CENTRAL ASIAN JOURNAL OF MEDICAL AND NATURAL SCIENCES

Volume: 04 Issue: 06 | Oct-Nov 2023 ISSN:2660-4159

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DIAGNOSTIC AND PROGNOSTIC VALUE OF ANAMNESIS IN

ADOLESCENT GIRLS WITH DISORDERED MENSTRUAL
ACTIVITY
Аnnotation: This article talks about the most common
1. Ashurova Nigora Gafurovna pathology in adolescent girls' gynecology - menstrual cycle
disorder and its causes, and the diagnostic value of the first
anthropometric and clinical signs. The diagnostic and
Received 28thSep 2023,
Accepted 28thOct 2023, prognostic significance of anamnestic data and body mass
Online 2nd Nov 2023 index in the early detection of menstrual disorders in 272
adolescent girls involved in the study was substantiated
using statistically reliable methods.
Bukhara State Medical Institute, Key words: menstrual cycle, adolescents, body mass index,
Uzbekistan1 risk factor, odds ratio.

Among the factors of menstrual cycle disorders, the increasing incidence of obesity in the growing
generation occupies a special place. Despite the fact that it is one of the most urgent medical and social
problems of our time, adolescent obesity is underreported in the media and is therefore increasingly
dangerous. In many countries of the world, the tendency to increase the number of adolescents with
obesity has become especially significant in the last decade [1,3,10].
Almost a third (27-32%) of adolescents involved in endocrinological preventive examinations had
cases related to derailment of fat metabolism. The prevalence of overweight and obesity among children
in the North-Western and Ural regions of Russia was 4-9% in 1995-2005, and 12.9-26.1% in 2008-2018.
By 2020, according to the Russian State Statistics Organization, 31.3% of children between the ages of
3 and 13 will be overweight. Obesity will occur in every 9th child, and the figure will be 15% in
adolescents aged 14-18 years. [3,4,6].
At the beginning of the 20th century, H. Evans and K. Bishop studied the effect of fatty foods on
the level of reproduction in animal feeding. Numerous studies have also proven that the female
reproductive system recovers when body weight returns to normal. Similarly, Leventhal and Stein's
article discusses the link between obesity and reproductive disorders. [2,5,9,11].
Accordingly, dysregulated gonadotropin secretion, insulin resistance, and hyperinsulinemia
underlie menstrual disorders in overweight adolescent girls, which lead to an increase in androgens over
time and this condition, in turn, is manifested by a specific appearance of the body structure [7,12].

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 CAJMNS Volume: 04 Issue: 06 | Oct-Nov 2023
There is no doubt that ovarian dysfunction in the context of hyperandrogenism (GA) causes
chronic anovulation. GA in obese teenage girls is 4-18%. Androgens derail the normalization of the
follicle and cause multiple atresia. The increasing concentration of androgens in the ovaries gradually
pushes the granulosa cells that produce estrogen out of the ovaries. This leads to hyperplasia of theca
cells and luteinization of the ovarian interstitial tissue, which are both considered androgen production
sites [2,8,10]. It is understood that the stimulating effect of hyperinsulinemia on ovarian steroidogenesis
is manifested in the form of hyperandrogenism.
Purpose: to study the diagnostic and prognostic value of anamnesis data in the formation of the
reproductive system of teenage girls.
Materials and styles. Clinical studies were conducted in the Regional Reproductive Center and
in secondary schools of Bukhara city, Kogon, Romitan, Jondor, Bukhara districts during 2019-2023. In
a scientific study, a questionnaire was conducted among 1018 11-18-year-old girls in order to evaluate
the prevalence of this pathology, the most common forms, possible complications, the effectiveness of
traditional treatment tactics, and the analysis of retrospective data. Anamnesis collection was carried out
by means of questionnaires and interviews. In addition to the general information of the passport part of
the questionnaire, information was collected including the range of special questions such as the age at
the onset of the menstrual cycle, its stabilization period, features of remission and recurrence, pain levels,
and the results of treatment effectiveness. The participation of the adolescent's parents and the school
nurse was ensured when filling out the questionnaire.
The prospective group consisted of 272 girls, 192 teenage girls with menstrual disorders, and 80
conditionally healthy teenage girls were included in the main group. Participants in the experimental
and control groups were between the ages of 11 and 17.
Distribution of patients by age

