people who live with this condition. In developing countries, diagnoses of DSD are associated with a delay in presentation until the patients developed ambiguous physical traits and features. PURPOSE: This study explores the menstrual experiences of people with DSD and sex reassignment in Nigeria. METHODS: A qualitative approach with a phenomenological study design was employed in this study to explore and describe the experiences of people with DSD at the Usmanu Danfodiyo University Teaching Hospital in Sokoto, Nigeria. The data were collected using face-to-face interviews, transcribed verbatim, and analyzed using NVivo software. RESULTS: The findings show that the participants experienced menstrual problems: men with menstruation and women with amenorrhea. The female participants generally described amenorrhea as a disappointment and linked menstruation with womanhood. Amenorrhea evinced both emotional and psychological effects. However, some of the female participants considered amenorrhea in a positive light and were happy with their lives without menstruation. The menstrual experiences of male participants included menarche, lower abdominal pain, regular monthly bleeding, and ovulation. The male participants described menstruation as a disaster in their lives and a source of anxiety, suicidal ideation, and depression. Menstruation negatively affected their psychosocial well-being. CONCLUSIONS: The menstrual experience of individuals with DSD negatively affects their quality of life. The women with DSD in this study showed a generally poor knowledge of menarche, menstruation, and puberty, indicating that their parents had ignored the initial symptoms of DSD. DSD were only recognized at puberty because of the development of ambiguous physical traits and of the onset of menstruation in men and the confirmation of amenorrhea in women.
Assuntos
Amenorreia/etiologia , Transtornos do Desenvolvimento Sexual/complicações , Distúrbios Menstruais/etiologia , Qualidade de Vida/psicologia , Adolescente , Adulto , Amenorreia/epidemiologia , Amenorreia/psicologia , Criança , Transtornos do Desenvolvimento Sexual/epidemiologia , Transtornos do Desenvolvimento Sexual/psicologia , Feminino , Humanos , Entrevistas como Assunto/métodos , Masculino , Distúrbios Menstruais/epidemiologia , Distúrbios Menstruais/psicologia , Nigéria/epidemiologia , Pesquisa QualitativaRESUMO
OBJECTIVES: To study the psychic self-representations and experiences of menstrual blood in women and their impact on the choice of a contraceptive method, with or without amenorrhea. METHODS: Qualitative study based on semi-structured interviews with French women over age 18, under contraception. RESULTS: Twenty-three interviews were conducted with women of various ages and socio-economic classes. Three themes have been studied: the menarche experience, the representation and experience of menstrual blood, and the representation and experience of amenorrhea induced by contraception. Menarche has been a negative experience for most of them, and menarche is known to influence menstrual self-representation. About menstrual bleeding, two profiles of women could be described. Those with a positive self-representation of menstrual blood considered it necessary for the purification of their bodies as well as for procreation and were reluctant to the idea of amenorrhea induced by their contraception. Those with a negative representation of menstrual blood considered it as a source of physical and mental suffering and accepted the idea of having amenorrhea induced by their contraception, amenorrhea being considered as a treatment or a release. CONCLUSION: The choice of a contraception with or without a induced-amenorrhea seems to be specific to every woman and depends on there self-psychic representation of menstrual blood, independently from their socio-economic class. The results of this study highlighted the effect of women's psychic representations and experience of menstrual blood on their contraceptive choice.
