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The acute effects of retrograde menstruation were studied by endoscopy and cytology. The findings suggest that spillage of menstrual blood into the peritoneal cavity is painful. The technique of making this diagnosis is discussed and the therapeutic implications considered.
Mononuclear and polymorphonuclear cells were isolated from the peripheral blood of normal menstruating women. Four of the subjects were not using oral contraceptives and five were taking various formulations. The women were tested once a week for 12 consecutive weeks. Plasma levels of 6-keto-prostaglandin F2 alpha (6-KF), prostaglandin E2 (PGE2), thromboxane B2 (TxB2), estrogen, and progesterone were measured by specific radioimmunoassays. The phagocytic activity of the mononuclear and polymorphonuclear cells isolated from the peripheral blood was measured with a bacterial phagocytosis and killing assay. The phagocytic activity of both types of cells was depressed perimenstrually in both groups of women. However, examination of individuals showed that those subjects not taking oral contraceptives had a worsening of phagocytic activities with approaching menses while the oral contraceptive subjects generally had an improving of these activities at this time. We were unable to correlate the phagocytic activities with either hormone or prostaglandin levels in the plasma of these subjects. However, the subjects on oral contraceptives had significantly lower levels of PGE2 and TxB2 than those women who were not using oral contraceptives.
Blood platelets from women showed increased sensitivity to adenosine diphosphate (ADP) during ovulation compared with menstruation. The increased sensitivity was registered as an increase in cytoplasmic calcium response measured with the fluorescent indicator fura-2. Agonist dose-response studies revealed an increased maximal response, but the dose that gave half maximal response was unchanged. This indicates an increased mobility of calcium, without changed affinity to receptor(s).
Progesterone stimulation of the estradiol (E2)-primed human endometrium initiates DZ of the stromal cells around the spiral arterioles. Under continued steroid stimulation, DZ spreads wave-like to establish the decidual cell as a major cell type of the luteal phase and pregnant endometrium. Because of their widespread distribution throughout the endometrium and concentration at perivascular sites, decidual cells are spatially and temporally positioned to mediate the opposing requirements of maintaining hemostasis during endovascular trophoblast invasion, yet promoting menstrual hemorrhage in the absence of implantation. The experimental results summarized in this review indicate that the paradoxical properties manifested by endometrial stromal/decidual cells are controlled by several proteins with either hemostatic or ECM-degrading or vasoactive activity, and that their expression is altered in response to changes in levels of circulating ovarian steroids during the menstrual cycle. These conclusions are drawn primarily from studies with a well-characterized in vitro model of DZ using monolayers of stromal cells derived from specimens of predecidualized endometrium. Thus, progestins modify the expression of several DZ-related markers in the cultured stromal cells, and E2 enhances these effects despite the lack of response to E2 alone. These responses are consistent with the differential actions displayed by E2 and progesterone in vivo, by which E2 primes the endometrium for the decidualizing effects of progesterone by elevating progesterone receptor levels. Accordingly, during steroid-induced in vitro DZ, a marked increase in the expression of stromal cell TF and PAI-1 and reciprocal inhibition of tPA activity suggest mechanisms to account for the absence of hemorrhage during invasion of the endometrial vasculature by implanting trophoblasts. In contrast to steroid-induced DZ, the events of menstruation are initiated in response to a decline in circulating levels of ovarian steroids. Accordingly, subjecting in vitro decidualized stromal cells to steroid withdrawal results in pronounced reversal in the expression of all of the end points listed above. Consequently, the local hemostatic environment is transformed into a hemorrhage-promoting milieu. Taken together with vascular injury resulting from ischemia induced by spiral artery vasoconstriction, the net effect is attainment of two prerequisites for menstrual hemorrhage, vascular injury and inadequate hemostasis.
The aim of this study was to investigate a possible interrelation between bronchial hyperreactivity and psychological hyperreactivity. In order to record changes in both bronchial and psychological reactions throughout the menstrual cycle, 10 women out-patients with moderate asthma were followed up for six months, and their physical and psychological status as well as their reactions to life-events and environmental influences were assessed through self-reporting measures and weekly psychotherapeutic sessions. Psychotherapy was used both as a supplement to the medical treatment and as a method of data collection. A relationship between lowered resistance to stress, lowered resistance to infections and increased bronchial hyperreactivity is suggested as background aetiological factors for the exacerbation of asthma around menstruation.
