Journal of Traditional Chinese Medicine ›› 2022, Vol. 42 ›› Issue (2): 272-278.DOI: 10.19852/j.cnki.jtcm.2022.02.010
• Research Articles • Previous Articles Next Articles
Menstrual cycle characteristics as an indicator of fertility outcomes: evidence from prospective birth cohort study in China
LIU Xiping1, WU Xiaqiu1, BAO Lirong2, PENG Jin3(
), Ka-Kit Hui4
- 1 School of Public Health, Zhejiang Chinese Medical University, Hangzhou 310053, China
2 Zhejiang Chinese Medical University, Hangzhou 310053, China
3 Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
4 Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles 90024, USA
-
Received:2021-07-23Accepted:2021-10-16Online:2021-12-14Published:2021-12-14 -
Contact:WU Xiaqiu,PENG Jin -
About author:Prof. Wu Xia-Qiu, School of Public Health, Zhejiang Chinese Medical University, Hangzhou 310053, China. wuxiaqiu2001@hotmail.com; Prof. PENG Jin, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China. Pengjin2000@126.com, Telephone: +86-13656693050; +86-13521403824
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Supported by:Scientific research of Zhejiang Provincial Department of Health (Wireless Sensor Model of Menstrual Cycle Health Monitoring)(2016ZA049);Young Scientists of Zhejiang Provincial Department of Health (Effects of Tiaojing Decoction on Expression of TGF-β3/Smads Pathway in Premature Ovarian Failure Model Rats)(2020ZQ021);National Science Foundation for Fostering Talents in Basic Research of the National Natural Science Foundation of China (Establishment and Evaluation of Female Pre Pregnancy Health Risk Identification and Evaluation Model)(81202737)
Cite this article
LIU Xiping, WU Xiaqiu, BAO Lirong, PENG Jin, Ka-Kit Hui. Menstrual cycle characteristics as an indicator of fertility outcomes: evidence from prospective birth cohort study in China[J]. Journal of Traditional Chinese Medicine, 2022, 42(2): 272-278.
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Table 1 Questionnaire for menstrual cycle characteristics
| Question | Option | Category |
|---|---|---|
| Length pattern: How long menstrual cycle on an average have you had during the past 3 months? | Usually 27 to 32 d | Normal |
| Usually 26 d or less | Short | |
| Usually longer than 32 d | Long | |
| Irregular length | Irregular | |
| Menstrual Blood color: What is the color of your menstrual bleeding during past 3 months? | Usually dark red | Dark red |
| Usually bright red | Bright red | |
| Usually light red | Light red | |
| Unknown | Unknown | |
| Blood clots: Do you have blood clots during your menstrual flow during the past 3 months? | Sometimes, or usually | Yes (1) |
| Never or occasionally | No (0) |
Table 1 Questionnaire for menstrual cycle characteristics
| Question | Option | Category |
|---|---|---|
| Length pattern: How long menstrual cycle on an average have you had during the past 3 months? | Usually 27 to 32 d | Normal |
| Usually 26 d or less | Short | |
| Usually longer than 32 d | Long | |
| Irregular length | Irregular | |
| Menstrual Blood color: What is the color of your menstrual bleeding during past 3 months? | Usually dark red | Dark red |
| Usually bright red | Bright red | |
| Usually light red | Light red | |
| Unknown | Unknown | |
| Blood clots: Do you have blood clots during your menstrual flow during the past 3 months? | Sometimes, or usually | Yes (1) |
| Never or occasionally | No (0) |
Figure 1 Menstrual blood color scale (1) Light Red, RGB: (255, 153, 153), (2) Bright Red, RGB: (255, 0, 0), (3) Dark Red, RGB: (102, 0, 0).
Figure 1 Menstrual blood color scale (1) Light Red, RGB: (255, 153, 153), (2) Bright Red, RGB: (255, 0, 0), (3) Dark Red, RGB: (102, 0, 0).
