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PubMed1982

[Serum ferritin in differential diagnosis of anemia (author's transl)].

The concentration of ferritin in the serum of normal males (n = 79) was 98 micrograms/l (geometric mean) with a 95% confidence range of 21-447 micrograms/l. In non-menstruating healthy females (n = 39), the concentration was 85 (26-279) micrograms/l. In menstruating females, serum ferritin was less than 30 micrograms/l only when the duration of menstruation was more than or equal to 4 days. Patients with uncomplicated iron-deficiency anemia had a serum ferritin level less than 20 micrograms/l. After oral or parenteral iron therapy, serum ferritin was greater than 20 micrograms/l in 7 to 17 patients. Serum ferritin was greater than 20 micrograms/l in 8 of 12 patients with a simultaneous inflammatory or malignant disease. Of patients with iron-deficiency anemia, 86% had a serum ferritin level lower than 40 micrograms/l. A serum ferritin level less than 40 micrograms/l was only observed in patients with iron-deficiency anemia and not in patients with other forms of anemia. Of patients with iron-deficiency anemia and a hemoglobin concentration lower than 100 g/l, 80% had a serum iron level less than 13 mumol/l and a total iron binding capacity higher than 70 mumol/l. Anemia of chronic disorders was diagnosed with a sensitivity of 0.93 and a specificity of 0.92 in patients with serum iron less than 13 mumol/l, total iron binding capacity less than 60 mumol/l, erythrocyte sedimentation rate greater than 25 mm in the first hour, and serum fibrinogen greater than 4 g/l. Somewhat better was the same combination except with the serum ferritin level greater than 50 micrograms/l instead of the iron binding capacity. However the predictive value using both combinations was too low.

Anemia, Hypochromic↗

PubMed2001

Apoptosis in human endometrium: apoptotic detection methods and signaling.

It is generally accepted that apoptosis occurs in human endometrium through the late secretory to menstruating phases. We found that Bcl-2 expression showed a cyclic pattern, peaking during the late proliferative phase. The decreased Bcl-2 in human endometrial glandular cells during the secretory phase was consistent with the appearance of apoptotic cells during the same phase. The expression patterns of both Sp-3 and c-Jun in glandular cells were similar to that observed in Bcl-2. Therefore, Sp-3 and c-Jun could be candidates for bcl-2 transcriptional factors in the human endometrium. In contrast to Bcl-2, both Fas and Fas ligand in glandular cells were coexpressed throughout the menstrual cycle. In particular, glandular cells showed the most intense expression of Fas ligand from the secretory to menstruating phases. The activities of caspase-3, -8 and -9 were higher from the secretory to menstruating phases than during the proliferating phase. We therefore conclude that bcl-2 transcription in glandular cells may be promoted by the binding of several transcriptional molecules to bcl-2 promoter, and the translated Bcl-2 blocks the release of cytochrome c from mitochondria to the cytosol during the proliferative phase. During the secretory phase, glandular cells may undergo apoptotsis via both death-receptor and mitochondrial pathways.

Animals↗

PubMed1988

Nonsteroidal anti-inflammatory drugs and changing attitudes toward dysmenorrhea.

