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PubMed2001

Lactational amenorrhea/anovulation and some of their determinants: a comparison of well-nourished and undernourished women.

OBJECTIVE: To study the effect of maternal nutritional status and some other possible determinants on lactational amenorrhea/anovulation. DESIGN: Prospective matched-pairs study. SETTING: Postpartum wards and community and academic settings. PATIENT(S): Thirty matched pairs of otherwise healthy, well-nourished (body mass index > or = 26.00 kg/m2) and undernourished (body mass index < or = 19.00 kg/m2) postpartum women were selected. INTERVENTION(S): Infant feeding pattern was recorded weekly, and infant weights, maternal body mass index, and maternal PRL levels were estimated every 4 weeks until resumption of menstruation. Ovulatory activity was determined using urinary estrone and pregnanediol glucuronide concentrations. MAIN OUTCOME MEASURE(S): Time of resumption of menstruation, regular and ovulatory. RESULT(S): Well-nourished women resumed regular menstruation significantly earlier than undernourished women but resumed ovulatory menstruation at almost the same time. Undernourished women had fewer anovulatory cycles preceding first postpartum ovulation and a higher prevalence of formula feeding. Effect of body mass index on lactational amenorrhea became nonsignificant when nonintroduction of formula feeds, maternal age, and socioeconomic status were controlled for. CONCLUSION(S): Improved maternal nutritional status has no significant effect on fertility: ovulation is not advanced despite early resumption of regular menstruation.

Adult↗
PubMed2003

Psychosocial correlates of emotional responses to menarche among Chinese adolescent girls.

PURPOSE: To determine the psychosocial correlates of emotional responses to menarche among Chinese adolescent girls. METHODS: A large sample of 1573 post-menarcheal Chinese junior high school students in Hong Kong completed questionnaires on knowledge and preparation of menarche, attitudes toward menstruation, gender-role attitudes, body image, self-esteem, and emotional responses to the onset of the first menstruation. Pearson correlation and hierarchical regression analyses were conducted to determine associations among variables. RESULTS: Participants' mean age at menarche was 11.67 years. Their emotional reactions to menarche were largely negative, with almost 85% reporting feeling annoyed and embarrassed. In spite of these negative feelings, about two-thirds of the participants also reported feeling grown up and another 40% felt as if becoming more feminine. Results of the hierarchical regression analyses showed that negative emotional responses to menarche were correlated with perceptions of menstruation as a negative event, inadequate preparation for menarche, endorsement of indigenous negative menstrual attitudes, and poor self-esteem (24.5% variance explained). Positive emotional responses to menarche were correlated with perceptions of menstruation as a natural event, rejection of indigenous negative menstrual attitudes, positive body image, and adequate preparation for menarche (13.4% variance explained). CONCLUSIONS: This study illustrates the need to attend to various psychosocial and cultural factors in the understanding of Chinese adolescent girls' responses to their first menstruation. In particular, general and indigenous menstrual attitudes, which may have been internalized by Chinese adolescent girls at an early age, are found to be the most salient correlates of their emotional responses to menarche.

Adolescent↗
PubMed1999

Variation of luteinizing hormone and androgens in oligomenorrhoea and its implications for the study of polycystic ovary syndrome.

We measured luteinizing hormone (LH) and androgen concentrations in patients at different phases of the oligomenorrhoeic cycle and compared the results with those of patients with normogonadotrophic amenorrhoea. Several blood samples separated by >/=7 days were obtained from each of 72 patients with oligomenorrhoea and 18 with normogonadotrophic amenorrhoea. The oligomenorrhoeic cycle was divided into five phases: the postmenstrual phase week 1 (day 1-7) and week 2 (day 8-14), the specific oligomenorrhoeic phase (SOP, day 15 after a menstruation to day 21 before the next menstruation), the possibly peri-ovulatory phase (days 21-11 before menstruation) and the premenstrual phase (days 10-1 before menstruation). Samples obtained in the possibly peri-ovulatory phase were excluded. Within individuals LH concentrations were significantly higher during the SOP than during all other phases of the oligomenorrhoeic cycle (paired t-test, P = 0.0001-0.03). In contrast to the other phases of the oligomenorrhoeic cycle, no significant differences in gonadotrophins, androgen or oestradiol concentrations were found between the SOP and normogonadotrophic amenorrhoea. In oligomenorrhoea timing of blood sampling influences the measurement of LH and androgen concentrations, and the accurate interpretation of these measurements requires that the dates of menstruation both before and after the sample is taken should be known. In patients with oligomenorrhoea blood samples should be obtained during the SOP, when the endocrinology is comparable with that of normogonadotrophic amenorrhoea.

