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PubMed2002

Clinical manifestations of low bone mass in amenorrhea patients with elevated follicular stimulating hormone.

OBJECTIVE: To study the characteristics of low bone mass in amenorrhea patients with elevated follicular stimulating hormone (FSH). METHODS: Amenorrhea patients with elevated FSH: Primary amenorrhea 18 cases, secondary amenorrhea 171 cases and age matched controls with normal menstruation, 180 cases. The descriptive parameters were: estrogen, alkaline phosphatase, urinary excretion of calcium to creatine ratio, cortical bone mineral density at the right radius measured by single photon absorptiometry and trabecular bone mineral density at the lumbar vertebra body measured by quantitative computerized tomography. RESULTS: Average E(2) levels in amenorrhea patients is under 150 pmol/L with significantly higher alkaline phosphatase and urine calcium to creatine ratio values than the normal menstruation group. Cortical bone mineral density in the secondary amenorrhea group (655 +/- 69 mg/cm(2)) was significantly lower than that of the normal menstruation group (677 +/- 56 mg/cm(2), P < 0.01). Trabecular bone mineral density in the secondary amenorrhea group (145 +/- 26 mg/cm(3)) was significantly lower than that of the NOR group (192 +/- 28 mg/cm(3), P < 0.001). The disparity with the normal menstruation group is even greater in the primary amenorrhea group. Bone mineral density of the amenorrhea patients was negatively correlated with duration of the menopause. CONCLUSIONS: Serum estrodiol levels in amenorrhea patients was so low that bone turnover was accelerated. This led to insufficient bone accumulation and a dramatically drop in trabecular bone mineral density. The extent was closely related to age of onset of amenorrhea and the duration of ovarian failure.

Adult↗
PubMedDate not supplied

[Assessment of premenstrual dysphoric disorder symptoms: population of women in Casablanca].

Menstruation is a biological phenomenon that has been subject of myths and taboos within and among various cultures. These myths distort the reality surrounding menstruation and create ambivalent feelings about the value and usefulness of this function outside of its necessity as mean of reproduction. Thus studies concerning menstruation need to take into account cultural and psychosocial factors that define the meaning, values and behavior associated with this biological phenomenon. According to several studies, 70% of women experience psychological faintness during this menstrual phase, 40% of them have these symptoms at each menstruation and between 3 to 8% of them suffer severely reacquiring medical support. This entity called premenstrual dysphoric disorder is defined by the presence of several symptoms (distress, tension, irritability, moodiness.) with a significant impairment in work or social functioning beginning during the week before and ending within a few days after the onset of menses. Several studies conducted over the past few years suggested that selective serotonin reuptake inhibitors (SSRIs) and serotoninergic tricyclic drugs may be more effective than other types of antidepressants in treating PMS symptoms. Two protocols are proposed; a continuous treatment or intermittent use during few days during pre-menstrual and menstrual phase for several cycles. The objective of the current study was to evaluate the prevalence of a potential premenstrual dysphoric disorder (PMDD) during one menstrual cycle, in a representative sample of general population of Casablanca, according the DSM IV criteria. On the other hand, a questionnaire, available from the authors, was used to explore socio-demographic data. Among 618 women interviewed, 310 met the criteria of a potential PMDD (50.2%). The mean age of the population with PMDD was 32.2 8 years ranging from 20 to 50 years; 54.8% of them were married, 33.9% of them were single and 66.5% of them had between 1 to 4 children. Two third of them were without a professional activity. During this premenstrual phase the following symptoms were found among the whole sample: marked depressive mood, feeling of hopelessness, or self-depreciation thoughts (77.7%, n=241%); difficulty of concentration (65%, n=201); marked change in appetite, overeating or specific food craving (82.8%, n=256); marked affective lability, with sadness tearful and increased sensitivity to rejection (65.8%, n=204); hypersomnia or insomnia (59.7%, n=185); subjective sense of being overwhelmed or out of control (55.7%, n=172); lethargy, excessive fatigability (91.6%, n=283); physical symptoms including breast tenderness, swelling, headache, joint or muscular pain, and a sensation of bloating and weight gain (81.9%, n=253). The most severe symptoms were fatigue and irritability. On the other hand, 73.9% of the sample had a disturbance in their socio-professional lives as a consequence to the psychological disturbances. Half of these women consulted a physician, mostly a general practitioner. These data are in accordance with the literature, confirming that this disorder is common and has a bad impact on mental health and on quality of life of the women suffering from PMDD.

