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Menstrual Disorders: Amenorrhea and Polycystic Ovary

Introduction

Menstrual disorders are something that women rarely pay attention to. Many of these disorders are either asymptomatic or have minor symptoms that do not violate the usual flow of life. That is why women tend to ignore those until the condition worsens, and a visit to a gynecologist can no longer be postponed. However, no menstrual disorder is harmless and can pass by itself, which is why every woman should regularly see her doctor to identify a disease if there is any in its early stages. Otherwise, more severe symptoms will occur. This paper partly addresses the case of amenorrhea and then focuses on the more severe menstrual disorder, called polycystic ovary syndrome (PCOS), which has amenorrhea as one of its primary symptoms (What causes amenorrhea, 2014, par. 3).

To start with, amenorrhea is not always a disorder – it can occur because of natural reasons. For example, pregnancy is considered to be the most common reason for amenorrhea when it comes to women in childbearing age (What causes amenorrhea, 2014, par. 3). Additionally, breastfeeding and menopause can also be the cause. However, when amenorrhea is accompanied by the symptoms that resemble the symptoms of polycystic ovary syndrome that is a disease. Moreover, if amenorrhea is not caused naturally, in approximately 30% of cases, it is caused by polycystic ovarian syndrome (Willacy & Newson, 2013, par. 13).

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There are two types of amenorrhea: primary amenorrhea and secondary amenorrhea. Primary amenorrhea (PA) is a condition, which is characterized by the absence of the first menstrual flow (the menarche) at the time when it is usually expected (Willacy & Newson, 2013, par. 3). Again, the absence of the menarche at the age of 14 is not always an abnormality. For example, if secondary sexual characteristics such as the growth of body hair or the breast growth are not present, menstruation may be absent just because it is not the time yet. As Willacy and Newson (2013) state, “the menarche is the last of the characteristics to develop”, which is why it is better to wait until the age of 16 before worrying about primary amenorrhea (par. 6). However, if menstruation is absent even at the age of 16, it is strongly recommended to consult a doctor. As for secondary amenorrhea (SA), it occurs when a woman has already reached her menarche and had menstrual periods but those have stopped for some reason for at least six months (Willacy & Newson, 2013, par. 3). Many people mistakenly believe that polycystic ovary syndrome can cause only secondary amenorrhea. Nevertheless, that is a false conclusion. As Willacy and Newson (2013) write, “almost every cause of secondary amenorrhoea can also cause primary amenorrhoea, if it is established before the menarche” (par. 7). In their study, Rachmiel, Kives, Atenafu, and Hamilton (2008) not only prove that women with primary amenorrhea can have PCOS but also show that they “may represent a more severe spectrum of a common condition” (p. 521).

Considering all of this, it can be concluded that amenorrhea, whether it is primary or secondary, is just a symptom while polycystic ovary syndrome is the real problem. This condition is greatly compounded by the fact that its etiology is still unknown, which is why it is usually defined as “a set of symptoms related to a hormonal imbalance” that can be observed in women reached reproductive age (Polycystic Ovary Syndrome, 2013, par. 1).

After the Congress enacted the Affordable Care Act where the state of public health in the US was summarized, and the tasks to promote the wellness of the population and prevent the diseases were established, the efforts to do this vastly increased (Shearer, 2010, p. 1). Many studies have been conducted to draw public attention to PCOS and its symptoms and prove that this condition is more serious than it seems. Many health plans included polycystic ovary syndrome in their agenda. For example, the Centers for Disease Control and Prevention (2014) admitted the importance of addressing the issue of PCOS with the help of various interventions and strategies under the National Public Health Action Plan for the Detection, Prevention, and Management of Infertility (p. 11). However, PCOS should be considered in the broader sense.