Dysmenorrhea, which may be primary or secondary, is the occurrence of painful uterine cramps during menstruation. Until a decade ago, medical and social attitudes toward dysmenorrhea were shrouded with folklore, psychoanalytical profiles, or psychosomatic bases. In secondary dysmenorrhea, there is a visible pelvic lesion to account for the pain, whereas only a biochemical abnormality is responsible for primary dysmenorrhea. Recent advances in the biochemistry of prostaglandins and their role in the pathophysiology of primary dysmenorrhea and intrauterine device (IUD)-induced dysmenorrhea have now firmly established a rational basis for the disorder. In primary dysmenorrhea, menstrual prostaglandin release is significantly increased but can be readily suppressed to normal levels when nonsteroidal anti-inflammatory drugs (NSAIDs) capable of inhibiting cyclo-oxygenase are given during menstruation. Many clinical trials (controlled and uncontrolled) have demonstrated the efficacy of NSAIDs such as the fenamates, indole-acetic acid derivatives, and arylpropionic acid derivatives in relieving primary dysmenorrhea as well as IUD-induced dysmenorrhea that is also due to elevated prostaglandin levels. With a few of these NSAIDs, it has been shown that the relief of pain is associated with a significant decrease in menstrual fluid prostaglandin levels. Cumulative data of clinical trials indicate that with the effective NSAIDs, 80 percent of patients with significant primary dysmenorrhea can be adequately relieved. Ongoing studies suggest that in some women, endometrial leukotriene, but not PGF2a production, is increased. With the official approval and availability of several effective NSAIDs for the specific treatment of primary dysmenorrhea in the United States, women who have primary dysmenorrhea have been greatly relieved and their productivity increased. Primary dysmenorrhea affects 50 percent of postpubescent women and absenteeism among the severe dysmenorrheics has been estimated to cause about 600 million lost working hours or 2 billion dollars annually. Thus, an effective, simple, and safe treatment of primary dysmenorrhea for two to three days during menstruation will not only have a positive economic impact but will also enhance the quality of life. The availability of effective dysmenorrhea therapy with NSAIDs has induced greater expectations of relief by the patient, as well as greater willingness to seek medical help, a more rational approach to patient management by physicians, changes in attitude toward women with primary dysmenorrhea, and the debunking of myths about dysmenorrhea that often have been perpetuated as fact.(ABSTRACT TRUNCATED AT 400 WORDS)

Absenteeism↗

PubMed1978

Inhibition of menstrual uterine motility during water diuresis.

Induced water diuresis blocks the central release of antidiuretic hormone (ADH) which is, in turn, supposed to play a role in the high uterine activity recorded during human menstruation. In order to further explore this possibility, uterine and antidiuretic activities were studied during water diuresis in 27 normal menstruating women, prior to the insertion of an intrauterine device. Shortly after the initiation of the water overload, simultaneous inhibition of both uterine and antidiuretic activities was obtained. Furthermore, the administration of ADH by intravenous infusion re-established the uterine motility to normal values while the administration of oxytocin did not. It is suggested that ADH has a direct role in the control of uterine activity during human menstruation.

Diuresis↗

PubMed1983

The effect of combined oral contraceptive steroids on the gonadotropin responses to LH-RH in lactating women with regular menstrual cycles resumed.

The effect of combined oral contraceptive steroids upon pituitary response to stimulation with 100 micrograms LH-RH was studied in both non-puerperal and lactating women with regular menstrual cycles. Serum prolactin concentration was 14.20 ng/ml in non-puerperal women whereas it was 39.37 ng/ml in lactating women. A comparability was shown in the LH response to LH-RH in non-puerperal women and lactating women. FSH response to LH-RH, however, was significantly exaggerated in lactating-menstruating women as compared to that of non-puerperal women. Combined oral contraceptive steroids lowered basal levels of LH and FSH in non-puerperal women and lactating women although the difference was not statistically significant in non-puerperal women. The LH and FSH maximal responses to LH-RH were significantly diminished in both non-puerperal and lactating women on combined oral contraceptives. There was, however, no difference in the mean LH or FSH responses between non-puerperal women and lactating women. Combined oral contraceptive steroids used in this study seemed to suppress ovulation by decreasing the pituitary responsiveness to LH-RH in lactating-menstruating women as well as in normally menstruating women.

Contraceptives, Oral↗

PubMed1995

Attitudes and practice of couples regarding sexual relations during the menses and spotting.

To determine attitudes and practices regarding sexual relations during menstruation and vaginal spotting, a cross-sectional descriptive survey was performed at the Instituto de Investigaciones Materno Infantil, Universidad de Chile, Santiago, Chile. A total of 287 women and 206 men were randomly selected from an urban population. Attitudes, beliefs, and practices regarding sexual relations during vaginal bleeding were surveyed and stratified by educational level and other demographic characteristics. Overall, 70% of women and 72% of men were found to avoid sexual relations during menstruation. Fifty-four percent of women and 60% of men avoided sexual relations during vaginal spotting. Women with higher education (technical or university) were less likely to avoid sexual intercourse compared to those with a lower educational level (basic or secondary education) during menstruation (73% vs. 57%) and vaginal spotting (69% vs. 34%). Men with a higher educational level (university) avoided intercourse less frequently when their partner was spotting (48% vs. 64%). As many methods of contraception affect a woman's menstrual cycle, they therefore may affect the intimacy of a couple. Counseling and education regarding the menstrual cycle and expected alterations by a contraceptive method may reduce any negative impact of a contraceptive device on a couple's sexual life.

