Menstrual disorders and related factors in women with multiple sclerosis

Document Type : Original Article

Authors

1 M.Sc. in Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.

2 Assistant Professor, Department of Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.

3 Associate Professor, Department of Neurology, Department of Neurology and Cognitive Sciences Research Institute of Cellular Sciences, Royan Research Center, Tehran, Iran.

4 Instructor, Department of Biostatistics, School of Management, Iran University of Medical Sciences, Tehran, Iran.

Abstract

Introduction: Multiple sclerosis (MS) is the most common autoimmune disease that often affects women within the reproductive age. Among the common clinical complaints in these women is variety of menstrual disorders. Thus, we aimed to examine menstrual disordersand related factors in women with MS.
Methods: A descriptive cross-sectional study was performed among 172 women with MS who visited the Neurology Specialized Clinic in Tehran, Iran, during 2016-2017. The participants filled out a questionnaire consisting of demographic (e.g., age, educational level, economic status, disease duration, vitamin D consumption duration, and Expanded Disability Status Scale [EDSS]) and disease characteristics (age at menstruation, duration of each period, interval between two periods, the amount of bleeding, presence or lack of presence of pain, and menstruation pain score). Data were analyzed by using SPSS version 22 and multiple logistic regression model, Chi-square test, and Spearman correlation coefficient. P-value less than 0.05 was considered significant.
Results: Overall, 88 patients (51.2%) experienced irregular menstruation patterns, and 116 patients (67.5%) had some forms of menstruation disorders. Multiple logistic regression reflected statistically significant correlations between disability score (β=0.702, P=0.001), moderate (β=2.561, P<0.001) and high (β=2.730, P<0.001) menstrual bleeding, duration of vitamin D intake (β= -0.187, P=0.048), dysmenorrhea (β=1.246, P=0.006), age of the menarche (β= -0.298, P=0.05) and menstrual pattern (β=1.912, P<0.001) with menstrual disorders. Spearman correlation and Chi-square revealed the significant relationship of menstruation pattern, dysmenorrhea, and amount of bleeding with menstrual disorders, which corroborated the results of regression. 
Conclusion: The results of the present study showed that menstrual disorders have high prevalence in women with MS. Our results also indicated that factors such as duration of vitamin D intake, menstrual bleeding, menarche, menstrual pattern, dysmenorrhea, and EDSS affect menstrual disorders.