Polycystic ovary syndrome is associated with numerous health-related conditions, which are not limited to reproductive criteria. Many researchers say that PCOS should be addressed as a metabolic disorder as well (Baldani, Skrgatic, & Ougouag, 2015). Considering the seriousness of the syndrome, two questions that I would like to explore further in this paper are the number of women who have this condition and its specific symptomatology. Even though many studies confirm the seriousness of polycystic ovary syndrome, it remains an underrecognized risk factor for women, which is why I am deeply concerned about it. My task as a nurse is to inform, encourage, and enable people to care for their health and make every effort to improve it. That is why I am so interested in this topic. I want to draw people’s attention to its importance and seriousness and make every woman who has even the slightest symptoms, especially amenorrhea, to consult her doctor and be examined. I also set a goal to encourage every healthy woman to undergo regular inspection at the gynecologist to be able to identify and cure any disorder in its early stages.

Literature Review

For this part of the paper, I have chosen two journal articles related to the topic of polycystic ovary syndrome and amenorrhea. Both of them contain information about the most recent studies since they have been published in the past two years.

The Research and Findings of the First Article

The first article is called Polycystic Ovary Syndrome: Important Underrecognised Cardiometabolic Risk Factor in Reproductive-Age Women. It was published in March 2015 in the International Journal of Endocrinology, a peer-reviewed journal that specializes in research and review articles in the field of endocrinology. The topic of polycystic ovary syndrome has deserved attention since PCOS is “the most common endocrine disorder amongst women of reproductive age” (Baldani et al., 2015, p. 1).

Firstly, the article provides a brief introduction. It gives the information regarding the number of women that are diagnosed with PCOS: 10% according to the NIH criteria used for diagnosis and nearly 20% according to the Rotterdam criteria (Baldani et al., 2015, p. 1). Then, acknowledging that the diagnosis is based only on the reproductive criteria and that infertility remains the primary focus in the case of PCOS, the authors tell about other health-related conditions, which patients with polycystic ovary syndrome risk to have. Among those are dyslipidemia and obesity, the insulin resistance (IR), type 2 diabetes mellitus, and many others (Baldani et al., 2015, p. 1).

To investigate the issue of PCOS, the authors used the qualitative research method, particularly literature review. They analyzed numerous books and articles related to the topic and published from 1980 to the present time. They concluded that three most common sets of criteria that were used to diagnose polycystic ovary syndrome in the previous two decades were the NIH criteria, the Rotterdam criteria, and the AE-PCOS Society (Baldani et al., 2015, p. 2). Each set of criteria contained different symptoms. The NIH criteria relied on oligo- or amenorrhea and signs of hyperandrogenism regardless of what ultrasound said (Baldani et al., 2015, p. 2). The Rotterdam criteria required two of the following three criteria to diagnose PCOS: oligo- or amenorrhea, signs of hyperandrogenism and polycystic ovaries detected by ultrasound (Baldani et al., 2015, p. 2). Finally, according to the AE-PCOS Society, ovarian dysfunction and signs of hyperandrogenism were enough to diagnose the syndrome (Baldani et al., 2015, p. 2). With this in mind, the authors identify four different phenotypes with their own sets of criteria: A, B, C, and D. Then, they compare women diagnosed under each of the phenotypes. At the main part, the study discusses each of possible consequences of PCOS, focusing mainly on obesity, insulin resistance, and cardiovascular risks. The authors prove that obesity aggravates the situation in many cases.

The Research and Findings of the Second Article

The second article I have chosen for my literature review is called Polycystic Ovary Syndrome in University Students: Occurrence and Associated Factors. It was published in December 2014 in the International Journal of Fertility & Sterility, a scientific and research journal that disseminates information about recent studies in its field. This study seems interesting to me because students (together with ballet dancers and athletes) are more often than others are diagnosed with polycystic ovary syndrome (Willacy & Newson, 2013, par. 4).