Adult↗
PubMed2004

Impact of migraine on patients and their families: the Migraine And Zolmitriptan Evaluation (MAZE) survey--Phase III.

OBJECTIVE: To investigate the impact of migraine on migraineurs and their families and evaluate migraineurs' preference for different treatment formulations. This study also assessed the prevalence and impact of migraine with menstruation. METHODS: Participants (n = 1028) from around the world (USA [39%], Canada [20%], Europe [37%] and other countries [4%]) completed an online questionnaire. Of these, 866 were migraineurs and 162 were non-migraineurs living with/related to migraineurs. Migraineurs were identified based on responses to a modified Kiel questionnaire and/or diagnosis of migraine by a doctor. Disability was quantified using the Migraine Disability Assessment Scale (MIDAS). RESULTS: Migraineurs missed more days from family/leisure activities than from work/school (mean 4.2 vs 2.4 days) in the previous 3 months. On an additional 6.2 days within the 3-month period, productivity at work/school was reduced by at least half. Inability and reduced ability (by at least half) to perform household work were reported on 6.0 and 6.5 days, respectively. Of the women surveyed, 51% identified menstruation as a trigger for attacks and 6% reported attacks solely with menstruation (i. e. attacks occurred during menstruation on at least 9 out of 10 occasions), the latter associated with a higher pain score than other attacks. Living with or being related to a migraineur decreased nonmigraineurs' ability to participate in home/family life (moderate/great impact 49%) and social/leisure activities (moderate/great impact 47%). In a tradeoff analysis, 60% of treatment choice was driven by formulation type and 40% was driven by speed of onset. As migraine disability increased, speed of onset became more important. CONCLUSIONS: This study confirms the significant burden of migraine on patients and families/cohabitants, highlighting not only reduced productivity and absences from work/school, but also time missed from family/social occasions. Many women identify menstruation to be associated with more painful attacks. Overall, in terms of treatment choice, formulation type was a more important driver than speed of onset; however, as migrainerelated disability escalates, speed of onset becomes more important. To optimise migraine management, treatment choice should be based on individual patients' needs and preferences.

Absenteeism↗
PubMed1995

Effects of estrogen exposure and reproductive factors on bone mineral density and osteoporotic fractures.

The risk of osteoporotic fracture is related to peak bone mass achieved at skeletal maturity and subsequent bone loss. Although premature menopause is a risk factor for osteoporosis, the effect of exposure to endogenous estrogen during a woman's reproductive years is poorly characterized. We analyzed the relationship between reproductive factors and estrogen exposure on bone mineral density (BMD) and incidence of atraumatic fracture in data from 1091 women (age: 70 +/- 7.2 yr; mean +/- SD) participating in the Dubbo Osteoporosis Epidemiology Study. Age- and weight-adjusted BMD among women who had used estrogen replacement therapy (ERT) for more than 5 yr was higher at the lumbar spine and femoral neck by 13.7% and 10.2% (P < 0.001), respectively, compared with women who had used ERT for less than 5 yr or nonusers. Duration of exposure to estrogen (years of menstruation plus postmenopausal ERT use) was associated with higher BMD, such that BMD increased by 2-3% for every 10-yr increase in years of estrogen exposure; thus women who menstruated for more than 40 yr had a 6-8% higher BMD than did women who menstruated for less than 30 yr. Higher BMD was also significantly associated with high parity, such that nulliparous women had 5-6% lower BMD than did their peers of the same age and weight. The incidence of atraumatic fractures among non-ERT users was higher than that of ERT-users [odds ratio (OR): 1.06; 95% confidence interval (CI): 0.94-1.16] and was significantly lower among parous women than among nulliparous women (OR 0.94; 95% CI: 0.84-0.98) in univariate analysis. Longer duration of menstruation was associated with lower fracture incidence (OR for 1 SD = 6.6 yr: 0.93; 95% CI: 0.86-1.02). Moreover, when all of these factors were considered simultaneously, parity remained a significant determinant of fracture as well as femoral neck BMD. We conclude that high parity and longer duration of exposure to estrogen, either through natural menstruation or postmenopausal ERT, have protective effects on BMD and are associated with a reduced incidence of atraumatic fracture in a population-based study.