Adult↗

PubMed1986

Recovery of reproductive function in patients with anorexia nervosa: a 10-year follow-up study.

The recoveries of reproductive function and body weight of 21 patients with anorexia nervosa were studied in a 10-yr period from the time of their first presentation. The recovery rates of both menstruation and eating behavior were 81.0%, although at the end of the study period the rate of amenorrhea (19.0%) was still higher than that (6%) in women in the general population. The change of mean body weight in patients in whom regular menstruation was restored was not significantly different from that of patients in whom amenorrhea persisted. Of the patients, 16 married after treatment and 14 of these (87.5%) became pregnant after spontaneous (11 patients) or induced (3 patients) ovulation, and 12 delivered a baby. The present study suggests that resumption of regular menstruation may not depend only upon body weight gain, and that most patients may be able to have a child after appropriate treatments.

Adult↗

PubMed1976

Prostaglandins, indomethacin and dysmenorrhea.

Uterine contractility was recorded during the period of menstruation in six dysmenorrheic women. A variable high tonus was observed in each case. Uterine recordings were repeated during the subsequent menstruation following pre-treatment with indomethacin at an oral dose of 75 mg or 200 mg per day beginning one day before the expected onset of menstruation. A lower uterine tonus was found in all indomethacin-treated cycles. Complete alleviation of spasmodic pain was obtained in the six subjects. The endogenous concentration of 15-keto-13, 14-dihydro PGF2alpha was determined by the gas chromatography-mass spectrometry method and observed to be relatively high in women with dysmenorrhea.

Diarrhea↗

PubMed1991

Sociocultural aspects of menstrual attitudes and premenstrual experiences in India.

Menstrual attitudes were studied in a group of 48 Indian women using the Menstrual Attitude Questionnaire, modified and adapted for Indian background. Attitudinal factors of menstruation being a natural, bothersome and debilitating event were studied, as also denial of the event and healthy/unhealthy attitudes. High rating was seen in menstruation being perceived as a natural event and least as a debilitating one. Older women considered menstruation as a natural event. Relating premenstrual experiences to attitudes, it was observed that distressful symptoms correlated significantly with debilitating and unhealthy attitudes. Similarly, premenstrual well-being correlated highly with naturalness attitudes, thereby suggesting that the personal experiences are likely to influence the menstrual attitudes.

Adult↗

PubMed1989

Labour pain: correlations with menstrual pain and acute low-back pain before and during pregnancy.

Low-back pain is a major component of labour pain in a substantial number of women. The purpose of this study was to determine whether episodes of acute low-back pain prior to pregnancy is a predictor of low-back pain during labour. 114 women received the Short-Form McGill Pain Questionnaire (SF-MPQ) during labour and were asked to describe the pain separately for front and back contraction pain or continuous pain. The day after the birth of the child the women were interviewed to determine whether they had (a) a history of episodes of acute low-back pain before pregnancy, (b) low-back pain during pregnancy, and (c) low-back pain during menstruation. The results show that episodic low-back pain before pregnancy is not correlated with any aspect of labour pain. However, it is significantly correlated with episodes of low-back pain during pregnancy. In contrast, low-back pain during menstruation is significantly correlated with labour pain scores recorded for back and front contraction pain as well as for continuous back pain. The significant correlation of labour pain with back pain during menstruation suggests that both share a common underlying mechanism. Similarly, the correlation of low-back pain during pregnancy with episodes of acute low-back pain before pregnancy suggests that the strain on back muscles during pregnancy may activate the mechanisms that underlie the usual forms of low-back pain.

Abdomen↗

PubMed1985

Gynaecology of middle-aged women--menstrual and reproductive histories.

