The Relationship Between Menstrual Disorders And Ovarian Reserve Function In Women With Procreating Period

Menstruation,the main performance of the mature reproductive capacity in the women at childbearing age, is the shedding of the uterine lining (endometrium) and blooding with cyclical changes of Hypothalamic-pituitary-ovarian axis hormones controlled by cerebral cortex. Menstrual Disorders, characterized for menstrual cycles changing or abnormal bleeding as well as accompaning some symptoms such as abdominal pain before or after menstruation, are common in women, but often ignored by clinicians. Many reports had pointed out that menstrual disorders especially the irregular menstrual cycles were the sign of the beginning of the menopausal transition and the indicators of Declining Ovarian Reserve(DOR) of perimenopausal women. However, at the present time, few reports regarding the research on the the relationship between menstrual disorders and ovarian reserve function in women with procreating period has been printed.DOR describing the reduced number of ovarian follicles retained in the ovaries, the diminished capacity of ovaries to produce eggs, and the declining quality of the follicular cells, results in reduced fertility. Premature Ovarian Failure (POF),describing as a stop in the functioning of the ovaries in women younger than 40, which has a serious impact on women’s reproductive capacity and quality of life. Therefor, DOR is the early state of POF. At the present, there is no breakthrough progresses in the pathogenesis and treatment studies of POF, but the incidence is increasing year by year, and the paitents have been getting younger and younger. Therefor, POF has been is a thorny problem in obstetrics and gynecology. Previous studies have shown that the ovarian function of some patients with DOR can restore after treatment, and even can slow down or reverse in patients with POF. As a result, early detection to DOR is very important.At present, the recognized indicators to predict ovarian reserve include age,the numbers of antral follicles (AFC), basal follicle stimulating hormone (FSH) levels, basal estradiol (E2) levels,the FSH/LH ratio, Clomiphene citrate challenge test and so on,and the FSH level and the FSH/LH ratio were more commonly used. The FSH>10IU/L and the FSH/LH ration≥2-3were concerned as the indicators of DOR. The indicators above are subject to time and the laboratory testing level constraints, sometimes can not reflect the ovarian reserve timely and truthfully. As a result, exploring a simple and fast detection method is significantly important for ovarian function.The hormonal changes often associated with some specific signs and symptoms.At the clinical work,we found that sex hormone testing often show that the values of serum FSH and the FSH/LHration increased in the majority of patients especially the infertilities with menstrual disorders in childbearing age. Therefore,we hypothesized that menstrual disorders may suggest the declining in ovarian reserve in women with procreating period after excluding other endocrine diseases. On the other hand, in daily life, many women have habits of recording menstrual calendar, which seems simple, easy, no time limit, and without any cost. As a result, menstrual calendar can be a preliminary means to know the ovarian reserve for medical workers and patients themselves.This topic aims to explore the relation between menstrual disorders and DOR, so as to improve the clinicians’ awareness of menoxenia, help patients concerning about their own status. Meantimes, clinicians need to evulate the ovarian function of the patients and make treatments as soon as possible in order to delay the declining of ovarian function,and prevent the occurrence of premature ovarian failure.Chapter1The Relationship Between Menstrual Disorders and Ovarian Reserve Function in Women With Procreating PeriodContents and MethodsTo investigate the relationship between menstrual disorders and ovarian reserve function in women with procreating period. A retrospective evaluation was conducted to analyze the clincial dates of282women in reproductive period divided into4groups,≤25y(n=81)、26-30y(n=90),31-35y(n=51)、36-40y(n=60), treated from November2009to August2011. The control group included101healthy women with normal menstrual, while the research one included181women with menstrual disorders in the past year, whom were divided into three groups according to the duration of menstrual disorders, group A (n=47) for1-4months, group B (n=59) for5-8months, group C (n=75) for9-12months; the control group were also divided into four groups according to the types of menstrual disorder, group1(n=62)patients with reduced menstrual flow; group2(n=27)patients with increased menstrual flow, group3(n=35)patients with shortened menstrual cycles, group4(n=57)patients with prolonged menstrual cycle. Analysis the incidence of menstrual disorders in different age-groups. Compared the age, the levels of FSH, LH, and E2and the FSH/LH ratio between the two groups and among A, B, and C groups.Also compared all the dates above between group1,group2,group3, group4and the control group respectively.Results 1. The incidence of menstrual disorders in different age groups were significantly different(χ2=10.971, P=0.012),which were highest in31—35y group and36—40y group, and the values were76.47%and75%respectively. The average values of age in4types of menstrual disorders were closed to, or more than30years old. In a word, the incidence of menstrual disorders significantly increased after30years old in women with procreating period;2. The average values of age, serum FSH, serum LH, E2and the FSH/LH ratio were (28.75±5.17)y,(7.36±2.61)mIU/ml,(5.96±2.26) mIU/ml,(43.86±24.72) pg/ml,(1.35±0.57), respectively;3. Compared with the control group, there was no significant difference in the level of age, LH and E2(t=1.200, P=0.231; t=1.587,P=0.114), which are more higher in the research group; the age,the basal FSH and the FSH/LH ratio,whose average levels were (30.17±5.81)y,(10.77±7.45) mIU/ml,1.94±1.05respectively, were significantly higher in the women with menstrual disorders (t=2.113, P=0.036; t=5.590, P<0.001; t=6.246, P<0.001);4. The differences of the levels of age, FSH, LH and the FSH/LH ratio among group A,B and C in the trial group were statistically significant (F=9.484,P<0.001; F=7.655,P=0.001; F=4.040,P=0.021; F=38.916,P<0.001), and with the extension of the duration of menstrual disorders, the age, FSH level and the FSH/LH ratio were rising, while the LH level was declining. Although there was no difference in the level of E2among group A,B and C (F=1.478,P=0.231), the levels of E2had a downward trend.The average levels of FSH and the FSH/LH ratio were (14.43±9.67) mIU/ml and (2.57±1.20)respectively,which were highest in the group C.5. Compared with the control group, there was no difference in the level of E2in the four types of patients with menstrual disorders (P>0.05);the LH level was significantly increased (t=2.262,P=0.027),while there were no difference in the LH levels of the other three groups (P>0.05); 6. Compared with the control group,in all patients with menstrual disorders,there was no difference in the levels of FSH in the patients with shortened menstrual cycles (t=1.755,P=0.088),which were significantly different in the other three groups (P>0.05); the FSH/LH ratio were significant higher in all four types of menstrual disorders(P<0.05), and closed to,or more than2; the FSH in4groups of menstrual disorders were more than10mIU/ml,and FSH in patients with shortened menstrual cycles was highest (11.28mIU/ml)SummaryThe incidence of menstrual disorders significantly increased after30years old in women with procreating period, and the ovarian reserve may begin to decline After excluding other endocrine diseases, the clinical workers should pay attention to that some obstacles happened to the patients with any type of menstrual disorder at childbearing age who has a declining ovarian function. Long extention of menstrual disorders and the changed menstrual cycles always mean the ovarian function declined more serious. As a result, the clinicians need to help patients concerning about their own status, evulate the ovarian function of the patients and make treatments as soon as possible in order to delay the declining of ovarian function,and prevent the occurrence of premature ovarian failure..Chapter2The Ovarian Reserve Function in the Infertilities with Menstrual DisordersContents and MethodsTo investigate the ovarian reserve function in the infertilities with menstrual disorders. A retrospective evaluation was conducted to analyze the clincial dates of292women in reproductive period. The control group included101women with normal menstrual, while the research one included191infertilities, whom were divided into two groups according to the menstruation, group A (n=103) infertilities with normal menstrual, group B (n=88) infertilities with menstrual disorders; All patients in group B were divided into four groups according to the types of menstrual disorder, group1(n=8)patients with increased menstrual flow; group2(n=19)patients with reduced menstrual flow, group3(n=35)patients with prolonged menstrual cycles, group4(n=57)patients with shortened menstrual cycles. Compared the age, the levels of FSH, LH, E2and the FSH/LH ratio between group A and group B, among the control group,group A and group B.Also compared the incidence and all the dates above among group1,group2,group3, and group4.Results1. In the infertilities, there was no significant difference in the age,LH and E2(t=0.062,P=0.951;t=1.875, P=0.063;t=0.359, P=0.720)between patients with normal menstrual and the ones with menstrual disorders,but all the results were higher in the latter one; the FSH and the FSH/LH ratio was significantly higher (t=3.611, P<0.001; t=2.287, P=0.024) in the latter,and the averages of the FSH and the FSH/LH ratio were (10.23±4.80) mIU/ml and (1.78±1.15),respectively;2. Although there were no difference in the age and E2among the control group, group A and group B(F=1.301,P=0.274; F=0.742,P=0.477), the levels of E2had an upward trend; the differences of the levels of FSH, LH and the FSH/LH ratio were significantly different (F=12.584,P<0.001; F=3.308,P=0.039; F=5.405,P=0.005), and all the levels above were rising.3. The levels of FSH, LH and the FSH/LH ratio of the control group were significantly different compared with the group B (P<0.001,P=0.033,P=0.042),while there were no difference compared with groupA (P=0.182,P=0.844,P=0.980)4. The incidence of the infertilities with increased menstrual flow, with reduced menstrual flow, with prolonged menstrual cycles, and with shortened menstrual cycles were9.10%,21.59%,34.09%and35.23%, respectively.5. In addition to the patients with increased menstrual flow,the age, the FSH/LH ratio and the number of spontaneous abortions were highest in the infertilities with shortened menstrual cycles, and the averages were (32.26±5.31) y、(2.19±1.18) mIU/ml、(1.39±1.65) respectively;there were no difference in the FSH、E2among group2,group3and group4(F=0.947,P=0.393; F=1.140, P=0.331), but the FSH in infertilities with shortened menstrual cycles was highest while the E2was lowest,and the values were (11.21±5.59) mIU/ml and (42.00±13.44) pg/ml,respectivelySummaryMenstrual disorders always suggested the decling ovarian function in the infertility patients especially the ones with shortened menstrual cycles whose faced the higher risk of spontaneous abortions or recurrent spontaneous abortion.. The clinical workers should emphasis the importance of protecting and recovering the ovarian function.Conclusion1. The incidence of menstrual disorders significantly increased after30years old in women with procreating period, and the ovarian reserve may begin to decline2. After excluding other endocrine diseases, the clinical workers should pay attention to that women with any type of menstrual disorder at childbearing age has a declining ovarian function.3. Long extention of menstrual disorders and the changed menstrual cycles always mean the ovarian function declined more serious. The duration of menstrual disorders and the changed menstrual cycles can be used as a preliminary means to assess the ovarian reserve in women with procreating period,which should be concered by dorctors and patients themselves;4. Menstrual disorders always suggested the decling ovarian function in the infertility patients especially the ones with shortened menstrual cycles whose faced the higher risk of spontaneous abortions or recurrent spontaneous abortion.. The clinical workers should emphasis the importance of protecting and recovering the ovarian function.