Keywords

References

  1. Marrie RA, Cohen J, Stuve O, Trojano M, Sørensen PS, Reingold S, et al. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview. Mult Scler 2015; 21(3):263-81.
  2. Browne P, Chandraratna D, Angood C, Tremlett H, Baker C, Taylor BV, et al. Atlas of multiple sclerosis 2013: a growing global problem with widespread inequity. Neurology 2014; 83(11):1022-4.
  3. Leray E, Moreau T, Fromont A, Edan G. Epidemiology of multiple sclerosis. Rev Neurol 2016; 172(1):3-13.
  4. Etemadifar M, Izadi S, Nikseresht A, Sharifian M, Sahraian MA, Nasr Z. Estimated prevalence and incidence of multiple sclerosis in Iran. Eur Neurol 2014; 72(5-6):370-4.
  5. Tullman MJ. Overview of the epidemiology, diagnosis, and disease progression associated with multiple sclerosis. Am J Manag Care 2013; 19(2):S15-20.
  6. Kingwell E, Marriott JJ, Jetté N, Pringsheim T, Makhani N, Morrow SA, et al. Incidence and prevalence of multiple sclerosis in Europe: a systematic review. BMC Neurol 2013; 13(1):128.
  7. Goodin DS. The epidemiology of multiple sclerosis: insights to disease pathogenesis. Handb Clin Neurol 2014; 122(6):231-66.
  8. Marrie RA, Reingold S, Cohen J, Stuve O, Trojano M, Sorensen PS, et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review. Mult Scler 2015; 21(3):305-17.
  9. Cocco E, Sardu C, Spinicci G, Musu L, Massa R, Frau J, et al. Influence of treatments in multiple sclerosis disability: a cohort study. Mult Scler 2015; 21(4):433-41.
  10. Dobryakova E, Genova HM, DeLuca J, Wylie GR. The dopamine imbalance hypothesis of fatigue in multiple sclerosis and other neurological disorders. Front Neurol 2015; 6:52.  
  11. Vitkova M, Rosenberger J, Krokavcova M, Szilasiova J, Gdovinova Z, Groothoff JW, et al. Health-related quality of life in multiple sclerosis patients with bladder, bowel and sexual dysfunction. Disabil Rehabil 2014; 36(12):987-92.
  12. Jasse L, Vukusic S, Durand-Dubief F, Vartin C, Piras C, Bernard M, et al. Persistent visual impairment in multiple sclerosis: prevalence, mechanisms and resulting disability. Mult Scler 2013; 19(12):1618-26.
  13. Klevan G, Jacobsen CO, Aarseth JH, Myhr KM, Nyland H, Glad S, et al. Health related quality of life in patients recently diagnosed with multiple sclerosis. Acta Neurol Scand 2014; 129(1):21-6.
  14. Planche V, Gibelin M, Cregut D, Pereira B, Clavelou P. Cognitive impairment in a population‐based study of patients with multiple sclerosis: differences between late relapsing-remitting, secondary progressive and primary progressive multiple sclerosis. Eur J Neurol 2016; 23(2):282-9.
  15. Patten SB, Marrie RA, Carta MG. Depression in multiple sclerosis. Int Rev Psychiatry 2017; 29(5):463-72.
  16. Hartung DM, Bourdette DN, Ahmed SM, Whitham RH. The cost of multiple sclerosis drugs in the US and the pharmaceutical industry Too big to fail? Neurology 2015; 84(21):2185-92.
  17. Merghati Khoei E, Qader K, Amini L, Haghani H. Study on sexual behavior and quality of life of women with multiple sclerosis referred to Iran MS society in Tehran in 2010. Iran J Obstet Gynecol Infertil 2012; 15(5):7-14. (Persian).
  18. Bove R, Alwan S, Friedman JM, Hellwig K, Houtchens M, Koren G, et al. Management of multiple sclerosis during pregnancy and the reproductive years: a systematic review. Obstet Gynecol 2014; 124(6):1157-68.
  19. Manouchehri E, Fathi Najafi T, Saeedi M, Bahri N. Menstrual pattern in women with multiple sclerosis. Iran J Obstet Gynecol Infertil 2017; 19(38):42-7. (Persian).
  20. Zakrzewska-Pniewska B, Golebiowski M, Zajda M, Szeszkowski W, Podlecka-Pietowska A, Nojszewska M. Sex hormone patterns in women with multiple sclerosis as related to disease activity--a pilot study. Neurol Neurochirur Pol 2011; 45(6):536-42.
  21. Nabavi SM, Koupai SA, Nejati MR, Garshasbi E, Jalali MR. Menstrual irregularities and related plasma hormone levels in multiple sclerosis patients treated with beta interferone. Acta Med Iran 2010; 48(1):36-41.
