Effect of Metformin and Its Combination with Probiotic on Menstrual Irregularity and TSH Levels in Patients with Polycystic Ovarian Syndrome: A Randomized Controlled Trial

Background: Polycystic ovarian syndrome (PCOS), the far most common endocrine disorder among sexually active women. The disease is typically characterized by irregular menstrual cycles and appears to be influenced by associated thyroid dysfunction. Aim: The goal of this research was to assess and compare the effects of Metformin and its combination with Probiotic on monthly cycle irregularity and TSH levels in PCOS women. Methodology: This was a single-center study conducted at Karachi's Gynecological Outpatient department from January 2019 to September 2019. A total of 52 PCOS patients aged 18 to 40 years were included in this trial, which followed Rotterdam criteria. After providing written and consent form, individuals were randomized into one of the two groups and received Metformin 500 mg TD (n = 26) or Metformin Combination (n = 26). Results: After three months of treatment, both groups improved in terms of menstrual cycle irregularity and TSH levels, but the combination treatment improved the most. Conclusion: Probiotics may be considered in conjunction with Metformin for improving TSH levels to achieve better results.

1090 Self-Reported Sleep Quality is a Robust Predictor of Depression in Women With Irregular Menstrual Cycles

Introduction Menstrual cycle regularity is an important marker of women’s health. Abnormalities are associated with serious health complaints, e.g., infertility, cardiovascular, and metabolic disorders. Cycle irregularity is also linked to depression, anxiety and poor quality sleep. In fact, poor sleep and circadian misalignment may precede menstrual irregularity for some. This study describes sleep and affective characteristics of women with menstrual cycle irregularity compared to regularly cycling women and examined the individual contributions of sleep and menstrual regularity to affective symptoms. Methods N=314 (Mage=20.95, SD=2.35) women provided reports of menstrual health characteristics (frequency, duration, related symptoms), sleep over the past month (Pittsburgh Sleep Quality Index; PSQI) and on the previous night, as well as mood (Center for Epidemiologic Studies Depression Scale) and anxiety (State Trait Anxiety Inventory) symptoms. Results Among the 20.4% (n=64) of women who endorsed “always irregular” periods, mean cycle length (m=31.33 days, sd=8.5) was significantly greater than among women more regular periods (m= 27.93, sd=3.83, t(55.37)=-2.78, p=.007). This subgroup also reported higher PSQI scores (t(181)=-2.56, p=.011), longer SOL (t(282)=-3.00, p=.003), poorer sleep quality overall (t(299)=-2.35, p=.02), and poorer sleep quality on the previous night (t(300)=2.70, p=.007). Irregular cyclers reported significantly more depressive (t(284)=-2.18, p=.03) but not anxiety symptoms. When sleep and menstrual irregularity were entered into a hierarchical linear regression to examine their relative influence on depressive symptoms (F[2,174]=13.15, p<.001, R2=.13), sleep remained the only significant predictor (b= 1.13, p <.001) and menstrual cycle effects were no longer significant. Conclusion In line with previous studies, cycle irregularity was associated with poorer sleep quality and depressive symptoms. Sleep quality was found to be a more robust predictor of depression than menstrual cycle irregularity, suggesting that sleep may underlie the affective disturbances in women with more irregular menstrual cycles. Support n/a

Association between menstrual cycle irregularity and tinnitus: a nationwide population-based study

This population-based cross-sectional study investigated the association between menstrual cycle irregularity and tinnitus in premenopausal Korean women. We used data from the 5th Korea National Health and Nutrition Examination Survey (2010–2012). A total of 4633 premenopausal women were included. Hierarchical multivariable logistic regression analysis was performed. Individuals with tinnitus accounted for 21.6%. Women with tinnitus or menstrual irregularity had significantly higher rates of stress, depressive mood, and suicidal ideation than those without. The proportion of individuals with irregular menstrual cycles with duration of longer than 3 months increased as the severity of tinnitus increased (P = 0.01). After adjusting for confounding variables, the odds of tinnitus increased in individuals with irregular menstrual cycles compared to those with regular menstrual cycles. The odds ratios (ORs) of tinnitus tended to increase as the duration of menstrual irregularity became longer (1.37, 95% confidence interval: 1.06–1.78 for duration of up to 3 months; 1.71, 1.03–2.85 for duration of longer than 3 months, P for trend = 0.002). Our study found a positive association between menstrual cycle irregularity and tinnitus. Menstrual cycle irregularity may be a related factor of tinnitus in women with childbearing age.