Patients age
Total
Groups 11 12 13 14 15 16 17
n % n % n % n % n % n % n %
Main 192
1 0,5 15 7,8 40 20,8 46 24,0 47 24,5 26 13,5 11 5,7
group
Control 80
0 0.0 12 15 18 22,5 22 27,5 18 22,5 8 10,0 4 5,0
group

The main group of patients selected for the study was divided into two groups depending on the
type of menstrual disorder: the first group - the menstrual disorder in patients is characterized by a
decrease in menstruation, a decrease in the duration of menstruation or a decrease in blood loss compared
to the physiological norm - hypo menstrual syndrome (n=105), the second group - the opposite, patients
with hypo menstrual syndrome (n=87), which is characterized by an increase in menstruation,
lengthening of the duration of menstruation, and an increase in blood loss compared to the physiological
norm (Table 1).
Results and their discussion.

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 CAJMNS Volume: 04 Issue: 06 | Oct-Nov 2023
According to the data determined by the objective appearance of the participants of the main and
control groups, the type of obesity (android or gynoid) was determined in obese girls using body mass
index (BMI), as well as waist circumference and hip circumference. In particular, during the study,
among the experimental group of patients, patients with a BMI index of up to 18.5 were 5.6%, patients
with a normal BMI were 27%, overweight patients were 38%, patients with first-degree obesity were
25.4%, patients with second-degree obesity were 4%, while these indicators were 12.5%, 31.2%, 37.5%,
15.6% and 3% in the control group, respectively (Table 2).

Table 2
Distribution of subjects of the experimental and control groups according to the indicator of
body mass index (BMI).
Groups <18,5 18,5-25 25-29,9 30-34,9 35-39,9

n % N % n % n % n %

Experimental 3 1,56 174 90,6 2 1,04 9* 4,68 4 2,08

group
Control group 1 1,25 77 96,2 2 2,5 0 0,0 0 0,0

Indication: compared to the control group, * - statistical reliability < 0.05; ** - statistical reliability
< 0.01; *** - statistical reliability < 0.001.
In addition, the main group was divided into patient groups according to the type of menstrual
disorder - with hypo menstrual and hyper menstrual disorder. The main and the control group
participants were divided according to their body weight at birth and the results of the patient groups
were compared with each other and the indicators of the control group (see Table 3). According to this
table, in both patient groups, birth with relatively low birth weight (<2500 gr) was statistically
significantly more frequent (p<0.05) than in the control group, and on the other hand, in the control
group, the weight was in the upper limit of normal variation (2500-3500 gr). It was found that the
frequency of births was statistically significantly higher (p<0.05). Also, when patient groups were
compared, it was found that there were more patients with hyper menstrual syndrome whose birth weight
was less than the normal variation (<2000 g) (p<0.05), while among patients with hypo menstrual
syndrome, there were more people with a birth weight of 2000-2500 g. (p<0.05).
Table 3.
Distribution of patients and control groups by body weight at birth.

Types of groups <2000 гр 2000-2500 гр 2500-3000 гр >3000 гр

n % n % n % n %

Main group 81*** 42,2 100*** 52,1 11*** 5,7 0*** 0,0
Hypo menstrual 34***^ 32,4 67*** ^^^ 63,8 4*** 6,7 0 0,0
syndrome
Hyper menstrual 47*** 54,0 33* 38,0 7*** 8,0 0 0,0
syndrome

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 CAJMNS Volume: 04 Issue: 06 | Oct-Nov 2023
Control group 0 0,0 16 20,0 54 67,5 8 10,0

