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PubMed1976

Comments on the critical metabolic mass and the age of menarche.

Data from Frisch and Revelle (1971) and Frisch et al. (1973) are used to show that some of their biological conclusions relating body composition to age at menarche follow directly from arithmetical operations on the two observed items of information: weight and height. This emphasizes the dangers of drawing biological conclusions from derived, as opposed to observed, data. The hypothesis that an age-unrelated critical body weight triggers off menarche is examined in relation to preliminary data from a longitudinal study of adolescent girls. It is unacceptable because: (a) mean weights at menarche showed an upward trend with increasing age; (b) for given body weights the proportion of girls starting to menstruate increased with age; (c) at all ages the variation of body weight at menarche was as large as that among non-menstruating girls: (d) only 41 per cent of girls started to menstruate at weights 48 +/- 5 kg; and (e) eleven of the 20 girls whose weight exceeded 48 kg at the age 10-5-11 years did not start to menstruate although 1-1-5 years had elapsed since they attained the "critical" weight. Although no direct body composition data are presented the behaviour of skinfold suggests that body composition is unlikely to be the primary trigger of menarche.

Adolescent↗
PubMed2005

Drospirenone in the treatment of severe premenstrual cerebral edema in a woman with antiphospholipid syndrome, lateral sinus thrombosis, situs inversus and epileptic seizures.

We report herein the case of 32-year-old woman with situs inversus, thrombophilia, antiphospholipid syndrome and severe premenstrual syndrome (PMS) with cerebral edema and epileptic seizures prior to menstruation. Seven days prior to regular menstruation she developed severe PMS, including headache, blurred vision, epileptic seizures, urinary incontinence, craving for food, depression and irritability. Papilledema was detected. Daily hormone analyses prior to and during menstruation confirmed an ovulatory cycle with extremely high progesterone, prolactin and insulin levels in the late luteal phase. From day 29 to day 31, progesterone and insulin decreased sharply and the estradiol/progesterone ratio changed, leading to epileptic seizures and the peak of her symptoms. Diuretic treatment was administered. All symptoms disappeared during the first few days of menstruation. A novel oral contraceptive, containing ethinyl estradiol and drospirenone, an antimineralocorticoid progestogen, was given during the next cycle and hormone analyses were repeated. All symptoms were reduced significantly and no cerebral edema and epileptic seizures occurred. This is the first report of a woman with severe PMS and cerebral edema being treated successfully with an oral contraceptive containing drospirenone.

Abortion, Habitual↗
PubMed2005

The effect of soybeans on the anovulatory cycle.

We treated 36 outpatients, suffering from secondary amenorrhea, who had no menstruation or no ovulation for more than 6 months before consulting our clinic. After polycystic ovary syndrome, hyperprolactinemia, and other ovarian disorders that require medical treatment had been ruled out through smear test examinations of the uterine cervix and uterine myoma, ovarian tumor, and endometriosis had been checked for with ultrasonography and serum CA-125, the subjects began to take 6 g/day of black soybean in micropowder form for 6 months (S group). We estimated the ovular improvement of theses patients, observing basal body temperature (BBT) and follicular development with ultrasonography during the menstrual cycle as the indexes for ovulation and compared them with 34 patients with no treatment (C group). In the S group, improved ovulation was seen in 12 patients, four patients became pregnant, and three patients had anovular menstruation within 3 months after starting to take soybean powder. The periods of first ovulation were 66 +/- 12 days. After ovulation started, all subjects had regular menstruations and ovulation, with more than a 7-day high phase in BBT. On the other hand, in the C group, improved ovulation was seen in two patients, and two patients had anovular menstruation. In conclusion, black soybean has the potential to improve the anovular menstrual cycle.

Adult↗
PubMed1996

Dual role of angiotensin II in the human endometrium.