Because we suspected the number of women harboring Staphylococcus aureus perivaginally to be higher than previously reported, we undertook an examination of normal, healthy volunteers. Of 97 young women, 26% yielded S. aureus from the external labia at the time of menstruation. Toxin associated with toxic shock syndrome was recovered from 5 of 25 subjects with positive genital cultures. Approximately one-half of the women with positive genital cultures yielded positive cultures from the posterior cervical fornix. These 12 women with positive vaginal cultures formed a distinct subgroup that was characterized by positive labial and tampon cultures, higher incidence of previous streptococcal infections, and more frequent vaginal insertion of their own fingers or those of a partner. Tampons were used by all but one woman in the group with positive labial cultures and all but one woman in the group with positive vaginal cultures. We concluded that the presence of S. aureus in the vagina involves mechanisms other than the use of tampons. Insertion of fingers and perhaps some aspect of immunological status appear to play a role.
Serum concentrations of fibrin degradation products were found to be higher during menstruation than in the intermenstrual phase. Higher concentrations were present in cases of menorrhagia as compared with healthy women and women with various gynaecological disorders but with normal menstrual function. Higher serum concentrations of fibrin degradation products in cases of menorrhagia may indicate increased local fibrinolytic activity in the uterus.
Of 100 children's emergency admissions to hospital nearly half (49%) were admitted during the mother's paramenstruum. There was a statistically significant association between the mother's menstruation and the child's admission both for accidents and for illnesses. The eldest child in the family appeared to be most affected.
The frequency of menstruation was reduced to once every three months in 196 women by the continuous administration of the oral contraceptive pill, Minilyn, for 84 days (tri-cycle regimen). No pregnancies occurred. One hundred and sixty-one women (82%) welcomed the reduction in the number of periods with the associated freedom from menstrual and premenstrual symptoms, and many found the tri-cycle regimen easier to follow. Weight gain of more than 2 kg, irregular cycle control, especially in the first three months, breast tenderness, and headaches were the main side effects. Menstrual loss was unchanged or reduced in all but seven women. The doctors and nurses on the clinic staff were less enthusiastic about this regimen than the volunteers themselves.
OBJECTIVE: To compare the efficacy and acceptability of ethamsylate, mefenamic acid, and tranexamic acid for treating menorrhagia. DESIGN: Randomised controlled trial. SETTING: A university department of obstetrics and gynaecology. SUBJECTS: 76 women with dysfunctional uterine bleeding. INTERVENTIONS: Treatment for five days from day 1 of menses during three consecutive menstrual periods. 27 patients were randomised to take ethamsylate 500 mg six hourly, 23 patients to take mefenamic acid 500 mg eight hourly, and 26 patients to take tranexamic acid 1 g six hourly. MAIN OUTCOMES MEASURES: Menstrual loss measured by the alkaline haematin method in three control menstrual periods and three menstrual periods during treatment; duration of bleeding; patient's estimation of blood loss; sanitary towel usage; the occurrence of dysmenorrhoea; and unwanted events. RESULTS: Ethamsylate did not reduce mean menstrual blood loss whereas mefenamic acid reduced blood loss by 20% (mean blood loss 186 ml before treatment, 148 ml during treatment) and tranexamic acid reduced blood loss by 54% (mean blood loss 164 ml before treatment, 75 ml during treatment). Sanitary towel usage was significantly reduced in patients treated with mefenamic acid and tranexamic acid. CONCLUSIONS: Tranexamic acid given during menstruation is a safe and highly effective treatment for excessive bleeding. Patients with dysfunctional uterine bleeding should be offered medical treatment with tranexamic acid before a decision is made about surgery.
In contrast with migraine, little is known about the relation between cluster headache and menstrual cycle, oral contraceptives, pregnancy, and menopause. A population based questionnaire study was performed among 224 female cluster headache patients, and the possible effect of hormonal influences on cluster headache attacks studied. For control data, a similar but adjusted questionnaire was sent to healthy volunteers and migraine patients. It was found that menstruation, use of oral contraceptives, pregnancy, and menopause had a much smaller influence on cluster headache attacks than in migraine. Cluster headache can, however, have a large impact on individual women, for example to refrain from having children.
A case of pituitary coma with continuing menstruation is presented. This association is extremely rare, but a history of recent menstrual periods does not exclude advanced hypopituitarism from the differential diagnosis of severe hyponatraemia.