Aged↗
PubMed1999

Apoptosis, proliferation, and sex hormone receptors in superficial parts of human endometrium at the end of the secretory phase.

Apoptosis with one regulator, Bcl-2, and proliferation with the marker Ki-67 were studied in 75 endometrial biopsies representing superficial parts of endometrium from 35 regularly menstruating women premenstrually and menstrually. Hormonal withdrawal was studied in serum samples and potentiated in epithelium by the decreasing 17beta-estradiol and progesterone receptor scores 4 days premenstrually. The apoptotic index increased 2 days before the onset of menstruation and peaked on the second menstrual day. The high apoptotic index together with low proliferation in endometrial epithelium at the end of the menstrual cycle are similar to the involution process seen in other hormone-dependent organs. In stroma, the apoptotic index increased later, at the onset of menstruation, and the increase was lower than that in epithelium. The Ki-67 index increased during the last 3 days of the secretory phase, parallel with an increasing progesterone receptor score and decreasing Bcl-2 staining, and peaked at the onset of menstruation. The findings in stroma concur with high proliferation at the end of the menstrual cycle and high cell turnover during menstruation, suggesting the participation of stroma in the renewal process of endometrium.

Adult↗
PubMed1995

Relationship of headache to phase of the menstrual cycle among young women: a daily diary study.

We investigated the relationship between headache occurrence and phase of the menstrual cycle in a 4-month daily diary study of 74 women, 22 to 29 years old, residing in Washington County, Maryland. We selected subjects from women reporting a history of migraine symptoms and at least two migraine headache attacks per month in a 1986 to 1987 population-based survey. Data collection was from March 1987 through April 1988. By using detailed headache symptom information collected daily, we classified headaches into four categories: migraine with aura, migraine without aura, tension-type, and all other headaches. Odds ratios were separately estimated for the individual headache types and all types combined during each of three phases of the menstrual cycle. Risk of migraine without aura was significantly elevated during the first 3 days of menstruation (odds ratio, 1.66; 95% confidence interval, 1.21 to 2.26), but headache risk was not significantly increased during the 2 days immediately preceding onset of menstruation or on the estimated day of ovulation (day 14 before the onset of menstruation). Participants reported headaches on 28% of the study days overall, suggesting that onset of menstruation is an independent but not exclusive precipitating factor for headache attacks among young adult women with migraine. Our data show that onset of menstruation only accounts for a small proportion of migraine attacks among young women with frequent episodes of migraine.

Adult↗
PubMed1984

Vasopressin and prostaglandins in premenstrual pain and primary dysmenorrhea.

Both vasopressin and PGF2 alpha are effective uterine stimulants in the non-pregnant human uterus, especially around the onset of menstruation. In order to clarify the relationship of these hormones to menstrual pain, plasma concentrations of vasopressin and two prostaglandin metabolites (15-keto-13,14-dihydro-PGF2 alpha and 11-ketotetranor PGF metabolites) were measured in serial blood samples taken premenstrually and during menstruation. Five women with premenstrual pain gave 7-9 blood samples at intervals of 30 minutes on the day preceding the onset of menstruation. From 5 women with severe primary dysmenorrhea a corresponding series of blood samples were taken during the first day of menstruation. Two groups of 5 women with no symptoms served as controls, either premenstrually or during menstruation. In the women with premenstrual pain the vasopressin concentrations were significantly higher than in the corresponding control group. Even higher and markedly fluctuating vasopressin levels were found in the women with dysmenorrhea who, in general, had more intense pain than the women with premenstrual symptoms. In the group with dysmenorrhea there was also a significant rise in plasma concentration of the PG metabolites. No such increase was seen in the group with premenstrual pain. It is concluded that the pathophysiology of premenstrual pain could imply increased vasopressin secretion. The more severe pain in primary dysmenorrhea seems to be the result of a combined effect of vasopressin and PGF2 alpha.

