WASHINGTON -- Girls diagnosed with type 2 diabetes have a high frequency of menstrual irregularities, according to a new study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.
Menstrual irregularities can have a variety of causes, including pregnancy, hormonal imbalances, infections, diseases, trauma and certain medications. Adult women with obesity are known to be at risk for menstrual disorders like polycystic ovary syndrome (PCOS), which can lead to the development of diabetes or other metabolic problems. However, little is known about the reproductive function in girls with youth-onset type 2 diabetes.
"It's important for girls with type 2 diabetes to be assessed for menstrual problems," said the study's main author, Megan Kelsey, M.D., M.S., of University of Colorado School of Medicine in Aurora, Colo. "Infrequent periods can be associated with heavy and painful periods, increased risk for fatty liver disease, fertility problems and long-term increased risk for endometrial cancer."
The researchers performed a secondary analysis of the data from the Treatment Options for Type 2 Diabetes in Youth (TODAY) study, a nationwide research study to find the best way to treat young people with type 2 diabetes. The new analysis focused on evaluating the frequency of menstrual irregularity in girls with recently diagnosed diabetes and whether the addition of intensive lifestyle or rosiglitazone to previous treatment with metformin helped to improve symptoms. These treatments are often used to treat both diabetes and PCOS.
The researchers found that more than 20 percent of girls in the TODAY study had irregular periods. Many of those girls also had high testosterone levels, pointing to PCOS as an underlying cause. Not all the TODAY girls with irregular periods had elevated testosterone, suggesting other causes for menstrual dysfunction. Despite two years of intensive treatment with either metformin alone, metformin and lifestyle changes, or metformin and rosiglitazone, the participants still had significantly irregular periods.
"Our findings suggest that girls with youth-onset diabetes may need the additional intervention above and beyond their diabetes treatment to improve their menstrual health," Kelsey said.
Other authors of the study include: Barbara Braffett of the Biostatistics Center of George Washington University in Rockville, Md.; Mitchell Geffner of Children's Hospital Los Angeles and Keck School of Medicine of USC in Los Angeles, Calif.; Lynne Levitsky of Massachusetts General Hospital and Harvard Medical School in Boston, Mass.; Sonia Caprio of Yale School of Medicine in New Haven, Conn.; Siripoom McKay of Baylor College of Medicine and Texas Children's Hospital in Houston, Texas; Rachana Shah of Children's Hospital of Philadelphia in Philadelphia, Pa.; Jennifer Sprague of Washington University in St. Louis, Mo.; and Silva Arslanian of University of Pittsburgh and Children's Hospital of Pittsburgh of UPMC in Pittsburgh, Pa., for the TODAY Study Group.
The study was supported by research grants from the National Institute of Diabetes and Digestive and Kidney Disease.
The study, "Menstrual Dysfunction in Girls from the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) Study," will be published online, ahead of print.
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The Journal of Clinical Endocrinology & Metabolism