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PubMed1997

Menstrual bleeding patterns in untreated women. Task Force on Long-Acting Systemic Agents for Fertility Regulation.

Menstrual histories recorded by more than 1000 healthy, untreated women have been analyzed using the reference period method. Results were obtained for each year of age from 15 to 49. Between menarche and age 19, the most important feature of menstrual patterns is their variability. Within-woman mean segment (cycle) length then decreases slowly but steadily, from 29.0 days at age 20 to 26. 7 days at age 40. The range of segment lengths over a year also falls, to a minimum of 7 days at age 38. During the 40s, mean segment length rises to 29 days at age 49, and there is a sharp increase in the range, to 28 days. The length and variability of bleeding episodes, however, changes little between the ages of 19 and 49. Modifications to the World Health Organization definitions of 'clinically important' bleeding patterns are proposed.

Adolescent↗
PubMed1993

Menstrual blood loss with use of a vaginal ring releasing 20 micrograms levonorgestrel per day. World Health Organization. Task force on long-acting systemic agents for fertility regulation.

Menstrual blood loss (MBL), haemoglobin and serum ferritin levels were studied in a total of 127 women from three developing country centres, using a vaginal ring releasing 20 micrograms levonorgestrel/day. The objective was to evaluate changes in MBL and body iron stores over one year of use. The discontinuation rate for bleeding problems varied between centres from 3 to 13% at one year, but these differences were not significant. There were no differences in MBL or iron status on admission between women who completed or discontinued from the study. Even though there was considerable variation in MBL and haemoglobin levels among the three centres before insertion of the ring, a decrease in MBL was observed in all centres after commencement of ring use. Conversely, an increase in haemoglobin levels was noted in all centres although the change reached significance only in Beijing. There were no alterations in serum ferritin levels. These results suggest that use of a vaginal ring releasing 20 micrograms levonorgestrel/day for one year will not significantly affect menstrual blood loss volume nor cause changes in body iron stores.

Administration, Intravaginal↗
PubMedDate not supplied

Beyond hormonal therapies in menopause.

Women in midlife often access health care providers with reports of hot flashes, sleep problems, and depressed mood, perhaps directly or indirectly associated with menopausal hormone shifts. Evidence that stress conditions have profound effects on reproductive function is suggestive that stress adaptation is important to understanding menopausal symptoms. This paper briefly outlines salient interactions between neurohormonal mechanisms of stress responses and reproduction known to be affected by exercise, dietary intake and cognitive strategies, as a basis for advocating research that tests these therapies as alternatives or complements to drug therapies for menopausal symptoms. Reductions in hot flashes and positive mood and sleep changes are evident with such therapies but specific study in midlife women is lacking. Specifically, exercise (type, duration, intensity, and timing), dietary intake (type and amount of macronutrients or micronutrients, fiber, and timing), and cognitive techniques (type, amount, duration, and timing), deserve testing for effects on catecholamines, serotonin, opioids, and other neuromediators; ovarian hormones and related steroids, as well as gonadotropins; and circulating neuromediator precursors in midlife women. Further outcomes for testing include body weight, temperature regulation, menstrual cycle regulation, fertility, mood state, eating and sleeping patterns, social patterns, disease risk factors, and symptoms.

Climacteric↗
PubMed1997

Women's hidden transcripts about abortion in Brazil.

Two folk medical conditions, "delayed" (atrasada) and "suspended" (suspendida) menstruation, are described as perceived by poor Brazilian women in Northeast Brazil. Culturally prescribed methods to "regulate" these conditions and provoke menstrual bleeding are also described, including ingesting herbal remedies, patent drugs, and modern pharmaceuticals. The ingestion of such self-administered remedies is facilitated by the cognitive ambiguity, euphemisms, folklore, etc., which surround conception and gestation. The authors argue that the ethnomedical conditions of "delayed" and "suspended" menstruation and subsequent menstrual regulation are part of the "hidden reproductive transcript" of poor and powerless Brazilian women. Through popular culture, they voice their collective dissent to the official, public opinion about the illegality and immorality of induced abortion and the chronic lack of family planning services in Northeast Brazil. While many health professionals consider women's explanations of menstrual regulation as a "cover-up" for self-induced abortions, such popular justifications may represent either an unconscious or artful manipulation of hegemonic, anti-abortion ideology expressed in prudent, unobtrusive and veiled ways. The development of safer abortion alternatives should consider women's hidden reproductive transcripts.

Abortion, Illegal↗
PubMed2000

Correlation between glycemic control and menstruation in diabetic adolescents.

