Menstrual Dysfunction in Adolescents with Chronic Illness: A Systematic Review

Area of Science:

• Reproductive Health
• Pediatric Endocrinology
• Chronic Disease Management

Background:

• Menstrual dysfunction affects adolescent physical and emotional well-being.
• Chronic diseases are linked to menstrual dysfunction in adults, but research in adolescents is limited.
• Adolescents with chronic illnesses often experience suboptimal disease control and treatment adherence.

Approach:

• Systematic literature search of EMBASE, PubMed, and Cochrane databases (to January 2022).
• Included studies of female adolescents (10-19 years) with chronic physical illnesses, excluding conditions where menstrual dysfunction is inherent or medications directly affect gonadal function.
• Analyzed data on age of menarche and menstrual cycle quality.

Key Points:

• Analysis of 43 studies involving adolescents with conditions including type 1 diabetes, cystic fibrosis, inflammatory bowel disease, juvenile idiopathic arthritis, celiac disease, and chronic renal disease.
• Meta-analysis of 933 patients with type 1 diabetes showed a significantly later age of menarche (0.42 years later; P ≤ .00001) compared to 5244 controls.
• Later age of menarche was associated with higher HbA1c and insulin dose (IU/kg) in type 1 diabetes.

Conclusions:

• Evidence suggests delayed menarche and irregular menses in adolescents with cystic fibrosis and type 1 diabetes.
• Most included studies were small and focused on single populations.
• Further structured research is necessary to fully evaluate menstrual dysfunction in adolescents with chronic illnesses and its relationship to their conditions.