Adult↗
PubMedDate not supplied

Managing the pain of primary and secondary dysmenorrhoea.

Dysmenorrhoea, pain during menstruation, affects 40-95 per cent of menstruating women, and has been reported as the most common causes of regular absenteeism among young women. There are two types of dysmenorrhoea: primary and secondary. Primary dysmenorrhoea is a painful menstruation with no detectable organic disease and is more common in adolescent women. Secondary dysmenorrhoea is painful menstruation that is frequently associated with a pelvic pathology. The symptoms that present with dysmenorrhoea, the management and treatment options that are available, and the implications for nursing practice are discussed.

Acupuncture Therapy↗
PubMed1986

[Effect of radiation and drug therapy on the hormonal status of patients with breast cancer, taking into consideration the receptor level of the tumor].

A study was made of the content of the steroid and peptide hormones in the blood of 115 patients with Stage III a,b,c breast cancer (54 patients at the reproductive age and 61 in the menopause) before treatment and during radio- and chemotherapy. A group of healthy women (28 with preserved menstruation and 20 in the menopause) was taken as controls. Data on the concentration of the steroid hormones in the patients' blood were compared with the presence of the respective receptors in tumor. Before treatment a significant rise of the estradiol concentration was noted in the blood of the menopause patients, that of prolactin both in the menopause patients and in the patients with preserved menstruation. A raised testosterone concentration was also noted in the patients with preserved menstruation. After radiotherapy the blood prolactin level, particularly in the patients with preserved menstruation, increased more than 2-fold. There was no correlation between the levels of the steroid and peptide hormones during therapy and its efficacy. The prolactin level can be used as a criterion of the efficacy of antitumor therapy, its stable rise in operated patients during therapy being an unfavorable prognostic sign.

Adult↗
PubMed1986

A survey of paramenstrual complaints by covert and by overt methods.

A covert method of assessing perception of health in relation to menstruation was applied prospectively to a group of women aged 20 to 40 years. Of the 1386 randomly selected women contacted, 838 (60%) provided information for the full study period of six weeks and 608 of these respondents menstruated during that time. A clear excess of women demonstrated premenstrual deterioration in perceived health. This rose to a peak at the onset of menstruation and subsided rapidly during menstruation, thus reflecting the conventionally defined pattern of the premenstrual syndrome.When, on completion of prospective recording, the same women were asked to return an overt and retrospective assessment of paramenstrual symptoms, the overall pattern of results was similar but, for individual women, there was little correspondence between similar data obtained by the two different methods.

Adult↗
PubMed1983

The bearing of diverse patterns of diet on growth and menarche in four ethnic groups of South African girls.

Anthropemetric and development studies were made on 4390 black rural and urban, coloured, Indian and white school girls of 6-17 years and a 24-h dietary recall recorded on subsamples. Mean weights and heights of non-white were lower at all ages than those of white girls. Prevalences of obesity (greater than or equal to 120% weight-for-height), were higher in black and coloured than in Indian and white girls, but mean percentage body fat was not significantly different at 17 years. Growth attained was in response to very different dietary patterns. However, this did not delay breast development, which occurred at much the same time in all groups. However, menstruation was delayed in black compared with coloured, Indian and white girls. Although breast development was present in all at 14 years, proportions (%) menstruating differed: 33 rural and urban black; 84 coloured; 93 Indian; 97 white. in non-menstruating girls of 8 years of age all had mean fat greater than 17% (the expected level of menstruation) and, except in black rural and coloured girls, this was greater than 22%, the critical level for regular ovulation. These studies throw doubt on the nutritional components as being wholly responsible for the delay of menarche, as breast development, the earliest sign of puberty in girls, is not delayed despite marked dietary differences. The emergence of obesity without dietary intervention in the 'poorest' of adolescent girls, further questions this hypothesis.

