Days Of Menstrual Bleeding Research Articles

On the frequency of intercourse around ovulation: evidence for biological influences.

Intercourse in mammals is often coordinated with ovulation, for example through fluctuations in libido or by the acceleration of ovulation with intercourse. Such coordination has not been established in humans. We explored this possibility by examining patterns of sexual intercourse in relation to ovulation. Sixty-eight sexually active North Carolina women with either an intrauterine device or tubal ligation provided data for up to three menstrual cycles. These women collected daily urine specimens and kept daily diaries of intercourse and menstrual bleeding. Major estrogen and progesterone metabolites excreted in urine were used to identify the day of ovulation. The fertile days of the cycle were defined as the 6 consecutive days ending with ovulation. Women contributed a total of 171 ovulatory cycles. Menstrual bleeding days were excluded from analysis. The frequency of intercourse rose during the follicular phase, peaking at ovulation and declining abruptly thereafter. The 6 consecutive days with most frequent intercourse corresponded with the 6 fertile days of the menstrual cycle. Intercourse was 24% more frequent during the 6 fertile days than during the remaining non-bleeding days (P < 0.001). There apparently are biological factors that promote intercourse during a woman's 6 fertile days.

Benefit-Risk Assessment of the Levonorgestrel Intrauterine System in Contraception

The levonorgestrel-releasing intrauterine system (IUS) is a long-acting, fully reversible method of contraception. It is one of the most effective forms of contraception available, and combines the advantages of both hormonal and intrauterine contraception. The levonorgestrel-releasing IUS also gives the users many non-contraceptive benefits: the amount of menstrual bleeding and the number of days of menstrual bleeding are reduced, which makes it suitable for the treatment of menorrhagia (heavy menstrual blood loss). Dysmenorrhoea (painful menstruation) and premenstrual symptoms are also relieved. In addition, the levonorgestrel-releasing IUS provides protection for the endometrium during hormone replacement therapy. The local release of levonorgestrel into the uterine cavity results in a strong uniform suppression of the endometrial epithelium as the epithelium becomes insensitive to estradiol released from the ovaries. This accounts for the reduction in menstrual blood loss. All possible patterns of bleeding are seen among users of the levonorgestrel-releasing IUS; however, most of the women who experience total amenorrhoea continue to ovulate. The first months of use are often characterised by irregular, scanty bleeding, which in most cases resolves spontaneously. The menstrual pattern and fertility return to normal soon after the levonorgestrel-releasing IUS is removed. The contraceptive efficacy is high with 5-year failure rates of 0.5-1.1 per 100 users. The absolute number of ectopic pregnancies is low, as is the rate per 1000 users. The levonorgestrel-releasing IUS is equally effective in all age groups and the bodyweight of the user is not associated with failure of the method. In Western cultures continuance rates among users of the levonorgestrel-releasing IUS are comparable with those of other long-term methods of contraception. Premature removal of the device is most often associated with heavy menstrual bleeding and pain, as with other long-term methods of contraception, and is most common in the youngest age group. When adequately counselled about the benign nature of oligo- or amenorrhoea, most women are very willing to accept life without menstruation. The risk of premature removal can be markedly diminished with good pre-insertion counselling, which also markedly increases user satisfaction. User satisfaction is strongly associated with the information given at the time of the levonorgestrel-releasing IUS insertion. Thus, the benefits of the levonorgestrel-releasing IUS make it a very suitable method of contraception for most women.

Self-reported heavy bleeding associated with uterine leiomyomata

Objective To characterize the relationship between self-reported bleeding symptoms and uterine leiomyoma size and location. Methods The leiomyoma status of a randomly selected sample of women aged 35–49 in the Washington, DC, area was determined using abdominal and transvaginal ultrasound to measure size and location of leiomyomata found at screening. Women were asked about symptoms of heavy bleeding (gushing-type bleeding, long menses, pad/tampon use) in a telephone interview. Using multivariable regression, we examined the relationships between leiomyoma characteristics and heavy bleeding symptoms among 910 premenopausal women. Results Women with leiomyomata ( n = 596) were more likely to report gushing-type bleeding than women without leiomyomata; risk increased with leiomyoma size. Adjusted relative risks with 95% confidence intervals (CI) for women in each leiomyoma size category compared with the reference category (women without leiomyomata) were as follows: adjusted relative risk of 1.4 (95% CI 1.1, 1.9) for diffuse only, adjusted relative risk of 1.4 (95% CI 1.1, 1.8) for small leiomyomata (less than 2 cm), adjusted relative risk of 1.6 (95% CI 1.3, 2.0) for medium leiomyomata (2–5 cm), and adjusted relative risk of 1.9 (95% CI 1.5, 2.5) for large leiomyomata (greater than 5 cm). Reported use of eight or more pads/tampons on the heaviest days of menstrual bleeding increased with leiomyoma size, with a nearly 2.5-fold risk for women with large leiomyomata compared with women without leiomyomata (adjusted relative risk of 2.4; 95% CI 1.8, 3.1). Nonsubmucosal leiomyomata were associated with essentially the same increase in heavy bleeding as submuscosal leiomyomata of similar size. Conclusion Small leiomyomata were associated with increased risk of heavy bleeding, and risk increased with size. Contrary to published articles, nonsubmucosal leiomyomata were associated with heavy bleeding to the same extent as submucosal leiomyomata.