Figure 2 Study flow of women enrollment, follow up and pregnancy diagnosis
Figure 2 Study flow of women enrollment, follow up and pregnancy diagnosis
Table 2 Characteristics of Study participants with different age group [n (%)]
| Item | Total (n = 2109) | Age (years) | P value | |||
|---|---|---|---|---|---|---|
| ≤ 25 (n = 409) | 25-30 (n = 1379) | 30-35 (n = 289) | 35-45 (n = b32) | |||
| Education | < 0.001 | |||||
| High school or less | 300 (14.22) | 129 (31.54) | 132 (9.57) | 31 (10.73) | 8 (25.00) | |
| Bachelor | 1514 (71.79) | 257 (62.84) | 1027 (74.47) | 210 (72.66) | 20 (62.50) | |
| Master/doctor | 278 (13.18) | 15 (3.67) | 213 (15.45) | 46 (15.92) | 4 (12.50) | |
| Missing | 17 (0.81) | 8 (1.96) | 7 (0.51) | 2 (0.69) | 0 (0.00) | |
| Age at menarche | 13.22 (1.36) | 13.3 (1.47) | 13.21 (1.33) | 13.14 (1.32) | 13.48 (1.7) | 0.326 |
| Abortion history | < 0.001 | |||||
| 0 | 1540 (73.02) | 304 (74.33) | 1041 (75.49) | 176 (60.90) | 19 (59.38) | |
| 1-2 | 457 (21.67) | 87 (21.27) | 270 (19.58) | 90 (31.14) | 10 (31.25) | |
| ≥3 | 19 (0.90) | 0 (0.00) | 11 (0.80) | 8 (2.77) | 0 (0.00) | |
| Missing | 93 (4.41) | 18 (4.40) | 57 (4.13) | 15 (5.19) | 3 (9.38) | |
| Menstrual Cycle Length | 0.47 | |||||
| Regular | 516 (24.47) | 97 (23.72) | 342 (24.80) | 69 (23.88) | 8 (25.00) | |
| Short | 318 (15.08) | 65 (15.89) | 206 (14.94) | 44 (15.22) | 3 (0.38) | |
| Long | 700 (33.19) | 142 (34.72) | 459 (33.28) | 93 (32.18) | 6 (18.75) | |
| Irregular | 575 (27.26) | 105 (25.67) | 372 (26.98) | 83 (28.72) | 15 (46.88) | |
| Menstrual Blood Color | 0.35 | |||||
| Dark Red | 735 (34.85) | 134 (32.76) | 491 (35.61) | 99 (34.26) | 11 (34.38) | |
| Bright Red | 1144 (54.24) | 224 (54.77) | 738 (53.52) | 167 (57.79) | 15 (46.88) | |
| Light Red | 75 (3.56) | 19 (4.65) | 44 (3.19) | 9 (3.11) | 3 (9.38) | |
| Unknown | 155 (7.35) | 32 (7.82) | 106 (7.69) | 14 (4.84) | 3 (9.38) | |
| Blood Clots | 0.86 | |||||
| Yes | 1135 (53.82) | 227 (55.50) | 738 (53.52) | 154 (53.29) | 16 (50.00) | |
| No | 974 (46.18) | 182 (44.50) | 641 (46.48) | 135 (46.71) | 16 (50.00) | |
| Fertility outcome | 0.01 | |||||
| Fail to conception | 715 (33.90) | 116 (28.36) | 494 (35.82) | 90 (31.14) | 15 (46.88) | |
| Achieve conception | 1394 (66.10) | 293 (71.64) | 885(64.18) | 199(68.86) | 17 (53.13) | |
| include: | ||||||
| Ongoing Pregnancy | 187 (13.41) | 17 (5.80) | 125 (14.12) | 38 (19.10) | 7 (41.18) | |
| Given birth | 1207 (86.59) | 276 (94.20) | 760 (85.88) | 161 (80.90) | 10 (58.82) | |
| Pregnancy outcome | 0.05 | |||||
| Live Birth | 1119 (92.71) | 265 (96.01) | 699 (91.97) | 147 (91.30) | 8 (80.00) | |
| Miscarriage | 88 (7.29) | 11 (3.99) | 61 (8.03) | 14 (8.70) | 2 (20.00) | |
Table 2 Characteristics of Study participants with different age group [n (%)]
| Item | Total (n = 2109) | Age (years) | P value | |||
|---|---|---|---|---|---|---|