Adipose Tissue↗
PubMed1981

[On the position of the human foetus and the probability of spontaneous change in position during pregnancy (author's transl)].

Since ultrasonic examinations became routine practice in pregnancy rather often breech presentations are being found in the course of pregnancy. The amounts of breech, vertex presentation and cross position in the course of pregnancy are shown in a curve which is made from 2.240 single measurements. There are significant differences between primiparae and multiparae as to the frequency of breech and vertex presentation. The analysis of all repeated determinations of fetal presentations allows predications about the probability of changing of a breech into a vertex presentation and vice versa in a determined week of pregnancy. For example the probability of the turning of a breech presentation into a vertex presentation is 44.6% in the 29th week post menstruation, 23.2% in the 33rd week post menstruation. From the 37th week onwards the fetus won't turn any more into the vertex presentation. A vertex presentation, for example in the 29th week post menstruation changes into a breech presentation with a probability of only 0.55%. From the 33rd week onwards a turn into a breech presentation is no longer to be expected. A diagram for the probabilities of the fetal presentations' turnings into the opposite presentations is given for the 13.-40. week post menstruation, from which the patient can immediately be informed about the individual chance. The turn into the vertex presentation is the most common one and seems to be the physiologic one. This turn occurs more or less constantly, not abruptly.

Breech Presentation↗
PubMed1976

Amenorrhea following oral contraception.

A prospective study was done on 326 nulliparous women who ceased oral contraception. Follow-up was obtained on 311. The mean age was 20.3 years (S.D. 2.5). Eighty-nine per cent began menstruating within 60 days after stopping therapy, and only 7 took 180 days or longer to menstruate. Late menarche strongly correlated with post-pill amenorrhea (PPA), but continous length of time on oral contraceptives and type of oral contraceptive showed no significant relationship. The incidence of PPA was 2.2 per cent. All women did eventually menstruate spontaneously, the longest period of amenorrhea being 540 days.

Adolescent↗
PubMed1979

The refief of primary dysmenorrhea by ketoprofen and indomethacin.

The prostaglandin biosynthesis inhibitors ketoprofen and indomethacin were compared in the treatment of primary dysmenorrhea in a double-blind, cross-over trial involving 23 patients. Each drug was used for 2-4 days during 3 consecutive menstruations in randomized order. Good or moderate overall relief was obtained in 60 of the 68 ketoprofen-treated menstruations (88%). A dysmenorrhea score, based on subjective estimations of 8 symptoms, similarly decreased from a mean (+/- S.E.M.) basal level of 9.6 +/- 0.6 to 3.6 +/- 0.3 during ketoprofen treatment and to 4.0 +/- 0.3 during indomethacin. Both drugs relieved pelvic and lower back pains and eliminated vomiting and diarrhea in 82-97% of the cycles whereas headache, fatigue and nervousness were less frequently alleviated (40-67%). Eighteen of the 23 women (78%) had been unable to work during the first day of menstruation, the rate of working days lost was reduced to 4% with ketoprofen and 9 with indomethacin. Mild side-effects occurred during 12 ketoprofen and 14 indomethacin therapies. Ketoprofen thus seems to be as effective and tolerable as indomethacin in the treatment of primary dysmenorrhea.

Adolescent↗
PubMed2003

Menstrual induction with mifepristone and misoprostol.

