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Clinical relevance of the baboon as a model for the study of endometriosis.

OBJECTIVE: To review the value of the baboon as a model for the study of endometriosis. DATA IDENTIFICATION AND SELECTION: Studies performed at the Institute of Primate Research in Nairobi, Kenya (1990-1994), and published in peer-reviewed journals. RESULT(S): Spontaneous endometriosis was found in about 25% of the baboons, and its prevalence increased with the duration of captivity. The laparoscopic appearance, pelvic localization, and microscopic aspects of the disease were similar to endometriosis in women. Microscopic endometriosis in macroscopically normal peritoneum was rare. Sampson's hypothesis (i.e., retrograde menstruation causes endometriosis) was supported by the increased incidence of retrograde menstruation in baboons with spontaneous endometriosis, the observation that cervical occlusion could cause retrograde menstruation and endometriosis, and the finding that intrapelvic injection of menstrual endometrium caused experimental moderate to severe endometriosis similar to the spontaneous disease. During follow-up of more than 2 years, endometriosis in baboons appeared to be a progressive disease, with active remodeling between several types of lesions. Progression was stimulated by high-dose immunosuppression. Fertility was normal in baboons with minimal disease but was reduced in baboons with mild, moderate, or severe endometriosis, possibly related to an increased incidence and recurrence of the luteinized unruptured follicle syndrome. CONCLUSION(S): The baboon is a good model for the study of endometriosis.

Animals↗

Effects of pretreatment with an oral contraceptive on the time required to achieve pituitary suppression with gonadotropin-releasing hormone analogues and on subsequent implantation and pregnancy rates.

OBJECTIVE: To assess the effect of pretreatment with an oral contraceptive (OC) on ovarian cyst formation during pituitary suppression with buserelin acetate. DESIGN: Prospective randomized trial. SETTING: Academic medical center. PATIENT(S): Eighty-three patients who were undergoing IVF-ET treatment. INTERVENTION(S): Patients in the study group were pretreated with an OC for 14 days starting on the first day of menstruation. The administration of SC buserelin acetate was initiated on the last day of OC administration. Patients in the control group began to receive buserelin acetate on day 2 of menstruation. Hormonal assays and ultrasound scans were performed on the first day of menstruation, and 7, 11, and 14 days after the commencement of buserelin acetate administration. Thereafter, these tests were performed weekly until pituitary suppression was achieved. MAIN OUTCOME MEASURE(S): Incidence of cyst formation. RESULT(S): A cyst developed in 27 patients in the control group (52.9%) and no patients in the study group (odds ratio [OR]=115; 95% confidence interval [CI]=10-617). Patients in the study group achieved pituitary suppression faster (median difference [MD]=7 days; 95% CI=4-14) and required fewer ampules of gonadotropin (MD=10; 95% CI=6-14). They recruited more follicles (MD=3; 95% CI=0-5) and had higher pregnancy rates (37.2% versus 33.3%). CONCLUSION(S): Pretreatment with an OC abolishes ovarian cyst formation, shortens the time required to achieve pituitary suppression, and decreases gonadotropin requirements without having a negative effect on pregnancy rates.

Adult↗

Menstrually related worsening of symptoms in multiple sclerosis.

The objective of this study was to investigate whether the menstrual cycle influences multiple sclerosis (MS) symptoms. Seventy-two normally menstruating women (aged 20-50 years) with MS were interviewed. Of the 60 patients with a relapsing-remitting form of MS (RR-MS), 26 (43%) regularly experienced worsening of their MS symptoms in the period just before, or at the beginning of, the menstruation. Significantly more patients of the group reporting no influence of the premenstrual period on MS symptoms were using an oral contraceptive (p=0.041), suggesting a protective effect. There were 12 patients with the primary chronic progressive form of MS (PCP-MS). None of them experienced an influence of the menstrual cycle on their symptoms. Our results suggest that hormonal changes preceding menstruation may worsen symptoms in a subgroup of women with RR-MS.

Adult↗

Alcohol consumption and age of maternal menopause are associated with menopause onset.