| ≤ 25 (n = 409) | 25-30 (n = 1379) | 30-35 (n = 289) | 35-45 (n = b32) | |||
| Education | < 0.001 | |||||
| High school or less | 300 (14.22) | 129 (31.54) | 132 (9.57) | 31 (10.73) | 8 (25.00) | |
| Bachelor | 1514 (71.79) | 257 (62.84) | 1027 (74.47) | 210 (72.66) | 20 (62.50) | |
| Master/doctor | 278 (13.18) | 15 (3.67) | 213 (15.45) | 46 (15.92) | 4 (12.50) | |
| Missing | 17 (0.81) | 8 (1.96) | 7 (0.51) | 2 (0.69) | 0 (0.00) | |
| Age at menarche | 13.22 (1.36) | 13.3 (1.47) | 13.21 (1.33) | 13.14 (1.32) | 13.48 (1.7) | 0.326 |
| Abortion history | < 0.001 | |||||
| 0 | 1540 (73.02) | 304 (74.33) | 1041 (75.49) | 176 (60.90) | 19 (59.38) | |
| 1-2 | 457 (21.67) | 87 (21.27) | 270 (19.58) | 90 (31.14) | 10 (31.25) | |
| ≥3 | 19 (0.90) | 0 (0.00) | 11 (0.80) | 8 (2.77) | 0 (0.00) | |
| Missing | 93 (4.41) | 18 (4.40) | 57 (4.13) | 15 (5.19) | 3 (9.38) | |
| Menstrual Cycle Length | 0.47 | |||||
| Regular | 516 (24.47) | 97 (23.72) | 342 (24.80) | 69 (23.88) | 8 (25.00) | |
| Short | 318 (15.08) | 65 (15.89) | 206 (14.94) | 44 (15.22) | 3 (0.38) | |
| Long | 700 (33.19) | 142 (34.72) | 459 (33.28) | 93 (32.18) | 6 (18.75) | |
| Irregular | 575 (27.26) | 105 (25.67) | 372 (26.98) | 83 (28.72) | 15 (46.88) | |
| Menstrual Blood Color | 0.35 | |||||
| Dark Red | 735 (34.85) | 134 (32.76) | 491 (35.61) | 99 (34.26) | 11 (34.38) | |
| Bright Red | 1144 (54.24) | 224 (54.77) | 738 (53.52) | 167 (57.79) | 15 (46.88) | |
| Light Red | 75 (3.56) | 19 (4.65) | 44 (3.19) | 9 (3.11) | 3 (9.38) | |
| Unknown | 155 (7.35) | 32 (7.82) | 106 (7.69) | 14 (4.84) | 3 (9.38) | |
| Blood Clots | 0.86 | |||||
| Yes | 1135 (53.82) | 227 (55.50) | 738 (53.52) | 154 (53.29) | 16 (50.00) | |
| No | 974 (46.18) | 182 (44.50) | 641 (46.48) | 135 (46.71) | 16 (50.00) | |
| Fertility outcome | 0.01 | |||||
| Fail to conception | 715 (33.90) | 116 (28.36) | 494 (35.82) | 90 (31.14) | 15 (46.88) | |
| Achieve conception | 1394 (66.10) | 293 (71.64) | 885(64.18) | 199(68.86) | 17 (53.13) | |
| include: | ||||||
| Ongoing Pregnancy | 187 (13.41) | 17 (5.80) | 125 (14.12) | 38 (19.10) | 7 (41.18) | |
| Given birth | 1207 (86.59) | 276 (94.20) | 760 (85.88) | 161 (80.90) | 10 (58.82) | |
| Pregnancy outcome | 0.05 | |||||
| Live Birth | 1119 (92.71) | 265 (96.01) | 699 (91.97) | 147 (91.30) | 8 (80.00) | |
| Miscarriage | 88 (7.29) | 11 (3.99) | 61 (8.03) | 14 (8.70) | 2 (20.00) | |
Table 3 Pregnancy outcome (live birth, miscarriage) by MC characteristics (n = 1394)
| crude OR | adj. ORa | P value (wald's test) | P value (LR-test) | ||
|---|---|---|---|---|---|
| Menstrual Cycle Length | 0.33 | ||||
| Regular | 1 | 1 | |||
| Short | 1.74 (0.88, 3.44) | 1.71 (0.85, 3.42) | 0.13 | ||
| Long | 0.99 (0.53, 1.85) | 0.97 (0.51, 1.84) | 0.92 | ||
| Irregular | 1.31 (0.69, 2.48) | 1.23 (0.64, 2.38) | 0.53 | ||
| Menstrual Blood Color | 0.41 | ||||
| Dark Red | 1 | 1 | |||
| Bright Red | 0.92 (0.57, 1.49) | 1.01 (0.6, 1.71) | 0.97 | ||