Menstrual induction refers to early uterine evacuation without laboratory confirmation of pregnancy in women with delayed menses. Mechanical aspiration is the method used in many countries but, as suggested by a pilot study, mifepristone followed by a prostaglandin analogue could also be effective. We launched the present study to evaluate the efficacy and side effects of 150 mg of mifepristone, followed 2 days later by 0.4 mg misoprostol vaginally, for menstrual induction among women with a menstrual delay of up to 7 days. The outcome of treatment was uterine evacuation, which could mean menstruation or termination of early pregnancy. A total of 720 women were recruited. The mean delay of menstruation at recruitment was 4.9 (SD = 1.7) days. Retrospective analysis of human chorionic gonadotropin from serum samples taken at admission showed that 492 (68.3%) women were pregnant at admission, and 228 (31.7%) women had delayed menstruation without pregnancy. One nonpregnant woman was lost to follow-up. Bleeding was induced in 479 (97.4%) pregnant women and in 222 (97.8%) nonpregnant women. Among the pregnant women, 455 (92.5%) had complete abortion, 12 (2.4%) had incomplete abortion and pregnancy continued in 25 (5.1%) women, including one ectopic pregnancy. Side effects were mild and uncommon. We conclude that 95.8% of the women treated had the expected outcome. Further research is needed to compare the efficacy, safety and acceptability of the medical regimen to vacuum aspiration. A rather high continuing pregnancy rate in this study is a concern.

Adult↗
PubMed1992

The induction of amenorrhoea.

A survey has shown that many women favour eliminating menstruation and it has been suggested that therapeutic induction of amenorrhoea might be an advantage in female personnel mobilised for war. The traditional method has been to take the oral contraceptive pill continuously. This produces weight gain and other side-effects; spotting and breakthrough bleeding can be a problem initially. The method is however cheap. The Gonadotrophin Releasing Hormone (GnRH) analogue, goserelin, is extremely effective, produces less side-effects, but it is very expensive. Two synthetic steroids, danazol and gestrinone, are moderately effective, have a variety of prominent side-effects and are also quite expensive. With all these drugs normal menstruation resumes in the cycle after they are discontinued. Although goserelin has many advantages over the continuously taken contraceptive pill, its cost precludes it from consideration as a means of eliminating menstruation.

Amenorrhea↗
PubMed1979

Suppression of prolactin secretion by lisuride throughout the menstrual cycle and in hyperprolactinaemic menstrual disorders.

Normally menstruating volunteers as well as patients with hyperprolactinaemic menstrual disorders were treated with lisuride hydrogen maleate (200 micrograms b.i.d.), an ergoline derivative with dopaminergic properties. Within 3 h after an oral dose of 200 micrograms lisuride, PRL levels decreased significantly in all subjects to a plateau which lasted up to 3 h. Thereafter a gradual increase of serum PRL was noted. In the normally menstruating volunteers lisuride treatment did not result in any significant change of gonadotrophin or of sex steroid secretion, while both, basal as well as metoclopramide (MTCL) stimulated PRL release were significantly diminished. The inhibition of PRL secretion in patients with short luteal phases resulted in an increase of luteal progesterone output. In both treated groups ovulation occurred 1 to 5 days earlier in cycles on lisuride than in control cycles. LF-RH/MTCL tests performed in the patient bearing a pituitary prolactinoma before and after lisuride treatment revealed a continuous increase of pituitary LH pools, while PRL secretion decreased under lisuride therapy. Subsequently ovulation and menstruation occurred. The data presented demonstrate that lisuride is a potent inhibitor of PRL secretion and has proven its clinical usefulness for treatment of hyperprolactinaemic menstrual disorders. Application of lisuride resulted in an increase of luteal progesterone secretion in previously demonstrated corpus luteum insufficiency as well as in restoration of normal cyclical feedback mechanisms in tumorous hyperprolactinaemic anovulation. The MTCL-PRL stimulation test is suitable to monitor PRL suppression during lisuride treatment, while LH-RH testing reveals the effectiveness of lisuride by demonstrating an increase of pituitary gonadotrophin pools.

Adenoma↗
PubMed2006

Menstrual symptoms: the importance of social factors in women's experiences.