Assuntos
Anticoncepção/métodos , Anticoncepção/psicologia , Menstruação/psicologia , Adolescente , Adulto , Amenorreia/etiologia , Amenorreia/psicologia , Sangue , Comportamento de Escolha , Feminino , França , Humanos , Menarca/psicologia , Pessoa de Meia-IdadeRESUMO
An 18-year-old virginal woman was referred to the reproductive endocrinology clinic with primary amenorrhoea and secondary sexual development in the absence of pelvic pain. Additionally, she had significant congenital sensorineural hearing loss, autism, bipolar disorder and class III obesity. On physical examination, secondary sexual development was confirmed (Tanner 5 breasts and Tanner 4 pubic hair). She refused further pelvic examination following prior attempts by the referring physicians. Serum leutinizing hormone (LH), follicle sitmulating hormone (FSH). prolactin, estradiol and total testosterone values were within normal limits. Karyotype was 46,XX. MRI demonstrated complete uterine agenesis, short vagina, sacral dysgenesis with complete absence of the coccyx and a horseshoe kidney. Diagnosis of Mayer-Rokitansky-Küster-Hauser Syndrome type 2 was established based on clinical, laboratory and MRI findings. The patient and family were counselled regarding the disease process, techniques for vaginal elongation, sexual activity and future reproductive options.
Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/diagnóstico , Amenorreia/etiologia , Anormalidades Congênitas/diagnóstico , Aconselhamento , Ductos Paramesonéfricos/anormalidades , Vagina/diagnóstico por imagem , Transtornos 46, XX do Desenvolvimento Sexual/psicologia , Adolescente , Amenorreia/congênito , Amenorreia/psicologia , Anormalidades Congênitas/psicologia , Feminino , Humanos , Cariotipagem , Vagina/anormalidades , Conduta ExpectanteRESUMO
OBJECTIVE: To determine the threshold of total body and trunk fat mass required for menstrual recovery and to assess the impact of body composition in psychopathology of adolescents with Anorexia Nervosa (AN). METHODS: Prospective study of 60 adolescents presented with secondary amenorrhea and diagnosed with AN. Anthropometrics, body composition by dual-energy X-ray absorptiometry, hormonal studies and responses to mental health screens (EAT-26), were obtained at the beginning and at complete weight restoration, in all adolescents, independently of menstrual recovery (Group A) or not (Group B). RESULTS: At weight restoration, Group A total body fat mass, trunk fat mass, and trunk/extremities fat ratio were significantly higher (p < .001) than Group B. Menstruation was expected in 20% of total body fat mass and 20% of trunk fat mass (% of total trunk tissue). At time of menstrual recovery, total body fat mass (%) and trunk fat mass (%) were significantly negatively correlated with EAT-26 (r = -0.363, p = .032) and (r = -0.416, p = .013), respectively, while an increase of 0.40% of trunk fat mass (%) lowers EAT-26 by one unit. DISCUSSION: Trunk fat mass distribution can positively influence psychopathology of adolescents with AN.
Assuntos
Tecido Adiposo/patologia , Anorexia Nervosa/etiologia , Anorexia Nervosa/metabolismo , Anorexia Nervosa/psicologia , Distribuição da Gordura Corporal , Hormônios/sangue , Ciclo Menstrual/fisiologia , Adolescente , Amenorreia/diagnóstico , Amenorreia/etiologia , Amenorreia/metabolismo , Amenorreia/psicologia , Composição Corporal/fisiologia , Criança , Feminino , Humanos , Psicologia do Adolescente , Psicopatologia , Recuperação de Função Fisiológica , Tórax , Adulto JovemRESUMO
OBJECTIVE: Both estrogen and exercise may have cognition enhancing benefits; however, young oligomenorrheic/amenorrheic athletes (OA) with estrogen deficiency have not been evaluated for cognitive deficits. Our objective was to determine whether 6 months of estrogen replacement will impact cognitive domains in OA. We hypothesized that estrogen replacement would improve verbal memory and executive control in OA. METHODS: We performed cognitive assessments at baseline and after 6 months in 48 OA (14-25 years) randomized to estrogen (EST+) (oral 30 µg ethinyl estradiol [n = 16] or transdermal 100 µg 17-ß-estradiol patch [n = 13]) or no estrogen (EST-) (n = 19) in an ongoing clinical trial. Neurocognitive testing included California Verbal Learning Test-Second Edition (CVLT-II) (for verbal memory) and Delis-Kaplan Executive Function System Color-Word Interference Test (D-KEFS-CWIT) (executive control). RESULTS: On average, subjects (mean ± SEM age: 19.9 ± 3.1 years, body mass index: 20.6 ± 2.3 kg/m²) participated in 10.3 ± 5.9 hours per week of weight-bearing activities of their lower limbs. The EST+ group performed better for CVLT-II verbal memory scores for immediate recall over 6 months of therapy compared to EST- (P < .05) even after controlling for baseline scores and age. Changes in D-KEFS-CWIT scores over 6 months did not differ between the groups. However, the EST+ group had greater improvements in inhibition-switching completion time over 6 months compared with the EST- group after controlling for baseline scores and age (P = .01). CONCLUSIONS: OA show improvements in verbal memory and executive control following 6 months of estrogen replacement. These findings in athletes, who are in their prime of neurocognitive development, underscore the need for future studies exploring cognition in OA. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00946192.
