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Insulin-dependent diabetes mellitus and menstrual dysfunction

M L Griffin1, S A South, V I Yankov

  • 1Department of Internal Medicine, University of Virginia, Charlottesville.

Annals of Medicine
|October 1, 1994
PubMed
Summary

Women with insulin-dependent diabetes mellitus (IDDM) often experience reproductive issues, primarily due to hypothalamic dysfunction affecting the GnRH pulse generator. This dysfunction may be linked to increased opioid, dopamine activity, or glucose deprivation.

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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.

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  • 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.