Angiotensin II (ANG) promotes cell proliferation and angiogenesis as well as being a potent vasoconstrictor. The cellular distribution of renin, ANG and its receptors in the endometrium has yielded useful information about the possible role of the renin-angiotensin system in cyclic menstruation. In the early proliferative phase, intense ANG-like immunostaining was detected in stroma and glandular epithelia, whereas in the late secretory phase, maximal immunoreactivity was localized in the perivascular stromal cells around the endometrial blood vessels. Quantitative receptor autoradiographic studies demonstrated that the human endometrium contains predominantly ANG type 2 receptor (AT2), with a relatively low expression of ANG type 1 receptor (AT1) and a novel non-AT1/non-AT2 ANG recognition site. AT receptors displayed cyclic changes, and the highest renin concentration was detected in the late secretory phase prior to menstruation. After long-term Norplant treatment, an increase in ANG-like immunoreactivity was observed in endometrial stroma and glandular epithelia, while in hyperplastic endometrium, ANG-like immunoreactivity decreased compared with normal cyclic endometria. The pattern of ANG immunostaining in endometria from patients with irregular menstruation was markedly different from that detected in normal endometrium. Normal function of the renin-angiotensin system in endometrium may be necessary for regular cyclic menstruation, and alterations in the distribution of ANG and/or the activity of its receptors are likely to be involved in dysfunctional uterine bleeding.

Angiotensin II↗
PubMed1989

The morphologic characteristics of menstrual hemostasis in patients with unexplained menorrhagia.

The endometrium in uteri removed by hysterectomy in patients with unexplained menorrhagia was compared with the endometrium in patients with normal menstruation who had a hysterectomy for uterine prolapse. The vascular ultrastructure and hemostatic plug formation were examined from the late secretory phase throughout menstruation to day 9 of the proliferative phase of the menstrual cycle. Endothelial defects, with and without hemostatic plugs, were more common and were present longer in the endometrial blood vessels of patients with unexplained menorrhagia than in patients with normal menstruation. In normal menstruation, no vascular defects were observed after day 3 of the cycle, whereas vascular defects were observed up to day 9 in the blood vessels of patients with unexplained menorrhagia. These morphologic features are likely to play a major role in the increased menstrual bleeding in such patients without uterine pathologic findings.

Adult↗
PubMedDate not supplied

Longitudinal follow-up of amenorrhea in eating disorders.

The authors recruited 229 treatment-seeking anorexic and bulimic women for a prospective, longitudinal study. Telephone interviews were arranged every 3 months for at least 1 year for 225 patients. At intake, 132 subjects were menstruating, 34 subjects were taking oral contraceptives, 5 subjects had an organic cause for amenorrhea (e.g., hysterectomy), and 58 subjects were amenorrheic. Each patient met Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) criteria for anorexia nervosa (AN, N = 41), bulimia nervosa (BN, N = 98), or AN/BN (N = 90). All subjects were interviewed with the Schedule for Affective Disorders and Schizophrenia-Lifetime Version, which was modified to include a section for DSM-III-R eating disorders, the Longitudinal Interval Follow-Up Evaluation, and the Structured Interview for DSM-III Personality Disorders. It was found that body weight was associated with menstrual status: those with amenorrhea had a mean percent ideal body weight (IBW, Metropolitan Life criteria) of 74 +/- 1% compared with 102 +/- 19% for menstruating patients (p < .01). Affective illness was more prevalent among patients with amenorrhea than among menstruating patients (75% vs. 56%, p < .05). Menses were regained within 1 year by 33% of amenorrheic patients. These patients gained an average of 7.3% of their IBW. Longer duration of eating disorder (p < .03) and the presence of an anxiety disorder (p < .05) were associated with persistent amenorrhea. Menses were lost within 1 year by 8% of menstruating patients. These patients lost an average of 5.0% of their IBW.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Computed tomography findings of pathologically confirmed pulmonary parenchymal endometriosis.