Assuntos
Amenorreia/tratamento farmacológico , Amenorreia/psicologia , Atletas , Terapia de Reposição de Estrogênios , Função Executiva/efeitos dos fármacos , Rememoração Mental/efeitos dos fármacos , Oligomenorreia/tratamento farmacológico , Oligomenorreia/psicologia , Aprendizagem Verbal/efeitos dos fármacos , Administração Cutânea , Administração Oral , Adolescente , Feminino , Seguimentos , Humanos , Testes Neuropsicológicos , Adulto JovemRESUMO
Inducing lactation in the absence of pregnancy (nonpuerperal lactation) is not always successful and, in many cases, only partial breastfeeding is achieved. Different protocols have been described, but scientific evidence and research are lacking in this area. The authors describe the case of a woman with a history of a miscarriage, for whom the lactation induction process was so effective that she became a milk donor even before she received her adopted child. She had not previously used hormone treatment. She was given domperidone as a galactogogue for 1 month. The pumping protocol began with a double electric breast pump combined with manual pumping 6 months before her child was delivered, and 3 months later, she was accepted as a donor by our milk bank. This highlights the importance of regular stimulation as a milk production mechanism. This is the first case of human milk donation in an adoptive mother described in the literature.
Assuntos
Adoção/psicologia , Amenorreia/patologia , Galactorreia/patologia , Leite Humano/metabolismo , Mães/psicologia , Doadores de Tecidos/psicologia , Adulto , Amenorreia/psicologia , Aleitamento Materno/métodos , Aleitamento Materno/psicologia , Feminino , Galactorreia/psicologia , Humanos , Infertilidade/etiologia , Lactação/metabolismo , Lactação/fisiologiaRESUMO
OBJECTIVE: DSM-5 revised the diagnostic criteria for anorexia nervosa (AN) by eliminating the amenorrhea requirement, liberalizing weight and psychological criteria, and adding the formal diagnosis of "atypical AN" for individuals with AN psychological symptoms without low weight. We sought to determine whether bone density (BMD) is impaired in women diagnosed with AN using the new, more liberal, DSM-5 criteria. METHOD: Cross-sectional study of 168 women, 18 - 45y: (1) AN by DSM-IV (DSM-IV AN) (n = 37), (2) AN by DSM-5 but not DSM-IV criteria (DSM-5 AN) (n = 33), (3) atypical AN (ATYPICAL AN) (n = 77), (4) healthy comparison group (HC) (n = 21). Measurements included dual energy X-ray absorptiometry, Eating Disorder Examination-Questionnaire, Eating Disorder Inventory-2, Hamilton Depression and Anxiety Rating Scales. RESULTS: BMD Z-score <-1.0 was present in 78% of DSM-IV, 82% of DSM-5, and 69% of ATYPICAL. Mean Z-scores were comparably low in DSM-IV and DSM-5, intermediate in ATYPICAL, and highest in HC. Lack of prior low weight or amenorrhea was, but history of overweight/obesity was not, protective against bone loss. Mean lean mass and percent fat mass were significantly lower in all AN groups than HC. DSM-IV, DSM-5, and ATYPICAL had comparable psychopathology. DISCUSSION: Despite liberalizing diagnostic criteria, many women diagnosed with AN and atypical AN using DSM-5 criteria have low BMD. Presence or history of low weight and/or amenorrhea remain important indications for DXA. Loss of lean mass, in addition to fat mass, is present in all AN groups, and may contribute to low BMD. The deleterious effect of eating disorders on BMD extends beyond those with current low weight and amenorrhea. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:343-351).
