Article Title

Menstrual irregularities, hormonal imbalance and obesity in adolescent girls in Hyderabad, Sindh, Pakistan: An observational study

Authors

Meharunnissa Khaskheli, Department of Obstetrics and Gynaecology, Liaquat University of Medical and Health Sciences, Liaquat University Hospital, Jamshoro Hyderabad, Sindh, PakistanFollow
Ramsha Zafar Durrani, Department of Obstetrics and Gynaecology, Liaquat University of Medical and Health Sciences, Liaquat University Hospital, Jamshoro Hyderabad, Sindh, PakistanFollow
Shahla Baloch, Department of Obstetrics and Gynaecology, Liaquat University of Medical and Health Sciences, Liaquat University Hospital, Jamshoro Hyderabad, Sindh, PakistanFollow
Aneela Sheeba Baloch, Department of Radiology, Liaquat University of Medical and Health Sciences, Liaquat University Hospital, Jamshoro/Hyderabad, Sindh, PakistanFollow
Syed Ghulam Sarwar Shah, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, England, United Kingdom; Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, England, United KingdomFollow

Abstract

Background: Obesity in young girls adversely affects reproductive health later in life and it is a serious public health issue. The objective was to study the association of obesity with menstrual irregularities and hormonal imbalance in teenage and adolescent girls.

Method: Participants comprised a convenience sample of 12-19 years old girls (N=83). The study was conducted in outpatient clinics at a university hospital. Data were collected through medical history by interview, physical examination and blood tests. Data were analysed using frequencies, descriptive statistics, Chi Squared tests of Independence and Binary Logistic Regression.

Results: The median age was 16 years (mean 15.9, SD 2.2) and the median BMI was 31.14 (mean 32.04, SD 4.51). Most of the girls were obese (95.2%) and some had a family history of obesity (33.7%), diabetes (28.9%) and cardiovascular disease (20.5 %). Clinical presentations included secondary amenorrhea (34.9%), heavy and irregular periods (22.9%) and oligomenorrhea (16.9%). Girls with a polycystic ovary (54.2%, n=45) had a reversed follicle stimulating hormone (FSH) / luteinizing hormone (LH) ratio (OR 11.33, 95% CI 2.98, 43.04, p < 0.001), an upper limit or raised fasting insulin (OR 7.20, 95% CI 2.33, 22.22, p < 0.001), a raised testosterone (OR=5.16, 95% CI 1.56, 17.11, p = 0.007 and a disturbed lipid profile (OR 5.67, 95% CI 1.72, 18.73, p = 0.004). Obesity was not statistically significantly associated with either polycystic ovary syndrome (PCOS) or any of the measured hormone levels.

Conclusion: Adolescent girls presenting with obesity, menstrual irregularities and hormonal imbalance may suggest manifestation of PCOS, which needs early investigation and proper management.

Keywords: Adolescent gynaecology, Child obesity, Endocrine disorders, Polycystic ovary syndrome, Reproductive health, Teenage obesity

Recommended Citation

Khaskheli M, Durrani RZ, Baloch S, Baloch AS, Shah S. Menstrual irregularities, hormonal imbalance and obesity in adolescent girls in Hyderabad, Sindh, Pakistan: An observational study. J Health Res. 2023; 37(1):26-32. DOI: https://doi.org/10.56808/2586-940X.1013

References

[1] World Health Organization. Obesity and overweight. Geneva, Switzerland: World Health Organization; 2020Apr [cited 2020 May 3]. Available from: https://www.who.int/ news-room/fact-sheets/detail/obesity-and-overweight.

[2] Goldsammler M, Merhi Z, Buyuk E. Role of hormonal and inflammatory alterations in obesity-related reproductive dysfunction at the level of the hypothalamic-pituitary ovarian axis. Reprod Biol Endocrinol 2018;16(1):45. https:// doi.org/10.1186/s12958-018-0366-6.

[3] Louwers YV, Laven JSE. Characteristics of poly cystic ovary syndrome throughout life. Ther Adv Reprod Health 2020;14: 1e9.https://doi.org/10.1177/2633494120911038.

[4] Akram M, Roohi N. Endo crine correlates of polycystic ovary syndrome in Pakistani women. J Coll Physicians Surg Pak 2015;25(1):22e6.

[5] Haq N, Khan Z, Riaz S, Nasim A, Shahwani R, Tahir M. Prevalence and knowledge of polycystic ovary syndrome (PCOS) among female science students of different public universities of Quetta, Pakistan. Imp J Interdiscip Res2017; 3(6):385e92.

