Insulin-dependent diabetes mellitus and menstrual dysfunction

Area of Science:

• Reproductive Endocrinology
• Diabetology
• Neuroendocrinology

Background:

• Disordered reproductive function is common in women with insulin-dependent diabetes mellitus (IDDM).
• Menstrual dysfunction affects nearly one-third of reproductive-aged women with IDDM, including delayed menarche.
• Previous research has explored various mechanisms, including ovarian, uterine, and pituitary functions.

Purpose of the Study:

• To review prevailing views on mechanisms disrupting hypothalamic-pituitary-gonadal function in uncontrolled IDDM.
• To synthesize current understanding of reproductive dysfunction in young women with IDDM.

Main Methods:

• Literature review of prevailing views on IDDM and reproductive function.
• Analysis of clinical and animal studies on IDDM's impact on reproductive organs and systems.
• Examination of hormonal assessments, including gonadotrophins and GnRH stimulation tests.

Main Results:

• Clinical studies do not support abnormal uterine or ovarian function as causes of menstrual dysfunction in young diabetic women.
• Pituitary function appears normal in young women with IDDM, though long-term effects require further investigation.
• Oligo/amenorrhea in IDDM is primarily hypothalamic, potentially due to intermittent GnRH pulse generator failure.

Conclusions:

• Hypothalamic dysfunction, specifically of the GnRH pulse generator, is the principal cause of menstrual irregularities in IDDM.
• Potential mechanisms include increased central opioidergic/dopaminergic activity and central glucose deprivation.
• Understanding and addressing IDDM's impact on reproductive potential is crucial, especially with emphasis on glycemic control.