Differences in anthropometric and ultrasonographic parameters between adolescent girls with regular and irregular menstrual cycles: a case-study of 835 cases.

STUDY OBJECTIVE: Exploring the relation between the age, time since menarche, anthropometric parameters and the growth of the uterus and ovaries in postmenarcheal girls. DESIGN: Cross sectional. SETTING: Department of Human reproduction at a tertiary pediatric referral center. PARTICIPANTS: Eight hundred thirty-five adolescent girls. INTERVENTIONS: Postmenarcheal girls were classified according to the regularity of their menstrual cycles in 2 groups (regular and irregular cycles) and compared. Anthropometric measurements and ultrasonographic examination of the pelvis was conducted with all participants. MAIN OUTCOME MEASURES: Anthropometric and ultrasonographic parameters were evaluated. RESULTS: Results of our study showed that girls with regular and irregular cycles differed in height, weight, body mass index, percentage of body fat and ovarian volumes. The size of the ovaries decreases in the group of girls with regular cycles (r = 0.14; P < .005), while it increases in girls with irregular cycles (r = 0.15; P < .001) with advancing age. Uterine volume in all patients increases gradually with age reaching consistent values at 16 years (r = 0.5; P < .001). Age at menarche, the time elapsed since menarche, the height, weight, body mass index and percentage of body fat in patients correlated with uterine volume. Ovarian volume correlated with patients' weight, BMI and percentage of fat. CONCLUSION: Uterus continues to grow in postmenarcheal years, with increasing height and weight of girls, regardless of the regularity of cycles. Postmenarcheal girls with irregular cycles were found to have heavier figures and larger ovaries.

Fetal free thyroxine concentrations in pregnant women with autoimmune thyroid disease.

CONTEXT: Fetuses from mothers with autoimmune thyroid disease (AITD) may be affected by antithyroid antibodies, antithyroid drugs, and iodine. OBJECTIVE: The study correlated fetal free T(4) (fT4) with fetal ultrasound parameters and maternal thyroid function, thyroid antibodies, and medication dose from mothers with AITD. DESIGN AND SETTING: The study was designed as a prospective cohort study and conducted in an academic referral center. PATIENTS: Eighty-three of 85 women with AITD completed the study; 38 were treated for hyperthyroidism and 25 for hypothyroidism, and 20 were euthyroid. MAIN OUTCOME MEASURES: Outcomes were as follows: 1) fetal-fT4, TSH, ultrasound parameters (morphology, biometrics, heart rate); and 2) maternal-fT4, TSH, antithyroid drug dose, and antithyroid antibodies, thyroid peroxidase and TSH receptor (TRAK). Parameters were determined at the same time, between the 22nd and 33rd wk gestation. RESULTS: A total of 48.3% of fetuses from hyperthyroid mothers, 60% of fetuses from hypothyroid mothers, and 10% of fetuses from euthyroid mothers had elevated fT4 levels (P = 0.006). In hypothyroid mothers, the presence of both thyroid antibodies was related to fetal hyperthyroidism, whereas absence was related to fetal euthyroidism (P = 0.019). Hyperthyroid mothers (TRAK-positive, thyroid peroxidase-negative) with hyperthyroid fetuses had significantly higher mean TRAK than hyperthyroid mothers with euthyroid fetuses (13.7 vs. 3.7 IU/liter; P = 0.02). Fetal fT4 correlated weakly negatively with maternal TSH within the normal range, but not with ultrasound parameters or with antithyroid drug dose. CONCLUSION: High fetal fT4 levels were unexpectedly frequent in women with AITD, including maternal autoimmune hypo- and hyperthyroidism. Further studies are needed, as well as noninvasive methods to assess fetal thyroid function.

[Maternal autoimmune thyroid disease and pregnancy complication].

BACKGROUND/AIM: Thyroid disorders exert a great impact on pregnancy course and outcome. The aim of the study was to investigate impact of autoimmune thyroid disorders on pregnancy course and outcome, frequency of pregnancy complications and pregnancy loss. METHODS: We followed 63 pregnancies prospectively during the period 1985-2007, 28 with hyperthyroid and 15 with hypothyroid autoimmune disorders, and 20 healthy pregnancies. Follow up included clinical, sonographic and laboratory investigations, including OGTT and postprandial glicemia. RESULTS: There was no difference between previous preterm and term labor in the observed groups (chi2 = 2.309; p > 0.05). Analysis of previous early pregnancy loss showed no significance (chi2 = 4.918; p > 0.05), including varieties of spontaneous and missed abortion (Fisher, p < 0.05). The hypothyroid patients developed gestational diabetes more frequently than the controls (chi2 = 7.638; p = 0.022), which is not the case with hyperthyroid patients (chi2 = 1.078; p > 0.05), or between the groups with thyroid disorders (chi2 = 3.619; p > 0.05). There was no difference among the groups in developing pregnancy-induced hypertension (chi2 = 1.953; p > 0.05). CONCLUSIONS: Controlling thyroid diseases reduces pregnancy complications. Development of gestational diabetes in hypothyroid patients requires controlling glycoregulation in all pregnant women with hypothyroidism.