OBJECTIVES: To examine whether a number of nutritional and familial factors were associated with menopausal development. METHODS: A prospective postal survey amongst a random sample of 1227 women aged 47 to 51 who were premenopausal in a cross-sectional survey 2 years previously. Women were classed into three groups; premenopause (regular menstruation); irregular menstruation; postmenopausal (absence of menstrual cycle for at least 6 months). Proportional odds regression was used to identify those factors which were independently predictive of subsequent menopausal development. RESULTS: There was an 80% (n = 983) survey response rate. After exclusion of current HRT users (n = 178); 150 (19%) women were postmenopausal, 277 (34%) had erratic menstruation and 378 (47%) were premenopause. There were significant univariate associations between menopausal status and age (P < 0.001), age of maternal menopause (P = 0.006), alcohol consumption (P = 0.005) and social class (P = 0.03). Maternal age and alcohol consumption were significantly correlated with estradiol levels (r = 0.45, P = 0.02, and r = 0.61, P = 0.02 for maternal age and alcohol consumption, respectively). In proportional odds regression analyses, age, maternal menopausal age, alcohol consumption and smoking were independently associated with menopausal status. CONCLUSIONS: These results suggest that, (1) there is a strong familial association in menopausal age, and (2) moderate consumption of alcohol is associated with delayed menopausal development.

Age Factors↗

Impaired ovarian function and risk factors for atherosclerosis in premenopausal women.

OBJECTIVES: The aim of the study was to obtain information on the possible relationship between impaired ovarian function and risk factors for cardiovascular disease. MATERIAL AND METHODS: Serum lipid levels, plasma fibrinolytic potential and histological and biochemical changes in the intima of the uterine artery were investigated in premenopausal women with irregular menstrual cycles, and the results were compared with those from regularly menstruating women. In addition, the same parameters were studied in postmenopausal women on hormone replacement therapy (HRT) and in postmenopausal women who had never used HRT. In total 64 patients undergoing hysterectomy for benign reasons were included the study. RESULTS: Plasma fibrinogen concentration was significantly higher in irregularly menstruating women as compared with women with regular cycles. In women with irregular cycles thickened or sclerotic arterial intima was a significantly more common finding as compared with regularly menstruating women. A significant positive correlation was observed between plasma fibrinogen concentration and intimal esterified cholesterol content in women with thickened or sclerotic uterine artery. CONCLUSIONS: These data suggest an important role for normal ovarian function in the prevention of atherosclerosis.

Adult↗

Pathogenesis of endometriosis.

Endometriosis is a common gynecologic disorder characterized by the presence of endometrial tissue outside the uterine cavity. Various theories have been put forth to explain the mechanisms for the development of this disease. Although no single theory can explain all cases of endometriosis, the retrograde menstruation theory has gained the widest acceptance. This theory proposes that viable endometrial tissue is refluxed through the fallopian tubes during menstruation and implants on peritoneal surface or pelvic organs. Retrograde menstruation occurs in 76% to 90% of women. The much lower prevalence of endometriosis suggests that additional factors determine susceptibility to endometriosis. Once in the peritoneal cavity, the survival and implantation of endometrial cells seem to be mediated by abnormal MMP and TIMP expression, altered immune milieu, aberrant local aromatase activity, and genetic and environmental factors.

Endometriosis↗

Physiological and pathological changes of plasma urokinase-type plasminogen activator, plasminogen activator inhibitor-1, and urokinase-type plasminogen activator receptor levels in healthy females and breast cancer patients.

The plasma urokinase-type plasminogen activator (uPA), plasminogen activator inhibitor-1 (PAI-1), and urokinase-type plasminogen activator receptor (uPAR) levels were measured in healthy volunteers and breast cancer patients. In pre-menopause healthy females, blood was sampled weekly during one menstruation cycle and menstruation phases (follicular, ovulatory, luteal) were determined by FSH/LH levels. uPA, PAI-1, and uPAR levels were at the nadir during ovulatory phase. uPA level was highest at follicular phase while PAI-1 level was highest at luteal phase. In comparison between pre- and post-menopause states, uPA and uPAR levels were higher in post-menopause state while PAI-1 level was higher in pre-menopause state. In breast cancer patients, uPA, PAI-1, and uPAR positive rates were low when we use the menopause-state-unmatched cut-off points. As we adjusted the cut-off points by menopause states, the PAI-1 positivity increased mainly in post-menopause cancer patients. These findings suggest that there is a minor but possible sequential change of these molecules during menstruation cycle which might blur the pathological positivity in pre-menopause cancer patients. The pathological elevation of PAI-1 was well detected in post-menopause cancer patients, but this elevation did not correlate with tumor burden such as number of metastatic sites or metastatic location. In conclusion, adjustment of physiological changes of uPA, PAI-1, and uPAR is required in determining pathological elevation of the plasma levels in cancer patients, especially in females.