The aims of the present study were to count Trichomonas vaginalis organisms recovered from the vaginas of patients with trichomoniasis, and to obtain data concerning changes in sizes of trichomonal populations during the menstrual cycle. In about 80% of symptomatic as well as symptomless patients, more than 1 x 10(5) parasites per ml could be obtained from vaginal washes. During menstruation, however, the number of trichomonads decreased appreciably, with subsequent increases within three to six days after bleeding. The results indicated that sufficient numbers of fresh trichomonads may be obtained from vaginal washes for biochemical and molecular experiments and also confirm the previously reported trichomonocidal effect of menstrual blood complement in vivo.
Serum ferritin, hemoglobin, serum iron and transferrin iron-binding capacity were evaluated in 107 healthy female students. 21 women had a serum ferritin of 12 micrograms/l or less, corresponding to an exhaustion of body iron stores. After 1 month of iron supplementation, significant increase of hemoglobin concentration and decrease of total iron-binding capacity were observed. Mean serum ferritin had increased from 24 to 41 micrograms/l, and all women had a serum ferritin above 12 micrograms/l. 1 month after the end of the trial, serum ferritin fell significantly. This study points out the problem of serum ferritin reference values and the definition of normal iron stores in menstruating women.
Decreased bone density has been reported in women with hyperprolactinaemia due to pituitary tumours. We identified a number of seemingly healthy women with hyperprolactinaemia, i.e. a serum prolactin concentration exceeding 500 mU/l (25 micrograms/l) on three occasions, during a study in 1980/1981 of a representative population sample of greater than 1,400 women in seven different age strata (range 26-72 years). We compared vertebral bone mineral content and bone mineral areal content in 5 hyperprolactinaemic normally menstruating 50-year-old women with that of 6 controls matched for age and menstrual status but found no difference. Since the degree of prolactin elevation was similar in our study group to that previously reported for hyperprolactinaemic subjects with pituitary tumours and the time of exposure to raised hormone concentration appears to be of the same magnitude, other hormonal changes than hyperprolactinaemia per se seem to be the cause of low bone mineral content in women with hyperprolactinaemia and amenorrhoea.
The understanding of menstruation as well as the image of women have much changed in the course of history. This development, as reflected by the views of the Old Testament (Leviticus), of Hippocrates and Aristoteles, its characterization in the books of Hildegard of Bingen and of Paracelsus, its description in the Renaissance and the 18th century, is followed up to our modern times.
Serum concentrations of androstenedione, testosterone and dehydroepiandrosterone sulfate (DHEAS) were measured in 29 patients with premature ovarian failure (POF) and an identical number of age-matched normal control subjects. The study was aimed at determining possible differences in androgen concentrations of ovarian and adrenal origin in POF patients and age-matched normal menstruating controls. Serum testosterone and DHEAS concentrations in the 2 populations were not significantly different. The serum androstenedione concentration in the POF patient group (3,077.50 +/- 1,122.33 pmol/l) was significantly lower than in age-matched normal control subjects (4,167.70 +/- 1,381.09 pmol/l, p < 0.005), possibly reflecting the loss of ovarian androstenedione secretion and/or a subtle defect in adrenal steroidogenic capacity.
We studied variations in DLCO during the menstrual cycle in 14 healthy women with a mean age of 29 (SD, 7) yr. Eight were using oral contraceptives, and six were not. DLCO was determined 1 to 7 d before the onset of menses, daily during each of the first 4 d of menses, and 5 to 10 d after onset of menses. In both groups of subjects, the highest values for DLCO were obtained before menses, the lowest were on the third day of menses, whereas after completion of menses the values increased but were not as high as prior to menses. The mean DLCO for all subjects was 23.1 (SD, 3.2) ml/min/mm Hg before menses, 20.9 (SD, 3.0) on the third day of menstruation, and 21.6 (SD, 3.3) 5 to 10 d after onset of menses. The mean percent difference between DLCO before and on the third day of menses in all 14 subjects was 9.2 (SD, 4.4) %. There were no significant changes in hemoglobin on these days to account for the changes in DLCO. Pulmonary capillary blood volume determined in 10 of the subjects did not show a significant change. It is concluded that DLCO can vary significantly during the menstrual cycle, with the highest values occurring prior to menses and the lowest values occurring on the third day of menses, with a mean difference between them of 9%. These variations need to be considered when evaluating DLCO in female patients in the menstrual age group.