Allodynia in Menstrually Related Migraine: Score Assessment by Allodynia Symptom Checklist (ASC-12).

OBJECTIVE: The aim of this study was to compare the allodynia score in headache attacks related and not related to menstruation in women diagnosed with menstrually related migraine without aura. BACKGROUND: Allodynia is an important symptom in migraine and has been associated with migraine chronification. No study has yet compared prospectively allodynia in menstrual vs non-menstrual attacks within the same cohort of patients. METHODS: This is a prospective cohort study, where participants had the 12-item Allodynia Symptom Checklist (ASC-12) assessed after 1, 2, 4, and 24 hours from the onset of migraine attacks in 2 different conditions, with menstrual migraine attack (MM+) and with non-menstrual migraine attack (MM-). RESULTS: A total of 600 women with headache complaints were screened from March 2013 to July 2014 in a headache outpatient or headache tertiary clinic. From these, 55 participants were recruited, and 32 completed the study. Participants' mean age was 27 years, BMI was 22.1, menarche age 12 years, migraine history was 11.5 years, and most women were young (ranged from 17 to 44 years of age), were in higher school (13/32 = 41%), single (20/32 = 63%), and used contraceptives (22/32 = 69%). Multiple pairwise comparisons of ANCOVA's test showed significant higher ASC-12 scores in MM+ group compared to MM- group at 2 hours [mean, 95% CI of difference: 2.3 (0.31, 4.7), P = .049)]. For the ASC-12 categorical scores (absent, mild, moderate, and severe) MM+ yielded higher scores than MM- at 1 hour (z = -3.08, P = .021) and 4 hours (z = -2.97, P = .03). CONCLUSION: This study demonstrated that in the patents from tertiary headache center assessed, menstrual-related migraine attacks augment allodynia scores in the beginning of attacks compared to non-menstrual migraine attacks.

Menstrual Disruption with Exercise Is Not Linked to an Energy Availability Threshold.

INTRODUCTION: Chronic reductions in energy availability (EA) suppress reproductive function. A particular calculation of EA quantifies the dietary energy remaining after exercise for all physiological functions. Reductions in luteinizing hormone pulse frequency have been demonstrated when EA using this calculation is <30 kcal·kg·fat-free mass (ffm)·d. PURPOSE: We determined whether menstrual disturbances (MD) are induced when EA is <30 kcal·kg ffm·d. METHODS: Thirty-five sedentary, ovulatory women age 18 to 24 yr (weight, 59.0 ± 0.8 kg; body mass index, 21.8 ± 0.4 kg·m) completed a diet and exercise intervention over three menstrual cycles. Participants were randomized to groups that varied in the magnitude of negative energy balance created by the combination of exercise and energy restriction. Menstrual disturbances were determined using daily urinary estrone-1-glucuronide and pregnanediol glucuronide, midcycle luteinizing hormone, and menstrual calendars. In a secondary analysis, we calculated EA from energy balance data and tested the association of EA with MD. RESULTS: A generalized linear mixed-effects model showed that the likelihood of a MD decreased by 9% for each unit increase in EA (odds ratio, 0.91; 95% confidence interval, 0.84-0.98; P = 0.010). No specific value of EA emerged as a threshold below which MD were induced. When participants were partitioned into EA tertile groups (low EA, 23.4-34.1; n = 11; moderate EA, 34.9-40.7; n = 12, and high EA, 41.2-50.1; n = 12 [kcal·kg ffm·d]), estrone-1-glucuronide (P < 0.001), pregnanediol glucuronide (P < 0.001), and luteal phase length (P = 0.031) decreased significantly, independent of tertile. CONCLUSIONS: These findings do not support that a threshold of EA exists below which MD are induced but do suggest that MD increase linearly as EA decreases. Menstrual disturbances can likely be prevented by monitoring EA using a simplified assessment of metabolic status.