Indication: compared to the control group, * - statistical reliability < 0.05; ** - statistical reliability
< 0.01; *** - statistical reliability < 0.001, compared to the indicators of patients with hyper menstrual
syndrome, ^ - statistical reliability < 0.05; ^^ - statistical reliability < 0.01; ^^^ - statistical reliability <
0.001
Also, the period of birth of patients with menstrual disorders of hypo menstrual and hyper
menstrual type and those examined in the control group were compared (Table 4). According to this
table, patients with hyper menstrual syndrome did not differ from the control group, on the other hand,
among patients with hypo menstrual syndrome, the number of late and premature births was significantly
higher than the results of the control group (p<0.05).
Table 4.
Distribution of examinees by date of birth.
Groups Birth at term Premature birth Late bitrh

n % n % n %

Main group 83*** 43,2 88*** 45,8 21*** 11

Hypo menstrual 3***^^^ 2,86 83***^^^ 79,0 19***^^^ 18,1
syndrome
Hyper menstrual 80 91,9 5 5,75 2 2,3
syndrome
Control group 77 96,25 2 2,5 1 1,25

Indication: compared to the control group, * - statistical reliability < 0.05; ** - statistical reliability
< 0.01; *** - statistical reliability < 0.001, compared to the indicators of patients with hyper menstrual
syndrome, ^ - statistical reliability < 0.05; ^^ - statistical reliability < 0.01; ^^^ - statistical reliability <
0.001
In addition, according to the results of anamnestic and objective examination of patients during
our study, hyper menstrual type disorder, hypo menstrual type disorder and control group examiners,
respectively, 27.5% (n=24 (p<0.05)), 25.70% (n=27 (p<0.05)) and 11.25% (n=9) thyroid diseases,
22.90% (n=20 (p<0.05)), 55.20% (n= 58 (p<0.05)) and 10.0% (n=8) anemia, 13.8% (n=12 (p>0.05)),
21.0% (n=22 (p<0 .05)) and 11.25% (n=9) respiratory system diseases, 11.50% (n=10 (p>0.05)), 25.70%
(n=27 (p<0.05 )) and 5.0% urinary system diseases, 4.60% (n=4 (p>0.05)), 4.76% (n=5 (p<0.05)) and
0.0% eye diseases were detected
No difference was found in the indicators of the patient and control groups for the remaining types
of diseases
When changes related to the menstrual cycle, in particular, the length of menstrual days and the
age of menarche were compared in the main and control groups, and also when the main group patients
were regrouped according to the type of menstrual disorder and compared to the control group and each
other, the length of menstrual days in patients with hypo menstrual disorder compared to the control
group, it was found that it was statistically less reliable, and it was statistically more reliable in patients

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 CAJMNS Volume: 04 Issue: 06 | Oct-Nov 2023
with hyper menstrual disorders. On the other hand, the age of menarche was not significantly different
between the patient and control groups (see Figure 1).

Figure 1. A) Length of menstrual days; B) Menarche age indicators. 1 – Main group; 2A – patients
with hypomenstrual syndrome; 2B – patients with hypermenstrual syndrome; 3 – control group. * -
statistical reliability < 0.05; ** - statistical reliability < 0.01; *** - statistical reliability < 0.001
Also, the duration of menarche after being calculated in the patient groups and the control group, and
the results were compared between the groups.
According to it, it was found that in almost all participants of the control group, the stabilization
of menstrual days after menarche was completed by 12 months, on the other hand, in almost 1/3 of
patients of the main group, the duration of the menstrual phase did not stabilize after 12 months (p<0.05).
When patient groups were compared, the number of patients with hypo menstrual syndrome who
had stabilization of the menstrual cycle immediately, after 6 months, and after 12 months was
significantly higher (p<0.05) compared to hypermenstrual syndrome patients. Among patients with
hypermenstrual syndrome, the number of patients whose menstrual cycle did not stabilize even after one
year was statistically significant (p<0.05). (see Table 5).
Table 5
Duration of stabilization of menstrual days after menarche in patient and control groups

