Correction of menstrual function disorders in girls with obesity

Obesity in adolescent girls is a major medical and social problem because excess body weight at an early age increases the risk of chronic metabolic, cardiovascular, and endocrine disorders, adversely affects reproductive health, and may cause psychosocial consequences. Adolescence is a transitional period characterized by rapid growth, pubertal development, and the onset of menstruation, during which menstrual disorders may emerge. The aim of this study was to analyze the relationship between obesity and menstrual disorders and to substantiate therapeutic strategies aimed at correcting the underlying pathogenetic mechanism. Material and methods. We performed a comprehensive clinical and laboratory examination of 79 girls aged 12−18 years with menstrual dysfunction associated with obesity (main group), and 31 girls of the same age with a regular menstrual cycle (control group). The main group included patients with menstrual dysfunction and delayed menstruation for up to 5 months. Results. In girls with a regular menstrual cycle, the absence of hyperandrogenism and insulin resistance was associated with HOMA-AD values below 3.45. When HOMA-AD was below this threshold, the prognosis for restoration of the menstrual cycle was favorable, and treatment aimed at improving insulin sensitivity was considered effective. At HOMA-AD values of 3.45 or higher, insulin sensitizers should be included in the treatment regimen. The diagnostic accuracy of this classification model was 94.2 %, with sensitivity of 93.3 % and specificity of 94.4 %. Retrospectively, 94 % of patients in the main group had values above the diagnostic threshold, indicating insulin resistance. Conclusions. Primary menstrual dysfunction associated with obesity indicates the need to improve therapeutic and preventive measures aimed at timely correction of reproductive and somatic health disorders. Compared with traditional treatment in patients with primary menstrual dysfunction lasting up to 2 years, the proposed non-hormonal treatment complex increased the frequency of menstrual normalization with BMI reduction after 3 months to 78.0 % versus 90.3 %, and after 1 year to 73.1 % versus 80.0 %. With longer duration of menstrual dysfunction, the frequency of excellent outcomes increased: the proportion of patients with reduced BMI after 3 months was 79.3 % versus 58.9 %, and after 1 year 69.8 % versus 51.4 %.