The Role of Kisspeptin in Menstrual Disorders in Adolescent Girls. Treatment of Clinically Manifested Endocrine Abnormalities
Objective of the Study: To assess kisspeptin Levels in girls of various body weights who have menstrual disorders, and evaluate the efficacy of device-assisted treatment options for patients with clinically manifested endocrine abnormalities. Study Design: This was a cohort prospective study. Materials and Methods: Seventy adolescent girls, aged 15 to 17, with various menstrual disorders were examined. They were divided into three groups by body weight. Group 1 consisted of 15 girls with low body weight due to anorexia nervosa; Group 2 was made up of 35 girls with obesity; and Group 3 comprised 20 normal-weight or overweight girls with incipient polycystic ovary syndrome. The control group consisted of 20 healthy girls of the same age. The examination included an assessment of the girls' physical development, age of menarche, and menstrual cycle characteristics. The following parameters were measured: kisspeptin, luteinizing hormone (LH), follicle-stimulating hormone, thyroid-stimulating hormone, and sex hormones. The girls also underwent pelvic ultrasound. Study Results: In girls with protein and calorie deficiency, amenorrhea was the most frequent menstrual disorder. The kisspeptinergic system was suppressed in these girls, which was manifested by significantly low levels of kisspeptin, gonadotropic hormones, and sex hormones. The obese girls had signs of hypercorticism, low levels of kisspeptin, LH, estradiol, and progesterone, and various menstrual disorders. The girls in Group 3 had significantly elevated levels of kisspeptin, total testosterone, and LH, which suggests the contribution of central mechanisms to the development of polycystic ovary syndrome. In Groups 2 and 3, a 10-15-day course of transcranial magnetic stimulation in combination with transcranial electrostimulation normalized the patients' hormonal status, improved their clinical condition, and restored normal menstrual cycles. Conclusion: This study revealed an association between kisspeptin levels and physical development parameters in adolescent girls. Significantly low body weight and obesity contribute to suppression of the kisspeptin pathways in the reproductive system, which is associated with various menstrual disorders. High levels of kisspeptin most likely reflect its role in the development of polycystic ovary syndrome. Transcranial stimulation improves patients' clinical condition and restores a normal menstrual cycle through its regulatory influence on the kisspeptinergic system.