Groups Very soon After 3 After 6 month After 6 month Was not
month stabilized
even after 1
year
n % n % n % n % n %

Main group 23*** 12 56 29,2 45** 23,4 49*** 25,5 19*** 9,9
Hypo menstrual 20^^^ 19 31 29,5 21*** 20 33***^^^ 31,4 0^^^ 0,0
syndrome

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 CAJMNS Volume: 04 Issue: 06 | Oct-Nov 2023
Hyper menstrual 3 3,4 25 28,7 24 27,6 16 18,4 19 21,8
syndrome
Control group 23 28,8 23 28,7 32 40 2 2,5 0 0,0

Indication: compared to the control group, * - statistical reliability < 0.05; ** - statistical reliability
< 0.01; *** - statistical reliability < 0.001, compared to the indicators of patients with hyper menstrual
syndrome, ^ - statistical reliability < 0.05; ^^ - statistical reliability < 0.01; ^^^ - statistical reliability <
0.001
Also, as the main group of patients was grouped into hypo menstrual and hyper menstrual types
the frequency of menstrual disorder symptoms was compared too. As expected, in patients with hypo
menstrual disorder, statistically reliable, primary amenorrhea (p<0.05), secondary amenorrhea (p<0.05),
oligomenorrhoea (p<0.05), oligomenorrhoea (p<0.05), hypomenorrhea (p <0.05) and algodysmenorrhea
(p<0.05) were found more often, but in patients with hypermenstrual disorder, pro menorrhea (p<0.05),
polymenorrhea (p<0.05) and hypermenorrhea (p<0.05) were found more.
In addition, according to the anamnestic and objective results of the patients during our study, the
frequency of occurrence of potential risk factors important in the development of menstrual disorders
was compared in the patient and control groups.
According to comparison, almost all factors (except factors such as thinness, mental retardation,
chronic insomnia, frequent change of weather and place of residence) are statistically reliably more
common in patient groups (p<0.05) (infertility in the mother's anamnesis, Potential risk factors such as
menstrual dysfunction, obesity, negative social life factors were statistically significantly more common
only in patients with hypomenstrual disorder compared to the control group (p<0.05), these indicators
did not differ statistically reliably in patients with hypermenstrual disorder (p> 0.05)), when the
indicators of patients with menstrual disorder of hypomenstrual and hypermenstrual type were
compared, it was found that male pattern baldness was more common in patients with hypomenstrual
disorder (p<0.05).

Figure 2. Factors listed as risk factors for the development of menstrual disorders were listed
according to the extimolar ratio index. A - Infertility in the history of the mother, B - Complicated course
of pregnancy, C - Complicated course of childbirth, D - Frequent recurrence of ARVI in the patient, E -

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 CAJMNS Volume: 04 Issue: 06 | Oct-Nov 2023
Menstrual dysfunction in the mother, F - The presence of euthyroid goiter, G - Negative social life
factors, H - Infertility and irrational eating.
Based on the results, statistically reliable common factors, hypo menstrual or hyper menstrual
disorders in both patient groups were calculated using the odds ratio (OR) indicator (see Figure 2).
According to it, hypo menstrual type and hyper menstrual type disorders as risk factors that
significantly increased the probability of development of pregnancy complications were 9.2 times
(95%CI: 4.44-14.1) and 8.0 times (95%CI: 3, 80-13.90), and increased frequent recurrence of ARVI by
5.25 times (95%CI: 2.44-11.3) and 3.68 times (95%CI: 1, 66-8.17), and increased the presence of
euthyroid goiter by 5.1 times (95%CI: 2.71-9.57) and 4.43 times (95%CI: 2.31-8.50), respectively.
Summary. In the diagnosis of menstrual cycle disorders in adolescent girls, based on anamnesis
data, use of special scales, and anthropometric measurements, it is possible to notice deviations in the
formation of the reproductive system in the early stages. Subjective and objective results obtained during
the study have an incomparable diagnostic and prognostic value in determining potential risk factors
that cause menstrual disorders.

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