Adolescent↗
PubMed1999

[A randomized, double-blind, multicentre study on comparing levonorgestrel and mifepristone for emergency contraception].

OBJECTIVE: To compare the efficacy, side effects and the effect on next menstruation of levonorgestrel(LNG) to low dose mifepristone in emergency contraception. METHODS: The study is a randomized double-blind multicenter comparative trial. The clients who have unprotected intercourse within 72 hours were allocated to one of the two study groups. In LNG group, 0.75 mg LNG was taken twice with 12 hours apart. In mifepristone (Mife-) group, single dose of 10 mg mifepristone was taken and a placebo 12 hours after. Follow-up visit was paid on the seventh day of the expected next menstruation to evaluate the contraceptive efficacy and to record side effects and menstruation. Contraceptive efficacy was calculated by Dixon's method. RESULTS: The total valid subjects in LNG and Mife- group were 643 and 633, respectively. There were 20 and 9 pregnancies occurred respectively in each group. The failure rate was 3.1% and 1.4%. Contraceptive efficacy rate of preventing pregnancy was 59.2% and 79.7%, the difference was statistically significant (P < 0.05). The incidence of various side effects was less than 10.0% which were mild. There was no statistically difference between the two groups. The percentage of subjects who had their next menstruation before or after their expected menstruation 3 days in LNG group and Mife- group was 77.7% and 78.5% respectively. The menstrual period less than 7 days was 95.0% and 93.3%. CONCLUSION: Use of levonorgestrel or low dose mifepristone for emergency contraception is effective and safe.

Adult↗
PubMed2003

[Effects of mifepristone of different doses on emergency contraception, a randomized double-blind study].

OBJECTIVE: To compare the effects of mifepristone of different doses on emergency contraception. METHODS: 3,052 healthy women with regular menstrual cycle who visited the 10 family planning institutes and hospitals in Beijing, Shanghai, Shangdong, Sichuan, Tianjin, Guangdong, and Liaoning for emergency contraception within the period of 120 hours after a single act of unprotected sex were given a single dose of 10 mg or 25 mg mifepristone randomly and double-blindly. They were asked to record the vaginal hemorrhage that would occur and not to have unprotected sex until the next menstrual onset when they were followed up. The trial for a specific subject ended when she menstruated. If the menstruation was irregular or a specific subject failed to menstruate on time a blood or urine human chorionic gonadotropin (hCG) test was made. If the hCG test was negative, an appointment was made to follow up once one week later. If the hCG test was positive ultrasound examination was made to detect pregnancy. If the subject still failed to menstruate and the hCG test was still negative follow-up for this subject could be finished. RESULTS: Twenty-two of the 3,052 subjects were lost to follow up. Among the remaining 3,030 women 1,516 were in the 10 mg group and 1 514 in the 25 mg group. Seventeen pregnancies occurred in each group, with a pregnancy rate of 1.1% for both groups. The relative risk of pregnancy of treatment of 25 mg mifepristone in comparison with treatment of 10 mg mifepristone was 1.0 (95% CI: 0.51-1.95). Both doses prevented about 85% approximately 86% of the anticipated pregnancy if no measure had been adopted. The pregnancy rate nearly doubled in the women who had unprotected sex after treatment of mifepristone. The efficacy of mifepristone decreased along with the delay of mifepristone administration. Side effects were uncommon and mild. Delay of 7 days or more in the onset of next menstruation occurred in 9%-10% of the women. CONCLUSION: Mifepristone of the dose of 10 mg is safe and effective for emergency contraception. Earlier administration is preferable, although the method can be used effectively up to five days after the unprotected sex.