Blood flow velocity in the uterine and ovarian arteries during menstruation.

Eleven healthy women with regular menstrual cycles were examined with a combination of two-dimensional real-time ultrasound and color and spectral Doppler techniques on the 7th day after follicular rupture, and on the 1st, 2nd, 3rd and 4th days of menstrual bleeding. Both uterine arteries, arteries in the stroma and hila of both ovaries, in the wall of the largest follicle of the non-dominant ovary and in the wall of the corpus luteum were examined with the Doppler technique. The pulsatility index (PI) and the time-averaged maximum velocity were calculated. In the uterine arteries, the PI was highest on the first day of menstrual bleeding (median PI 3.2 for the dominant and 3.0 for the non-dominant uterine artery), after which it decreased to its lowest values on the second day (median PI 2.1 and 1.8, respectively) and third day (median PI 2.2 and 2.1, respectively). The time-averaged maximum velocity reached its highest value on the second and third days of menstruation. The corpus luteum was still visible on the first day of menstrual bleeding in all women, and on the second day in five. It was indistinguishable on the third and fourth days of menstruation in all women. In the dominant ovary, the time-averaged maximum velocity of flow in the arteries in the ovarian hilum decreased during menstrual bleeding and was lower during menstruation than in the preceding luteal phase. In the non-dominant ovary, neither the PI nor the time-averaged maximum velocity manifested any consistent changes during the period studied. We conclude that substantial changes in PI and time-averaged maximum velocity occur in the uterine arteries and in the arteries of the dominant ovary during menstruation.

Effect of an oral contraceptive in primary dysmenorrhea — Changes in uterine activity and reactivity to agonists

Mechanisms for the therapeutic effect of oral contraceptives in dysmenorrhea were studied by recording intrauterine pressure on the first day of menstrual bleeding in women with moderate to severe symptoms and after three weeks of oral contraceptive therapy (150 μg levonorgestrel +30 μg ethinyl estradiol, daily). Spontaneous uterine activity and reactivity to intravenous injections of vasopressin (6 pmol/kg body weight; n = 8) or prostaglandin F 2μ (12 nmol/kg body weight; n = 9) at the two sessions were compared. During the first recording when all women had dysmenorrhea, the uterine activity and reactivity to both agonists were pronounced. After therapy, when the women felt essentially no pain, a statistically significant decrease in spontaneous uterine activity in terms of total pressure area, frequency and amplitude of contractions was observed. The agonist injections induced less pain at the second recording, although the magnitude of responses, superimposed on the much smaller uterine activity at this time, were not significantly different from those at the first recording during dysmenorrhea. The mechanism of pain relief by oral contraception in dysmenorrhea could be a lesser impact of the decreased contractile activity on uterine blood flow, abolishing the local ischemia. A reduced uterine reactivity to agonists might also to some extent contribute to the therapeutic effect.

The normal menstrual cycle has no effect on gastric emptying.

Recent studies have demonstrated that orocaecal transit time is prolonged both in the luteal phase of the ovulatory cycle in normal women and during pregnancy, but have made no attempt to differentiate between the individual effects of gastric emptying and small intestinal transit. We have assessed the effect of the normal menstrual cycle on gastric emptying of solids and liquids in 10 women, using a dual isotope scintigraphic technique. In each subject gastric emptying was measured on 2 days: first during the follicular phase (day 8-10) and then during the luteal phase (day 18-20) of one ovulatory menstrual cycle (where day 1 was the first day of menstrual bleeding). Measures of solid and liquid gastric emptying did not change significantly between the follicular and luteal phases indicating that the normal menstrual cycle has no effect on gastric emptying.

Effects of chronic luteinizing hormone-releasing hormone agonist treatment on dysfunctional uterine bleeding in the stumptailed macaque.

