Risk factors of menstrual cycle disorders in girls with hypothalamic dysfunction
Patients and methods. A retrospective cohort study was performed among adolescent girls (n = 170), whose mean age was 14.41 ± 0.26 years. All patients had dysfunction of the hypothalamic-pituitary-gonadal system manifested by neuroendocrine (overweight or obesity) and neurotrophic (pink or white striae) disorders. All respondents in the period from 2000 to 2014 were hospitalised to the gynecological department of the Amur Regional Children’s Clinical Hospital. The HBSC questionnaire (Health возBehaviour in School-Aged Children) adapted for Russia was used for assessment of their socioeconomic and behavioural status and the way of life. Overweight and obesity were determined in according to the «Federal Clinical Recommendations on diagnosis and treatment of obesity in children and adolescents» (2013). Influence of a particular factor was assessed by a relative risk value (RR): relative risk greater than 1 was determined as a risk factor. Also, we calculated attributable risk (AR), etiologic fraction (EF) and criterion χ2, if necessary, Yates correction was used. The values of χ2 ≥ 3.8414 with probability 95% (р < 0.05) were considered significant.
Results. Of 170 adolescent girls with HD 66 (38.8%) were overweight. Obesity was recorded in 104 (61.1%) cases (grade 1 – 75.9%, 2 – 18.3%, 3 – 6.7%). The average body mass index was 30.54 ± 0.66 kg/m2. Amenorrhoea (both primary and secondary) was diagnosed in 56 (32.9%), abnormal uterine bleeding (AUB) – in 41 (24.0%) adolescent girls with HD. RR for development of amenorrhoea with high EF was significant in girls with tense family relations (RR – 1.8%; χ2 = 7.48, р < 0.01) and in low income levels (RR – 1.7%; χ2 = 5.99, р < 0.05). The most significant medico-biological factors (RR = 2.02%) for development of amenorrhoea were duration of HD manifestation for 5 years and longer and obesity (RR – 1.9%). In mother’s complicated pregnancy (preeclampsia) and in neonatal asphyxia this parameter was 1.6 and 1.7, respectively, with р < 0.05. A risk for AUB in girls with HD during puberty was significant in case of herpes infection (RR – 1.7%) and mother’s threatened miscarriage in the 1st trimester.
Conclusion. In adolescent girls with HD and overweight or obesity, amenorrhoea was found in 32.9% of cases, AUB – in 24.0%. Significant risk factors for development of amenorrhoea have been specified (duration of HD manifestations more than 5 years; obesity; neonatal asphyxia, mother’s preeclampsia; tense relationships in the family; low-income families) and AUB (herpes infection in girls, threatened miscarriage in the 1st trimester in mothers).
Key words: amenorrhoea, abnormal uterine bleeding, hypothalamic dysfunction, risk factors.
For citation: Zhukovets I.V., Leshchenko O.Ya., Atalyan A.V. Risk factors of menstrual cycle disorders in girls with hypothalamic dysfunction. Vopr. prakt. pediatr. (Clinical Practice in Pediatrics). 2017; 12(1): 13–18. (In Russian).