OBJECTIVE: To determine if a correlation exists between the degree of glycemic control in insulin-dependent diabetic adolescents and menstrual regulation. STUDY DESIGN: A retrospective review of charts of diabetic girls aged 10-18 was performed. Office visits were scheduled every three to six months, at which time pubertal development, menstrual function, growth and diabetic control, including hemoglobin (Hgb) A1C, and complications were assessed. Forty-six patients were eligible for data analysis. Descriptive and inferential statistics, including chi 2 and Student t tests, were applied. RESULTS: Thirty-seven (81%) patients had regular menstrual cycles, and nine (19%) had menstrual disturbances, including secondary amenorrhea (one), oligomenorrhea (seven) and primary amenorrhea followed by oligomenorrhea (one). There were two pregnancies. Six patients used hormonal contraception but none for menstrual regulation. There was a statistically significant difference (P < .05) in mean Hgb A1C concentrations between those with menstrual disturbances (11.4) and those with regular menses (9.7). As Hgb A1C values increased, the percent of patients with menstrual disturbances increased, becoming statistically significant when the Hgb A1C was > 10 (odds ratio 7.3, 95% confidence interval 1.5-35.6). There was no difference (P > .05) between the two groups with respect to age at menarche (156 vs. 152 months), age at onset of diabetes (144 vs. 108 months) and interval between diabetes onset and menarche (54 vs. 41 months). There were no patients in either group with diabetic retinopathy or nephropathy. Four patients were hypertensive, but there was no statistically significant difference (P > .05) between groups. CONCLUSION: Tighter glycemic control, as measured by Hgb A1C concentrations, corresponded to improved menstrual regulation in adolescent insulin-dependent diabetics.

Adolescent↗
PubMed1992

A randomized clinical trial of mifepristone (RU486) for induction of delayed menses: efficacy and acceptability.

Mifepristone (RU486) should be useful for inducing menstrual bleeding in women with menses delayed up to 10 days. We evaluated this potential use for "menstrual regulation" in a randomized clinical trial with 16 women, half of whom received a single 600 mg dose and half of whom received a placebo. Four of eight women in each treatment group proved to be pregnant. Seven of eight who received mifepristone were not pregnant at two-week follow-up, in contrast to four of eight who received the placebo (p = 0.15). Mifepristone may hold promise for "menstrual regulation" for women who do not have access to medical confirmation of pregnancy or who choose not to have this determination made.

Abortion, Induced↗
PubMed1990

Progesterone receptor antagonists and prostaglandins in human fertility regulation: a clinical review.

Progesterone receptor antagonists have been developed by substitutions at the 11-beta and 17 side-chain positions of the progestagen norethisterone. The most studied progesterone receptor antagonists are mifepristone (Mifegyne; Roussel-UCLAF; RU486) and ZK98734 and ZK98299 (Schering AG). These compounds bind avidly to the progesterone receptor and glucocorticoid receptor but have essentially no binding to the mineralocortocoid, oestrogen or androgen receptors. Mifepristone also binds avidly to albumin, resulting in a half-life of approximately 24 h after oral administration. Progesterone receptor antagonists can induce menstruation by a direct action upon the endometrium. They have also been shown to exert weak progesterone agonist actions in certain circumstances and to modulate pituitary hormone secretion by antagonizing the feedback actions of progesterone. Moreover, they release prostaglandin F2 alpha and E2 from human endometrium or early pregnancy decidua and reduce the metabolism of these eicosanoids. Clinically, progesterone receptor antagonists have been used in trials of menstrual regulation, abortion and induction of labour, and during treatment of breast or ovarian cancer, some forms of hypertension and meningioma. Progesterone receptor antagonists have been administered to approximately 70,000 women in 18 countries as medical abortifacients. They have been proven, especially when combined with prostaglandin analogues, to be as effective as surgical methods of termination of pregnancy. Progesterone receptor antagonists have focussed international attention on menstrual regulation, abortion and the rights of women to regulate their fertility.

Abortifacient Agents, Steroidal↗
PubMed1999

Once-a-month treatment with a combination of mifepristone and the prostaglandin analogue misoprostol.

In this two centre study, the efficacy of 200 mg mifepristone orally followed 48 h later by 0.4 mg misoprostol orally for menstrual regulation was investigated. The dose of mifepristone was taken the day before the expected day of menstruation. Each volunteer was planned to participate for up to 6 months. A plasma beta human chorionic gonadotrophin (HCG) was measured on the day of mifepristone intake. The study was disrupted prematurely due to low efficacy. In 125 treatment cycles the overall pregnancy rate was 17.6% (22 pregnancies) and the rate of continuing pregnancies (failure) was 4.0%. Eight women discontinued the study due to bleeding irregularities which were seen in 15 cycles (12%). These effects on bleeding pattern made the timing of treatment day difficult. Late luteal phase treatment with a combination of mifepristone and misoprostol is not adequately effective for menstrual regulation.