Assuntos
Anorexia Nervosa/diagnóstico , Ansiedade/diagnóstico , Composição Corporal/fisiologia , Densidade Óssea/fisiologia , Transtorno Depressivo/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Absorciometria de Fóton , Adolescente , Adulto , Amenorreia/fisiopatologia , Amenorreia/psicologia , Anorexia Nervosa/fisiopatologia , Anorexia Nervosa/psicologia , Ansiedade/fisiopatologia , Ansiedade/psicologia , Peso Corporal , Estudos Transversais , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Adulto JovemRESUMO
PURPOSE: The purpose of this study was to determine whether a history of overweight, weight suppression, and weight gain during treatment have an effect on return of menses (ROM) in adolescents with eating disorders (EDs). METHODS: Retrospective chart review of female adolescents presenting to an ED program from January 2007 to June 2009. RESULTS: One hundred sixty-three participants (mean age, 16.6 ± 2.1 years) met eligibility criteria. The mean median body mass index percent at ROM for those previously overweight was 106.1 ± 11.7 versus 94.2 ± 8.9 for those not previously overweight (p < .001). Both groups needed to gain weight for ROM. Greater weight suppression (odds ratio, 0.90; 95% confidence interval, 0.84-0.98; p = .013) was associated with lower likelihood of ROM, and greater weight gain during treatment (odds ratio, 1.20; 95% confidence interval, 1.07-1.36; p = .002) was associated with higher likelihood of ROM in those not previously overweight. CONCLUSIONS: Previously overweight amenorrheic patients with EDs needed to be at a higher median body mass index percent for ROM compared to those who were not previously overweight.
Assuntos
Amenorreia/etiologia , Índice de Massa Corporal , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Sobrepeso/complicações , Adolescente , Amenorreia/psicologia , Amenorreia/terapia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Humanos , Sobrepeso/psicologia , Estudos Retrospectivos , Aumento de Peso/fisiologia , Redução de Peso/fisiologiaRESUMO
OBJECTIVES: To obtain more precise and detailed information regarding the bleeding patterns of nomegestrol acetate (NOMAC)/17ß-estradiol (E2) and drospirenone/ethinyl estradiol (DRSP/EE) and to identify whether baseline demographic characteristics were associated with unscheduled bleeding, absent scheduled bleeding, or amenorrhea. STUDY DESIGN: This analysis pooled results from two pivotal open-label, randomized trials that compared bleeding patterns of NOMAC/E2 and DRSP/EE. In the two studies 4317 women aged 18-50 years from 24 countries across the Americas, Europe, and Asia underwent treatment. RESULTS: 2835 women taking NOMAC/E2 (2.5 mg/1.5 mg) in a 24/4-day regimen and 938 women taking DRSP/EE (3 mg/30 µg) in a 21/7-day regimen had at least 1 evaluable cycle for vaginal bleeding analyses. The frequency of absent scheduled bleeding was higher (p<.0001) for women using NOMAC/E2 than DRSP/EE across all 11 cycles (cycles 2-12), ranging between 17.6% and 31.6% and between 3.4% and 5.8%, respectively. For women who had absent scheduled bleeding in cycles 2, 3, or 4 the incidence of absent scheduled bleeding in subsequent cycles was high and ranged between approximately 50%-60% for NOMAC/E2 and approximately 40%-50% for DRSP/EE. Amenorrhea increased over time with both regimens, being higher with NOMAC/E2. Both absent scheduled bleeding and amenorrhea with NOMAC/E2 were more common in older women, overweight women, switchers, and smokers; unscheduled bleeding was more common in starters, but had no association with age, body mass index, and smoking. CONCLUSIONS: NOMAC/E2 is associated with a higher prevalence of absent scheduled bleeding compared with DRSP/EE. Absent scheduled bleeding and amenorrhea were associated with age, body weight, switching and smoking. Unscheduled bleeding was more common in starters. IMPLICATIONS: Information about the factors associated with bleeding patterns may help clinicians provide guidance to women considering use of the NOMAC/E2 oral contraceptive.
