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Rising obesity rates around the world have a profound impact on female reproductive health.
Menstrual irregularities are common in both overweight and obese women, starting in the adolescent years and extending into adulthood.
Childhood obesity is associated with early onset of puberty, menstrual problems including irregularities during adolescence and Polycystic Ovary Syndrome (PCOS).
Obesity and Pubertal Disturbance
There ar several epidemiological studies that suggest changes in body weight are critical factors regulating pubertal development in young women.
Leptin and increased amounts of Androgens, both caused by Obesity, imbalance the hormones and causes pubertal disturbance.
Some studies have reported that obese girls had their menarche earlier than normal-weight girls.
Obesity and Irregular Menstrual Cycles
The association between obesity and menstrual problems including irregularities in menstrual cycle has been recognized.
Obesity was present at a fourfold higher rate in women with menstrual irregularities compared with normally menstruating females.
Historical data from 26,638 women, aged 20–40 years, were used to study the association between obesity and menstrual abnormalities, including evidence of infertility. It was found that women with evidence of an-ovulatory cycles, in other words, irregular cycles greater than 36 days and hirsutism, were more than 30 lb (13.6 kg) heavier than women with no menstrual abnormalities after adjusting for height and age.
Link Between Obesity And Menstrual Problems
Overweight and obese women have a higher incidence of menstrual dysfunction and anovulation.
Rogers and Mitchell found that menstrual disturbances were fourfold more common in obese women.
Hartz et al. found this incidence to be 3.1 times higher in obese women than normal weight women.
Obesity and Adolescents
In adolescents and young women, the age of onset of obesity and that of menstrual problems are significantly correlated.
In the 1958 British birth cohort, Lake et al. tracked 5,799 females at the ages 7, 11, 16, 23 and 33 years and noted that obesity in childhood and early twenties increased the risk of menstrual problems.
Obesity at 23 years and obesity at 7 years both independently increased the risk of menstrual problems by age 33 years.
Centrally Distributed Body Fat
It has been suggested that centrally distributed body fat or Visceral fats may be more strongly associated with menstrual abnormalities. It is also associated with adverse hormonal profiles than measures of peripheral body fat or overall adiposity.
The quantity and distribution of body fat affect the menstrual cycle through a range of hormonal mechanisms. The more excess weight and the more abdominal fat, the greater the risk of fertility difficulties.
Excess weight, particularly excess abdominal fat, is linked to insulin resistance (when the body has to produce more insulin to keep blood sugar levels normal) and decreased levels of sex hormone-binding globulin (SHBG), a protein that is involved in the regulation of the sex-hormones androgen and oestrogen. This increases the risk of irregular menstrual cycles, which in turn reduces fertility.
Women with a BMI of 35 have a fivefold higher risk of long menstrual cycles compared with those with a BMI between 22 and 23.
Role of Androgens in Menstrual Irregularities
Clinical studies have also shown elevated total and free androgen levels and depressed SHBG in obese women with amenorrhea or oligo-menorrhea.
The results suggest that testosterone and SHBG may play an important role in the development of menstrual irregularity in obese women.
Even in non-obese healthy women, menstrual irregularities appeared to be associated with higher levels of circulating androgens.
Role of Leptin in Menstrual Disturbance
A fine hormonal balance regulates the menstrual cycle. Overweight and obese women have higher levels of a hormone called leptin, which is produced in fatty tissues called adipocytes,. This can disrupt the hormone balance and lead to reduced fertility.
Changes in the fine-tuned hormonal balance that regulates the menstrual cycle triggered by excess weight and obesity also increase the risk of anovulation (when no egg is released by the ovaries).
Leptin is thought to inhibit ovarian follicular development. Furthermore, circulating insulin, which is increased in obese women secondary to peripheral tissue resistance, results in increased ovarian androgen production. It can lead to menstrual irregularities and difficulty with conception.
Obesity in Young Age and Fertility
Women who were overweight and obese at 23 years of age were less likely to conceive within 12 months of unprotected intercourse.
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Menstrual Disturbance and Irregular Menstrual cycles are strongly associated with body weight in young ages. The first treatment of menstrual disturbance in obese girls must be weight control.
Obesity and Menstrual Irregularity: Associations With SHBG, Testosterone, and InsulinShuying Wei ,Michael D. Schmidt, Terence Dwyer, Robert J. Norman, Alison J. Venn
Obesity and anovulatory infertility: A review
Impact of obesity on female fertility and fertility treatment
- Maternal obesity and associated reproductive consequences:Kelecia Brown†, Joseph Apuzzio & Gerson Weiss; https://journals.sagepub.com/doi/full/10.2217/WHE.10.9