Dysfunctional uterine bleeding is a disorder which presents problems for effective treatment and management. We have utilized the ability of chronic LRH agonist treatment to suppress ovarian steroid production to examine its effects on stumptailed macaques with a detailed history of excessive days of menstrual bleeding. Five monkeys were treated for 6 months with daily injections of D-Ser[But]6 LRH (1-9) nonapeptide-ethylamide. This was successful in suppressing ovarian steroid production in all monkeys as indicated by the maintenance of serum concentrations of oestradiol at less than 100 pg/ml and progesterone at less than 1 ng/ml. All monkeys menstruated for their typical time period during the first treatment cycle, but thereafter bleeding stopped in 2 monkeys and was considerably reduced in a further 2. In the remaining monkey, no significant improvement occurred. The results indicate that suppression of ovarian function in this way may have a significant role to play in the treatment of dysfunctional uterine bleeding.

Effect of enucleation of the corpus luteum at different stages of the luteal phase of the human menstrual cycle on subsequent follicular development.

To investigate the mechanism of suppression of follicular development during the luteal phase of the human menstrual cycle, the corpus luteum was enucleated surgically from 10 women at various times after ovulation. In the 24 h after CL enucleation there was an immediate and rapid fall in the concentration of oestradiol and progesterone and a temporary decline in the concentration of FSH and LH. Within 3 days, however, all 10 women showed evidence of renewed follicular activity as indicated by a progressive rise in the concentration of oestradiol. This rise was preceded by a rise in the concentration of FSH and LH, and ovulation, as indicated by a mid-cycle surge in LH and rise in the concentration of plasma progesterone, occurred 16-19 days after enucleation. There was no significant difference in the time to ovulation following enucleation at different times of the luteal phase. The post-operative follicular phase, measured from the time of enucleation, was 3 days longer than that observed pre-operatively from the first day of menstrual bleeding. In the follicular phase of post-operative cycles the concentration of FSH was higher and that of oestradiol lower than the corresponding values before surgery. These results indicate that the absence of healthy antral follicles in the luteal phase of the cycle is due to the inhibitory effects of the corpus luteum. The fact that, after CL enucleation, emergence of the dominant follicle was always preceded by a rise in the concentration of FSH and LH suggests that suppression of gonadotrophins by ovarian steroids secreted by the corpus luteum is responsible for the inhibition of follicular development during the luteal phase of the cycle.

Artificial insemination by donor: a review of 12 years' experience.

Foss (1982) writes:… ‘Guerrero (1974) in a large series showed no relationship of the child's sex to the cycle day of insemination…’. It seems to me that this is ambiguous. If the first day of menstrual bleeding is taken as the time origin, then Foss is correct. But if the biologically more relevant estimated day of ovulation is taken as the time origin, he is not. Using the latter time origin, Guerrero found that for natural inseminations the variance of cycle day of male conceptions was significantly greater than that of female conceptions. In other words, boys are more likely to be conceived at the beginning and end of the fertile period, and girls in the middle. Harlap (1979) has reported findings which seem to confirm those of Guerrero. It has been suggested (James, 1980a, b) that these and other findings would be explained if maternal gonadotrophin levels at the time of conception partially controlled the sex of the zygote.

A multicenter study of levonorgestrel—Estradiol contraceptive vaginal rings III — Menstrual patterns: An international comparative trial

Menstrual events among users of contraceptive vaginal rings (CVRs), releasing levonorgestrel and estradiol, were studied in comparison with a combined oral contraceptive, Nordette, ∗ ∗ Nordette is a registered trademark of Wyeth-Pharma, Munster, West Germany. in multicentered trials. CVRs were made with outside diameters of 50 and 58 mm and released about 250 μg and 290 μg of levonorgestrel and 150 μg and 180 μg of estradiol per day, respectively. The CVRs were used continuously for 3 weeks and then removed for 1 week. Both the CVRs and Nordette were perceived to reduce menstrual flow and days of menstrual bleeding. Twenty to 25% of CVR users perceived increased inter menstrual bleeding or spotting. Diaries indicate, however, that on average, CVR users experienced about 1 day per month of bleeding or spotting with the ring in place. CVRs and Nordette produced approximately the same total number of bleeding and spotting days during 6 cycles of use, 27–29, but the small (50-mm OD) ring was associated with somewhat more spotting. This ring was also associated with somewhat more prolonged bleeding and spotting runs and with more prolonged nonbleeding intervals than reported by users of the larger (58-mm OD) ring or of Nordette. Differences among regimens, however, tended to be small even when statistically significant. Evidence from menstrual diaries indicates that these CVRs, and in particular the 58-mm ring, provide control over the menstrual cycle comparable to that of Nordette.

