On the question of the characteristics of the menstrual cycle in adolescent girls with obesity

Background. Due to the increasing prevalence of abnormal uterine bleeding (AUB) among obese adolescent girls, a factorial analysis of the probable causes of this pathology is highly relevant.

Aim. To analyze and characterize clinical, hormonal, metabolic features and parameters relevant to the assessment of ovarian reserve in adolescent girls with obesity and AUB.

Materials and methods. The study included 2 groups of obese adolescent girls who have passed at least 12 months from the start of menarche, who do not have endocrine and severe somatic diseases; main group: adolescent girls with obesity (SDS BMI more than 2) and abnormal uterine bleeding of the type of opso-oligomenorrhea and secondary amenorrhea; comparison group: adolescent girls with obesity (SDS BMI more than 2) and absence of menstrual cycle disorders.

Results. Among adolescent girls without AUB, severe forms of obesity (3–4 art.) were more common than in the group with AUB. According to the metabolic status, plasma triglyceride and cholesterol levels were significantly higher in the AUB group compared with adolescent girls without menstrual disorders (p=0.035 and 0.043, respectively).When assessing carbohydrate metabolism, no significant differences between the groups were obtained (p=1.000). According to the results of the study of the hormonal status, no significant differences between the groups were obtained. The hirsute number had no significant differences in the groups. The correlation analysis revealed a positive correlation between the severity of obesity with the HOMA index (p=0.034), a positive correlation of the prolactin level with the hirsute number (p=0.021) and estradiol (p=0.04). The median level of anti-muller hormone in the group with AUB was significantly higher compared to the group without AUB (6.13 ng/ml vs 2.09 ng/ml, p<0.05). When analyzing the follicular apparatus of the ovaries, it was found that the median volume of both the right and left ovaries in girls of group 1 with obesity and the AUB was larger than in the comparison group. The median number of follicles in the section in group 1 also indicated a greater number of them compared to the comparison group.

Conclusion. In the studied groups, girls with a more severe degree of obesity were more often associated with the absence of AUB, but metabolic disorders were more common in the group of girls with AUB. When assessing the ovarian reserve, a direct correlation was obtained between the level of anti-muller hormone and the number of antral follicles in the ovary.