Total Estrogen Excretion Research Articles

Pregnancy in a patient after cadaveric renal transplantation.

Abstract. This paper describes the course of a pregnancy in a 25‐year‐old primipara after transplantation of a cadaver kidney. Signs of chronic rejection occurred during this pregnancy and increased abruptly after about 35 weeks. A caesarean section was performed, after which the graft function did not improve. Data on histocompatibility of donor, husband, patient and child and other possible relationships between pregnancy and graft function are discussed. The urinary total estrogen excretion was low during pregnancy. This could not be ascribed to abnormalities in placental steroid synthesis. The child is a boy in good physical and mental health.

Premature Ovarian Failure

Abstract. Twenty‐six patients with premature ovarian failure (last menstrual period before the age of 30 years) were evaluated clinically and endocrinologically and, in addition, ovarian biopsies were obtained in 15 out of the 26 patients. Only 1 of the patients revealed a family history of early menopause. The typical menstrual pattern indicated a normal age at menarche with regular periods for various length of time followed either by amenorrhoea abruptly or by a period of oligomenorrhoea before the onset of amenorrhoea. All patients showed normal or slightly underdeveloped secondary sexual characteristics, and it should be noted that 2 patients had been pregnant previously.It was characteristic of all patients that the excretion of total gonadotropins was constantly increased and that the excretion of total oestrogens was low, whereas both the adrenal and thyroid function were normal. All patients were X‐chromatin positive.In 13 out of the 15 patients, in whom ovarian biopsies were obtained, the histological examination revealed a normal stroma without or with very few primordial and atretic follicles, a picture very similar to that characteristic of the postmenopausal ovary. In the last 2 patients, however, the histological examination showed a quite different picture, viz. a normal stroma with numerous primordial and primary follicles and even a few growing follicles. In spite of these morphologically normal follicles, it was not possible to stimulate the follicular development and to induce ovulation even with very high doses of human gonadotrophins. It is, therefore, concluded that the presence of a few growing follicles in the ovaries does not seem to exclude the diagnosis of premature ovarian failure.Only 14 out of the 26 patients had the typical symptoms of the climacteric, and even in these cases the nuisance was only of a mild to moderate degree. It is generally agreed that all patients with symptoms should receive substitution therapy, but the essential risk of ischaemic heart disease and osteoporosis, together with the unquestionable psychological effect of having regular menstrual bleeding, have led us to the conclusion that this therapy is indicated in all cases of premature ovarian failure. Cyclical treatment either with a sequential preparation or with oestrogens alone is the treatment of choice.

Impairment of intrauterine growth--early warning by cervical mucus ferning.

SummaryPatients considered to be at extra risk of fetal loss because of previous history were assessed throughout pregnancy for hormone deficiency by cervical mucus smears, vaginal cytology and total oestrogen excretion. There was a significantly higher incidence of light‐for‐dates babies when cervical mucus ferning was noted early in pregnancy and persisted or recurred after 16 weeks. Early detection of‘placental insufficiency’by ferning in the mucus would allow closer study of the factors which impair intrauterine growth.

Effects of continuous daily administration of 0.1 mg of norethindrone on the plasma levels of progesterone and on the urinary excretion of luteinizing hormone and total oestrogens.

ABSTRACT Daily determinations of the plasma level of progesterone and the urinary excretion of LH and oestrogens were performed in four women during one control cycle followed by three months of daily treatment with 0.1 mg of norethindrone. According to the plasma progesterone pattern, all four women seemed to ovulate during their control cycle. Two women became pregnant during their second cycle of treatment. During treatment all four women showed an atypical LH pattern without any distinct midcycle peak. The mean LH excretion during treatment was not significantly different from the mean level of follicular phase of normal cycles. The oestrogens and progesterone levels were within normal ranges. It is concluded that during treatment with 0.1 mg of norethindrone daily an apparently normal pregnancy may occur in spite of a different LH excretion pattern.

Urinary Oestrogen Excretion in the Beagle Bitch

SUMMARY Total urinary oestrogen excretion has been measured in beagle bitches during the normal oestrous cycle and in animals receiving exogenous gonadotrophins. Oestrogen levels rose during proestrus to reach a mean value of approximately 2, μg/24 hours in late proestrus and early oestrus. A significant correlation was found between urinary and plasma oestrogen levels in three bitches studied during proestrous and oestrus. The administration of pregnant mare serum gonadotrophin and human chorionic gonadotrophin was associated with a marked increase in oestrogen output suggesting that ovarian overstimulation had occurred.