The aim of this study was to investigate menstrual history, reproductive functions, fertility regulation and gynaecological operations is a representative sample of middle-aged women. A sample consisting of 1746 women aged 40-66 was randomly selected. Of those initially selected, a total of 1413 (81%) were investigated. Gynaecological data were acquired by means of questionnaires. Eighty-six percent of menstruating women reported a cycle length of 22-30 days and menstrual flows lasting 4-7 days. The median age at natural menopause was 50.9 yr. The oldest menstruating women were 57 yr old. Curettage had been performed in 53%, and 9% were hysterectomised. Every fourth woman had had three or more children, and 15% were nulliparous. Abortion (spontaneous or induced) was reported by 28% of the women. Of 714 menstruating women, 62% were utilising contraceptive methods, among which barrier or natural methods predominated. Nine percent of women aged 40-44 used combined oral contraceptives. Previous or current use of contraceptive pills was reported by 32% of all the women, and of these 20% had been on the pill for 10 or more yr.

Adult↗

PubMed2005

The endocrine and reproductive function of the female Yucheng adolescents prenatally exposed to PCBs/PCDFs.

BACKGROUND: Polychlorinated biphenyls (PCBs) and related compounds such as polychlorinated dibenzofurans (PCDFs) and polychlorinated dibenzo-dioxins (PCDDs) alter sexual maturation and endocrine function in animals. In 1978-1979, a mass poisoning occurred in central Taiwan from cooking oil contaminated by heat-degraded PCBs and oxidated compounds PCDFs. We tested the hypothesis that in utero exposed to PCBs/PCDFs alter sexual maturation, endocrine, and reproductive function in the human pubescent females. METHODS: In 1997-1999, girls aged 13-19 years, born to mothers exposed to PCBs/PCDFs, was invited to participate in the study. Menstruation characteristic was recorded daily for 84 days and serum levels of estradiol, LH, FSH, and testosterone were measured on the 3rd day of menstruation. RESULTS: A total of 17 exposed girls and controls participated, the exposed girls reported shorter mean duration of bleeding per cycle than 16 unexposed (5.5 vs 6.5 days, P=0.0055). There was a higher rate of irregular menstrual cycle in the exposed girls (40% vs 0%, P=0.018). Serum levels of estradiol (P=0.016) and FSH (P=0.061) were higher in exposed girls as compared to controls. CONCLUSIONS: We conclude that prenatal exposure to PCBs/PCDFs resulted in abnormal menstruation and higher estradiol and FSH levels in follicular phase of menstrual cycle in adolescent girls.

Adolescent↗

PubMed2004

Attitude of German women and gynecologists towards long-cycle treatment with oral contraceptives.

Long-cycle regimens with continuous use of oral contraceptives (OCs) for 3 or 6 months followed by a hormone-free interval of 7 days may reduce or prevent cycle-dependent and menses-related complaints. A representative survey carried out with 1195 German women in different age groups revealed that only 26-35% of the women aged between 15 and 49 years preferred monthly bleeding, while 37-46% wished to never bleed. The reasons for the refusal of regular menstruations were fewer severe menstrual complaints, better hygiene, higher quality of life, and less blood loss. Among the women who preferred regular withdrawal bleeding during the use of OCs, the main reasons were fear of pregnancy, infertility and adverse effects, and that menstruations were natural. Between 32% and 54% of the women would suppress menstruation sporadically and 11-14% for a longer period of time. After continuous treatment with a combination of 30 microg ethinyl estradiol and 2 mg dienogest for 6 months, the majority of women preferred the long-cycle regimen as compared to the conventional OC regimen despite a higher rate of irregular bleeding. Bleeding occurred primarily in first-time users of OC, particularly during the administration of the second OC pack. A survey carried out with German gynecologists revealed that most physicians prescribed extended OC cycles primarily for medical reasons, e.g., dysmenorrhea, hypermenorrhea, endometriosis and premenstrual dysphoric disorder. The gynecologists preferred a regimen with three packs of extended use of OCs.

Adolescent↗

PubMed2006

The role of endometrium in endometriosis.