OBJECTIVE: To evaluate the usefulness of computed tomography (CT) in the localization of parenchymal pulmonary endometriosis and to correlate the CT findings with fiberoptic bronchoscopic and pathologic findings. METHODS: A prospective study of 5 patients presenting with catamenial hemoptysis was conducted. The CT scans and fiberoptic bronchoscopy were performed twice during and 2 weeks after menstruation. After the localization of the presumed bleeding focus, surgical resection was performed. RESULTS: The CT scans obtained during menstruation revealed a well-demarcated area of consolidation (n = 4) and ground-glass opacity (n = 5), whereas CT scans obtained after menstruation demonstrated ground-glass opacity (n = 4) or complete resolution of the previously noted lesion (n = 1). Fiberoptic bronchoscopy exhibited trails of blood clot at the orifice of the involved bronchi unilaterally (n = 4) or a thin bloody secretion in the bronchi bilaterally. Histopathologic examination of the resected specimens showed typical findings of pulmonary endometriosis. CONCLUSION: Computed tomography scans during and after menstruation were useful for the precise preoperative localization of parenchymal pulmonary endometriosis.

Adult↗
PubMed2005

Molds in floor dust and building-related symptoms among adolescent school children: a problem for boys only?

UNLABELLED: In this stratified cross-sectional study in eight 'wet' and seven 'dry' schools, 1024 adolescent school children reported potentially building-related symptoms (BRS) in self-administrated questionnaires. From their classrooms dust samples were collected from floors, ventilation ducts, and air; settled dust was collected in cardboard boxes over a period of 5 months. Measurements of temperature, relative humidity and CO2 were performed. BRS were strongly associated with personal factors like recent airway infections, hay fever, asthma and psycho-social work load, but also to molds in floor dust and presence of mechanical ventilation. The association between molds in floor dust and BRS has in stratified analyses shown a strong association among adolescent school boys, and no association among adolescent school girls using multivariable analyses controlling for relevant confounders. In contrast to the menstruating school girls, the symptoms among the small group of not yet menstruating girls were associated with the levels of molds in floor dust. Their symptom prevalences were very similar to those of the boys. This finding makes us suggest a new hypothesis: The higher endogenous estrogen levels of sexually matured adolescent females seems to protect them from the effects of molds in dust, despite their overall higher symptom prevalence. PRACTICAL IMPLICATIONS: In this cross-sectional epidemiological study of adolescent school children we found independent significant positive associations between building-related symptoms and viable molds in floor dust in boys and non-menstruating girls. In contrast, no such associations were seen among menstruating girls. The identification of these two susceptible groups adds further support the relevance of minimizing sources of dust and mold exposure.

Adolescent↗
PubMed1992

Mood, mileage and the menstrual cycle.

Forty women took part in a study to determine the effects of high-intensity training and the menstrual cycle on mood states. Half of the sample were competitive distance runners following a training load of between 50 km and 130 km running per week. Seven athletes were amenorrhoeic and 13 either eumenorrhoeic or oligomenorrhoeic. The remaining 20 subjects were inactive women who menstruated regularly. The mean age of all 40 subjects was 29 years. Each subject completed two identical Profile of Mood States (POMS) questionnaires. The 33 menstruating subjects completed both a premenstrual and a midcycle form and the amenorrhoeic athletes completed the questionnaires at a 3-week interval, which acted as a control for the potential effects of premenstrual syndrome (PMS) among the menstruating females. Results showed highly significant differences in mood profiles among amenorrhoeic athletes, non-amenorrhoeic athletes and inactive women. The greatest difference was between premenstrual and midcycle measures for the inactive group. PMS appears to cause marked negative mood swings among menstruating women which the POMS inventory is sensitive in detecting. While the lower-intensity-training runners appeared to benefit psychologically from a training distance of approximately 50 km week-1, high-intensity training had an adverse effect on mood.

Adult↗
PubMed1989

Relationships between symptoms, menstrual cycle and orocaecal transit in normal and constipated women.

Because severe constipation is a disorder largely confined to young women, the possibility that menstrually related factors contribute to disturbed gastrointestinal motor function has been raised. It has also been reported that normal menstruating women show changes in upper gut transit between the follicular and luteal phases of the menstrual cycle and that patients with constipation show prolonged transit. We therefore studied relationships between symptom severity and orocaecal transit during the menstrual cycle in a group of 14 constipated women and a series of control groups comprising seven normal menstruating women, five postmenopausal women, and eight normal men, to determine whether phases of the menstrual cycle were associated with alteration in symptoms or transit. A regular menstrual cycle was reported by 13 of the 14 patients (range 26-30 days) and by all the menstruating female volunteers. Seven patients noted variation in constipation during the menstrual cycle, in all cases this comprised an improvement in symptoms just before or during menstruation. No consistent relationship between symptom severity and follicular or luteal phase was noted. Repeated orocaecal transit measurements in the four study groups showed no consistent differences (greater than 0.05) between groups or during the menstrual cycle (mean change weeks 1-4, -10 +/- 20 min). These findings are inconsistent with the hypothesis of a progesterone related effect upon orocaecal transit in either normal or constipated women.

