Modarelli Rachel E, Molsberry Samantha A, Malave-Ortiz Sofia, Calvert Madison, Lucien Janet, Denslow Sheri, Zaccaro Daniel, Kamoun Camilia, Shaw Natalie D
Division of Pediatric Endocrinology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Pediatric Neuroendocrinology Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS), Durham, North Carolina.
Social & Scientific Systems, A DLH Holdings Company, Durham, North Carolina.
J Pediatr Adolesc Gynecol. 2025 Feb;38(1):52-59. doi: 10.1016/j.jpag.2024.10.006. Epub 2024 Nov 5.
To determine the natural history of menstrual pain without pelvic pathology, the role of progesterone in its pathophysiology, and associated risk factors in a longitudinal study of early postmenarchal girls in North Carolina.
Participants contributed daily urine samples for up to 3.5 years to measure pregnanediol-3-glucuronide (PdG) (mean 589 urines/participant), completed menstrual diaries, and reported menstrual pain using the Menstrual Symptom Questionnaire (MSQ) biannually. MSQ scores were log-transformed and generalized estimating equations assessed associations with gynecologic age, cycle peak PdG, presumed ovulation, physical activity, anxiety, and depression. Models were adjusted for age at menarche, baseline body mass index, race/ethnicity, parental education and employment, and gynecologic age.
Forty-three girls, aged 12.6 ± 1.1 years (mean ± SD) at enrollment with a gynecologic age 0.3 ± 0.2 years, participated. Total MSQ scores were higher for every 1-year increase in gynecologic age (MSQ score ratio: 1.12; 95% CI: 1.08, 1.17; P < .0001). Overall MSQ (ratio: 1.04; 95% CI: 1.02, 1.06; P = .0002) and abdominal pain-specific (ratio: 1.04; 95% CI: 1.01, 10.7; P = .004) scores were higher for every 1000 ng/mg creatinine increase in peak PdG in the preceding cycle. Overall MSQ scores were higher (ratio 1.26; 95% CI: 1.11, 1.44; P = .0005) if the preceding cycle was presumed ovulatory. Menstrual pain was not associated with physical activity, anxiety, or depression.
In early postmenarchal girls, gynecologic age and PdG were associated with menstrual pain, suggesting a pathophysiologic role for progesterone and other unknown factors in the development of menstrual pain.
在北卡罗来纳州对月经初潮后早期女孩进行的一项纵向研究中，确定无盆腔病理状况下痛经的自然病史、孕酮在其病理生理学中的作用以及相关危险因素。
参与者连续3.5年每日提供尿液样本以测量孕二醇-3-葡萄糖醛酸苷（PdG）（平均每位参与者589份尿液样本），完成月经日记，并每半年使用月经症状问卷（MSQ）报告痛经情况。对MSQ评分进行对数转换，并使用广义估计方程评估其与妇科年龄、周期峰值PdG、推测的排卵、身体活动、焦虑和抑郁之间的关联。模型针对初潮年龄、基线体重指数、种族/族裔、父母教育程度和职业以及妇科年龄进行了调整。
43名女孩参与研究，入组时年龄为12.6±1.1岁（平均±标准差），妇科年龄为0.3±0.2岁。妇科年龄每增加1岁，MSQ总分就更高（MSQ评分比：1.12；95%置信区间：1.08，1.17；P<.0001）。前一周期峰值PdG每增加1000 ng/mg肌酐，总体MSQ（评分比：1.04；9%置信区间：1.02，1.06；P=.0002）和腹痛特异性评分（评分比：1.04；95%置信区间：1.01，10.7；P=.004）就更高。如果前一周期推测为排卵周期，则总体MSQ评分更高（评分比1.26；95%置信区间：1.11，1.44；P=.0005）。痛经与身体活动、焦虑或抑郁无关。
在月经初潮后早期女孩中，妇科年龄和PdG与痛经相关，提示孕酮和其他未知因素在痛经发生发展中具有病理生理学作用。