Edad de menarquia y ascendencia indígena: Un estudio poblacional en Chile / Age at menarche and indigenous ancestry: A population study in Chile

Background: The age at menarche may influence decisively health and disease in women. It also indicates the beginning of the reproductive period and, as a consequence, the possibility of biological continuity for the human species. Genetic and environmental determinants define the age of menarche and can explain differences found among different populations. Aim: To determine the age at menarche among adolescents with different levels of indigenous descent (parental indigenous surnames), considering the effect of socioeconomic and demographic factors. Material and Methods: An observational study of historic cohorts of8.624 girls from the Arauca-nía Region (central-southern Chile) was carried out. Data were collected by health professionals using a previously validated questionnaire. Occurrence of menarche was estimated through survival analysis and compared between groups (according to indigenous parental surnames) adjusted for parents' income and educational level and provenance (rural/urban). Results: Estimated median age of menarche was 151 months (95% Cl: 150-151). In female with four indigenous surnames, menarche occurred two months later than girls without indigenous surnames and with two indigenous surnames (p < 0,001). In girls whose parents had lowest level of schooling, the difference increased to eight months later (p < 0,005). Conclusions: Age at menarche in the group with higher indigenous descent is later even if socio-economic conditions remain stable. Genetic factors might play an important role, however conditions of vulnerability can influence and further delay the onset of reproductive competency.

[Age at menarche and indigenous ancestry: a population study in Chile]. / Edad de menarquia y ascendencia indígena: un estudio poblacional en Chile.

BACKGROUND: The age at menarche may influence decisively health and disease in women. It also indicates the beginning of the reproductive period and, as a consequence, the possibility of biological continuity for the human species. Genetic and environmental determinants define the age of menarche and can explain differences found among different populations. AIM: To determine the age at menarche among adolescents with different levels of indigenous descent (parental indigenous surnames), considering the effect of socioeconomic and demographic factors. MATERIAL AND METHODS: An observational study of historic cohorts of 8.624 girls from the Araucanía Region (central-southern Chile) was carried out. Data were collected by health professionals using a previously validated questionnaire. Occurrence of menarche was estimated through survival analysis and compared between groups (according to indigenous parental surnames) adjusted for parents' income and educational level and provenance (rural/urban). RESULTS: Estimated median age of menarche was 151 months (95% Cl: 150-151). In female with four indigenous surnames, menarche occurred two months later than girls without indigenous surnames and with two indigenous surnames (p < 0,001). In girls whose parents had lowest level of schooling, the difference increased to eight months later (p < 0,005). CONCLUSIONS: Age at menarche in the group with higher indigenous descent is later even if socio-economic conditions remain stable. Genetic factors might play an important role, however conditions of vulnerability can influence and further delay the onset of reproductive competency.

Contraception, and pregnancy in adolescents with type 1 diabetes: a review.

Adolescence is a critical period for girls with type 1 diabetes mellitus (T1D). Reproductive issues, such as menstrual abnormalities, risk of an unplanned pregnancy, and contraception, should be addressed during this phase of life. This paper reviews several reproductive issues that are important in the care of adolescents, including pubertal development, menstrual abnormalities, ovulatory function, reproductive problems, the effects of hyperglycemia, contraception, and treatment of an unplanned pregnancy. A review of the literature was conducted. A MEDLINE search January 1966 to March 2011 was performed using the following MESH terms: puberty, menarche, ovary, polycystic ovary syndrome, menstruation, contraception, contraception-barrier, contraceptives-oral-hormonal, sex education, family planning services, and pregnancy in adolescence. This literature search was cross-referenced with an additional search on diabetes mellitus-type 1, diabetes complications, and pregnancy in diabetes. All published studies were searched regardless of the language of origin. Bibliographies were reviewed to extract additional relevant sources.

[Difficulties and pitfalls in the diagnosis of polycystic ovary syndrome]. / Dificuldades e armadilhas no diagnóstico da síndrome dos ovários policísticos.

The polycystic ovary syndrome is one of the most common endocrinopathies, affecting approximately 7% of women of reproductive age. Although it was described in 1935, only in 1990 was published the first Consensus regarding it its diagnosis. Today, the syndrome is also considered a cardiovascular risk factor, with a high prevalence of metabolic disorders. Reflecting this new vision of the syndrome, several documents, including Consensus, Statement and Guidelines have been published, addressing different aspects of the syndrome. This review is an analysis of documents obtained through a survey in the PubMed database, using the keywords "polycystic ovary syndrome", "hyperandrogenism" and "hirsutism", separately, taking as limiting the term Type of Article (Practice Guideline, Consensus Development Conference, Guideline) without limitation of time, language and age, having been selected only those documents prepared under the sponsorship of Medical Entities and with more than one author.