[Exogenous luteinizing hormone for assisted reproduction techniques in poor response patients].

BACKGROUND/AIM: Two gonadotrophins, two cell theory refers to necessity of both gonadotrophin activities for theca and granulose cells steroidogenesis of dominant follicle. The aim of this study was to determine the influence of recombinant LH in women qualified as poor responders in the first assisted reproduction procedure (IVF), on fertility results, expressed as percentage of clinical pregnancies. METHOD: The study included 12 women, 35 years and older who were their own controls. The next trial of IVF was with the same dose of recombinant FSH and GnRH agonist, and with the same, long protocol. Recombinant LH was added in the dose of 75 IU from the 2nd to 7th day of the cycle, and 150 IU from the 8th day of the cycle to the aspiration of oocytes. RESULTS: Within the two different protocols: there was no significant difference between LH concentration in 8th and 12th day of cycle; there was no significant difference between E2 concentration on day 2nd and day 8th; there was a significant difference between E2 concentrations on day 12th; endometrial thickness was not significantly different on the day of aspiration, neither was the number of follicles and embryos. In the two patients, clinical pregnancy was detected (pregnancy rate 17%), and they delivered in term. So, a statistically significant difference between the two protocols was in the rate of clinical pregnancies. CONCLUSION: The patients with low response to a long protocol in IVF procedures had significantly better results according to the clinical pregnancy rate when the recombinant LH was added to recombinant FSH in the stimulation protocol.

Tibolone: the way to beat many a postmenopausal ailments.

OBJECTIVE: The effects of tibolone on climacteric symptoms, osteoporosis, cardiovascular disease, breasts and the endometrium are summarised, and its role in clinical practice is reviewed in this article. BACKGROUND: Tibolone has tissue-specific effects on receptors and enzymes that influence the synthesis and metabolism of endogenous sexual steroid hormones. METHODS: This evaluation was based on the findings from several randomised studies, which addressed the basic and clinical research on tibolone. RESULTS/CONCLUSION: Clinical trials prove that tibolone is effective in the treatment of the menopausal symptoms and for the postponement and calming of symptoms accompanying age-related diseases. The findings of basic researchers that tibolone affects the metabolism of every cell, including malignant cells, opened a door to a whole new domain of research that has a promising future.

The most frequent hormone dysfunctions in juvenile bleeding.

The main goal of this study was to investigate the precise hormone dysfunction that leads to dysfunctional uterine bleeding (DUB) in adolescent girls so that, with the appropriate therapy, the occurrence of organic dysfunctions of their reproductive function can be prevented. This study included 70 adolescents with DUB aged 14.70 +/- 1.70 and 30 healthy adolescents aged 13.7 +/- 1.83. Hormone examinations indicated the presence of three typical endocrinological findings of the adolescents with DUB: the first group with FSH values within the normal range, but low LH values, the lower value of estradiol and absence of hyperandrogenism; the second group with higher LH values and normal FSH values but one third with hyperandrogenism; and the third group with normal FSH and LH values, but with hyperinsulinemia and hyperandrogenism. Comparing the hormone values obtained in the control group and the group with DUB, we have concluded that hyperandrogenism, hyperinsulinemia, lower values of progesterone, and dysfunctions in secretion of gonadotropin are statistically important factors for the origin of juvenile bleeding.

Tibolone and osteoporosis.

BACKGROUND: We conducted a 5-year prospective, observational, controlled study to assess the effects of tibolone 1.25 mg/day on bone mineral density (BMD) in postmenopausal women with osteopenia or osteoporosis. METHODS: The subjects were 420 women, an average of 66.4 years old, who had been postmenopausal between 8 and 19 years when enrolled in the study. Of the 420 women enrolled, 346 agreed to take tibolone for 5 years. The 74 who refused tibolone took only calcium/vitamin D supplements and served as the control group. BMD was measured in the lumbar spine and total hip region at baseline and annually by dual-energy X-ray absorptiometry (DXA). RESULTS: At the first two follow-up visits, women taking tibolone had a significant increase in BMD at the spine (P < 0.001) and at the hip (P < 0.001) when compared to baseline values and when compared to BMD values for the control group, which decreased from baseline. In the final 3 years of the study, BMD values (spine and hip) continued to decrease in the control group and also tended to decrease in the tibolone group, but at the end of the fifth year, mean BMD in the tibolone group was still higher than BMD before the start of tibolone treatment (P < 0.05). Calculations showed that if women taking tibolone continued to lose BMD at the same rate as during the final 3 years of the study, after 11 years of tibolone treatment the average patient would have the same BMD as she had when treatment started. CONCLUSION: This 5-year observational study provides evidence that tibolone is effective in increasing BMD in postmenopausal women with osteopenia and osteoporosis during the first 2 years of treatment, but because BMD starts to decline in the third year, it is vital that postmenopausal women start treatment with tibolone as early as possible, so that bone mineral density levels are kept high as long as possible.