BACKGROUND: Menstrual disorders are a common presentation in primary care. Heavy menstrual bleeding is the most common concern, and is often treated by medical and surgical means despite lack of pathology. AIM: To explore women's experiences of menstrual disorders. DESIGN OF STUDY: Two qualitative studies using semi-structured interviews. SETTING: Inner-city London. METHOD: An initial study recruited women with heavy menstrual bleeding via their GPs. A follow-up study recruited women with a variety of menstrual problems via general practice and the community. Interviews were taped and transcribed then analysed using the constant comparative method. RESULTS: Management of menstruation was a prominent theme in interviews. Women acted to comply with a strong social message that menstruation should be concealed, although this behaviour was often 'taken for granted.' The need to conceal evidence or reminders of menstrual bleeding was particularly important. Onset of menstrual symptoms often challenged established strategies for menstrual management. Menstrual management then became a conscious problem and a source of continuing stress. The breakdown of management strategies, by real or threatened episodes of leaking or staining, influenced consultation behaviour and decisions about treatment. CONCLUSION: The social pressure to maintain concealment of menstruation is a strong influence on women's health-related behaviour in response to menstrual concerns. Women's choices may be better understood if attention is paid to the social context in which they live.

Adolescent↗
PubMed1985

The effect of a prostaglandin synthetase inhibitor, indomethacin, on excessive uterine bleeding.

Indomethacin, a prostaglandin synthetase inhibitor given to 94 women suffering from functional menorrhagia, IUD's and sub mucous fibroid related bleeding, reduced menstrual loss and duration of menstruation in 70 patients (74.5 percent). A significant decrease in duration of menstruation of 2.1 days was obtained in the responding group. In functional bleeding, the mean decrease was 1.7 days, in IUD's related menorrhagia 2.9 days and in menorrhagia due to submucous fibroids 2 days. Age, parity and duration of menstruation before treatment had no significant effect on the response or reduction of duration of bleeding. The medication was discontinued only in two patients because of minor gastronntestinal symptoms.

Adult↗
PubMed1979

Plasma hormone profile in anovulation.

Daily plasma hormones, including luteinizing hormone (LH), follicle-stimulating hormone (FSH), estrone (E1), estradiol (E2), progesterone, androstenedione, and testosterone (T), were measured in 16 anovulatory patients for a span of 3 to 4 weeks. The clinical diagnoses in this group of patients included the following: anovulation-eumenorrhea (n = 5), anovulation-polymenorrhea (n = 1), anovulation-oligomenorrhea (n = 3), congenital adrenal hyperplasia (n = 1), polycystic ovarian disease (n = 4), severe hypothalamic amenorrhea (n = 1), and postpartum amenorrhea-galactorrhea (n = 1). Follicular activity was evident in polymenorrheic and oligomenorrheic patients, and menstruation occurred in these patients following estrogen withdrawal. No follicular maturation was noted in the group of patients with anovulation-eumenorrhea, and menstruation in these patients was considered breakthrough bleeding. Low FSH levels were observed in anovulatory patients with eumenorrhea, polymenorrhea, and oligomenorrhea. Significantly high LH values were noted in both classic and non-classic polycystic ovarian disease. Extremely low E1 and E2 levels were found in patients with severe hypothalamic amenorrhea and postpartum amenorrhea-galactorrhea. Slightly elevated progesterone levels were observed in polymenorrheic and oligomenorrheic patients prior to menstruation; this was frequently associated with an LH surge or elevation. Elevated T levels were consistently associated with hirsutism but not with obesity.

Adolescent↗
PubMed1982

[Contraction of non-gravid human uterus in various menstrual phases (author's transl)].