The Menstrual Cycle in Women Using an Intrauterine Device

The duration and hormonal characteristics of the menstrual cycles of women using Copper T intrauterine devices (IUDs) were studied. Daily load samples were obtained during both the pre- and postovulatory phases of 30 IUD-associated cycles and the hormone values were compared with those of 15 normally menstruating women not using contraception. The ovulation rate and peak levels of 17 beta-estradiol and luteinizing hormone (LH) were not significantly different between the two groups. The average number of days from the 1st day of menstrual bleeding to the LH peak (the proliferative phase) was longer in the IUD users. The number of days from the LH peak to the onset of menstrual bleeding (the luteal phase) was shorter in the IUD users. Because of the compensating nature of these statistically significant differences, the total cycle length appeared to be unchanged. At the time of menstruation, the plasma levels of both progesterone and 17 beta-estradiol were significantly higher among IUD users. It is concluded that the presence of an IUD does not influence ovarian function, but that ovarian steroid production and endometrial events become asynchronous.

Endogenous levels of prostaglandin F2α and its main metabolites in plasma and endometrium of normal and dysmenorrheic women

The concentrations of prostaglandin F2α, 15-keto-13,14-dihydro-PGF2α, and 13,14-dihydro-PGF2α were determined in plasma and in endometrial specimens taken from both dysmenorrheic and normal women at the time of their menstruation. The estimations were carried out by means of the gas chromatography-mass spectrometry method. The plasma levels of 15-keto-13,14-dihydro-PGF2α in dysmenorrheic women ranged between 32 and 105 pg. per milliliter, which are significantly higher than the corresponding levels in eumenorrheic women, 20 to 33 pg. per milliliter. On the first day of menstrual bleeding the concentration of PGF2α in the endometrium was approximately 4 times higher (300 to 2,600 pg. per milligram) in cases of dysmenorrhea than in normal subjects. Treatment with either oral contraceptives or prostaglandin synthetase inhibitors lowered the concentrations significantly and the majority of patients became symptom free.

A new approach to estrogen-free contraception based on progesterone receptor blockage by mid-cycle administration of ethyl norgestrienone (R 2323)

Attempts to prevent conception without ovulation inhibition have failed so far. The daily use of progestins interferes with the hormonal pattern and disrupts the cycle. Since the anti-progesterone, 13-ethyl-17-hydroxy-18, 19-dinor-17α-pregna-4,9,11-trien-20-yn-3-one (R 2323), competes for the progesterone/progestin binding sites of the uterine cytosol receptor in various species, we have postulated that blockage by R 2323 of progesterone binding to the estrogen-induced receptor at the beginning of the luteal phase could upset progesterone-dependent changes and thus exert a contraceptive effect. In a two-year clinical trial in Haiti (1362 cycles), R 2323 (50 mg) has been administered orally, once a day for three consecutive days, exactly two weeks after the first day of menstrual bleeding (15, 16, 17th days). Results indicate that: Cycle length varies from 21 to 35 days (93%), but is perfectly regular for each woman; there is no incidence of amenorrhea, menstrual bleeding lasts 3 to 5 days (83%) with hardly any spotting or breakthrough bleeding (9%). The main side-effect is vomiting. Pregnancy rate expressed as the Pearl Index is 4.6% for drug-failure and 5.5% for patient failure. Since four pregnancies are due to omissions, it appears that R 2323 does not affect return to fertility.

The viability of the cast-off menstrual endometrium

The histogenesis of endometriosis is still under discussion, although Sampson's implantation theory has been widely accepted in this country. Some experimental work has been advanced to support Sampson's hypothesis but evidently no one has shown definitely that the endometrium exfoliated at menstruation is capable of survival and growth. The purpose of this communication is to show that under some conditions cast-off menstrual endometrium is viable in tissue culture preparations.A contraceptive diaphragm was inserted in the vagina on the second day of menstrual bleeding and left in place from eight to twelve hours. After removal the diaphragm was placed in a sterile Petri dish and the collected fluid was immediately examined for bits of tissue. In two out of seven instances sufficient material was obtained for tissue culture explantation.

The Hydrogen Ion Concentration of Human Vaginal Discharge

Summary The available literature on vaginal acidity is reviewed. A quinhydrone microelectrode for the determination of the pH of undiluted vaginal discharge is described and its operation detailed. The pH of the vaginal discharge varies directly with the character of the vaginal flora, higher acidities being associated with a preponderance of the vaginal bacilli of Doderlein which are normally present in pure culture but may be entirely absent in certain infections (gonorrhea). The vaginal discharge is normally quite acid (pH 4.0 to 4.5) during the intermenstrual period but approaches or exceeds neutrality during the early days of menstrual bleeding. During gestation the acidity is somewhat less than in the nonpregnant, irrespective of the bacterial character of the discharge. The pH of the upper (posterior) vagina is usually slightly lower than that of the lower (anterior) portion. Dilution of the vaginal discharge with neutral water tends to raise the pH although the acidity of vaginal washings may be higher than that of the undiluted discharge.