Effect of Calcium and Vitamin D Supplements as an Adjuvant Therapy to Metformin on Menstrual Cycle Abnormalities, Hormonal Profile, and IGF-1 System in Polycystic Ovary Syndrome Patients: A Randomized, Placebo-Controlled Clinical Trial

Objective. This study aims to investigate the effect of combining calcium and vitamin D supplements with metformin on menstrual cycle abnormalities, gonadotropins, and IGF-1 system in vitamin D-deficient/insufficient PCOS women. Study Design. This is a randomized, placebo-controlled clinical trial. Setting. This study was performed in Damascus University of Obstetrics and Gynecology Hospital and Orient Hospital, in Damascus, Syria. Materials and Methods. Forty PCOS women with 25-OH-vitamin D < 30 ng/ml were randomly assigned to take either metformin (1500 mg/daily) plus placebo or metformin (1500 mg/daily) plus calcium (1000 mg/daily) and vitamin D3 (6000 IU/daily) orally for 8 weeks. Serum levels of gonadotropins (luteinizing hormone (LH) and follicle-stimulating hormone (FSH)), insulin-like growth factor-1 (IGF-1), and insulin-like growth factor binding protein-1 (IGFBP-1) were detected at the baseline during the early follicular phase of a spontaneous or induced menstrual cycle and after 8 weeks of intervention (except for the final gonadotropins levels which were assayed from samples obtained during the early follicular phase of a spontaneous menstrual cycle). Results. Thirty-four patients (85%) completed the study. After 8 weeks of intervention, calcium and vitamin D co-supplementation led to a significant increase in 25-OH-vitamin D levels and calcium levels in the supplementation group compared to the other group (change in 25-OH-vitamin D levels: +19.38 ± 7.78 vs +0.11 ± 4.79 ng/ml, respectively; p value=0.0001) (change in calcium levels: +0.83 ± 0.82 vs +0.01 ± 0.86 mg/dl, respectively; p value=0.014). An improvement in menstrual cycle irregularity was detected in 38.5% and 58.8% of patients in metformin-placebo group and metformin-calcium-vitamin D group, respectively; but the change was statistically significant only in the supplementation group (p value=0.002). Nevertheless, the means of changes from baseline in gonadotropins levels (serum levels of LH, FSH, and LH to FSH ratio) and the studied parameters of IGF-1 system (serum levels of IGF-1, IGFBP-1, and IGF-1 to IGFBP-I ratio) did not differ significantly between the two groups. Conclusions. Calcium and vitamin D supplements can support metformin effect on regulation of menstrual cycle irregularity in vitamin D-deficient/insufficient PCOS patients, but this effect is not associated with any significant changes in gonadotropins or IGF-1 system. These results suggest a possible role of calcium and vitamin D supplements in managing PCOS. However, further studies are needed to identify the underlying mechanisms. The Clinical Trial Registration Number is NCT03792984.

Evaluation of the Association between Menstrual Cycle Irregularity and Dental Pain or Chewing Discomfort in Women before Menopause

This study was performed to assess the relationship between menstrual irregularity and dental pain or chewing discomfort in women before menopause, using nationally representative data. This study analyzed 4595 participants who were ≥19 years or older, and did not have missing values for outcome variables from the Korean National Health and Nutrition Examination Survey. Tooth pain was considered present if the participant felt throbbing discomfort, pain, or sensitivity when eating hot or cold food or drinking hot or cold beverages. Self-reported oral chewing discomfort was obtained. Adjusted odds ratios and their 95% confidence intervals for tooth pain in the individuals with menstrual cycle irregularity were 1.30 (1.05, 1.62) after adjustment for age, body mass index, drinking, smoking, income, exercise, stress, metabolic syndrome, and the frequency of tooth brushing. Adjusted odds ratios and their 95% confidence intervals for chewing discomfort in the individuals with menstrual cycle irregularity were 1.33 (1.03, 1.72) after adjustment. The association between menstrual irregularity and dental pain or chewing discomfort in women before menopause was proven—after adjusting for confounding factors—by multiple logistic regression analyses. Menstrual cycle irregularity may be considered a potential risk indicator for dental pain or chewing discomfort in Korean women before menopause.