Adult↗
PubMed1994

Mid-menstrual cycle decline in creatinine and urea clearances.

In 6 pre-menopausal and 6 post-menopausal women we compared urine volume and excretion of creatinine and urea daily from day 2 of the 1st period of menstruation to day 1 of the 2nd, along with clearances of creatinine (CCr) and urea (C-urea). Clearances were based on 7 serum samples which were taken on day 2 of the 1st menstruation and on days 8, 14, 15, 16, 21, and day 1 of the next menstruation, when 4 cycling hormones were also assayed. Mean group ages were 35 and 59 years for pre- and post-menopausal women. CCr cycled only in the pre-menopausal group, with a nadir around the time of ovulation. The mean CCr combining days 14 and 15 was lower than that for the average of the 5 other days by 22% (p < 0.003) in the pre-menopausal but not in the post-menopausal group (p = 0.99). Average CCr values fell from the peak mean of 129 ml/min on day 8 in the follicular phase to the mean nadir of 93 ml/min for days 14 and 15 and recovered to 117 ml/min by day 1 of the 2nd menstruation; the percent fall in CCr ranged from 9 to 39%. A mid-cycle nadir was also present for C-urea (p = 0.03), also found only in the pre-menopausal group. We conclude that, in pre-menopausal women, there is generally a fall in CCr and C-urea from a peak in the follicular phase to a nadir around ovulation.

Adult↗
PubMed1984

Sex hormones in amenorrheic women with alcoholic liver disease.

Urinary excretion of estrogens and plasma concentrations of estrone, estradiol, LH, FSH, PRL, progesterone, testosterone, and sex hormone binding globulin were measured in nine chronic alcoholic women with cirrhosis or alcoholic fatty liver. They were aged 24-40 yr and all had secondary amenorrhea which had lasted for at least 3 months. The response of pituitary gonadotropin secretion to administration of LHRH and estradiol benzoate and of PRL secretion to TRH were also investigated. Urinary excretion of estrogens in the alcoholic women with liver disease was similar to that in normal postmenopausal women and less than half that in normal women of the same age in the midfollicular phase of the menstrual cycle. Plasma estradiol levels in the alcoholic women were lower than in the menstruating women but higher than in the postmenopausal women, whereas their plasma estrone levels were higher than in the menstruating women. Plasma concentrations of progesterone and testosterone in the alcoholic women did not differ from those in the postmenopausal women but were lower than in the menstruating women. In spite of the relative estrogen deficiency plasma LH and FSH levels were not elevated in the alcoholic women. The responses of LH and FSH to LHRH were similar in the patients and in the menstruating women. Intramuscular administration of estradiol benzoate did not increase plasma LH and FSH concentrations in the alcoholic women. Hyperprolactinemia was not found and there were no differences in the PRL responses to TRH between the patients and the control groups. In conclusion, disturbed regulation of gonadotropin secretion is an important factor in the genesis of estrogen deficiency and amenorrhea in alcoholic women with liver disease, although ovarian function may also be directly impaired.

Adult↗
PubMed1998

The long-term effect of menopause on postmenopausal bone loss in Japanese women: results from a prospective study.