Assuntos
Amenorreia/induzido quimicamente , Androstenos/efeitos adversos , Anticoncepcionais Orais Combinados/efeitos adversos , Estradiol/efeitos adversos , Etinilestradiol/efeitos adversos , Megestrol/efeitos adversos , Metrorragia/induzido quimicamente , Norpregnadienos/efeitos adversos , Adolescente , Adulto , Amenorreia/psicologia , Estrogênios , Feminino , Humanos , Ciclo Menstrual , Metrorragia/psicologia , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVE: The goal of the study was to examine differences between adolescents and young women with functional hypothalamic amenorrhea (FHA) and control groups in personality traits, eating attitudes and behaviours, and perception of parental behaviour. BACKGROUND: The FHA is stress-induced anovulation, both related to metabolic challenges, such as excessive exercise and malnutrition, and psychogenic challenges, such as perfectionism and poor coping strategies. METHODS: Three groups of adolescents and young women participated in the study: the FHA group (N = 25), the organic anovulation group (N = 21) and the eumenorrheic group with regular menstrual cycle (N = 20). Questionnaires on multidimensional perfectionism, self-control methods, eating attitudes and behaviours and perception of parental behaviour were administered. A clinical interview (SCID) was conducted with each participant. RESULTS: The FHA group had higher levels of perfectionism traits, i.e. higher levels of concerns over mistakes and personal standards, compared to control groups. The FHA group did not engage in disordered eating behaviours more often in comparison with control groups, but reported more prevalent history of anorexia nervosa. The FHA group did not differ from controls in perception of parental rejection, emotional warmth or overprotection. CONCLUSION: The findings suggest that FHA can be characterised by the subtle psychological differences in personality traits, so the patients need to be diagnosed carefully.
Assuntos
Amenorreia/fisiopatologia , Amenorreia/psicologia , Atitude , Doenças Hipotalâmicas/fisiopatologia , Autocontrole , Adulto , Anorexia Nervosa/psicologia , Índice de Massa Corporal , Escalas de Graduação Psiquiátrica Breve , Feminino , Humanos , Determinação da Personalidade , Inquéritos e Questionários , Adulto JovemRESUMO
Individuals under chronic psychological stress can be difficult to identify clinically. There is often no outwardly visible phenotype. Chronic stress of sufficient magnitude not only impacts reproductive function, but also concomitantly elicits a constellation of neuroendocrine changes that may accelerate aging in general and brain aging in particular. Functional hypothalamic amenorrhea, a phenotypically recognizable form of stress, is due to stress-induced suppression of endogenous gonadotropin-releasing hormone secretion. Reversal of functional hypothalamic amenorrhea includes restoration of ovulatory ovarian function and fertility and amelioration of hypercortisolism and hypothyroidism. Taken together, recovery from functional hypothalamic amenorrhea putatively offers neuroprotection and ameliorates stress-induced premature brain aging and possibly syndromic Alzheimer's disease. Amenorrhea may be viewed as a sentinel indicator of stress. Hypothalamic hypogonadism is less clinically evident in men and the diagnosis is difficult to establish. Whether there are other sex differences in the impact of stress on brain aging remains to be better investigated, but it is likely that both low estradiol from stress-induced anovulation and low testosterone from stress-induced hypogonadism compromise brain health.
