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PubMed1977

Menstruation and control of diabetes.

Seventy per cent of the patients aged 45 years or under and suffering from diabetic ketoacidosis who were seen in one diabetic clinic over five years were women. The association of menstruation with ketoacidosis was assessed over two and a half years, and it was found that menstruation was associated with ketoacidosis more often than would be expected by chance (P less than 0-01). Two hundred women were interviewed and 76 observed that menstruation changed their diabetic control. Fifty-three found that control deteriorated and hyperglycaemia occurred, while 23 found that control improved and hypoglycaemia was a common problem. Menstruation appears to be an important factor in influencing control of diabetes. The mechanism of the changes observed has not yet been determined, but it seems to be a subject worthy of further investigation.

Adolescent↗
PubMedDate not supplied

Iron deficiency and smoking. Comparative criteria for buccal mucosa keratinization in menstruating and postmenopausal women.

OBJECTIVE: To compare the degree of keratinization of buccal mucosa between nonsmoking menstruating and postmenopausal women without oral complaints whose iron status was established. STUDY DESIGN: Samples collected from 26 nonsmoking, regularly menstruating women (mean age, 26 years) and 18 nonsmoking, postmenopausal women without oral complaints (mean age, 57 years) were stained according to the method of Papanicolaou. Keratinization was evaluated by the karyopyknotic index (KI). Iron status was assessed with blood ferritin levels. RESULTS: Mean ferritin values of menstruating and postmenopausal women were statistically significantly different (mean ferritin value = 28.97 micrograms/L and 103.69 micrograms/L, respectively). The difference in the degree of keratinization of buccal mucosa between menstruating women (mean KI = 16.03%) and postmenopausal women (mean KI = 13.16) was statistically nonsignificant. CONCLUSION: Our results indicate that the degree of keratinization of buccal mucosa does not show any alteration after menopause.

Adult↗
PubMed2002

Safety of tissue plasminogen activator for acute stroke in menstruating women.

BACKGROUND: Menses is a theoretical contraindication to intravenous tissue plasminogen activator (tPA) treatment. We sought to establish the safety of intravenous tPA in the treatment of acute ischemic stroke in women who are actively menstruating. SUMMARY OF REPORT: We provide a case report and review of the National Institute of Neurological Disorders and Stroke (NINDS) database for women coded as actively menstruating. Nine subjects were coded as actively menstruating in the NINDS trial (4 placebo and 5 in the treatment). One subject in the treatment group who had a 1-year history of dysfunctional uterine bleeding required emergent uterine artery ligation. We also report a case of a woman requiring transfusion after intravenous tPA administration for acute ischemic stroke. CONCLUSIONS: Intravenous tPA may be administered relatively safely in women who are menstruating and should be used with caution in women with a history of dysfunctional uterine bleeding. Potential patients should be advised that they might require transfusion for increased menstrual flow.

Acute Disease↗
PubMed2003

Elafin in human endometrium: an antiprotease and antimicrobial molecule expressed during menstruation.

Elafin is an antiproteinase and antimicrobial molecule that is expressed at epithelial sites (for example, cervix). This study details the expression and regulation of elafin in the human endometrium. Elafin mRNA and protein expression were examined in endometrium throughout the menstrual cycle and in first-trimester decidua. Real-time quantitative PCR showed that expression of elafin mRNA peaked during menstruation. Elafin protein was localized to leukocytes scattered in the endometrial stroma during the late secretory and menstrual phases. Faint immunostaining was also present in glandular epithelium at these cycle stages. Immunofluorescent colocalization of elafin with neutrophil elastase confirmed that elafin was expressed by endometrial neutrophils around the time of menstruation. This is consistent with the expression profile observed from immunohistochemical studies. Primary endometrial epithelial cells were treated with proinflammatory molecules, and elafin mRNA was studied. A combination of the proinflammatory mediators, IL-1 beta and TNFalpha, increased elafin mRNA levels by 4.6-fold. These results show that endometrium expresses elafin in a menstruation-dependent manner. This is attributable to the presence of infiltrating leukocytes and increased inflammatory signaling. Elafin will regulate proteolytic enzymes during menstruation and will contribute to the innate defense against uterine infection.