The aim of this study was to elucidate perimenopausal bone loss in relation to menstrual conditions and to investigate the long-term effect of menopause on bone loss in aged women. The rate of change in bone mineral density (BMD) was measured twice at an exact interval of 12 months by dual-energy X-ray absorptiometry (DXA) at the lumbar spine in 176 pre- and postmenopausal healthy women 41-65 years of age. Serum follicle-stimulating hormone, intact and N-fragment osteocalcin (OC), three types of vitamin D3, parathyroid hormone (PTH), and calcitonin were also determined. Women who exercised regularly or had anatomical changes at the lumbar spine were excluded from this study. The subjects were divided into eight groups based on their menstrual status and years since menopause. Annual bone loss at the lumbar spine of premenopausal women with regular menstruation was -0.2+/-1.9% (95% confidence interval, -0.9 approximately -0.4%) and was not statistically different from zero, while that of women with irregular menstruation or at menopausal transition was -2.1+/-3.4% (-3.4 approximately -0.8%), and -3.3+/-2.3% (-5.2 approximately -0.3%), respectively, and was significantly different from zero. Serum OC levels of women at menopausal transition were significantly higher than those of women with regular menstruation, suggesting that bone loss had commenced in these women. The rate of annual change in BMD of women who were menopausal for 1-3, 4-6, 10-12, and more than 13 years was -3.1+/-4.0% (-4.7 approximately -1.5%), -1.2+/-2.6% (-2.2 approximately -0.2%), -1.0+/-3.0% (-2.3 approximately -0.3%), and -2.3+/-2.1% (-3.7 approximately -1.0%), respectively, and was significantly less than zero. But the annual bone loss of women who were menopausal for 7-9 years was -1.5+/-2.6% (-3.0 approximately -0.1%) and was not statistically significant from zero. These results indicate that postmenopausal women lose BMD in two phases. The early bone loss is rapid and commences during irregular menstruation, then is attenuated within 6 years after the onset of menopause. The second bone loss commences after the attenuation of the first bone loss. Among bone metabolic hormones, intact PTH alone showed an age-related increase and was suggested as being a causal factor of bone loss in women who were menopausal for 13 years or more.

Absorptiometry, Photon↗
PubMed2004

Temporal expression and signalling of prostacyclin receptor in the human endometrium across the menstrual cycle.

Prostacyclin (PGI(2)) synthesis and function in the human uterus has been implicated in the regulation of the process of normal and dysfunctional menstruation. PGI(2) synthesis is elevated during normal menstruation and is also associated with blood loss in women who suffer from heavy menses. This study was designed to outline further the role of PGI(2) in menstruation by investigating the temporal pattern and site of expression of prostaglandin I synthase (PGIS) and the prostacyclin receptor (IP receptor) in the non-pregnant human endometrium across the menstrual cycle. Quantitative RT-PCR demonstrated increased expression of PGIS and IP receptor during the menstrual phase of the cycle compared with all other phases (P < 0.05). Furthermore, PGIS and IP receptor were localised to the glandular epithelium, stromal and endothelial cells in the basal and functional layers of the endometrium. Functionality of the IP receptor in the human endometrium was assessed by measuring cAMP generation following treatment with 100 nmol l(-1) of the PGI(2) analogue, iloprost. cAMP generation was significantly higher in endometrial tissue collected during the proliferative compared with the secretory phase of the menstrual cycle (P < 0.05). In conclusion, this study has confirmed increased expression and signalling of PGIS and IP receptor during the menstrual phase and outlines a potential autocrine/paracrine role for PGI(2) on several cellular compartments in the endometrium including the endothelium. This may underscore a pivotal role for PGI(2) receptor signalling in normal and dysfunctional menstruation.

Cyclic AMP↗
PubMed2006

Magnetic resonance imaging of morphological and functional changes of the uterus induced by sacral surface electrical stimulation.

The purpose of this study is to examine the morphological and kinematical changes of the uterus induced by electrical stimulation applied to the skin just above the second and fourth posterior sacral foramens (sacral surface electrical stimulation [ssES]) in 26 healthy subjects. Out of them, eight subjects who had severe pain subjectively during every menstruation received ssES just in menstruation. Morphological and functional changes of the uterus were examined by using T2-weighted magnetic resonance (MR) imaging and T1-weighted MR cinematography, respectively. Cyclic electrical stimulation for 15 min with 5 sec ON and 5 sec OFF was applied just before MR scanning. A decrease in thickness of the muscular layer of the uterus was observed in every subject after ssES for 15 min and was significant as compared with the thickness before ssES. Periodic uterine movement during menstruation was observed in the subjects with severe menstrual pain in MR cine and the power spectrum analysis of the movement showed a marked decrease in peak power and frequency after ssES treatment. We conclude that ssES causes a reduction of static muscle tension of the uterus in all menstrual cycle periods and suppression of uterine peristalsis during menstruation in the subjects with severe menstrual pain. Possible neural mechanisms for these static and dynamic effects of ssES on the uterus at spinal level are discussed.