Adult↗

Obesity, rather than menstrual cycle pattern or follicle cohort size, determines hyperinsulinaemia, dyslipidaemia and hypertension in ageing women with polycystic ovary syndrome.

OBJECTIVE: The aim of this study was to investigate if ageing women with polycystic ovary syndrome (PCOS) who gained regular menstrual cycles differed from women who continued to menstruate irregularly with regard to risk factors for developing diabetes mellitus and atherosclerosis. DESIGN AND PATIENTS: In the original study of a population of 346 PCOS patients, defined in the past as having oligo- or amenorrhoea and elevated LH concentrations, we had sent out a questionnaire to investigate changes in the pattern of their menstrual cycles while ageing. From this cohort of patients, a significantly older group of 53 women (mean age: 41.3 years, range: 33.3-49.4) who were not using oral contraceptives or other hormones visited the outpatient clinic. These women did not differ from the non-participating group in BMI, ethnic origin, the proportion with regular menstrual cycles by age group, parity or the use of clomiphene citrate or gonadotrophins in the past. MEASUREMENTS: A physical examination and a transvaginal ultrasound were performed. The size of the follicle cohort was determined by counting the number of small follicles in the ovaries. Thirty-four women were also willing to give two fasting blood samples for measuring their glucose, insulin and lipid status. RESULTS: Forty-one of the 53 (77.4%) women had a regular menstrual cycle (shorter than 6 weeks) and 12 (22.6%) had an irregular cycle (longer than 6 weeks). The body mass index (BMI), waist: hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and prevalence of diabetes (1-9%) and hypertension (11.3%) did not differ between the two menstrual cycle groups. Also, the fasting glucose, insulin, glucose/insulin ratio, total cholesterol, HDL-c, and LDL-c concentrations did not show any significant difference between the two groups. Instead, these parameters all were significantly higher in women with a BMI > 27 kg/M2 compared to women with a BMI < or = 27 kg/m2. Regularly menstruating PCOS women were older (P < 0.01), showed less follicles in their ovaries (n = 48, P < 0.01) and had lower androgens (n = 34, P < 0.05) than the irregularly menstruating women. Logistic regression analysis showed a second significant influence, after age, of the BMI on the menstrual cycle pattern (age, P < 0.01; BMI, P < 0.05). If age was excluded from the analysis, only the follicle count significantly predicted the menstrual cycle pattern (P < 0.02). CONCLUSIONS: We conclude that hyperinsulinaemia, dyslipidaemia and hypertension in our population of ageing women with polycystic ovary syndrome are not related to the menstrual cycle pattern but rather to obesity. Age and the size of the follicle cohort are the main factors determining the menstrual cycle pattern in ageing women with polycystic ovary syndrome, although an association with the BMI was also found.

Adult↗

Seizure occurrence during ovulatory and anovulatory cycles in patients with temporal lobe epilepsy: a prospective study.

We investigated the influence of ovulatory and anovulatory menstrual cycles on seizure occurrence in female patients with complex partial seizures. We prospectively documented seizures in relation to menstrual cycles (defined by measurement of basal body temperature and progesterone serum concentrations) in 39 female patients. One hundred and thirty-two cycles of 35 patients entered final analysis. Only eight patients had anovulatory cycles, in 18 patients all cycles were ovulatory. In the remaining nine patients anovulatory as well as ovulatory cycles were documented. In ovulatory cycles the mean frequency of seizures during the days of menstruation was significantly higher as compared to the periovulatory or the luteal phase of the cycles. During anovulatory cycles seizure frequency was significantly lower during menstruation than in the remaining days of the cycles. Since progesterone is known to exhibit anticonvulsant effects, seizure occurrence during menstruation seems to be related to ovulatory cycles, possibly due to the premenstrual decrease of progesterone. Therapeutic recommendations for the treatment of seizures related to the menstrual cycle (catamenial seizures) include the administration of hormones, as progesterone (recommended especially for women with catamenial epilepsy who have a documented inadequate luteal phase) or the suppression of the menstrual hormonal cycle by synthetic gonadotropin releasing hormone analogs.

Journal Article↗

Hyperandrogenism in girls with juvenile neuronal ceroid lipofuscinosis.

