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The effect of residual beta cell activity on menstruation and the reproductive hormone profile of insulin-dependent diabetics.

To investigate the cause of secondary amenorrhoea in insulin-dependent diabetes gonadotrophins, sex steroid hormone levels and residual beta cell activity (C-peptide index) were estimated in a group of 43 women with IDDM. Among 26 women with residual insulin secretion, the C-peptide positive (CpP) group, 5 had secondary amenorrhoea (CpP-Am); among 17 women without endogenous beta cell activity, the C-peptide negative (CpN) group 6 had secondary amenorrhoea (CpN-Am). In this study two different types of secondary amenorrhoea in insulin-dependent diabetics were observed. All CpP-Am women have the classical hormone profile of the polycystic ovary syndrome (increased (LH/FSH ratio, increased serum testosterone, decreased SHBG) together with a history of oligomenorrhoea and excess weight before the onset of diabetes. On the other hand, all CpN-Am women had decreased LH levels as well as low LH/FSH ratio and testosterone levels. These results strongly suggest that a lack of residual pancreatic beta cell activity influences hypothalamus-pituitary function in insulin-dependent diabetes. It might be concluded that PCOS is independent of diabetes while low LH amenorrhoea seems to be the consequence of diabetes and is strongly associated with a lack of residual insulin secretion.

Amenorrhea↗

Iron status markers, serum ferritin and hemoglobin in 1359 Danish women in relation to menstruation, hormonal contraception, parity, and postmenopausal hormone treatment.

Iron status was assessed by measuring serum (S-) ferritin and hemoglobin (Hb) in a population survey comprising 1359 nonpregnant Danish women, in age cohorts of 30, 40, 50, and 60 years; 809 were premenopausal and 550 postmenopausal. Median age for menarche was 14 years, for menopause (artificial and natural) 48 years. Premenopausal women had lower S-ferritin (median 37 micrograms/l) than postmenopausal women (median 71 micrograms/l; p less than 0.0001). Of the premenopausal women, 17.7% had S-ferritin less than 15 micrograms/l (i.e., depleted iron stores), and 23.1% S-ferritin of 15-30 micrograms/l (i.e., small iron stores). Corresponding figures in postmenopausal women were 3.3% and 10.3%. Hb values in premenopausal women were mean 137 +/- 10 (SD) g/l (8.5 +/- 0.6 mmol/l) vs. 140 +/- 10 g/l (8.7 +/- 0.6 mmol/l) in postmenopausal women (p less than 0.0001); 4.1% of pre- and 3.3% of postmenopausal women had values less than 121 g/l (7.5 mmol/l). Iron deficiency anemia (i.e., S-ferritin less than 15 micrograms/l and Hb less than 121 g/l) was found in 2.6% of pre- and 0.36% of postmenopausal women. Premenopausal multipara had lower S-ferritin than nulli- and unipara (p less than 0.04). The use of oral contraceptives had a marked influence on iron stores; premenopausal women taking the pill had higher S-ferritin and a lower frequency of depleted iron reserves than nonusers (p less than 0.01). Postmenopausal estrogen treatment had no influence on S-ferritin or Hb.

Adolescent↗

[The menstruation cycle in the postoperative phase. Its effect of the incidence of nausea and vomiting].

OBJECTIVE: Several studies suggest that the menstrual cycle has an impact on postoperative nausea and vomiting (PONV). However, many studies report inconsistent results. Thus, in this systematic review the results of all available studies are compared and statistically synthesised. MATERIALS AND METHODS: A systematic search of the literature was performed (Medline, the Cochrane-Library, reference lists of matching articles). The main end point in each study was defined as occurrence of PONV during an observation interval of at least 12 h postoperatively. These data were extracted from each article and the pooled incidences of PONV for each day of the menstrual cycle were calculated. These incidences were analysed using the chi 2-test. Furthermore the pooled incidences of PONV during the following phases of the menstrual cycle were calculated: days 1-7, 8-12, 13-15, 16-24, and 25-end of cycle. RESULTS: A total of 12 studies with 2625 patients containing informations on the incidence of PONV on different days or phases of the menstrual cycle were analysed. The total incidence of PONV was 37.3%. The incidence of PONV was lowest (26.9%) on day 20 and reached its maximum on day 5 (45.0%) with no statistically significant differences concerning the incidences of PONV between the different days (p = 0.75). Furthermore there were no clinically relevant differences in the incidences of PONV during the phases of the menstrual cycle: day 1-7: 40.4%; day 8-12: 32.9%; day 13-15: 38.1%; day 16-24: 34.5%; day 25-end of cycle: 41.5%. Prophylactic administration of an antiemetic in some of the studies had no impact on these results. CONCLUSION: Studies investigating the influence of the menstrual cycle on the incidence of PONV show inconsistent results. Summarising the data of these studies suggests that the phase of the menstrual cycle has no impact on the occurrence of PONV.

Antiemetics↗