Adult↗
PubMed2002

In vivo evidence for active matrix metalloproteinases in human endometrium supports their role in tissue breakdown at menstruation.

Human endometrium remodels extensively during each reproductive cycle culminating in loss of most functionalis tissue at menstruation. Evidence suggests that menstruation results from the action of the matrix metalloproteinases (MMP), enzymes secreted in latent forms. MMP activation is thus an important regulatory step. It has not been established that MMPs are active within menstrual endometrium in vivo. We used in situ zymography to demonstrate active forms of MMPs in human endometrium across the normal menstrual cycle. Both gelatinase and collagenase activities were detected in most endometrial tissues. Semiquantitation demonstrated a substantial and significant increase in both gelatinase and collagenase activity in menstrual samples compared with those at any other time of the cycle. Gelatinase activity was both associated with cells and extracellular. All collagenase activity was extracellular. Immunoreactive MMP-2 and MMP-9 colocalized with active gelatinase, although much immunoreactive gelatinase was inactive. Some gelatinase activity colocalized with CD45(+) leukocytes. Menstruation is initiated at discrete foci, and active MMPs were similarly at foci within the tissue. This is the first in vivo evidence for increased active MMPs in menstrual endometrium compared with other stages of the cycle. These findings position the MMPs for a critical role in the matrix degradation at menstruation.

Collagenases↗
PubMed1997

Skeletal involvement in female acromegalic subjects: the effects of growth hormone excess in amenorrheal and menstruating patients.

Bone involvement is a common clinical feature in acromegalic patients, though previous studies gave divergent results possibly because of the different gonadal status of the patients studied. To study the influence of estrogen milieu in these patients, we evaluated 23 acromegalic patients with active disease, subdivided into two groups: menstruating and amenorrheal patients, comparable for duration and activity of disease. Forty-two matched women served as controls. Skeletal involvement was studied by measuring: (a) the main biomarkers of bone turnover: serum alkaline phosphatase total activity (AP), bone GLA protein (BGP), serum carboxy-terminal propeptide of type I collagen (PICP), serum type I cross-linked N-telopeptide (ICTP), and urinary pyridinoline and deoxypyridinoline corrected for creatinine (Pyr/Cr, D-Pyr/Cr) and urinary calcium/creatinine ratio (Ca/Cr); (b) bone mineral density (BMD), as measured by quantitative computed tomography both at lumbar spine and distal radius, and by dual X-ray absorptiometry both at lumbar spine and at three femoral sites (Ward's triangle, femoral neck, and great trochanter). AP, BGP, ICTP, Pyr/Cr, D-Pyr/Cr were significantly higher in patients than in controls, independent of the menstrual pattern. Higher PICP levels were found in the whole group and in menstruating acromegalics when compared with control women; no difference was found in amenorrheal patients, who in turn showed higher urinary Ca/Cr values. When patients were considered all together, BMD at spine, femoral neck, and trochanter was higher than in controls. In contrast, when the gonadal status was taking into account and, menstruating and amenorrheal subjects were considered separately, BMD at spine, but not in other sites, was significantly higher in menstruating patients than in controls. In contrast, no difference of BMD values at any site was observed between amenorrheal patients and controls. The mean BMD Z scores allowed us to detect an unequal involvement of different skeletal sites. Our results show that bone turnover is increased in acromegalic women and suggest that GH anabolic effect on bone is more evident in the presence of estrogens and that different skeletal sites may be affected differently by hormone excess.

Acromegaly↗
PubMed2002

Matrix metalloproteinases and their specific tissue inhibitors in menstruation.

The timely breakdown of extracellular matrix is essential for menstruation. Matrix metalloproteinases, which are able to degrade virtually all components of the extracellular matrix, are spatiotemporally expressed in the cyclic endometrium. The expression of most matrix metalloproteinases is regulated transcriptionally and their proteolytic activities are precisely controlled. The balance between matrix metalloproteinases and their specific tissue inhibitors is believed to be crucial for menstruation. This review focuses on the roles of matrix metalloproteinases and their tissue inhibitors in the initiation of menstruation and on the regulation of matrix metalloproteinase expression and activation. For example, the function of matrix metalloproteinases and their tissue inhibitors in endometrial re-epithelialization and angiogenesis during endometrial regeneration, when cell migration is facilitated to ensure endometrial repair, is discussed. This and other processes, although not fully resolved, serve to illustrate the involvement of matrix metalloproteinases and their tissue inhibitors in the process of menstruation.