Dificuldades e armadilhas no diagnóstico da síndrome dos ovários policísticos / Difficulties and pitfalls in the diagnosis of polycystic ovary syndrome

A síndrome dos ovários policísticos é uma das endocrinopatias mais comuns, afetando aproximadamente 7 por cento das mulheres na idade reprodutiva. Embora tenha sido descrita em 1935, somente em 1990 foi elaborado o primeiro consenso com relação ao seu diagnóstico. Hoje, a síndrome é considerada também um fator de risco cardiovascular, com uma alta prevalência de distúrbios metabólicos. Como reflexo dessa nova visão da síndrome, vários documentos, entre Consensos, Posicionamentos e Orientações, têm sido publicados, abordando diversos aspectos da síndrome. O objetivo desta revisão é uma análise crítica desses documentos, obtidos mediante um levantamento na base PubMed, por meio dos unitermos polycystic ovary syndrome, hyperandrogenism e hirsutism, separadamente, tendo como limitador o termo Type of Article (Practice Guideline, Consensus Development Conference, Guideline), sem limitação de data, língua e idade. Foram selecionados apenas os documentos elaborados sob patrocínio de Entidades Médicas e com mais de um autor.

The polycystic ovary syndrome is one of the most common endocrinopathies, affecting approximately 7 percent of women of reproductive age. Although it was described in 1935, only in 1990 was published the first Consensus regarding it its diagnosis. Today, the syndrome is also considered a cardiovascular risk factor, with a high prevalence of metabolic disorders. Reflecting this new vision of the syndrome, several documents, including Consensus, Statement and Guidelines have been published, addressing different aspects of the syndrome. This review is an analysis of documents obtained through a survey in the PubMed database, using the keywords "polycystic ovary syndrome", "hyperandrogenism" and "hirsutism", separately, taking as limiting the term Type of Article (Practice Guideline, Consensus Development Conference, Guideline) without limitation of time, language and age, having been selected only those documents prepared under the sponsorship of Medical Entities and with more than one author.

Does the reproductive cycle influence sleep patterns in women with sleep complaints?

OBJECTIVE: The aim of the present study was to investigate how prominent gynecological factors (regular/irregular menstrual cycle, premenstrual complaints, or menopause) can influence both subjective and objective sleep data. METHODS: A total of 931 women who sought clinical assistance because of a sleep complaint were included in the investigation. All subjects filled out a sleep and gynecological questionnaire prior to undergoing a polysomnography (PSG) recording. RESULTS: Premenopausal women with an irregular menstrual cycle were more likely to report sleep difficulties (related to falling sleep and insomnia symptoms) than those with a regular cycle (odds ratio 2.1; 95% confidence interval 1.2-3.5). These women showed increased light sleep stages and awakenings. Premenstrual complaints were reported by a higher percentage of women with periodic leg movement, lower time in saturation under 90%, and higher sleep efficiency. A lower percentage of women who took hormonal contraceptives reported snoring, had fewer arousals and longer REM latency compared to those not taking hormonal contraceptives. Menopausal women with hot flushes had more restless leg complaints. Awake time was shorter in hormone therapy users compared with non-users. Women with menopause are more likely to have an apnea-hypoapnea index greater than 5/h. CONCLUSION: The present findings suggest that gynecological status is associated with subjective sleep quality and objective sleep parameters in women with sleep complaints.

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.

Insulin resistance in adolescents with menstrual irregularities.

PURPOSE: To assess the presence of insulin resistance as well as the incidence of polycystic ovary syndrome (PCOS) in adolescents with menstrual disorders. METHODS: A case-control study was conducted with 34 adolescents during the period of 2 to 4 years after menarche. The patients were divided into two groups: group I (G I) with 22 patients with menstrual irregularity, and group II (G II) with 12 patients with regular menstrual cycles. Body mass index and Ferriman-Gallway index were calculated for all patients, who also received a pelvic ultrasound. We measured DHEA-S, 17 hydroxyprogesterone, testosterone, TSH, LH, FSH, and prolactin in serum sample and conducted the glucose tolerance test with 75 mg dextrose with measurement of glucose and insulin. RESULTS: Mean +/- SD ovary volume was larger in G I (11.38 +/- 4.06 cm(3)) than in G II (7.72 +/- 5.59 cm(3)); P < 0.05. DHEA-S (G I = 47.23; G II = 38.38 microg/dl) and testosterone (G I = 54.19; G II = 32.53 ng/dl) levels were higher in patients with menstrual irregularity. In G I we detected two patients with diabetes mellitus and one patient with glucose intolerance. Sixteen patients in this group had clinical or hormonal characteristics of PCOS. The mean values of the area under the insulin curve (AUIC) were higher in patients with menstrual irregularities (8,556.52 muIU/mL/2 h) than in controls (5,743.38 microIU/mL/2 h); P < 0.05. CONCLUSIONS: The presence of PCOS was detected in 95% of the adolescents with menstrual irregularity. Patients with menstrual disorders presented higher AUIC values than controls.

