Department of Epidemiology and Environmental Health, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY.ROR
The purpose of this study is to characterize the patterns of medication intake in healthy, reproductive-age women not using hormonal contraception.
Methods
Two hundered fifty-nine healthy, premenopausal women (18-44 years of age) enrolled in the BioCycle Study (2005-2007) were followed over two menstrual cycles. Women were excluded if they were currently using oral contraceptives or other chronic medications. Over-the-counter and prescription medication use among participants was evaluated daily throughout the study via a diary assessing type of medication, dosage, units, and frequency. Medications were categorized as allergy, antibiotics, central nervous system (CNS), cold and cough, gastrointestinal, musculoskeletal, and pain medication based on primary active ingredient. Medication use within each category was assessed across standardized 28-day cycles to evaluate differences in use across cycle phases (i.e., early, middle, and late).
Results
Medication use was reported by 73% of participants. The most and least frequently used medications, respectively, were pain (69%) and musculoskeletal medications (1%). Pain, CNS, and antibiotic medication use varied significantly across the cycle, with pain and CNS medication more frequently reported during menses and antibiotics more frequently during the luteal phase. Allergy, cold and cough, gastrointestinal, and musculoskeletal medication use did not vary across the cycle.
Conclusions
Patterns of medication use among reproductive age women vary across the menstrual cycle for certain types of medications, particularly in pain (e.g., Ibuprofen), antibiotics (e,g, Amoxicillin), and CNS (e.g., Adderall) medications. Future studies involving use of these types of medication in premenopausal women may need to consider the relationship of their use to the menstrual cycle.
medication use menstrual cycle patterns, over-the-counter drug use premenopausal, analgesic use reproductive age women, NSAID menstrual cycle phase timing, BioCycle Study medication patterns, prescription drug menstrual phase, pain medication follicular luteal phase, premenopausal women medication exposure, cyclic medication use fertile women, OTC drug reproductive health effects
PMID 26954695 26954695 DOI 10.1002/pds.3993 10.1002/pds.3993
Cite this article
Johnson, K. A., Sjaarda, L. A., Mumford, S. L., Garbose, R. A., Schliep, K. C., Mattison, D., Perkins, N. J., Wactawski-Wende, J., & Schisterman, E. F. (2016). Patterns and prevalence of medication use across the menstrual cycle among healthy, reproductive aged women. Pharmacoepidemiology and drug safety, 25(6), 618-627. https://doi.org/10.1002/pds.3993
Johnson KA, Sjaarda LA, Mumford SL, Garbose RA, Schliep KC, Mattison D, et al. Patterns and prevalence of medication use across the menstrual cycle among healthy, reproductive aged women. Pharmacoepidemiol Drug Saf. 2016;25(6):618-627. doi:10.1002/pds.3993
Johnson, K. A., et al. "Patterns and prevalence of medication use across the menstrual cycle among healthy, reproductive aged women." Pharmacoepidemiology and drug safety, vol. 25, no. 6, 2016, pp. 618-627.
Attention-Deficit/Hyperactivity Disorder (ADHD) in girls and women is under-recognised and under-researched, despite increasing awareness of clinical challenges and unmet needs. This review by the Eunethydis Special Interest Group on Female ADHD, addresses current knowledge and identifies research gaps for future work. Issues in women with ADHD across the lifespan such as late diagnosis, pubertal development, sexual health, hormonal birth control, executive function difficulties, and gynaecological disorders associated with ADHD are highlighted. The review synthesises existing literature and self-reported experiences of women with ADHD to explore the impact of hormonal fluctuations [puberty, menstrual cycle, pregnancy, (peri)menopause] on ADHD symptoms and mood disturbances. It examines the interplay of oestrogen and progesterone with dopaminergic pathways, when periods of lower oestrogen may affect cognition, as well as the manifestation of executive function deficits, and the intersection of ADHD with reproductive health. Hormonal transitions exacerbate ADHD symptoms and mood disturbances, yet pharmacological research and tailored treatments are lacking. Executive function deficits manifest differently in girls and women with ADHD and are influenced by neuropsychological and neurobiological profiles. Diagnostic practices and sociocultural factors contribute to delayed diagnoses, increasing the risk of comorbidities, impaired functioning, and diminished quality of life. Undiagnosed women have increased vulnerability to premenstrual dysphoric disorder, postpartum depression, and cardiovascular disease during perimenopause. Longitudinal, sex-specific studies incorporating hormonal status and lived experience are needed. Individualised interventions should be developed to address the unique needs of girls and women with ADHD. Addressing these gaps will advance more equitable diagnosis, management, and support for girls and women with ADHD, improving outcomes across the female lifespan.