Assuntos
Amenorreia/psicologia , Anovulação/psicologia , Hipogonadismo/psicologia , Menstruação/psicologia , Neuroproteção/fisiologia , Caracteres Sexuais , Estresse Psicológico/psicologia , Envelhecimento/psicologia , Estradiol/sangue , Feminino , Humanos , Hipogonadismo/diagnóstico , Masculino , Doenças Neurodegenerativas/patologia , Doenças Neurodegenerativas/psicologia , Estresse Psicológico/diagnóstico , Testosterona/sangueRESUMO
Functional hypothalamic amenorrhea is a diagnosis of exclusion that is common in female athletes, particularly those participating in aesthetic sports (ballet, other dance genres, figure skating, and gymnastics) and endurance sports (cross-country running). Although common, it should be considered abnormal even in the high-level elite athlete. Amenorrhea in combination with low energy availability and low bone density is labeled "the Female Athlete Triad." Studies have demonstrated numerous long-term consequences of athletes suffering from all or a portion of this triad, including increased rate of musculoskeletal injuries, stress fractures, abnormal lipid profiles, endothelial dysfunction, potential irreversible bone loss, depression, anxiety, low self- esteem, and increased mortality. This article provides the clinician with the tools to evaluate an athlete with secondary amenorrhea, reviews the recommended treatment options for affected athletes, and discusses when to return to the activity in an effort to facilitate "healthy" participation.
Assuntos
Amenorreia/etiologia , Síndrome da Tríade da Mulher Atleta , Esportes/fisiologia , Adolescente , Amenorreia/diagnóstico , Amenorreia/psicologia , Amenorreia/terapia , Terapia Combinada , Feminino , Síndrome da Tríade da Mulher Atleta/diagnóstico , Síndrome da Tríade da Mulher Atleta/etiologia , Síndrome da Tríade da Mulher Atleta/psicologia , Síndrome da Tríade da Mulher Atleta/terapia , Humanos , Volta ao Esporte , Esportes/psicologiaRESUMO
OBJECTIVES: Our aim was to assess the level of inconvenience associated with monthly bleeding, determine how many women would prefer a bleeding frequency of less than once a month, and what would motivate their choice. METHODS: A 15-min quantitative online survey was carried out among 2883 women aged between 18 and 45 years in six European countries (Austria, Belgium, France, Italy, Poland and Spain). RESULTS: Of those surveyed, 1319 women used a combined hormonal contraceptive (CHC group) and 1564 used a non-hormonal contraceptive or no contraceptive (non-HC group). The menstrual period was significantly longer (5 vs. 4.5 days), heavier (16% vs. 8% heavy menstrual flow) and associated with more symptoms (6.1 vs. 5.6) in non-HC users than in CHC users (p < 0.0001). More than half of the women in each group reported pelvic pain, bloating/swelling, mood swings and irritability, but the rate was significantly higher in the non-HC group. Given the choice, 57% of women in both groups said they would opt for longer intervals between periods. Sexuality, social life, work and sporting activities were key factors affecting their decision. CONCLUSIONS: The majority of women would prefer to have menstrual periods less than once a month, with a frequency ranging from once every 3 months to no periods at all. This can be explained by the desire to avoid the unpleasant aspects of menstruation and its negative impact on private and professional life.