Influence of adiposity on leptin, LH and androgen levels in lean, overweight and obese PCOS patients.

BACKGROUND: Leptin modulates hypothalamic-pituitary-gohadal axis functions. OBJECTIVE: To assess the influence of leptin on LH, and to investigate the potential association of leptin with body mass index (BMI) and androgen concentrations in women with polycystic ovary syndrome (PCOS). DESIGN: Levels of leptin, LH, FSH, E2, testosterone, and androstenedione were measured. PATIENTS: 91 patients with PCOS were included in this study. METHODS: Patients were stratified into three groups according to BMI: normal weight (NW group, N=31), overweight patients (OW group N=30) and obese PCOS patients (Ob group, N=30). Results-Hyperandrogenemia was present in the studied group. A significant correlation was observed between BMI and androgens (both P < 0.01), and between leptin levels and androgens (respectfully for androstenendione P < 0.01 and for testosterone P < 0.05). A positive correlation between the LH and leptin levels in NW (P < 0.05) and OW (P < 0.001) patients was noticed, while negative correlation is seen in the Ob group (P < 0.01). In OW patients the significant positive correlation between leptin levels and androstenendione was found (P < 0.001), after correction for BMI. A linear regression model indicated that leptin concentrations and BMI contributed negatively and significantly (P < 0.001) to LH concentrations. CONCLUSION: LH secretion in PCOS patients can be viewed as a consequence of the activity of different adipocyte and neuroendocrine factors. The attenuation in basal LH levels in obese PCOS women might be related to a leptin-resistant state.

Endometriosis in a woman with mosaic Turner's syndrome: case report.

The coexistence of endometriosis and Turner's syndrome is extremely rare, and therefore poses certain questions on the mechanisms of endometriosis. We present a case of a 27-year-old woman with Turner's syndrome [(46, X(x) (q10); 45X], primary amenorrhea and menopausal hormonal profile in which peritoneal endometriosis was revealed laparoscopically.

[Effects of tibolone on the risk factors for cardiovascular diseases in postmenopausal women].

BACKGROUND/AIM: Tibolone is a preparation that belongs to the group of steroidal substances. The effects of the use of the use of tibolone are the consequence of the activities of its metabolities, considering that their hormonal activity depends on the type of tissue in which they develop. The aim of this study was to evaluate the influence of the use of tibolone on risk factors for the development of cardiovascular diseases in postmenopausal women. METHODS: A prospective observational stady included 94 patients who had the concentration of 17beta estradiol < 50 pg/ml and who was in menopause more than a year. Out of the total number of patients, 63 accepted to receive tibolone 2.5 mg daily (tibolone group), while 31 of the patients refused to take tibolone (control group). We measured the concentration of lipids (cholesterol, LDL cholesterol, HDL cholesterol, triglicerides), antitrombin III, fibrinogen, and C-reactive protein, before and after the treatment within a 6-month period. Then, we compared the difference between the values of concentrations and tested the statistical significance of the difference. We also evaluated the changes of values in the concentrations of the examinated parametars inside a 6-month period in the control group. RESULTS: In 31 patients of the control group, from the control group there were no significant changes in the values of the defined parametars as compared to their initial values after six months. But there were changes of statistical significance (p < 0.001) in values of the concentrations of the exeminated parametars before and after the treatment in the tibolone group. In fact, we recorded decreases in the total cholesterol by 17.8%, HDL cholesterol by 27%, LDL cholesterol by 4% (without statistical significance p > 0.05) and triglicerids by 35%. There were no statistical differences in the concentrations of antitrombin III, fibrionogen, and C-reactive proteine in the tibolone group before and after the treatment CONCLUSION: The use of tibolone dose decrease the concentration of the total cholesterol, triglicerides, HDL cholesterol, without a significant decrease of LDL cholesterol. Also, the use of tibolone does not have any significant effect on the concentrations of antitrombin III, fibrinogen and C-reactive proteine. The number of serum parameters measured in this study was limited, thus that was the reason to discuss only about the metabolism of lipids in the patients from the tibolone group. The final condusion about the risk for cardiovascular diseases in the patients on tibolone, howerer, reqnires were extensive further clinical exeminations.