青少年痛经需要仔细排查子宫内膜异位症——一项大型病例对照研究中对早期月经经历的分析。
Dysmenorrhea in adolescents requires careful investigation of endometriosis-an analysis of early menstrual experiences in a large case-control study.
作者信息
El-Hadad Samia, Lässer Daksha, Sachs Maike-Katja, Schwartz Alexandra Sabrina Kohl, Haeberlin Felix, von Orelli Stephanie, Eberhard Markus, Leeners Brigitte
机构信息
Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland.
Division of Gynecological Endocrinology and Reproductive Medicine, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
出版信息
Front Reprod Health. 2023 Aug 25;5:1121515. doi: 10.3389/frph.2023.1121515. eCollection 2023.
INTRODUCTION
Recent evidence shows that endometriosis, a significant cause of infertility, may already present in adolescents. Dysmenorrhea, often leading to school absences, is a key symptom of the maturing menstrual cycle but also of endometriosis. However, it is often perceived as "normal" and left untreated. In adolescents, laparoscopy, the standard procedure to diagnose endometriosis, is performed particularly cautiously. To improve reproductive health in adolescents, we evaluate associations between early menstrual experiences and endometriosis.
METHODS
Retrospective data on early menstrual experiences from 563 women with surgically/histologically verified endometriosis and from 563 age-matched controls were compared. Study participants were recruited in Switzerland, Germany, and Austria. Information on menstrual experiences was collected via a structured questionnaire.
RESULTS
The bivariate analysis showed that early menarche ( = 0.004), dysmenorrhea and negative memories of menarche ( < 0.001) were significantly associated with a diagnosis of endometriosis. After controlling for confounders in bivariate regression analysis occurrence of dysmenorrhea ( = <0.001, OR 5,74, 95% CI 3.82-7.22) especially with onset >3 years after menarche (( = <0.001, OR 3.42, 95% CI 2.09-5.64) remained statistically significant predictors for diagnosis of endometriosis. Dysmenorrhea in mothers and mothers' perceived attitude towards menstruation were not associated with the occurrence of Endometriosis.
CONCLUSIONS
Dysmenorrhea and onset of dysmenorrhea at menarche or several years after it are strongly associated with the development of endometriosis. As mothers perceived attitudes towards menstruation show no significant association with their daughters' experiences, physical symptoms accompanying menarche and menstrual period pain in adolescents seem to be very reliable predictors in diagnosis of endometriosis. Therefore, dysmenorrhea in adolescents requires careful investigation of possible endometriosis, especially if it does not respond to medical management.
CLINICAL TRIALS REGISTRATION
The study was registered on ClinicalTrials.gov, identifier (NCT02511626).
引言
最近的证据表明，子宫内膜异位症作为不孕症的一个重要原因，可能在青少年时期就已出现。痛经往往导致缺课，是月经周期成熟的关键症状，也是子宫内膜异位症的症状。然而，它常常被视为“正常”情况而未得到治疗。在青少年中，腹腔镜检查作为诊断子宫内膜异位症的标准程序，实施时格外谨慎。为改善青少年的生殖健康，我们评估早期月经经历与子宫内膜异位症之间的关联。
方法
比较了563名经手术/组织学证实患有子宫内膜异位症的女性和563名年龄匹配的对照组女性的早期月经经历的回顾性数据。研究参与者在瑞士、德国和奥地利招募。通过结构化问卷收集月经经历信息。
结果
双变量分析显示，初潮早（P = 0.004）、痛经和对初潮的负面记忆（P < 0.001）与子宫内膜异位症的诊断显著相关。在双变量回归分析中控制混杂因素后，痛经的发生（P = <0.001，OR 5.74，95%CI 3.82 - 7.22），尤其是初潮后3年以上开始出现的痛经（P = <0.001，OR 3.42，95%CI 2.09 - 5.64）仍然是子宫内膜异位症诊断的统计学显著预测因素。母亲的痛经情况以及母亲对月经的认知态度与子宫内膜异位症的发生无关。
结论
痛经以及初潮时或初潮几年后出现痛经与子宫内膜异位症的发展密切相关。由于母亲对月经的认知态度与女儿的经历无显著关联，青少年初潮时伴随的身体症状和经期疼痛似乎是诊断子宫内膜异位症非常可靠的预测因素。因此，青少年痛经需要仔细检查是否可能患有子宫内膜异位症，尤其是在痛经对药物治疗无反应的情况下。
临床试验注册
该研究已在ClinicalTrials.gov上注册，标识符为（NCT02511626）。
Zotero 插件