Assuntos
Amenorreia/psicologia , Distúrbios Menstruais/psicologia , Menstruação/fisiologia , Menstruação/psicologia , Preferência do Paciente/psicologia , Adolescente , Adulto , Anticoncepção/efeitos adversos , Anticoncepção/métodos , Anticoncepcionais/efeitos adversos , Anticoncepcionais Orais Hormonais/efeitos adversos , Emoções , Europa (Continente)/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Distúrbios Menstruais/epidemiologia , Pessoa de Meia-Idade , Tempo , Saúde da Mulher , Adulto JovemAssuntos
Amenorreia/psicologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Cooperação do Paciente/psicologia , Tamoxifeno/uso terapêutico , Adulto , Amenorreia/induzido quimicamente , Neoplasias da Mama/patologia , Neoplasias da Mama/psicologia , Feminino , Humanos , Ovário/efeitos dos fármacos , Receptor ErbB-2/análiseRESUMO
PURPOSE OF REVIEW: We provide an overview of new insights into the genetic causes of primary ovarian insufficiency (POI) and address the challenges faced by clinicians who care for adolescents with this condition. RECENT FINDINGS: In most cases, the cause of POI remains a mystery after appropriate clinical testing has been completed. Large-scale genomic sequencing approaches are uncovering new mechanisms underlying the disorder. Gene variants that affect the normal processes of primordial germ-cell proliferation and migration, oocyte meiosis, and ovarian follicle formation/activation are plausible mechanisms. Whole exome sequencing has been used to associate many of these variants with human POI. POI is a serious chronic condition with no cure. It qualifies as a rare disease and as such presents special challenges to patients, parents, and clinicians. Although the diagnosis of POI is often delayed because of the assumption that irregular menses are common among adolescents, early detection is critical for the maintenance of bone and cardiovascular health. Treatment options have focused on hormonal therapy and fertility preservation. However, many studies prove the increasing need to incorporate mental health support and a family systems approach into the management plan. SUMMARY: Large-scale genomic sequencing has recently identified new mechanisms of POI. However, at present this testing is not clinically indicated as routine. Practice will change as genomic medicine is integrated into standard care. Adolescents with POI are best served by an integrated personal care approach centered on the patient and provided by a primary care clinician who has support from a multidisciplinary team.
Assuntos
Amenorreia/etiologia , Terapia de Reposição de Estrogênios/métodos , Preservação da Fertilidade/métodos , Infertilidade Feminina/etiologia , Insuficiência Ovariana Primária/diagnóstico , Adolescente , Amenorreia/psicologia , Diagnóstico Precoce , Feminino , Preservação da Fertilidade/psicologia , Proteína do X Frágil da Deficiência Intelectual , Aconselhamento Genético , Humanos , Infertilidade Feminina/psicologia , Pais , Insuficiência Ovariana Primária/psicologia , Insuficiência Ovariana Primária/terapiaRESUMO
OBJECTIVES: Disordered eating may negatively impact bone in athletes. However, it is not known whether this effect is independent of the associated amenorrhea and relative hypercortisolemia. We aimed to compare attitudes, feelings, and cognitions associated with disordered eating using the Three-Factor Eating Questionnaire (TFEQ) and Eating Disorder Inventory-2 (EDI-2) in normal-weight oligomenorrheic athletes (OA), eumenorrheic athletes (EA), and nonathletes, and determine the associations with bone independent of confounders. METHOD: 109 OA, 39 EA, and 36 nonathletes (14-25 years) completed the TFEQ and EDI-2. Dual-energy X-ray absorptiometry was used to assess spine bone mineral density (BMD), and high-resolution pQCT to assess radius microarchitecture. We measured integrated cortisol (q 20', 11 PM-7 AM), bone formation (procollagen Type 1 N-terminal propeptide, P1NP), and resorption (C-telopeptide, CTX) markers in a subset. RESULTS: OA had lower spine BMD Z-scores than EA. Cognitive eating restraint (CER), drive for thinness (DT), ineffectiveness, and interoceptive awareness (IA) were higher in OA than EA (p < 0.05); CER was higher in OA versus nonathletes (p = 0.03). Pulsatile cortisol was positively associated with DT, ineffectiveness, and IA (p < 0.03). CER was inversely associated with BMD Z-scores and P1NP, and ineffectiveness with radius cross-sectional area even after controlling for age, BMI, amenorrhea duration, and cortisol (p < 0.03). DISCUSSION: Higher CER in athletes independently predicts lower BMD.