| Light Red | 2.28 (0.89, 5.85) | 2.39 (0.91, 6.28) | 0.08 | ||
| Unknown | 1.03 (0.41, 2.55) | 1.01 (0.40, 2.53) | 0.99 | ||
| Blood Clots, Y | 1.34 (0.85, 2.11) | 1.26 (0.77, 2.07) | 0.35 | 0.35 |
Table 3 Pregnancy outcome (live birth, miscarriage) by MC characteristics (n = 1394)
| crude OR | adj. ORa | P value (wald's test) | P value (LR-test) | ||
|---|---|---|---|---|---|
| Menstrual Cycle Length | 0.33 | ||||
| Regular | 1 | 1 | |||
| Short | 1.74 (0.88, 3.44) | 1.71 (0.85, 3.42) | 0.13 | ||
| Long | 0.99 (0.53, 1.85) | 0.97 (0.51, 1.84) | 0.92 | ||
| Irregular | 1.31 (0.69, 2.48) | 1.23 (0.64, 2.38) | 0.53 | ||
| Menstrual Blood Color | 0.41 | ||||
| Dark Red | 1 | 1 | |||
| Bright Red | 0.92 (0.57, 1.49) | 1.01 (0.6, 1.71) | 0.97 | ||
| Light Red | 2.28 (0.89, 5.85) | 2.39 (0.91, 6.28) | 0.08 | ||
| Unknown | 1.03 (0.41, 2.55) | 1.01 (0.40, 2.53) | 0.99 | ||
| Blood Clots, Y | 1.34 (0.85, 2.11) | 1.26 (0.77, 2.07) | 0.35 | 0.35 |
Table 4 Fertility outcome by MC characteristics (n = 2109)
| Item | Achieve conception [n (%)] | Crude FOR (95% CI) | adj. FOR (95% CI) a | P value (wald's test) | P value (LR-test) | |
|---|---|---|---|---|---|---|
| Menstrual Cycle Length | < 0.001 | |||||
| Regular | 359 (69.57) | 1 | 1 | |||
| Short | 212 (66.67) | 0.85 (0.62, 1.15) | 0.81 (0.6, 1.11) | 0.2 | ||
| Long | 483 (69.00) | 0.97 (0.75, 1.25) | 0.92 (0.71, 1.2) | 0.56 | ||
| Irregular | 340 (59.13) | 0.63 (0.49, 0.82) | 0.59 (0.45, 0.77) | < 0.001 | ||
| Menstrual Blood Color | 0.11 | |||||
| Dark Red | 503 (68.44) | 1 | 1 | |||
| Bright Red | 735 (64.25) | 0.82 (0.67, 1) | 0.79 (0.63, 0.98) | 0.04 | ||
| Light Red | 49 (65.33) | 0.86 (0.52, 1.44) | 0.87 (0.52, 1.47) | 0.61 | ||
| Unknown | 107 (69.03) | 1.05 (0.71, 1.56) | 1.13 (0.76, 1.68) | 0.55 | ||
| Blood Clots, Y | 759 (35.99) | 1.08 (0.89, 1.3) | 1.02 (0.83, 1.25) | 0.88 | 0.88 |
Table 4 Fertility outcome by MC characteristics (n = 2109)
| Item | Achieve conception [n (%)] | Crude FOR (95% CI) | adj. FOR (95% CI) a | P value (wald's test) | P value (LR-test) | |
|---|---|---|---|---|---|---|
| Menstrual Cycle Length | < 0.001 | |||||
| Regular | 359 (69.57) | 1 | 1 | |||
| Short | 212 (66.67) | 0.85 (0.62, 1.15) | 0.81 (0.6, 1.11) | 0.2 | ||
| Long | 483 (69.00) | 0.97 (0.75, 1.25) | 0.92 (0.71, 1.2) | 0.56 | ||
| Irregular | 340 (59.13) | 0.63 (0.49, 0.82) | 0.59 (0.45, 0.77) | < 0.001 | ||
| Menstrual Blood Color | 0.11 | |||||
| Dark Red | 503 (68.44) | 1 | 1 | |||
| Bright Red | 735 (64.25) | 0.82 (0.67, 1) | 0.79 (0.63, 0.98) | 0.04 | ||
| Light Red | 49 (65.33) | 0.86 (0.52, 1.44) | 0.87 (0.52, 1.47) | 0.61 | ||
| Unknown | 107 (69.03) | 1.05 (0.71, 1.56) | 1.13 (0.76, 1.68) | 0.55 | ||
| Blood Clots, Y | 759 (35.99) | 1.08 (0.89, 1.3) | 1.02 (0.83, 1.25) | 0.88 | 0.88 |
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Abstract |
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