  22. Heesen C, Gold S, Huitinga I, Reul J. Stress and hypothalamic–pituitary–adrenal axis function in experimental autoimmune encephalomyelitis and multiple sclerosis-a review. Psychoneuroendocrinology 2007; 32(6):604-18.
  23. Guo ZN, He SY, Zhang HL, Wu J, Yang Y. Multiple sclerosis and sexual dysfunction. Asian J Androl 2012; 14(4):530-5.
  24. D'hooghe M, D'hooghe T, De Keyser J. Female gender and reproductive factors affecting risk, relapses and progression in multiple sclerosis. Gynecol Obstet Invest 2013; 75(2):73-84.
  25. Wei W, Liu L, Cheng ZL, Hu B. Increased plasma/serum levels of prolactin in multiple sclerosis: a meta-analysis. Postgrad Med 2017; 129(6):605-10.
  26. Correale J, Farez MF, Ysrraelit MC. Role of prolactin in B cell regulation in multiple sclerosis. J Neuroimmunol 2014; 269(1):76-86.
  27. Zivadinov R, Jakimovski D, Gandhi S, Ahmed R, Dwyer MG, Horakova D, et al. Clinical relevance of brain atrophy assessment in multiple sclerosis. Implications for its use in a clinical routine. Expert Rev Neurother 2016; 16(7):777-93.
  28. Kazemijaliseh H, Ramezani Tehrani F, Behboudi-Gandevani S, Khalili D, Hosseinpanah F, Azizi F. The prevalence of menstrual disorders in reproductive aged women and its related factors. Iran J Endocrinol Metab 2015; 17(2):105-12.
  29. Jonathan SB, Berek B, Paoulo AB. Berek and Novak's gynecology. Maryland: Library of Congress Cataloging; 2014.
  30. Fraser IS, Critchley HO, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med 2011; 29(5):383-90.
  31. Bayas A, Rieckmann P. Managing the adverse effects of interferon-β therapy in multiple sclerosis. Drug Saf 2000; 22(2):149-59.
  32. Tavakol S, Shakibapour S, Bidgoli SA. The level of testosterone, vitamin D, and irregular menstruation more important than omega-3 in non-symptomatic women will define the fate of multiple scleroses in future. Mol Neurobiol 2018; 55(1):462-9.
  33. Voskuhl RR, Gold SM. Sex-related factors in multiple sclerosis susceptibility and progression. Nat Rev Neurol 2012; 8(5):255-63.
  34. Kümpfel T, Schwan M, Weber F, Holsboer F, Trenkwalder C, Bergh FT. Hypothalamo-pituitary-adrenal axis activity evolves differentially in untreated versus treated multiple sclerosis. Psychoneuroendocrinology 2014; 45:87-95.
  35. Sepúlveda M, Ros C, Martínez-Lapiscina EH, Solà-Valls N, Hervàs M, Llufriu S, et al. Pituitary-ovary axis and ovarian reserve in fertile women with multiple sclerosis: a pilot study. Mult Scler 2016; 22(4):564-8.
  36. Jukic AM, Steiner AZ, Baird DD. Lower plasma 25-hydroxyvitamin D is associated with irregular menstrual cycles in a cross-sectional study. Reprod Biol Endocrinol 2015; 13(1):20.
  37. Tehrani HG, Mostajeran F, Shahsavari S. The effect of calcium and vitamin D supplementation on menstrual cycle, body mass index and hyperandrogenism state of women with poly cystic ovarian syndrome. J Res Med Sci 2014; 19(9):875-80.
  38. Zegeye DT, Megabiaw B, Mulu A. Age at menarche and the menstrual pattern of secondary school adolescents in northwest Ethiopia. BMC Womens Health 2009; 9(1):29.
  39. D’hooghe M, Haentjens P, Nagels G, D’Hooghe T, De Keyser J. Menarche, oral contraceptives, pregnancy and progression of disability in relapsing onset and progressive onset multiple sclerosis. J Neurol 2012; 259(5):855-61.
  40. Kordi M, Mohamadirizi S, Shakeri MT. Investigating the age of menarche, dysmenorrhea and menstrual characteristics in high school girl students in Mashhad city in year 2011. Iran J Obstet Gynecol Infertil 2013; 15(33):10-8. (Persian).
  41. Foroughipour A, Norbakhsh V, Najafabadi SH, Meamar R. Evaluating sex hormone levels in reproductive age women with multiple sclerosis and their relationship with disease severity. J Res Med Sci 2012; 17(9):882-5.
  42. Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiol Rev 2013; 36(1):104-13.
  43. Zangene M, Veisi F, Nankali A, Rezaei M, Ataee M. Evaluation of the effects of oral vitamin-d for pelvic pain reduction in primary dysmenorrhea. Iran J Obstet Gynecol Infertil 2014; 16(88):14-20. (Persian). 
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 21, Issue 4
June 2018
Pages 43-52

Files

Share

How to cite

Statistics