Animals↗
PubMed1981

[Influence of menstruation on epilepsy].

From 3.457 epileptic patients, 1.574 females from 12 to 50 years old, considered probably in ovulatory age, were studied regarding the influence of menstruation upon epileptic fits. The females were compared with a group of epilepsies in general and with a group of male epileptic patients (476 cases) of same age exhibiting monthly seizures, a rhythm similar to the menstrual cycle in woman. The results led the author to the following conclusions: 1) In 353 epileptic females (22,4%) the epilepsy was influenced by the menstruation. 2) The exacerbation of fits predominate in the premenstrual and menstrual periods. 3) No significant differences was observed when compared females in ovulatory age exhibiting monthly seizures (14%) with male of similar age and similar frequency of seizures (16%); this fact is against the correlation between the cyclical events represented by epileptic fits and menstruation. 4) Focal non-temporal abnormalities predominate in the females that was influenced by menstruation.

Adolescent↗
PubMed1998

[Spontaneous menstruation in patients with Turner syndrome in our observations].

OBJECTIVES: Patients with Turner syndrome (TS) may present a wide spectrum of gonadal function including spontaneous menstruation and fertility. DESIGN: The aim of our study was to present the patients with Turner syndrome (TS) with spontaneous menstruations considering specific karyotype and X-inactivation processes. MATERIALS AND METHODS: 5 women from group of 55 patients in age from 15 to 38 years with diagnosis of TS and gonadal function were found. Clinical analysis included the evaluation of spontaneous pubertal development and hormones levels. Cytogenetic analysis was performed on peripheral blood samples using GTG banding technique. X inactivation studies were done by dynamic RBG technique. RESULTS: In two patients with mosaic karyotype and predominant 46,XX line two pregnancies were observed. They had regular menses and normal sexual development. In one patient (karyotype: 45,X[2]/46,XX[98]) spontaneous abortions and premature birth were present. Second patient was (46,XX[245]/46,X,r(X)(p22q26)[5]) in pregnancy in this time. Another three patients menstruated irregularly. The menarche appeared later. The karyotypes were: 46,X,del(X)(p11.3) in two patients and 45,X[64]46,X,r(X) (p22q26)[18]/46,XX[4] in one. CONCLUSIONS: We conclude that spontaneous menstruations and possibility of pregnancy depend on specific karyotype in patients with TS.

Adolescent↗
PubMed1999

Bone density in a population of long term oral contraceptive pill users does not differ from that in menstruating women.

Prevention of osteoporosis is a major public health issue. Amenorrhoeic women have lower bone density than normally menstruating women, which is related to the duration of amenorrhoea and the severity of oestrogen deficiency. Bone mineral density (BMD) in amenorrhoeic women can be improved by oestrogen replacement in the form of the combined oral contraceptive pill (COCP), so increased BMD might be an important non-contraceptive benefit of the COCP in menstruating women. Previous studies have been variably reported, but have used different methodologies for measurement of BMD. We measured BMD using the DEXA technique in long term COCP users and compared this with menstruating women who had never used the COCP. No differences in bone density were found, suggesting that the COCP does not improve bone mass in menstruating women who are adequately oestrogenised by their own ovaries.

Absorptiometry, Photon↗
PubMed1989

A content analysis of educational media about menstruation.

Researchers and practitioners frequently have criticized educational media's coverage of menstruation as being too oriented toward the "hygienic crisis" while de-emphasizing the emotional and other developmental aspects of puberty. In the present study, 31 audiovisual media currently available for sale/rental were reviewed for content related to the physical and psychological aspects of menstruation, the portrayal of adolescent girls, parents, and peers, and the relationship of menstruation to the developmental process. Seven films were produced by sanitary product manufacturers; 24 by other commercial filmmakers. The majority of the media depicted female anatomy by animated images and related the menstrual process to pubertal development. The relationship between menstruation and reproduction was mentioned in three cases. In general, variations in physical and emotional responses were described as normal. In all cases, fear and embarrassment were acknowledged. Openness in discussions among peers and with female adults was emphasized.