Insulin resistance and hyperinsulinaemia significantly influence female hormone regulation and reproductive health. Despite increasing research, the complex pathways by which nutritional and metabolic signals regulate reproductive function remain poorly understood. Sex hormone-binding globulin (SHBG) is a key protein whose function is modulated by hyperinsulinaemia, liver function, and metabolic status, thereby influencing the active signalling of circulating sex steroids and intracellular signalling, which in turn, impacts endocrine and reproductive physiology. Consequently, SHBG serves as a valuable biomarker for understanding the metabolic-hormonal interactions within the endocrine axis. Ketogenic diets have demonstrated efficacy in reversing insulin resistance, resolving markers of liver disease, and improving metabolic health. In this study, we investigated the impact of suppressing ketosis (hypoketonaemia) on biomarkers of female reproductive and endocrine function in the Ketosis Suppression and Ageing cohort. Ten lean (BMI, 20.52 kg/m2 ± 1.39), healthy, premenopausal women (mean age, 32.30 ± 8.97 years), who maintained nutritional ketosis for an average of 3.9 years (± 2.3), participated in a 21-days of baseline data-collection in euketonaemia, 21-days of hypoketonaemia, and 21-days return to euketonaemia. Suppression of ketosis resulted in a significant 0.67-fold decrease in SHBG levels (p = 0.0015). SHBG was significantly and inversely associated with insulin (p = 0.0010), insulin resistance score (HOMA-IR; p = 0.0012), glucose ketone index (GKI; p = 0.0183), leptin (p = 0.0016), insulin-like growth factor-1 (IGF-1; p = 0.0172), free T3 (p = 0.0001), and gamma-glutamyl transferase (GGT; p = 0.0024). A significant positive association between SHBG and GLP-1 (p = 0.0295) was observed. Menstrual cycle phase was a statistically significant predictor of follicle-stimulating hormone (FSH) levels, with higher FSH levels during ovulation than during the follicular phase (p = 0.0097). SHBG is a sensitive biomarker of metabolic-endocrine status, with broader implications for cancer, and reproductive function. Chronic hypoketonaemia negatively affects SHBG production and hormonal balance. The implications of sex-hormone regulation for cancer prevention and therapy are discussed.
Miscarriage is defined as spontaneous loss of pregnancy prior to 20 weeks gestation. With an estimated risk of 15% of clinically confirmed pregnancies ending in miscarriage, it is the most common adverse event in pregnancy. Woman's age is the primary risk factor for miscarriage, while medical conditions, including hormonal abnormalities, are also associated. Progesterone is essential for maintaining pregnancy. A short luteal phase may reflect inadequate levels of progesterone production, but it is unclear whether a short luteal phase correlates with an increase in the risk of miscarriage. Using a cohort study design, we conducted a secondary data analysis from four cohorts of couples who used a standardized protocol to track biomarkers of the female cycles. A short luteal phase was defined as less than 10 days, with < 11, < 9, and < 8 days as alternate definitions in sensitivity analyses. We included women who experienced a pregnancy with a known outcome, identified the length of the luteal phase in up to 3 cycles prior to conception and assessed the relationship with miscarriage using a modified Poisson regression analysis, adjusting for demographic characteristics, smoking, alcohol use and previous pregnancy history. In our sample of 252 women; the overall miscarriage rate was 18.7%. The adjusted incident risk ratio of miscarriage in women who had at least one short luteal phase < 10 days, compared to those who had none, was 1.01 (95% CI: 0.57, 1.80) Similar null risk was found when assessing alternative lengths of short luteal phase. Women who had short luteal phases < 10 days in all 3 cycles prior to the conception cycle had an incident risk ratio of 2.14 (95% CI: 0.7, 6.55). Our study found that a short luteal phase in the three cycles prior to conception was not associated with higher rates of miscarriage in an international cohort of women tracking their cycles, but our sample size was limited. Further research to determine if short luteal phases or luteal phase deficiency is associated with early pregnancy losses among preconception cohorts with daily tracking of cycle parameters, in addition to progesterone and human chorionic gonadotropin levels, is warranted. Additionally, future studies should include women with recurrent short luteal phases as a more likely risk factor than isolated short luteal phases.
Reproductive EndocrinologyMenstrual Cycle
Open Access