Abortifacient Agents, Nonsteroidal↗
PubMed1985

Sequential hormone measurements after first trimester abortion in normal Nigerian women.

This study looks at the dynamics of the pituitary hormones and progesterone in normal adult Nigerian females during their first postabortal cycle. Serial determinations of serum concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PrL) and progesterone were carried out on eleven normal Nigerian women during the first postabortal period after menstrual regulation. Nine out of the eleven subjects (82%) attained LH peaks within the first 22 days after menstrual regulation, seven had discernible FSH peaks and seven had serum progesterone concentrations greater than 6 nmol/l during the second half of the study period. Subjects probably ovulated during the first postabortal cycle; serial LH seems to be the most reliable index of ovulation in our subjects. We hope these data will aid in development of effective family planning strategies for women in the first postabortal cycle.

Abortion, Induced↗
PubMed2002

Expression and localization of endothelial monocyte-activating polypeptide II in the human endometrium across the menstrual cycle: regulation of expression by prostaglandin E(2).

A role for prostaglandins (PGs) in the regulation of endometrial functions, such as menstruation, has been established, although the mechanisms by which this is achieved are not fully elucidated. In the present study, cDNA array analysis has identified endothelial monocyte-activating polypeptide II (EMAP II) as a PGE(2)-regulated gene in endometrial epithelial cells. Incubation of endometrial epithelial cells with 100 nM PGE(2) for 4 and 24 h resulted in a 2.3- and 16-fold decrease in EMAP II expression, respectively. In endometrial tissue collected across the menstrual cycle, a significant increase in EMAP II mRNA was observed during the late secretory phase, compared with the proliferative and early-midsecretory phases. The temporal pattern of EMAP II expression was confirmed further by Western blotting; EMAP II protein expression was detected as a 43-kDa band. In situ hybridization and immunohistochemistry localized EMAP II mRNA and protein expression in glandular epithelial, endothelial, and stromal cells in the functionalis and basalis layers of the endometrium. Finally, the role of PGE(2) in the regulation of EMAP II expression in the endometrium was assessed. Incubation of fresh endometrial tissue (n = 5) with 3 micro g/ml indomethacin resulted in an increase in EMAP II protein expression, compared with control untreated tissue. However, cotreatment of the cells with 100 nM PGE(2) resulted in a significant decrease in EMAP II protein expression, compared with tissue incubated with indomethacin alone (P < 0.05). These data confirm temporal variation in EMAP II expression in the human endometrium across the menstrual cycle and localize expression to glandular epithelial, endothelial, and stromal cells. Moreover, EMAP II expression is negatively regulated by PGE(2).

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2003

Differential menstrual cycle regulation of hypothalamic-pituitary-adrenal axis in women with premenstrual syndrome and controls.

Previous studies in animals indicate that reproductive steroids are potent modulators of the hypothalamic-pituitary-adrenal (HPA) axis, a physiologic system that is typically dysregulated in affective disorders, such as major depression. Determination of the role of reproductive steroids in HPA axis regulation in humans is of importance when attempting to understand the pathophysiology of premenstrual syndrome (PMS), a disorder characterized by affective symptoms during the luteal phase of the menstrual cycle. We performed two studies using treadmill exercise stress testing to determine the effect of menstrual cycle phase and diagnosis on the HPA axis in women with PMS and controls and the role of gonadal steroids in HPA axis modulation in control women. The results of these studies indicate that women with PMS fail to show the normal increased HPA axis response to exercise during the luteal phase and that progesterone, not estradiol, produces increased HPA axis response to treadmill stress testing in control women. These data demonstrate that women with PMS, when symptomatic, appear to have an abnormal response to progesterone and, furthermore, do not display the HPA axis abnormalities characteristic of major depression.

Adrenocorticotropic Hormone↗
PubMed2000

Expression of estrogen receptor alpha and beta in the rhesus monkey corpus luteum during the menstrual cycle: regulation by luteinizing hormone and progesterone.