Using microtransducer, the author has studied the uterine contraction in various menstrual phases and during dysmenorrhea, and also the effect of the administration of PG synthetase inhibitors. The results obtained can be summarized as follows: 1) In normal non-gravid uterus, the contraction was 25.6mmHg in amplitude and 19.9/10min. in frequency in the proliferative phase, 12.4 and 28.4 in the early half of secretory phase, 28.3 and 11.5 in the latter half, and 42.3 and 12.9 during menstruation. In other words, while the contractions were the most pronounced during menstruation, no difference was found between proliferative and the latter half of secretory phase, and they were the weakest during the early half of secretory phase with the ripple like small waves. 2) During the proliferative phase, relatively regular contractions were found in various kinds of patients, - that is - , patients with normal menstrual cycles, with organic disorders but without dysmenorrhea, with functional dysmenorrhea, or with organic dysmenorrhea. 3) Compared to other menstrual phases, the contractions were weak in the early half of secretory phase. However, the patients with organic dysmenorrhea had stronger contractions than other patients. 4) In the latter half of secretory phase, the patients with organic disorders or organic dysmenorrhea showed stronger contractions than in those without the organic changes, and the contractions were approximately 55mmHg in amplitude in patients with organic change, -almost twice higher than in patients without organic change. 5) During menstruation, patients with dysmenorrhea, functional or organic, showed contractions with the average amplitude of 87mmHg, -more than twice the height found in the patients without dysmenorrhea. 6) When the amplitude was higher then 140mmHg, all the patients complained of pain. 7) In patients with dysmenorrhea, the administration of PG synthetase inhibitors, such as Indomethacin, Naproxen, etc., caused the reduction of contraction amplitude, resulting in the relief of pain.

Female↗
PubMed1999

Ovarian failure and flares of systemic lupus erythematosus.

OBJECTIVE: To study the effects of ovarian failure on disease flares in systemic lupus erythematosus (SLE). METHODS: Fifty-four female premenopausal SLE patients who were under the age of 45 years and treated with continuous oral cyclophosphamide (CYC) for no more than 12 months were studied. All patients had been followed up for >5 years following CYC treatment. Demographic characteristics, clinical and serologic profiles, and information concerning disease flares were recorded. Comparison of the number of severe and mild/moderate flares during the first 5 years after CYC treatment was made between patients who developed CYC-induced ovarian failure and those who did not. RESULTS: Fourteen SLE patients had documented ovarian failure with hypoestrogenemia within 2 years after CYC treatment. Compared with the menstruating group of patients, those who developed ovarian failure were significantly older at the time of CYC therapy (mean 37.9 versus 25.5 years; P < 0.001), but otherwise no significant differences in organ manifestations and autoantibody profiles between the 2 groups were observed. Both the ovarian failure group and menstruating group of patients had similar SLE Disease Activity Index scores at the time of CYC treatment (mean 15.6 versus 17.7; P = 0.16), and had comparable treatment durations (mean 8.2 versus 7.8 months; P = 0.68) and cumulative doses of CYC (mean 20.4 versus 17.9 grams; P = 0.34). Flares of SLE were uncommon during the first year following CYC administration. However, during the 5-year followup period, patients who developed CYC-induced ovarian failure had significantly fewer severe flares (mean 0.014 versus 0.075 flares/patient-year; P = 0.01) and smaller total number of flares (mean 0.128 versus 0.250 flares/patient-year; P = 0.03) when compared with those who were still menstruating. CONCLUSION: This study provides an important clinical observation to support the notion that ovarian failure with hypoestrogenemia is protective against lupus flares and emphasizes the importance of estrogen status in the determination of disease activity in SLE.

Adult↗
PubMedDate not supplied

Menarchal age in Nigerian schoolgirls: its relationship to their height, weight and menstrual profile.

Interviews with 119 students in a girls' residential secondary school in Ondo, Nigeria, revealed that 105 of them had menstruated, their mean age at menarche being 13.85 years, their mean height 156.8 cm and their mean weight 51.13 kg. The duration of menstrual bleeding was 4.43 days, the heaviest occurring at 1.82 days. Dysmenorrhea was reported by 32%. There was no correlation between the weight/height ratio and the mean age of the study group who were menstruating and the 14 students who were not. However, the difference in mean weight and height of those who had and had not attained menarche was significant. It is suggested that certain levels of weight and height are critical to achievement of spontaneous menstruation.

Adolescent↗