Acne and hirsutism are common findings in girls with juvenile neuronal ceroid lipofuscinosis (JNCL). A study on their hormonal status was conducted to investigate the mechanisms underlying these symptoms. Sixteen girls with JNCL entered the study. Ten of the girls had periodic menstruation, while three were given medroxyprogesterone acetate therapy to prevent menstrual bleeding, and three had earlier undergone an ovariectomy. Ten age- and weight-matched healthy girls served as controls. Age at menarche, menstrual cycle length, acne, and hirsutism were assessed. Extensive hormonal laboratory tests were made in the early follicular phase. In addition, 1.5 Tesla magnetic resonance imaging of the lower abdomen was performed to search for structural abnormalities of the ovaries. The mean age at menarche in these JNCL patients was 11.6 years. Of the patients with periodic menstruation, four of ten had irregular (prolonged) cycles, but, in patients with regular cycles, the mean ovarian cycle was short (26 days). Hyperandrogenism, characterized by acne, hirsutism and/or hyperandrogenaemia, was found significantly more often in the patients than in the controls (p<0.01). No significant differences were found in the laboratory parameters. Polycystic ovaries were found in two of seven of the patients who menstruated, but in none of the healthy controls. Hyperandrogenism is common in patients with JNCL. In addition, there is an early menarche and signs of anovulation. The factors underlying these hormonal changes seem complex, possibly including a neurodegenerative process, the obesity associated with JNCL, and the drugs used for symptomatic treatment of the patients.

Acne Vulgaris↗

Lung function changes in relation to menstrual cycle in females with cystic fibrosis.

Oestrogen and progesterone have been shown to have impact on cystic fibrosis transmembrane conductance regulator (CFTR) gene expression, tone of smooth muscle in the airways, immune response, exhaled nitric oxide and cytology in the tracheobronchial epithelium. The aim of this investigation was to study the influence of menstrual cyclicity on airway symptoms among cystic fibrosis (CF) females. Twelve CF women (mean age 30 years, mean Shwachman score 85) kept daily records during three menstrual cycles of lung function, sputum quality and need for intravenous antibiotics. Paired t-test was used as a statistical method to compare the airway symptoms between the time of ovulation (high levels of oestrogen and low levels of progesterone), the luteal phase (high levels of oestrogen and progesterone) and menstruation (low levels of oestrogens and progesterone). Forced expiratory volume in 1 sec (FEV1) was significantly higher during the luteal phase (66% of predicted) compared to during ovulation (63%) and menstruation (61%) (P<0.01). Forced vital capacity (FVC) showed the same pattern, being significantly higher during the luteal phase compared with during menstruation (mean 75% vs. 70%, P<0.01). In conclusion, lung function changes were found during menstrual cycles in women with cystic fibrosis. These changes are probably related to changes in progesterone levels during the menstrual cycles. This result warrants further studies to understand the complexity of CF lung disease in women.

Adolescent↗

Nutritional anaemia in pregnant Beninese women: consequences on the haematological profile of the newborn.

An assessment of iron and folic acid status, blood thick film and haemoglobin (Hb) electrophoresis was performed on 126 pregnant women (and their newborn infants) and in ninety-five menstruating women in Cotonou (Benin). Anaemia (according to the World Health Organization (1972] was observed in 55% of pregnant women and in 39% of menstruating women. Fe-deficiency was defined as a low serum ferritin concentration (12 micrograms/l or less), combined with a low transferrin saturation (less than 16%) or a high erythrocyte protoporphyrin level (more than 3 micrograms/g Hb), or both. A moderate elevation in the serum ferritin concentration (between 13 and 50 micrograms/l), associated with a low transferrin saturation or a high erythrocyte protoporphyrin level, or both, indicated Fe-deficiency in an inflammatory context. Fe-deficiency was present in 73% of pregnant women and in 41% of menstruating women. Folate deficiency (defined as erythrocyte folate below 160 micrograms/l) was observed in 45% of pregnant women. In pregnant women, anaemia was associated with Fe-deficiency in 83% of cases and with folate deficiency in 48% of cases. Haemoglobinopathies were mainly heterozygous and did not seem to contribute significantly to anaemia. Intensity of malaria was not related to Hb level, but Plasmodium falciparum was found in 99% of subjects. Hb concentration and mean corpuscular volume were significantly lower in babies born of Fe-deficient mothers than in babies born of Fe-sufficient mothers. Hb concentration in newborn infants was positively correlated with maternal serum ferritin.

Adolescent↗

A double-blind treatment study of bacterial vaginosis with normal vaginal lactobacilli after an open treatment with vaginal clindamycin ovules.