[6] Almis H, Orhon FS, Bolu S, Almis BH. Self-concept, depression, and anxiety levels of adolescents with polycystic ovary syndrome. J Pediatr Adolesc Gynecol 2021;34(3):311e6. https://doi.org/10.1016/j.jpag.2020.12.011.

[7] Sari SA, Celik N, UzunCicek A. Body perception, self esteem, and comorbid psychiatric disorders in adolescents diagnosed with polycystic vary syndrome. J Pediatr Adolesc Gynecol 2020;33(6):691e6. https://doi.org/10.1016/ j.jpag.2020.08.018.

[8] He Y, Tian J, Oddy WH, Dwyer T, Venn AJ. Association of childhood obesity with female in fertility in adulthood: a 25 year follow-up study. Fertil Steril 2018;110(4):596e604. https://doi.org/10.1016/j.fertnstert.2018.05.011.e1.

[9] Todd AS, Street SJ, Ziviani J, Byrne NM, Hills AP. Overweight and obese adolescent girls: the importance of promoting sensible eating and activity behaviors from the start of the adolescent period. Int J Environ Res Publ Health 2015;12(2):2306e29. https://doi.org/10.3390/ ijerph120202306.

[10] Elizondo-Montemayor L, Hernandez-Escobar C, Lara Torre E, Nieblas B, Gomez-Carmona M. Gynecologic and obstetric consequences of obesity in adolescent girls. J Pediatr Adolesc Gynecol 2017;30(2):156e68.https://doi.org/ 10.1016/j.jpag.2016.02.007.

[11] Solorzano CMB, McCartney CR. Obesity and the pubertal transition in girls and boys. Reproduction 2010;140(3): 399e410.https://doi.org/10.1530/REP-10-0119.

[12] Ford ND, Patel SA, Narayan KMV. Obesity in low-and middle-income countries: burden, drivers, and emerging challenges. Annu Rev Publ Health 2017;38(1):145e64.https:// doi.org/10.1146/annurev-publhealth-031816-044604.

[13] Government of Pakistan. Pakistan economic survey 2018-19. Islamabad: Ministry of Finance; 2019 [cited 2020 May19]. Available from: https://www.finance.gov.pk/survey_1819. html.

[14] Templin T, Cravo Oliveira Hashiguchi T, Thomson B, Dieleman J, Bendavid E. The overweight and obesity transition from the wealthy to the poor in low-and middle-income countries: a survey of household data from 103 countries. PLoS Med 2019;16(11):e1002968.https://doi.org/ 10.1371/journal.pmed.1002968.

[15] Government of Pakistan. National nutrition survey 2018. Islamabad, Pakistan: Ministry of National Health Services, Regulation and Coordination; 2018 [cited 2021 Mar 23]. Available from: https://www.unicef.org/pakistan/media/ 2826/file/National%20Nutrition%20S.

[16] Nazir F, Tasleem H, Tasleem S, Sher Z, Waheed K. Polycystic ovaries in adolescent girls from Rawalpindi. J Pakistan Med Assoc 2011;61(10):961e3.

[17] White MJ, McClure E, Killeen J, Howard J, Skinner AC, Spears T, et al. Changes in the recreational built environment and youth body mass index. Acad Pediatr 2021;21(1): 76e83.https://doi.org/10.1016/j.acap.2020.09.004.

[18] World Health Organization. BMI-for-age GIRLS 5 to 19 years (percentiles). Geneva, Switzerland. 2007 [cited 2020 Oct 14]. Available from: https://cdn.who.int/media/docs/defaultsource/child-growth/growth-reference-5-19-years/bmi-forage-(5-19-years)/bmifa-girls-5-19years-per.pdf.

[19] Commission on Ending Childhood Obesity. Facts and figures on childhood obesity. Geneva, Switzerland: World Health Organisation; 2019 [cited 2020 May 25]. Available from: https://www.who.int/end-childhood-obesity/facts/en/.

[20] Wadden TA, Bray GA, editors. Handbook of obesity treatment. 2^nd ed. New York: Guilford Press; 2018.

[21] US Centre for Disease Control. BMI Percentile Calculator for Child and Teen. In: Weight, Nutrition, and Physical Activity. Atlanta, GA; 2020.USA. [cited 2020 Dec 30]. Available from: https://www.cdc.gov/healthyweight/bmi/calculator.html.