Adult↗
PubMed1985

Plasma beta-endorphin and the menstrual cycle.

beta-Endorphin (beta-E) takes part in the regulation of luteinizing hormone (LH) and prolactin secretion, but little is known about its role in the menstrual cycle. Using a specific assay, plasma concentration of beta-E was followed in healthy women in the periovulatory period and before and during menstruation. The mean concentration of beta-E in the eight women studied showed an increase at the midcycle, being 3.2 +/- 0.5 (standard error) pmol/l on day LH -1 and rising to 4.6 +/- 0.7 pmol/l on day LH 0 and further to 7.5 +/- 1.2 pmol/l on day LH +1. Thereafter, the mean beta-E level remained at 5.3 +/- 0.8 pmol/l and 5.2 +/- 0.4 pmol/l on days LH +2 and LH +3, respectively. Ten additional women were studied before and during menstruation. The highest mean plasma concentration of beta-E, 5.1 +/- 0.9 pmol/l, was found at the onset of menstruation, declining to 3.3 +/- 0.6 pmol/l and 2.9 +/- 0.6 pmol/l on the second and fifth days of menstruation, respectively. These findings suggest that beta-E secretion increases at the time of ovulation. At the onset of menstruation, pain may increase endorphin secretion.

Adult↗
PubMed1987

Serum sex hormone concentrations in adolescent secondary amenorrhoea.

The hormone concentrations of 17 amenorrhoeic adolescent girls, with no apparent environmental factor associated with the secondary amenorrhoea, were evaluated. 28 regularly menstruating adolescent girls served as controls. The clinical characteristics of both groups were similar, except that the amenorrhoeic girls showed clinical signs of androgenicity significantly more often than the regularly menstruating group. The concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, oestradiol, progesterone, testosterone, androstenedione, dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulfate (DHEAS), and sex hormone-binding globulin (SHBG) were determined in weekly blood specimens from the amenorrhoeic girls and during one menstrual cycle from the regularly menstruating girls. The amenorrhoeic girls had significantly higher concentrations of LH, androstenedione and free testosterone than the regularly menstruating girls. The LH/FSH ratio was significantly higher in the amenorrhoeic group than in the control group. The SHBG concentrations were significantly lower in the amenorrhoeic group than in the regularly menstruating group. Evaluation of the clinical signs of androgenicity combined with LH and androgen measurements seems important in the investigation of adolescent menstrual disorders.

Adolescent↗
PubMedDate not supplied

Menstrual and premenstrual experiences of women in a developing country.

The menstrual and premenstrual experiences of black Zimbabwean women were examined. Twenty-five professional women and twenty-five domestic workers were interviewed using semistructured, open-ended interviews designed to explore their experiences. An analysis of consensual data indicated a number of predominant themes, including secrecy associated with menstruation, the negativity surrounding menarche, the breakdown of the traditional family network that passes on information about menstruation, and the acceptance of menstrual cycle experiences by the women. The main differences between the two groups concerned explanations of the functions and purpose of menstruation and the reporting of physical and affective symptoms. These differences are suggestive of the impact of educational level on experiences of menstruation.

Adult↗
PubMed1975

Plasma concentration of gonadotrophins, oestrogens and progesterone in thyrotoxic women.

Plasma levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), oestrogen and progesterone were measured daily in 15 thyrotoxic women in the reproductive age for 28 to 30 consecutive days before commencement of therapy and for a similar period following restoration of the euthyroid state. Five of these patients had secondary amenorrhoea whilst the other 10 had hypomenorrhoea. Twelve healthy volunteer eythyroid women of similar age and parity, with no history of menstrual abnormality, served as controls. The levels of both gonadotrophins (LH and FSH) and oestrogen were found to be significantly raised in all thyrotoxic patients in comparison with levels in the euthyroid female controls (P less than 0.001). "Mid cycle" LH and FSH peaks were present in thyrotoxic patients who were still menstruating whilst they were absent in those who developed amenorrhoea. Plasma oestrogen concentration rose to a peak on the day before the surge of LH (and FSH) in all euthyroid frmale controls as well as in thyrotoxic patients who were still menstruating. In contrast, oestrogen peaks occurred without ensuing LH (and FSH) peaks in thyrotoxic patients who had developed amenorrhoea, suggesting a failure of the positive feed-back mechanism. The levels and patterns of plasma progesterone in thyrotoxic subjects who were still menstruating were similar to those of euthyroid controls. However, no significant circulating plasma progesterone was detected in thyrotoxic subjects who were amenorrhoeic. The levels and patterns of all of these hormones (gonadotrophins, oestrogen and progesterone) became normal after restoration of euthyroid state and normal menstruation.

Adult↗
PubMed1977

The benefit of lactation amenorrhea as a contraceptive.