Endometriosis is defined as the presence of endometrial glands and stroma outside the uterus. Several theories have been proposed to explain the pathogenesis of this disease. According to Sampson's retrograde menstruation theory, endometrial cells are refluxed through the fallopian tubes during the menstruation and implant onto peritoneum or pelvic organs. Since retrograde menstruation is a very common phenomenon among women of reproductive age, there must be other factors that may contribute to the pathophysiology and/or pathogenesis of endometriosis. Genetic predisposition, environmental factors, and alterations in immune and endocrine functions are believed to play significant roles in the establishment and maintenance of endometriosis. Although the eutopic endometriums of women with and without endometriosis are histologically similar, studies revealed that there are many fundamental differences between these two tissues. Invasive properties, decreased apoptosis, alterations in expression of specific gene and proteins, and increased steroid and cytokine production have been identified in eutopic endometrium of women with endometriosis. Furthermore, significant biochemical differences exist even between ectopic and autologous eutopic endometrium. These differences can be explained by the direct effects of an inflammatory peritoneal environment.

Cell Adhesion↗

PubMed2004

Endometriosis: the consequence of neurological dysfunction?

Endometriosis describes endometrium found outside the uterine cavity and is frequently associated with clinical presentations of chronic pelvic pain, dysmenorrhoea, dyspareunia and subfertility. It was originally attributed to retrograde menstruation with endometrium passing in a reverse direction along the Fallopian tubes into the peritoneal cavity though this theory does not account for the spectrum of intrapelvic findings. Denervation followed by reinnervation in the uterine isthmus is proposed as the primary source of clinical symptoms, and, retrograde menstruation with adhesion of endometrium to injured tissue surfaces the variable laparoscopic findings. Primary sources of denervation are difficult intrapartum episodes (parous women) and persistent straining to achieve defaecation (nulliparous women). Progressive reinnervation including stromal nerve fibre proliferation, microneuroma formation and periarterial nerve fibre proliferation, takes place over five to ten years. Damage to uterine innervation interrupts normal patterns of uterine contractility, causing loss of fundocervical polarity which promotes retrograde menstruation. Ectopic endometrium may be a marker for prior tissue damage and does not contribute to the clinical symptoms--the disease may have been largely defined by an epiphenomenon.

Clinical Trials as Topic↗

PubMed1996

The hypothalamus-pituitary-ovary and hypothalamus-pituitary-thyroid axes in spinal cord-injured women.

Sixteen women with spinal cord injury (SCI) underwent studies of the hypothalamus-pituitary-ovary (HPO) and hypothalamus-pituitary-thyroid (HPT) axes with luteinizing hormone (LH) releasing hormone (LHRH) and thyrotropin (TSH) releasing hormone (TRH) stimulation tests during the early follicular phase. The mean interval from injury to participation in this study was 7.5 years (range, 1.5 to 13.1). All subjects were menstruating regularly. Five (35.7%) SCI subjects who were menstruating before injury had postinjury amenorrhea for 1 to 12 months, and the other nine (64.3%) SCI subjects had no interruption of menstruation after injury. Two SCI subjects whose injury occurred in preadolescence proceeded to menarche without any delay. The amount of menstrual flow was noted to be reduced in nine (64.3%) SCI subjects. Two and three SCI subjects had elevated follicle-stimulating hormone (FSH) and prolactin (PRL) levels, respectively. LH responses to LHRH were significantly higher in the SCI group (P < .001). Ten (62.6%) SCI subjects had enhanced LH responses to LHRH. The mean TSH, PRL, and FSH responses to TRH and LHRH of the SCI group were not significantly different from those of age-matched controls. However, five (31.2%), four (25.0%), and five (31.2%) SCI subjects had enhanced TSH, PRL, and FSH responses to TRH and LHRH, respectively. Six (37.5%) SCI subjects had a delayed FSH response to LHRH. In total, 13 (81.2%) SCI subjects had at least one axis abnormality. These findings are consistent with the hypothesis that changes of central neurotransmitters may occur after SCI.

Adolescent↗

PubMed1975

Migraine and reporoductive hormones throughout the menstrual cycle.

