Age at Menarche, Duration of Monthly Flow and Cycle Length as Risk Factors for Endometriosis in Sub-Sahara Black African Women| Stephy Publishers
Pregnancy and Women’s Health Care International Journal - (PWHCIJ)| Stephy Publishers
Abstract
Introduction: Endometriosis is an enigmatic and
multifaceted ailment that distresses a large number of women worldwide which
may trigger pain, infertility and other discomforts such as dysmenorrhea.
Materials and Methods: Data from the medical records of 113
women with and 113 age-matched women without endometriosis were analyzed
retrospectively to investigate association of three domains of menstrual
characteristics – age at menarche, duration of menstrual flow and cycle length
– with risk of developing endometriosis. STATA 13 statistical software was used
for analysis of data.
Results: Sub-fertile women with menarche at
<11 years were 1.80 times more likely to have endometriosis (OR=1.80, 95%
CI: 0.51, 6.33) and had 1.29 times the risk of the disease (RR=1.29, 95% CI:
0.81, 2.06) influenced by body mass index (BMI in Kg/m2). Women with duration of flow of 4-7 days were 2.33 times more
likely to have endometriosis. Women with cycle length of ≥28 days were 1.45
times more likely to also have endometriosis. Mean egg yield at OPU from
endometriotic women was significantly lower than that from women without
endometriosis when age at menarche was ≥14 years (t-test=-4.44,
P-value=0.00000001), when duration of flow (days) was 4-7 (t-test=-4.78,
P-value=0.00000001) and when cycle length was ≥28 days (t-test=-4.35,
P-value=0.00000001). The mean matured eggs (MII) was very significantly higher
when age at menarche was ≥14 years (t-test=-2.59, P-value=0.006), when duration
of flow was 4-7 days (t-test=2.81, P-value=0.003) and when the cycle length was
≥28 days (t-test=-2.79, P-value=0.003). Multivariate regression analysis
indicated that menarche, number of days of menstrual flow and cycle length gave
a significant 90% of the variation found in endometriosis (R2=0.9001, F=648.77,
P-value=0.000000001).
Conclusion: Menarche at age <11 years and cycle length
of ≥28 days were significantly associated with and were better predictors of
laparoscopic ally confirmed endometriosis. BMI influenced all of the three
domains of menarche, duration of flow (days) and cycle length. Endometriotic
women produced fewer oocytes but fertilization rate was not compromised.
Keywords
Endometriosis,
Menstrual characteristics, Dysmenorrhea, Egg yield at ovum pick up (OPU),
Sub-sahara african women, Infertility
Abbreviations
APAHAC: african,
pan-african health alliance and collaborative; BMI: body mass index; CI:
confidence interval; Coef: coefficient; MII: Eggs in the second phase of
meiosis and are mature; NFC: nordica fertility center; OPU: ovum pickup; OR:
odds ratio; PID: pelvic inflammatory disease; RR: risk ratio; SSA: sub-sahara
africa; Std Err: standard error; WHO: world health organization
Introduction
Controversy still
surrounds the issue of age at menarche and cycle length as risk factors for
endometriosis a disease that has been well studied over the years but still an
enigma till today. It is a very common ailment occurring in 6-10% of the
general female population; in women with pain, infertility or both, with a
frequency of 35-50%.1 Endometriosis is the presence of
endometrial-like tissue (glands and stroma) outside the uterus that induces a
chronic inflammatory reaction, scar tissue and adhesions that may distort a
woman’s pelvic anatomy.2 In this disorder, the ectopic
endometrial tissue is non-malignant, proliferative and is diagnosed by
laparoscopic observation of lesions, implants, nodules and cysts on the pelvic
peritoneum, the pelvic organs,3,4 or other parts
of the body such as the uterosacral ligament, retro-cervical area, rectovaginal
septum, rectum sigmoid colon, terminal ileum, vermiform appendix, bladder and
ureter.5–9 Studies have suggested early age at
menarche as a risk factor for endometriosis,10,11 and
that menarche at 14 years or after diminishes the risk of endometriosis.12,13 Matalliotakis et al.,14 suggested that
menstrual cycle characteristics such as cycle length, may be related to
endometriosis incidence while others had a different opinion.15–17 The prevalence and risk-factors of endometriosis are
abundantly documented among women in developed world, though data on this
ailment is still rare among indigenous sub-Saharan Black African women. The
present study assesses the association or otherwise between menarche, days of
menstrual flow and cycle length on one part and the probability of
endometriosis on another part. This study is important in view of growing
attention from patients, clinicians, embryologists and scientists in
sub-Saharan Africa, to improve awareness, diagnosis and treatment of
endometriosis.18 The goal of this study is to provide
further information on endometriosis and its risk factors among Black African
women. The objective is to determine the menstrual characteristics that
associate more with endometriosis among this group of women.
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