In the introduction to the article, the authors provide the statistics regarding the issue of PCOS. They say that approximately one in ten women has it, although many of them are not even aware of it (Attlee, Nusralla, Eqbal, Said, Hashim, & Obaid, 2014, p. 261). Then, some of the symptoms are named, including both those from the reproductive perspective and others, such as obesity, insulin resistance, problems with the cardiovascular system, and so forth. The last paragraph of the introduction explains why students have been chosen for the study. Although female students are “the future mothers of the society”, ironically, they often do not know if they have PCOS or not until they marry and face fertility problems (Attlee et al., 2014, p. 262). With their study, the authors wanted to pay people’s attention to the importance of assessing PCOS occurrence in young population as soon as possible.

The method the authors have used is quantitative. Although the background information about the participants has been collected through the interviews, the article contains a lot of measurements, and the results are presented in numbers, percentages, and tables. The participants are fifty female students, which have been chosen with the help of convenience sampling method. The age of participants varies from 17 to 23; one of the women is married, none has children (Attlee et al., 2014, p. 263). Approximately 8% of the participants (4 students) had PCOS and were aware of their condition (Attlee et al., 2014, p. 263). However, during the study, six more women who thought that they were healthy were diagnosed with PCOS by ultrasound. And that leaves us with 20% of students diagnosed with polycystic ovary syndrome (Attlee et al., 2014, p. 263). Among those, 16% had oligomenorrhea (infrequent menstrual periods at intervals of more than 35-40 days), 4% had polymenorrhea (irregular menstruation at intervals of less than 22 days), and nobody had amenorrhea (Attlee et al., 2014, p. 263). That can be explained by the fact that amenorrhea is the aggravated condition of oligo- or polymenorrhea, and since students refer to younger population, they have PCOS in its early stages. Approximately one-third of the participants had difficulties in maintaining normal body weight. Indeed, the weight of all participants varied from 40 to 98 kg, and students diagnosed with polycystic ovary syndrome had a mean weight of approximately 77 kg while the same value for the students without the syndrome was 58 kg (Attlee et al., 2014, p. 263). In addition, such values as body mass index (BMI), waist-hip ratio (WHR), percent body fat (PBF), fat-free mass (FFM), and visceral fat area (VFA) were also higher in students with polycystic ovary syndrome in comparison with those healthy ones (Attlee et al., 2014, p. 263). With all of this in mind, the authors concluded “the global occurrence” of PCOS and admitted that more studies were needed in this area (Attlee et al., 2014, p. 265).

Comparison and Contrasting of Two Articles

Two articles that I have chosen for this assignment are very different. Nevertheless, they still have something in common. Firstly, both of them address the topic of polycystic ovary syndrome and mention amenorrhea as one of its main consequences. Secondly, in both articles, it is said that PCOS is a very common endocrine disorder, which women in the reproductive age have. Baldani et al. (2015) give the statistics from 10% to 18% according to different methods (p. 1). Attlee et al. (2014) say that approximately one in ten women has PCOS, which is 10% (p. 261). According to the results of the second study, 20% of participants have been diagnosed with the syndrome, but we can not rely on this value when it comes to women of all ages since it has already been mentioned that students more often have PCOS.

The authors also agree on the point that the majority of women are not aware of their condition. Baldani et al. (2015) state that more than 70% of PCOS cases remain undiagnosed (p. 1). Attlee et al. (2014) do not provide any statistics in this regard but mention that “university students may appear healthy and not realize that they have PCOS until problems in conceiving are encountered during marriage” (p. 262). There are many similarities in the symptoms, which the authors of the first and the second article describe. However, Baldani et al. (2015) pay much more attention to cardio and metabolic conditions, while Attlee et al. (2014) focus mainly on obesity and other body composition variables.

