Menstrual cycle lengths and bone mineral density: a cross-sectional, population-based study in rural Chinese women ages 30–49 years

Ouyang, Fengxiu; Wang, X.; Arguelles, Lester; Rosul, Linda; Venners, Scott A.; Chen, C.; Hsu, Yi‐Hsiang; Terwedow, Henry; Wu, Di; Tang, Genfu; Jiao, Yang; Huang, Xing; Zang, Tonghua; Wang, B.; Xu, Xiping

doi:10.1007/s00198-006-0210-2

Cited by 10 publications

(6 citation statements)

References 40 publications

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“…In general, longer cycle lengths are associated with lower estradiol levels and BMD values [37, 38]. In some young women, however, oligomenorrhea is related to anovulatory androgen excess (AAE, as in “polycystic ovary syndrome,” PCOS) and associated with higher LH, testosterone, DHEAS, androstenedione, and estrogen levels, but absent or rare ovulation and absolute or relative progesterone deficiency [39].…”

Section: Resultsmentioning

confidence: 99%

Progesterone and Bone: Actions Promoting Bone Health in Women

Seifert-Klauss

Prior

2010

Journal of Osteoporosis

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Estradiol (E2) and progesterone (P4) collaborate within bone remodelling on resorption (E2) and formation (P4). We integrate evidence that P4 may prevent and, with antiresorptives, treat women's osteoporosis. P4 stimulates osteoblast differentiation in vitro. Menarche (E2) and onset of ovulation (P4) both contribute to peak BMD. Meta-analysis of 5 studies confirms that regularly cycling premenopausal women lose bone mineral density (BMD) related to subclinical ovulatory disturbances (SODs). Cyclic progestin prevents bone loss in healthy premenopausal women with amenorrhea or SOD. BMD loss is more rapid in perimenopause than postmenopause—decreased bone formation due to P4 deficiency contributes. In 4 placebo-controlled RCTs, BMD loss is not prevented by P4 in postmenopausal women with increased bone turnover. However, 5 studies of E2-MPA co-therapy show greater BMD increases versus E2 alone. P4 fracture data are lacking. P4 prevents bone loss in pre- and possibly perimenopausal women; progesterone co-therapy with antiresorptives may increase bone formation and BMD.

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Section: Resultsmentioning

confidence: 99%

Progesterone and Bone: Actions Promoting Bone Health in Women

Seifert-Klauss

Prior

2010

Journal of Osteoporosis

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“…However, it was associated with lower LS BMD in a model including BMI and height as well as androgen excess. A large data-set in 30–39 year-old Chinese women who were predominantly farmers showed similar negative BMD relationships with amenorrhea, but at the FN and TH sites, rather than the LS [ 22 ]. One difference may be that these Chinese data examined spinal segments L2-4 rather than L1-4 which tends to be more sensitive to change and that their lumbar spine model explained very little of the variance.…”

Section: Discussionmentioning

confidence: 99%

Adult Premenopausal Bone Health Related to Reproductive Characteristics—Population-Based Data from the Canadian Multicentre Osteoporosis Study (CaMos)

Goshtasebi

Berger

Barr

et al. 2018

IJERPH

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Amenorrhea is important for women’s bone health. However, few have reported reproductive, anthropometric (body mass index [BMI], height) and bone health (areal bone mineral density [BMD], prevalent fractures) in a population-based study. The purposes of this cross-sectional study of women in the randomly-selected Canadian Multicentre Osteoporosis Study (CaMos) population were: (1) to describe reproductive, demographic, anthropometric and lifestyle variables; and (2) in menstruating women, to relate reproductive and other variables to BMD at the lumbar spine (L1-4, LS), femoral neck (FN) and total hip (TH) sites and to prevalent fragility fractures. This study describes the reproductive characteristics of 1532 women aged 30–60 years. BMD relationships with reproductive and other variables were described in the 499 menstruating women. Mean menarche age was 12.8 years, 96% of women were parous and 95% had used combined hormonal contraceptives (CHC). Infertility was reported by 9%, androgen excess by 13%, amenorrhea by 8% and nulliparity by 4%. LS BMD was negatively associated with amenorrhea and androgen excess and positively related to current BMI and height. A later age at menarche negatively related to FN BMD. BMI and height were strongly related to BMD at all sites. Prevalent fragility fractures were significantly associated with quartiles of both LS and TH BMD.