The expected 4-week cure rate after conventional treatment of bacterial vaginosis are only 65-70%. In an attempt to improve the cure rate by adding probiotic lactobacilli we performed a double-blind placebo-controlled study of adjuvant lactobacilli treatment after an open treatment with vaginal clindamycin ovules. Women with bacterial vaginosis as defined by Amsel's criteria were treated with clindamycin ovules. Vaginal smears were collected and analysed according to Nugent's criteria. During the following menstruation period the women used, as an adjuvant treatment, either lactobacilli-prepared tampons or placebo tampons. The lactobacilli tampons were loaded with a mixture of freeze-dried L. fermentum, L. casei var. rhamnosus and L. gasseri. The cure rate was recorded after the second menstruation period. There was no improvement in the cure rate after treatment with lactobacilli-containing tampons compared to placebo tampons; the cure rates as defined by Amsel's criteria were 56% and 62%, respectively, and 55% and 63%, as defined by Nugent's criteria. This is the first study to report cure rates for women with 'intermediate' wet smear ratings according to Nugent's classification and this group had an overall cure rate of 44%. The cure rate of treatment of bacterial vaginosis was not improved by using lactobacilli-prepared tampons for one menstruation.

Administration, Intravaginal↗

Bleeding disorders among young women: a population-based prevalence study.

BACKGROUND: Bleeding problems are prevalent in the general population but may indicate a general bleeding disorder. Our aim was to describe the prevalence of perceived bleeding symptoms, including menorrhagia, in young healthy females. METHODS: By aid of school nurses we distributed a questionnaire to all girls (n =1,410) in the first grade of the upper secondary schools in the town of Malmö, Sweden. We received 1,019 (72%) responses. The questionnaire consisted of 17 main questions addressing general bleeding problems, menses and menstrual bleeding problems, family history, and other health related questions. RESULTS: The mean age of the girls was 16.7 years. Eight girls had a previously diagnosed bleeding disorder and had a higher frequency of most bleeding symptoms. Seventy-three percent of girls experienced at least one bleeding symptom, 43% had more than one symptom, 23% were troubled by more than two symptoms, and 10% more than three symptoms. Thirty-seven percent experienced heavy menstruation and of these 22% had different drugs as treatment for menorrhagia. Thirty-eight percent had a family history of heavy menstruation and half of them suffered from heavy menstruation themselves. CONCLUSIONS: Bleeding symptoms were relatively prevalent in this population and similar to other population-based studies.

Adolescent↗

Prevalence of daily breakfast intake, iron deficiency anaemia and awareness of being anaemic among Saudi school students.

Iron deficiency anaemia is one of most prevalent nutritional disorders worldwide. It is known to affect the health and cognitive ability of children and adolescents. Studies in Saudi Arabia concentrate only on the population of young children and pregnant females or girls. Studies on the whole school student population is lacking. The objectives of this study were to identify the nutritional habits and the prevalence of anaemia among school students in Jeddah, as well as to recognize the students' awareness of their anaemic nutritional status. Data were collected from a sample of Saudi school children in Jeddah City from 42 boys' and 42 girls' schools during the month of April 2000. Data collection was done by an in-person interview to collect socio-demographic factors, nutritional habits, weight and height. Haemoglobin was measured in a sample of 800 students selected at random from both genders and different age groups. Anaemia was defined according to the new WHO cut-off levels for haemoglobin as: blood haemoglobin <11.5 g/dl for the 5-11 years boys and girls; <12.0 g/dl for 12-14 years boys and girls; <12.0 g/dl for 15+ girls and <13.0 g/dl for 15+ years boys. Proportion and 95% confidence intervals (CI) were calculated and significance was considered when the 95% CI did not overlap. Anaemia was reported among 20.5% of school students. Anaemia was more prevalent among students of at least 12 years as compared to the younger age group. Also, anaemia was more marked among governmental school attendees and those born to low-educated mothers. Menstruating girls were at around double the risk of being anaemic than non-menstruating girls. Anaemia was associated with negative impact on school performance and was more marked among those who failed their exams as compared to students with excellent results. Skipping breakfast was reported by 14.9% of students and this habit did not differ by age, sex, body mass index or social class. Skipping breakfast was more marked among students with poor school performance as compared to those with very good or excellent results. Only 34.1% of anaemic school students were aware of being anaemic. Awareness was nearly equal in all age groups and social classes but girls were more aware of their anaemic status than boys. Iron deficiency anaemia appears to be prevalent among school students. At age 12 years and over, low social class and menstruating girls constitute the high-risk groups. Screening is recommended for high-risk groups and school health programs are crucial to improve students' nutritional habits, knowledge and awareness.