There are conflicting reports on the presence or absence of estrogen receptor (ER) in the primate corpus luteum, and the discovery of a second type of estrogen receptor, ERbeta, adds an additional level of complexity. To reevaluate ER expression in the primate luteal tissue, we used semiquantitative RT-PCR based assays and Western blotting to assess ERalpha and beta messenger RNA (mRNA) and protein levels in corpora lutea (n = 3/stage) obtained from adult female rhesus monkeys at early (days 3-5), mid (days 6-8), mid-late (days 10-12), and late (days 14-16) luteal phase of the natural menstrual cycle. ERalpha mRNA levels did not vary across the stages of the luteal phase, and ERalpha protein was not consistently detected in luteal tissues. However, ERbeta mRNA and protein levels were detectable in early and mid luteal phases and increased (P < 0.05) to peak levels at mid-late luteal phase before declining by late luteal phase. To determine if ERbeta mRNA expression in the corpus luteum is regulated by LH, monkeys received the GnRH antagonist antide either alone or with 3 daily injections of LH to simulate pulsatile LH release. Treatment with antide alone or concomitant LH administration did not alter luteal ERbeta mRNA levels. When monkeys also received the 3beta-hydroxysteroid dehydrogenase inhibitor trilostane to reduce luteal progesterone production, luteal ERbeta mRNA levels were 3-fold higher (P < 0.05) than in monkeys receiving antide + LH only. Replacement of progestin activity with R5020 reduced luteal ERbeta mRNA levels to those seen in animals receiving antide + LH. Thus, there is dynamic ERbeta expression in the primate corpus luteum during the menstrual cycle, consistent with a role for estrogen in the regulation of primate luteal function and life span via a receptor (ERbeta)-mediated pathway. Increased ERbeta expression in the progestin-depleted corpus luteum during LH exposure suggests that the relative progestin deprivation experienced by the corpus luteum between LH pulses may enhance luteal sensitivity to estrogens during the late luteal phase of the menstrual cycle.

Animals↗
PubMed1975

The current status of prostaglandins as abortifacients.

The present use and potential uses of prostaglandins as abortifacients are summarized. Pertinent history, chemistry, prostaglandins' possible role in physiologic and pathologic processes and pharmacologic actions are discussed. The results of natural prostaglandins and their analogues by systemic and intrauterine administration for the purposes of postcoital contraception, menstrual regulation, first- and second-trimester abortion, preoperative dilation of the cervix, and delivery of patients with death in utero are presented. The only approved method of induction of abortion with prostaglandins, prostaglandin F2alpha by the intra-amniotic route for the induction of midtrimester abortion, is evaluated and compared to other methods of midtrimester abortion. It was concluded that: (1) the present use of prostaglandins is an important addition to the obstetrician's armamentarium, (2) more effective and/or convenient methods that are useful in patients over a wider gestational age appear to have been defined, and (3) the routine use of prostaglandins for postcoital contraception, menstrual regulation, and first-trimester abortion will require the development of analogues that are more specific as to their abortifacient actions than the natural prostaglandins and/or the development of improved delivery systems.

Abortifacient Agents↗
PubMed1987

[Significance of progesterone production in regulating the menstrual cycle].

Premature luteolysis, which can be brought about by injection of a crystalline suspension of estradiol into the ovary carrying the corpus luteum, is cancelled out by a concomitant injection of an appropriate dose of a crystalline progesterone suspension, together with a simultaneous increase in the plasma progesterone level. The authors discuss whether preovulatory production of progesterone has a similar protective influence on the growth and estrogen and androgen production of the vesicular ovarian follicles and the dominant follicle.

Corpus Luteum↗
PubMed1986

The regulation of menstrual cycle and its relationship to the moon.

UNLABELLED: A synchronous relationship between the menstrual cycle and lunar rhythm was confirmed by: Investigative data: Among the 826 female volunteers with a normal menstrual cycle, aged between 16 and 25 years, a large proportion of menstruations occurred around the new moon (28.3%), while at other times during the lunar month the proportion of menstruations occurring ranged between 8.5-12.6%; the difference was significant (p less than 0.01). LABORATORY FINDINGS: The 6-hydroxymelatonin levels in the urina sanguinis of 3 female volunteers reached their zenith prior to and during menstruation, gradually declining to their nadir during ovulation. The difference in 6-hydroxymelatonin between menstruation and ovulation was significant (p less than 0.01). Two of these three volunteers had their zenith in the period of the new moon and nadir 3-4 days prior to the full moon respectively. Clinical experience: The lunar-menses-regulatory therapy in treatment of Nephropenic secondary amenorrhea revealed 4 clinical cure, 5 marked effect, 8 menogogue and 3 ineffect out of 20 cases.

Adolescent↗