A group of 148 lactating women who delivered normally at El-Galaa Hospital, Cairo, were followed up monthly for 1 year to study the pattern of lactation amenorrhea, the return of menstruation and ovulation, and the incidence of pregnancy. By the end of the sixth week postpartum, only 1.3 percent of the women had begun menstruating; the percentage gradually increased to 60.2 percent by the end of the first year. The amount of blood loss and the duration of menstruation increased gradually until the fourth postpartum menstrual period. Ovulation had occurred in 58.1 percent and pregnancy in 26.1 percent of all cases at the end of the 12th postpartum month. Among menstruating, lactating mothers, ovulation occurred in 86.5 percent and pregnancy in 32.6 percent, while in amenorrheic, lactating mothers only 6.1 percent had become pregnant at 1 year postpartum.

Amenorrhea↗
PubMed1985

Iron stores in female blood donors evaluated by serum ferritin.

Iron stores were evaluated by serum ferritin determinations in 948 menstruating and 141 non-menstruating female blood donors. Blood donation was associated with a decrease in ferritin. First-time donors (n = 163) had a geometric mean ferritin of 24 micrograms/l and multiple-time donors a value of 19 micrograms/l (p less than 0.01). In the donating population 31.5% had ferritin values less than 15 micrograms/l (i.e. depleted iron stores). Menstruating donors had lower mean serum ferritin than non-menstruating donors (p less than 0.001), and a higher frequency of ferritin values less than 15 micrograms/l (p less than 0.05). There was no relationship between ferritin levels and the number of pregnancies. The frequency of donations was more predictive of ferritin levels than the number of donations. Mean ferritin displayed a moderate fall up to the 2nd donation, and was hereafter relatively constant, whereas an increase in donation frequency was accompanied by a significant decrease in ferritin. Female donors, especially when phlebotomised greater than or equal to 3 times per year, should have their iron status checked at appropriate intervals by measurement of serum ferritin and should be advised regular iron supplementation.

Adolescent↗
PubMed1984

Diagnostic bias and toxic shock syndrome.

Diagnostic bias could have occurred in the tampon/toxic shock syndrome association if the original diagnostic judgments by physicians or the subsequent diagnostic selections by investigators were influenced by knowledge of the patient's gender, menstrual history, or catamenial product. To determine whether such diagnostic bias can occur, a set of descriptive vignettes was prepared for six cases (Series X) having diverse resemblances to toxic shock syndrome or Kawasaki's disease. For each vignette in Series X, a paired case in a complementary Series Y was described in identical text except for different information about gender, menstrual history, or tampon use. Either Series X or Series Y was sent to a randomly selected sample of internists, family practitioners, and infectious disease subspecialists. The physicians were asked to provide a diagnosis for each case, using their own nomenclature or choosing from a list of 22 diagnostic possibilities. Six weeks later, respondents were asked to provide diagnoses for the complementary series of cases. Regardless of medical specialty or type of series received first, the 368 responding physicians were more likely to diagnose toxic shock for menstruating tampon-users or menstruating women than for non-menstruating women or men. In the most striking difference, toxic shock was diagnosed in 85 percent of instances when the case was described in a menstruating tampon-user, but in 23 percent of instances when the same case was described in a man (odds ratio = 18.8). Since the current epidemiologic data may be seriously distorted by diagnostic bias, the results indicate the need for scientifically valid investigations of the toxic shock syndrome/tampon relationship.

Adolescent↗
PubMed1995

The effect of pleasant odors and hormone status on mood of women at midlife.

The effect of odors on the mood of 56 women ranging in age from 45 to 60 years was determined using the POMS (Profile of Mood States). The 56 subjects were divided into four groups of 14 subjects each on the basis of hormonal status. Group 1 consisted of 14 women who were still menstruating; group 2 consisted of 14 women who were no longer menstruating and taking estrogen; group 3 consisted of 14 women who were no longer menstruating and taking estrogen and progesterone; and, group 4 consisted of 14 women who were no longer menstruating and taking no hormone replacement. Use of pleasant odors significantly improved scores on tension, depression, and confusion factors. In addition, women using estrogen replacement with or without progesterone had better mood scores than those who did not, which is consistent with previous studies.

Affect↗