Adolescent↗

Airway inflammation in premenstrual asthma.

Premenstrual asthma (PMA) is a clinical picture with worsening of asthmatic symptoms and pulmonary functions in the late luteal phase of the menstrual cycle. The aim of this study was to evaluate the inflammatory changes in asthmatic women who complain of PMA. Forty asthmatic women attending our outpatient clinic were questioned about worsening of their asthma before menstruation. Eleven women (aged 17-40) who complained of PMA participated in the study. Subjects were asked to record peak expiratory flow rates, symptom scores, and beta-agonist use daily. After the first menses on the seventh day of their cycle, and before the onset of the next menstruation, on the 26+/-3rd day of the cycle, patients were evaluated with pulmonary function tests, methacholine challenge test, and fractionated exhaled nitric oxide (FE(NO)) levels. Eosinophils in peripheral blood and induced sputum were also evaluated. When comparing the two groups of results, the significant changes were in FENO levels, day-time symptom scores, and eosinophils in induced sputum (29.25 ppb/9.16 ppb p < 0.05, 1/0.45 p = 0.05, %6.63/%4.09 p < 0.01, respectively, before and after menstruation). These results show that PMA is not only a clinical picture with a decrease in airway calibre that can be related to the regulation of 2 receptors, but also a complex state with worsening of airway inflammation.

Adolescent↗

The effect of a levonorgestrel-releasing intrauterine system on uterine artery blood flow, hormone concentrations and ovarian cyst formation in fertile women.

To determine the effect of long-acting intrauterine progestin on the impedance to blood flow in the uterine arteries, we applied a levonorgestrel-releasing (20 microg/day) intrauterine contraceptive system (LNG-IUS) to the uterine cavity of 27 fertile, regularly menstruating women. Measurements were performed using transvaginal colour Doppler ultrasonography in the mid-luteal phase and on day 1 of menstruation in the absence of the LNG-IUS and 3 months later in its presence. The mean (SD) mid-luteal uterine artery pulsatility index (PI) had risen from a pretreatment level of 2.28 (0.48) to 2.70 (0.67) after 3 months use of the LNG-IUS (P < 0.01), but as regards day 1 of menstruation, no change was observed. The increase in the mean PI (SD) at the mid-luteal phase was present only in subjects with serum levonorgestrel concentrations >200 pg/ml (n = 16) [pretreatment, 2.25 (0.47); with LNG-IUS, 2.83 (0.59), P < 0.001], and absent in those with serum levonorgestrel concentrations <200 pg/ml (n = 10) [pretreatment, 2.31 (0.53); with LNG-IUS, 2.51 (0.79), ns]. Mean progesterone concentrations were lower with the LNG-IUS in place in both groups. We conclude that a levonorgestrel-releasing intrauterine device appears to increase the impedance to blood flow in the uterine arteries during the mid-luteal phase in correlation with serum concentrations of LNG and a concomitant decrease in serum progesterone concentrations.

Adult↗

Fluctuations in CA 125 and CA 15-3 serum concentrations during spontaneous ovulatory cycles.

The aim of this study was to investigate cycle dependent changes of serum CA 125 and CA 15-3 concentrations during spontaneous ovulatory cycles. Twenty apparently healthy women with spontaneous menstrual cycles attending our infertility clinic were included. Of these women, 18 had occluded tubes as a result of sterilization. Ovulation was confirmed by luteinizing hormone test and ultrasonography and, to exclude endometriosis, a laparoscopy was performed. Serum samples for CA 125, CA 15-3, 17 beta-oestradiol and progesterone determinations were taken every second day starting on the 2nd day of the cycle until the 7th day of the next cycle. After correction for inter-individual variation in serum concentrations, highest CA 125 concentrations were found during the menstruation. During the follicular and peri-ovulatory phase CA 125 serum concentrations were lowest. For CA 15-3, serum concentrations were not statistically different throughout the cycle. CA 125 and oestradiol concentrations were negatively correlated, CA 15-3 and oestradiol concentrations were positively correlated. Absolute serum concentrations of both CA 125 and CA 15-3 vary among females. Within the female, fluctuations of CA 125 are phase related. In the population studied most of the patients had tubal obstruction and high CA 125 serum concentrations during menstruation, which revokes the theory that the menstrual rise of CA 125 is due only to retrograde menstruation.

Adult↗