Adolescent↗
PubMed1988

Imagery associated with menstruation in advertising targeted to adolescent women.

Education about menstruation is not restricted to school instruction or information provided by adults and peers; exposure to advertisements in teen media provides imagery depicting menstruation and feminine role expectations. This paper analyzes the imagery in advertisements for sanitary products and products for the relief of menstrual symptoms. A 25% random sample of Seventeen magazine issues from 1976 to 1986 stratified by year were reviewed. A total of 135 ads for sanitary products and 32 ads for products for the relief of menstrual discomfort were analyzed. Each ad was examined for recurrent themes in text, context and tone. Data collected were examined for similarities in themes across both product type and time. The ads depict menstruation as a "hygienic crisis" that is best managed by an effective "security system" affording protection and "peace of mind." The failure of adequate protection places the woman at risk for soiling, staining, embarrassment and odor. Menstruating women are depicted as dynamic, energetic and always functioning at their optimal level. Such imagery may encourage guilt and diminished self-esteem in the adolescent who experiences discomfort. A lack of maternal, teacher or male figures in the ads is evident; the importance of peer support is reinforced.

Adolescent↗
PubMed1979

Menstruation.

Societal attitudes to menstruation are largely negative, and so serve to reinforce the inferior social status of women. These attitudes have extended into medical practice and research on menstruation. As a result, much research on 'premenstrual syndrome' has been biased both in methodology and interpretation. Correlations between hormone levels, mood changes and other behavioural measures, which cycle together, are often incorrectly assumed to indicate causal relationships. These problems are discussed along with the report of a pilot study which used a new, and more comprehensive method of studying menstruation. This study has demonstrated numerous correlations between hormone levels, mood and psycho-physical performance. A relationship was found between task performance and early education about menstruation. Studied of the kind reported here provide a basis on which to formulate new questions about causal influences, which can only be established by entirely different methods of study.

Attitude to Health↗
PubMed1978

Young adolescents' beliefs concerning menstruation.

In order to explore the early socialization of attitudes and expectations about menstruation, 54 young adolescent girls (both pre- and postmenarcheal) and boys responded to a questionnaire assessing evaluative attitudes toward menstruation, expected symptomatology, perceived effects on moods and activities, and sources of information for these beliefs. The results showed that even premenarcheal girls and young boys have a reasonably well-defined and mostly negative set of attitudes and expectations. Most believed that menstruation is accompanied by physical discomforts, increased emotionality, and a disruption of activities and social interactions. Although the responses of the 3 groups were remarkably similar, premenarcheal girls had a somewhat less negative evaluation of menstruation than both postmenarcheal girls and boys. Other analysis showed that symptom expectations for "girls in general" were more severe than for selves, though these 2 sets of responses were highly correlated. On the basis of these findings and the data concerning sources of information, the possible role of socialization processes in the menstrual experience is discussed.

Adolescent↗
PubMed1993

Effects of breast feeding after resumption of menstruation on waiting time to next conception.

We investigate the association between breast feeding after resumption of menstruation and the duration from resumption of menses to the next conception. Data from a survey, "Breast-Feeding and Its Effect on Fertility," conducted in 1987 under the auspices of the Centre of Population Studies, Banaras Hindu University, India, were used. We used hazard models of conception rates after the return of menstruation with breast-feeding duration as a time-dependent covariate. The interaction of breast-feeding duration after resumption of menses and postpartum amenorrhea have a significant effect on the rate of conception after return of menses. After resumption of menstruation, when there is no breast feeding, the risk of conception increases with the increase in postpartum amenorrhea. However, breast feeding attenuates the effects of postpartum amenorrhea. These results suggest that breast feeding beyond the resumption of menstruation plays a significant role in the proximate determinants to reduce fertility.

Adult↗
PubMed1983

Recollections of menarche and women's subsequent experiences with menstruation.