In a clinical survey the relation between migraine and menstruation was studied in 142 otherwise healthy women. In 24, onset of migraine coincided with the year of menarch. Of the 138 patients in whom onset of migraine predated the menopause, there were only 13 in whom attacks occurred regularly, and only, just before or during menstruation; in a further 11 attacks occurred regularly in relation to menstruation and at other times. Those with menstrually related migraine were more likely to have onset of migraine at menarche, to have associated weight gain and breast discomfort as part of a periodic syndrome, and to show improvement during pregnancy. There appeared no clear pattern of change at the menopause. In a study of reproductive hormones, blood was collected daily throughout a menstrual cycle from each of 8 women with menstrually related migraine, 6 with menstrually non-related migraine, and 8 healthy headache-free controls. Plasma levels of follicle-stimulating hormone (F.S.H.), luteinising hormone (L.H.), prolactin, oestrogen, and progesterone were measured in all. Plasma-testosterone was measured in 8 migraine patients. Mean plasma oestrogen and progesterone levels were significantly higher in migraine patients than controls for most of the menstrual cycle, with the most striking differences found in the late luteal phase for progesterone. No significant difference was found between the menstrually related and non-related patients for these or the other hormones measured. Mean plasma-prolactin levels were lower in migraine subjects than controls, but the difference was not significant. Mean plasma F.S.H. and L.H. levels were similar in both migraine and control groups. Plasma-testosterone levels were within the range for normal in the 8 migraine patients studied. No specific hormone changes were associated with the occurrence of a migraine attack, nor did rising or falling levels, or greater increments of change over given cycle phases, appear important in provoking attacks.

Adolescent↗

PubMed1997

Gynecologic and reproductive issues in women on dialysis.

Most women on dialysis are amenorrheic and do not ovulate, but little information about menstrual patterns in women on dialysis exists, especially since the introduction and use of recombinant human erythropoietin, a therapy that may improve sexual interest and function. In this study, women who were < or = 55 years of age at the start of dialysis (n = 76) completed questionnaires and form the study group. Women older than 55 years at the start of dialysis did not complete the entire questionnaire (n = 115), but their medication records were reviewed for estrogen replacement therapy. The questionnaire asked about pregnancies, menstrual periods (regularity, frequency, duration, character of flow, menopause), and menopause before beginning dialysis and currently. Women also responded to questions about sexual activity, use of birth control, contraception counseling by physicians, yearly Papanicolaou smears, and mammograms. Demographic data (age, race, age at the time dialysis started, mode of dialysis, use of recombinant human erythropoietin, and history of renal transplant) were also obtained through the questionnaires. Fifty-nine percent of the 76 women who completed the study were white and had been on dialysis a median of 3 years (range, 0.1 to 18 years). The median age was 43 years, 68% were on hemodialysis, 90% were receiving recombinant human erythropoietin, and 70% had been pregnant (a total of 179 pregnancies; four pregnancies in four women occurred after the start of dialysis). Significantly more women were menstruating before dialysis started than currently (63% v 42%; P < 0.025), but the difference could be explained by patient age: currently menstruating women were younger (37 +/- 9 v 46 +/- 11 years; P = 0.0002). More women reported menstrual regularity before beginning dialysis (75% v 42% currently; P < 0.005), but there were no differences in number of days between or number of days of menstruation before beginning dialysis and currently. Menstrual flow was reported as heavier currently by more women (64% heavy flow with clots v 38% before dialysis started; P < 0.05). The median age at menopause was 47 years; 28% of the women were postmenopausal. Fifty percent of the women were sexually active, but only 36% used birth control. Discussions between the women and their nephrologist about possible pregnancy and contraception were reported by only 13% of women. Sixty-three percent of the women reported having yearly Papanicolaou smears and 73% had had a mammogram. Only 5% of the 113 women who were older than 55 years when they began dialysis were receiving estrogen replacement therapy. Amenorrhea was reported in this study by a smaller proportion of women than in studies conducted before the introduction of recombinant human erythropoietin. The possibility that erythropoietin may restore normal hormonal cyclic function in women with end-stage renal disease requires further study. Nephrologists as well as primary care physicians and gynecologists need to focus more on the gynecologic concerns of women on dialysis, including the potential for pregnancy. The effects of estrogen replacement on atherosclerosis and osteoporosis, and consideration of such therapy in women on dialysis warrants attention.

Adolescent↗