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“…The responses of (4) and (3) were categorized as ‘positive’, and responses of (2), (1) or (0) were categorized as ‘negative’”. The majority of women (46 of 61) felt they could not tell that their period was coming (responses of 0–2); however, 15 felt that they could feel that their period would soon start [ 3 , 4 ]. In that or the next cycle, cycle-timed serum progesterone (a serum level of 16 nmol/L was used as evidence for ovulation) was obtained on or about day 22 and confirmed to be at least three days before the next flow.…”

Section: Methodsmentioning

confidence: 99%

“…Traditionally, estrogen/estradiol is understood to preserve premenopausal areal bone mineral density (BMD) and thus prevent osteoporosis [ 1 ]. Hypothalamic amenorrhea is strongly associated with rapid bone loss, low bone density, and fracture; these risks at the population-level can even be seen with longer cycle lengths within the normal range of 21–35 days [ 2 , 3 ]. In addition, estradiol-sufficient, normal-length cycles are not always ovulatory and may not produce progesterone levels that are sufficient to counterbalance and complement the effects of estradiol [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Does Molimina Indicate Ovulation? Prospective Data in a Hormonally Documented Single-Cycle in Spontaneously Menstruating Women

Prior

Konishi

Hitchcock³

et al. 2018

IJERPH

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Approximately 33% of normal-length (21–35 days) cycles have subclinical ovulatory disturbances and lack sufficient progesterone, although their normal length ensures enough estrogen. Subclinical ovulatory disturbances are related to significant premenopausal spine bone loss (−0.86%/year). Molimina, non-distressing premenstrual experiences, may detect ovulation within normal-length cycles. This prospective study assessed the relationship between molimina and ovulation. After 1-cycle of daily diary and first morning urine collections, women answered the Molimina Question (MQ): “Can you tell by the way you feel that your period is coming?” and were invited to share (a) predictive premenstrual experience(s). A 3-fold increase in follicular-luteal pregnanediol levels confirmed ovulation. In 610 spontaneously menstruating women (not on hormonal contraception, mean age 31.5 ± 5.3, menarche age 12.7 ± 1.5, cycle length [CL] 29 days, MQ positive in 89%), reported premenstrual experiences which included negative moods (62%), cramps (48%), bloating (39%), and front (26%) or axillary (25%) breast tenderness. Of 432 women with pregnanediol-documented cycles, 398 (92%) were ovulatory (CL: 29 ± 5) and 34 (8%) had ovulatory disturbances (CL: 32 ± 14). Women with/without ovulatory cycles were similar in parity, body mass index, smoking, dietary restraint and the MQ; ovulatory-disturbed cycles were longer. Molimina did not confirm ovulation. A non-invasive, inexpensive ovulation indicator is needed to prevent osteoporosis.

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Menstrual cycle lengths and bone mineral density: a cross-sectional, population-based study in rural Chinese women ages 30–49 years

Abstract: We conclude that prolonged menstrual cycle length is associated with decreased BMD in pre- and perimenopausal women in this population.

Cited by 10 publications

References 40 publications

Progesterone and Bone: Actions Promoting Bone Health in Women

Progesterone and Bone: Actions Promoting Bone Health in Women

Adult Premenopausal Bone Health Related to Reproductive Characteristics—Population-Based Data from the Canadian Multicentre Osteoporosis Study (CaMos)

Does Molimina Indicate Ovulation? Prospective Data in a Hormonally Documented Single-Cycle in Spontaneously Menstruating Women

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