Effect of the menstrual cycle on carbohydrate and lipid metabolism in normal females.

ABSTRACT In continuation of previous investigations on hormonal contraception (Seng et al. 1969) and on gestation and the puerperium (Becker et al. 1971) in 10 female volunteers with no apparent endocrinological disturbances various parameters of lipid and carbohydrate metabolism were determined on days 7–9, at least on three consecutive days during ovulation, and on days 23–25 during the corpus luteum phase of the menstrual cycle. The concentration of glucose, pyruvate and lactate as well as glycerol, glycerid-glycerol, free fatty acids, acetoacetate and β-hydroxybutyrate in the blood were analyzed and the data obtained to basal temperature measurements, total oestrogen excretion values and blood progesterone levels. Only during the luteal phase, i. e. at the highest progesterone levels was a statistically significant increase of free fatty acids found in the blood, accompanied by a distinct but not significant rise in free glycerol. None of the other parameters measured showed any statistically significant correlations to the various phases of the menstrual cycle. The importance of the increase in free fatty acids on the sequence of events observed at the corpus luteum phase under hormonal contraception and during late gestation is discussed.

Ovarian sensitivity to human gonadotrophins in women with amenorrhoea after oral contraceptive treatment.

ABSTRACT Twelve young women with a history of 9–11 months of amenorrhoea after combined oral contraceptive therapy, were treated with human menopausal gonadotrophin (HMG) in order to assess the functional capacity of their ovaries. An initial endocrinological investigation did not reveal any organic cause for the amenorrhoea. The serum levels of the gonadotrophins were within the normal ranges. The endogenous oestrogen production was low. An individually adjusted treatment schedule was used for the administration of the HMG. The treatment was monitored by daily determinations of the total urinary oestrogen excretion. Ovulation was induced by a single injection of 9000 IU human chorionic gonadotrophin when the total urinary oestrogen excretion averaged 60 μg per 24 h. All the 12 women showed a follicular response, i. e. an increase in the total urinary oestrogen excretion to a level of at least 50 μg per 24 h. Ten women ovulated and three of six women who wanted to become pregnant conceived after the first treatment. None of the women reverted to spontaneous menstrual bleedings after the treatment. A total HMG dose of between 750 and 4425 IU (2nd IRP-HMG) was required to produce the follicular response. This six-fold variation in dose requirement is in agreement with that found in women with amenorrhoea not related to the use of oral contraceptives. A decreased ovarian sensitivity to human gonadotrophins does not explain the amenorrhoea following oral contraceptive therapy.

Oestrogen excretion and corpus luteum function in early normal and induced pregnancies.

SummaryUrinary total oestrogen excretion in thye first 40 days of one normal and three induced pregnancies showed a temporary fall, beginning about 20 days after ovulation and lasting for 7–16 days. This fall may represent a change in thesite of hormone production from the corpus luteum to the placenta.

Luteinizing hormone (LH) and progesterone in plasma and LH and oestrogens in urine during 42 normal menstrual cycles.

ABSTRACT The plasma levels of luteinizing hormone (LH) and progesterone and the urinary excretion of LH and oestrogens were measured during the normal menstrual cycle of 22 young and healthy women. A total of 42 cycles were investigated. The urinary excretion of total oestrogens increased during several days before the rise of LH in the urine. The day of maximum excretion of LH and total oestrogens coincided during the midcycle period. The mid-cyclic rise in LH was found to occur on the same day in the plasma and urine and the days of maximum values coincided in 11 out of 16 cycles. In 5 cycles the maximum level was reached one day later in the urine. The plasma levels of progesterone started to increase during the LH and oestrogen peaks. The days for maximum levels of progesterone coincided with the second peak of urinary oestrogens. The levels of progesterone in the plasma reached values above 10 ng per ml in all normal cycles. The plasma levels of progesterone were below 1 ng per ml plasma when menstrual bleeding started. The length of the luteal phase was 14.4 ± 1.1 (s) days. The sum of daily urinary excretion of total oestrogens and the sum of the daily plasma progesterone levels varied within 15 per cent of the mean in five out of six women studied during more than two cycles. The variation in values for the sums of daily oestrogen excretion and plasma progesterone levels was considerably larger between menstrual cycles of different women than between menstrual cycles of the same woman.

Pituitary functions as judged by urinary excretion of FSH and LH in normal married young women cyclically treated with 0.5 mg megesterol acetate.

