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The fibrinolytic enzyme system in normal menstruation and excessive uterine bleeding and the effect of tranexamic acid.

The fibrinolytic enzyme system of menstrual and peripheral blood was studied in three groups of women: Group 1, 20 subjects (mean age 37.2 years) with normal menstrual loss; Group 2, 20 patients (mean age 39 years) with dysfunctional uterine bleeding studied before treatment, and Group 3, during treatment with a fibrinolytic inhibitor, tranexamic acid (AMCA) (1 g 8-hourly). The fibrinolytic activity (plasminogen activator and plasmin) of menstrual blood was significantly higher than that of peripheral blood in the three groups (p less than 0.001). Both plasminogen activator and plasmin were higher in the menstrual blood of patients with menorrhagia (Group 2) compared with the control subjects (Group 1) (p less than 0.001 and p less than 0.1 respectively). Treatment with AMCA significantly reduced both plasminogen activator (p less than 0.01) and plasmin (p less than 0.05) in the menstrual blood of patients with menorrhagia (Group 3). No significant differences in fibrinolytic activity were found in peripheral blood between Groups 1 and 2; however, both plasminogen activator and plasmin were significantly lower (p less than 0.01) in Group 3 than in Group 2. Plasmin activity was also significantly lower (p less than 0.05) in Group 3 compared to Group 1. These findings confirm the presence of increased fibrinolytic activity in the uterus in excessive (dysfunctional) bleeding.

Administration, Oral↗

Psychosocial and biological influences on menstruation: synchrony, cycle length, and regularity.

The purpose of the study was to determine some psychosocial and biological variables as predictors of menstrual synchrony, menstrual cycle length, and menstrual regularity. One-hundred-and-seventy subjects at two all-women colleges kept monthly menstrual records and answered questions about their backgrounds, menstrual histories, and social habits. They also took the Personality Research Form E. Subsets of the total subject group were used in different analyses. Both psychosocial and biological factors were found to predict individual differences in menstrual synchrony among 80 of the women studied. In a group of 144 women, cycle length and cycle regularity were found to depend, in part, on age at menarche. Psychosocial and personality traits also predicted cycle length and regularity. As a group, 86 women did not significantly synchronize their cycles with those of their roommates, although there was a trend towards synchrony. Certain characteristics particular to this sample may have accounted for this finding, including cycles that were relatively long and irregular compared with those reported in other studies. The results support the concept that menstrual cycle variables depend on personality and psychosocial factors as well as on biological ones.

Adult↗

Hemostasis and menstruation: appropriate investigation for underlying disorders of hemostasis in women with excessive menstrual bleeding.

The evaluation of excessive menstrual bleeding carries a relatively high yield of discovering an underlying disorder of hemostasis in females. This review highlights important components in a structured history and outlines primary and secondary hematologic testing that should be considered in the evaluation of excessive menstrual bleeding.

Blood Coagulation Disorders↗

Utero-ovarian ultrasonographic and Doppler flow analyses in female childhood cancer survivors with regular menstruation and normal circulating follicle-stimulating hormone levels.

OBJECTIVE: To analyze the hormonal, ultrasonographic, and color Doppler parameters in a population-based follow-up study of female childhood cancer survivors with regular menstrual cycle and normal early follicular FSH values. DESIGN: Controlled, prospective clinical study. SETTING: University hospital. PATIENT(S): Twenty-eight female patients affected by a malignant tumor during childhood and 14 age-matched healthy controls. INTERVENTION(S): Hormonal, ultrasonographic, and color Doppler analyses. MAIN OUTCOME MEASURE(S): In the midluteal phase of the cycle, the patients underwent hormonal assay of gonadotropins, E2, and P; ultrasonographic evaluation of the uterine and ovarian volume, the endometrial thickness, and of the corpus luteum characteristics; color Doppler analysis of uterine, intraovarian, and periluteal arteries. RESULT(S): A greater uterine volume and a better utero-ovarian vascularization was observed in controls in comparison with cancer survivors. In patients who suffered from childhood malignancies the P values were lower than in controls. On the basis of circulating P (> or < 20 nmol/L) values, we divided the former group in ovulatory and nonovulatory patients. We observed that even if there were no differences between ovulatory cancer survivors and controls, the nonovulatory group showed a reduced uterine volume associated with elevated resistance at the level of uterine and intraovarian arteries. Among these two groups the time elapsed between the diagnosis of cancer and menarche was shorter in nonovulatory than in ovulatory women, and was directly correlated with both uterine volume (r = 0.660) and ovarian volume (r = 0.597). CONCLUSION(S): Ultrasonographic and Doppler analyses may noninvasively study the subtle utero-ovarian modification after anticancer therapies.

Arteries↗