Seventy college women aged 18 to 22 and 67 older women aged 30 to 45 completed a questionnaire comprised of multiple choice and open-ended questions covering recollections of menarche, preparation for menstruation, menstrual symptoms, and current attitude. The hypothesis that menarche was a significant developmental event that would be readily recalled by a majority of women regardless of age was confirmed. Almost all of the women remembered their first menstruation and the early experiences described by both groups were similar. Most women felt they were adequately prepared and a significant relationship was found between adequacy of preparation and positive reaction to menarche among the college women. Both groups reported a similar incidence of menstrual pain, bleeding, and amenorrhea. However, the incidence of menstrual symptoms in adult women was not significantly related to preparation for menstruation or to whether or not menarche was a positive event.

Adolescent↗
PubMed1994

Blood flow velocity in the uterine and ovarian arteries during menstruation.

Eleven healthy women with regular menstrual cycles were examined with a combination of two-dimensional real-time ultrasound and color and spectral Doppler techniques on the 7th day after follicular rupture, and on the 1st, 2nd, 3rd and 4th days of menstrual bleeding. Both uterine arteries, arteries in the stroma and hila of both ovaries, in the wall of the largest follicle of the non-dominant ovary and in the wall of the corpus luteum were examined with the Doppler technique. The pulsatility index (PI) and the time-averaged maximum velocity were calculated. In the uterine arteries, the PI was highest on the first day of menstrual bleeding (median PI 3.2 for the dominant and 3.0 for the non-dominant uterine artery), after which it decreased to its lowest values on the second day (median PI 2.1 and 1.8, respectively) and third day (median PI 2.2 and 2.1, respectively). The time-averaged maximum velocity reached its highest value on the second and third days of menstruation. The corpus luteum was still visible on the first day of menstrual bleeding in all women, and on the second day in five. It was indistinguishable on the third and fourth days of menstruation in all women. In the dominant ovary, the time-averaged maximum velocity of flow in the arteries in the ovarian hilum decreased during menstrual bleeding and was lower during menstruation than in the preceding luteal phase. In the non-dominant ovary, neither the PI nor the time-averaged maximum velocity manifested any consistent changes during the period studied. We conclude that substantial changes in PI and time-averaged maximum velocity occur in the uterine arteries and in the arteries of the dominant ovary during menstruation.

Journal Article↗
PubMed2001

Effect of menstruation and intrapelvic injection of endometrium on inflammatory parameters of peritoneal fluid in the baboon (Papio anubis and Papio cynocephalus).

OBJECTIVE: Our purpose was to test the hypothesis that menstruation and intrapelvic injection of endometrium for the induction of endometriosis affect inflammatory parameters in peritoneal fluid from baboons. STUDY DESIGN: In the first part of this study, 107 laparoscopies were performed in 62 female baboons with a normal pelvis during menstruation, the follicular phase, and the luteal phase. In the second part of this study, 21 baboons were studied during paired laparoscopies in the follicular phase and the luteal phase of the cycle. In the third part of this study, 11 baboons were studied by paired laparoscopies during menses and during the nonmenstrual phase of the cycle. In the fourth part of this study, paired laparoscopies were performed in 7 baboons before and after intrapelvic injection of endometrium. Peritoneal fluid was aspirated and measured in all laparoscopies and assessed for leukocyte concentration. In the third and fourth parts of the study, peritoneal fluid was analyzed for the concentrations of inflammatory cytokines and for the proportions of cells with immunohistochemical staining positive for these cytokines. RESULTS: During menstruation, in comparison with nonmenstrual phases of the cycle, the leukocyte concentration of the peritoneal fluid was increased significantly, as were the proportions of peritoneal fluid cells with positive staining for tumor necrosis factor alpha, transforming growth factor beta(1), and intercellular adhesion molecule 1 and the peritoneal fluid concentrations of transforming growth factor beta(1) and interleukin 6. After intrapelvic injection of endometrium, the peritoneal fluid leukocyte concentration and the proportions of peritoneal fluid cells with positive staining for tumor necrosis factor alpha, transforming growth factor beta(1), CD3, and human leukocyte antigen (DR locus) significantly increased. CONCLUSION: Subclinical peritoneal inflammation occurs in baboons during menstruation and after intrapelvic injection of endometrium.

Animals↗