Menstrual disturbances in patients with systemic lupus erythematosus without alkylating therapy: clinical, hormonal and therapeutic associations.

We have evaluated 36 consecutive systemic lupus erythematosus (SLE) female patients, age 18-39 years, without current or previous alkylating therapy, in order to determine the prevalence of the menstrual disturbances and their clinical, hormonal and therapeutic associations. Seventeen patients presented normal cycles, whereas menstrual alterations were observed in 19. Ovarian function was generally preserved in these groups. Sub-clinical thyroid disease (normal free T4 and elevated TSH) and slightly increased prolactin levels were detected in 8% of patients, with comparable frequencies in both groups. Similarly, the current use of azathioprine was not associated with menstrual disturbances. Percentages of prednisone current use (P = 0.3), mean dose (P = 0.062), and percentages of patients on high doses (> or = 30 mg/day; P = 0.09) were comparable in patients with or without menstrual alterations. In contrast, the mean SLEDAI levels (P = 0.02) and the frequency of patients with SLEDAI > or = 8 (P = 0.008) were higher in patients with irregular cycles. Interestingly, 5/7 (71%) of the patients with menstrual disturbances and a new significant flare (SLEDAI > or = 8) were evaluated before the introduction of high dose steroid, supporting the idea that disease activity is a major factor in menstrual disorders in SLE patients without alkylating therapy.

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.

Perturbaçöes menstruais e a acupuntura / Menstrual disturbances and acupuncture

As perturbaçöes menstruais, segundo a Medicina Tradicional Chinesa, podem ser classificadas em três tipos: formas Plenitude, Vazio e Vazio de Qi e de Xue (Sangue), relacionados com as alteraçöes energéticas do Gan (Fígado), Pi (Baço/Pâncreas) e do Shen (Rins). A primeira forma deve-se ao Calor (Fogo) do Gan (Fígado em Plenitude), a segunda, à deficiência do Shen (Rins) e/ou do Pi (Baço/Pâncreas) e a terceira, pelo Vazio e/ou Falso-Calor desses Orgäos isoladamente ou em associaçäo a outros Orgäos. Os pontos de acupuntura empregados no tratamento das perturbaçöes menstruais podem ter relaçäo neuratômica e neurofisiológica com as estruturas orgânicas envolvidas na patologia menstrual, de modo que o emprego de certas técnicas, como "Shu-Mo" e a utilizaçäo de pontos à distância pode ser explicada por meio da ligaçäo destes procedimentos, respectivamente, com o arco-reflexo sômato-visceral e projeçöes dos estímulos nervosos, desencadeados pela acupuntura, para estruturas encefálicas, como o sistema límbico, formaçäo reticular, hipotálamo e córtex cerebral.

O prazer de ser mulher / The pleasure to be woman

Traz informações e confissões sobre a sexualidade feminina colhidas ao longo de 22 anos da experiência clínica de ginecologista e obstetra da autora, que alia neste livro o saber científico às experiências de vida. Com uma linguagem simples e bem-humorada, a autora dá uma visäo geral da realidade corporal feminina

Long-acting oral bromocriptine (Parlodel SRO) in the treatment of hyperprolactinemia.

OBJECTIVES: To compare the effect of Parlodel SRO (Sandoz, Basel, Switzerland), a long-acting oral bromocriptine, to Parlodel (Sandoz) and to study the chronic effects of Parlodel SRO. DESIGN: The study was twofold: (1) random, double-blind and (2) open. SETTING: Patients were studied in an academic environment. PATIENTS: Hyperprolactinemic patients were selected. Sixteen patients were treated during 1 month. Ten patients completed the 1-year follow-up. INTERVENTIONS: Parlodel SRO or Parlodel was administered during 1 month (first 15 days: 5 mg/d; afterwards: 10 mg/d). Parlodel SRO was given during 1 year in variable doses (maximal 20 mg/d). MAIN OUTCOME MEASURES: Prolactin (PRL) levels, clinical improvement, and side effects were evaluated. RESULTS: After 1 month, 63% of the patients in both groups had normal PRL and 43% had menses. Side effects were similar. After 1 year all patients except one had normal PRL levels, and 89% were ovulating. CONCLUSIONS: The efficacy, tolerability, and long duration of action of Parlodel SRO make it an excellent alternative for the treatment of hyperprolactinemic patients.