Adult↗
PubMed1993

Lactational infertility in family planning.

The contraceptive effect of breast-feeding is the single most important determinant of human population growth rates in traditional societies without access to modern forms of contraception; lactational amenorrhoea is Nature's contraceptive. Even today, breast-feeding still prevents more pregnancies than all modern forms of contraception in many developing countries. Afferent neural inputs from the nipple pass via the spinal cord to the hypothalamus, where they cause a local release of beta endorphin. This acts to depress GnRH secretion, thereby inhibiting pituitary gonadotrophin secretion, ovarian follicular development, ovulation and menstruation. The hypothalamic beta endorphin release also inhibits dopamine production, resulting in increased pituitary prolactin secretion. The higher the suckling frequency, the more beta endorphin that is released and hence the longer the duration of lactational amenorrhoea. Lactational amenorrhoea can be relied up to give over 98% contraceptive protection to breast-feeding women in the first 6 months postpartum, regardless of their nutritional status or the time of first supplement introduction to the baby. This is because the first postpartum menstruation usually precedes the first ovulation during these early months. Once menstruation has resumed, lactation's contraceptive effect can no longer be relied upon, even though the woman continues to breast-feed. In breast-feeding women whose amenorrhoea extends beyond 6 months, there is an increasing tendency for the first ovulation to precede the first menstruation, thereby decreasing the reliability of lactational amenorrhoea as a contraceptive. Nevertheless, many women who continue to breast-feed may still have up to 1-2 years of good contraceptive protection from prolonged lactational amenorrhoea.(ABSTRACT TRUNCATED AT 250 WORDS)

Amenorrhea↗
PubMed1984

The influence of strenuous muscle stimulation on the menarche.

Nowadays, the average age at which menarche begins is lowering by three to four years every century, that is, four months every decade, according to both Japanese, and European and American annual changes of the average age. It emerged that the menarche shows a tendency to occur later in female gymnasts, because of the influence of strenuous muscle stimulation, and the fact that a higher level of technic is required in gymnastic games each year. These conclusions have been drawn from replies submitted to a questionnaire distributed among a relatively small number of gymnasts who participated in the competitions including the Inter High School Championship and the World Cup Championship. For example, at the age of 14, the percentage of women who had menstruated is almost 100% among women in general, but only 24% among World Cup Championship gymnasts, the average age at menarche of the latter being later than that of the former by as many as 3 years. At the age of 16, the percentage of women who had menstruated is 100% among women in general, but on the other hand, it is only 60% among World Cup Championship gymnasts, in other words, only a low percentage of women, of the latter group, had menstruated. Finally in our study, we established that the age at menarche of gymnasts is three or five years later than that of women in general. From our study, we concluded that the excessive burden imposed on muscles might cause an abnormal menstrual cycle, and the influence on menstruation would be considerable.

Adolescent↗
PubMed2001

Milk composition changes--a simple and non-invasive method of detecting ovulation in lactating women.

OBJECTIVE: To assess the possibility of detecting ovulation through observing changes in composition of milk and using this as a simple and non-invasive method. METHOD: Twenty five normal lactating women (menstruating and non-menstruating), varying in age from 18-35 years and taking no hormonal contraceptives were included in this study. Hormonal estimation was done by radioimmunoassay and changes in milk composition were observed by measuring the concentration of Na+, Cl-, K+ and lactose. RESULTS: Changes were observed in milk composition of four menstruating women (ovulatory), characterized by significant increase in concentration of Na+ and Cl- and decrease in concentration of lactose and K+. However, in one non-menstruating woman who was found to have ovulation, these findings could not be observed. CONCLUSION: Results show that the determination of Na+, K+, Cl- and lactose in milk of lactating women have a high value for detection of ovulation.

Adolescent↗