As for the distinctions, the articles address different aspects of the syndrome; besides, the first article is theoretical, while the second one describes a concrete evidence-based experience. The research methods and data collection tools also differ. The study by Baldani et al. (2015) was qualitative, conducted only with the help of literature analysis. The works that were analyzed were published starting with 1980 year. The results were obtained through an inductive approach of the data analysis. Attlee et al. (2014), on the contrary, conducted a cross-sectional quantitative study, the participants of which were selected using the convenience sampling method. The results were obtained through the statistical analysis and comparison of received measurements. Finally, the first article provides the results that are more fundamental since they are based on studies of two decades, while the second article gives specific data about only one particular study of fifty participants.

Synthesis of Literature and Proposal

To conclude, both of the articles are valuable for an understanding of the topic. However, further studies in this area are still necessary.

First of all, the picture of the symptomatology and the occurrence of polycystic ovary syndrome is still not fully investigated and even constantly changing. For example, in the articles I have discussed above, the authors say that the percentage of women who have PCOS is from 10% to 18%. However, while I was reviewing the literature for this assignment, I found other statistics. In their article Polycystic Ovary Syndrome: It’s Not Just Infertility, Hunter & Sterrett (2000) claimed that approximately 6% of women had the syndrome (p. 1079). Hence, it can be concluded that the number of women with PCOS has increased, which is why further studies in this area are imperative to investigate the concept better.

Second of all, there is an issue that is still not addressed in either of these articles. That is an aspect of a particular geographic region and associated ethical/cultural origins. Why is it important? Let us consider the following example. As Baldani et al. (2015) claim, obesity is one of the factors that can aggravate the consequences and symptoms of polycystic ovary syndrome. For example, insulin resistance is more common among obese women with PCOS than among lean ones; besides, body mass index (BMI) has its effect on the magnitude of IR as well (Baldani et al., 2015). Many other studies confirm the same fact – the one conducted by Gambineri, Pelusi, Vicennati, Pagotto, & Pasquali (2002), for instance. The authors state that obesity can be “partly responsible” for IR and even use such a phrase as “obesity-related hyperinsulinemia” (Gambineri et al., 2002, p. 883). According to Baldani et al. (2015), at least 80% of women that have polycystic ovary syndrome in the US are obese, while the obesity level of women with PCOS in other countries is only 38-50% (p. 4). Even when it comes to the general obesity in the country, this value in the US is much higher than outside. For example, in Italia, only 8% of females are obese (Baldani et al., 2015). Another study, conducted by Sam (2007), states the same. The author says that not only the levels of obesity among the US females with PCOS are higher but also the severity of obesity is worse (Sam, 2007, p. 69). Admittedly, obesity levels are affected by people’s lifestyles, ethnicity, environmental criteria, and many other factors that vary from country to country. Does the high level of obesity in America mean that more women here have polycystic ovary syndrome and/or more severe symptoms of this health condition? Considering all mentioned above, I am inclined to give a positive answer to this question. However, additional research is needed to prove or disprove that. And that is only one of the examples why geographical location should be taken into account.

So, a research question is whether the percentage of women diagnosed with polycystic ovary syndrome depends on the geographical location and is connected to ethical/cultural origins or not. And if so, which factors and symptoms are more frequent and/or severe in female representatives of one country and less frequent and/or severe in representatives of other countries? For a start, we can take the areas inside the US and outside it. I think that a qualitative research and literature analysis would be appropriate in this case. Since it would be too hard to examine female representative from other countries in person, I suggest to find several practical studies connected to the topic and analyze those. As an example, the second article, which is discussed in my literature review, describes a study conducted in the United Arab Emirates (Attlee et al., 2014). In addition, there is a very similar cross-sectional study by Ou, Wu, Lin, and Chen (2015) conducted among female patients of a medical center in China. And a lot of other suchlike studies can be found. Therefore, the target population will consist of people both inside the US and outside the country. The research will contribute to social change since it will address the issue that has not been discussed before and will make a conclusion if the prevalence and severity of the symptoms of polycystic ovary syndrome depend on geographical region or not. That, in its turn, will help us to address the problem of PCOS better among our population.