Using specific biological assay procedures FSH and LH excretion was measured in 2 normally menstruating young subjects before during and after administration of megesterol acetate from Days 5 to 25 of the cycle. Urinary excretion of total estrogen was also estimated. The laboratory data and the results of the preliminary clinical trial regarding the reproductive performance of the subjects are discussed.(FULL TEXT)

Comparison of daily with twice-weekly injections of follicle-stimulating hormone for treatment of failure of ovulation

Ten patients with anovulation were investigated in 24 courses of treatment to compare daily with twice-weekly injections of follicle-stimulating hormone (FSH). Human pituitary FSH (CP1) with a ratio of FSH to luteinizing hormone (LH) of about 5.1 was given in 12 courses of treatment, and human menopausal gonadotropin††Humegon, Organon Laboratories, Limited, Morden, Surrey, England. (HMG) with a ratio of FSH to LH of about 1 to 1 was given in the other 12. A balanced experimental design was used. The different methods of treatment could not be compared on the basis of the pregnancies because there were too few of them. The doses of HMG and of CP1 required to produce a positive response in excretion of total estrogen were the same for twice-weekly injections as for daily injections, indicating that both preparations were as effective when given in twice-weekly doses as in daily doses. Daily injections of CP1, however, produced a significantly greater rate of increase of excretion of total estrogen than did twice-weekly injections of CP1, implying that twice-weekly injections are less likely to result in multiple pregnancies. This effect did not occur with HMG. It was found that on average 56 per cent more HMG was required to obtain a positive response in the second course of treatment than in the first. This did not occur with CP1. This effect was probably due to the different ratios of FSH to LH in the 2 preparations.

Neutrophil alkaline phosphatase in pregnancy and its relationship to urinary estrogen excretion and serum heat-stable alkaline phosphatase levels

Two hundred and sixteen paired estimations of neutrophil alkaline phosphatase (NAP) and total urinary estrogen excretion and 369 paired NAP and serum heat-stable alkaline phosphatase (HSAP) estimations were carried out during normal and hypertensive pregnancies. In the latter, positive correlations were found between the NAP estimations on the one hand and total urinary estrogen excretion and serum HSAP levels on the other. There was no correlation between the estimations in normal pregnancy. The significance of these results is discussed.

Hypersecretion of estrogen in Takayasu's disease

The 24 hour urinary excretion of total estrogens was measured by the methods of Cohen, 17 Brown, 18 and Nishi 19 in 20 healthy women aged 18 to 45 (mean 31.8 ± 6.8) and in 20 patients with typical Takayasu's disease aged 18 to 45 (mean 32.2 ± 7.8) during the follicular and luteal periods, respectively. A continuous high level of urinary excretion of total estrogens without normal biphasic rhythm was found in those with Takayasu's disease. The 24 hour urinary excretion of total estrogens during the follicular period was 7.4 ± 0.8 μg per day in the control subjects and 13.7 ± 1.4 μg per day in the patients; the difference was statistically significant (p < 0.01). During the luteal period the excretion was 10.7 ± 0.9 μg per day in the control subjects and 12.7 ± 1.2 μg per day in the patients. The continuous high level of urinary excretion of total estrogens found in this study has been discussed as one possible explanation of the characteristic localization of this morbid condition in the arterial system.

Amenorrhoea associated with increased production of gonadotrophins and a morphologically normal ovarian follicular apparatus.

ABSTRACT Three cases of amenorrhoea associated with increased production of gonadotrophins and a morphologically normal ovarian follicular apparatus are presented. The first patient was 23 years old and had primary amenorrhoea. The other 2 patients were 28 and 26 years old, and had secondary amenorrhoea of 26 and 12 months' duration, respectively. It was characteristic of all 3 patients that the secondary sexual characteristics were developed before they had received any substitution therapy. The urinary excretion of total gonadotrophins was markedly increased, and by selective assays it was shown that the excretion of both FSH and LH was increased. The excretion of total oestrogens and pregnanediol was low. Furthermore, histological examination of ovarian biopsies in all 3 patients revealed ovaries with a normal stroma without any luteinization or hyperplasia of the hilus cells and a follicular apparatus with numerous primordial follicles. Very few of these, however, showed progression to the antrum stage and practically none showed any further development. In an attempt to stimulate the development of the ovarian follicles and to induce ovulation 1 patient was treated with clomiphene, and in addition all 3 patients were treated with very high doses of human gonadotrophins, but all attempts were unsuccessful. The explanation is probably that the ovaries of these patients are resistant to stimulation with gonadotrophins. Unfortunately, the possibility of an autoimmune reaction in the ovaries with formation of antigonadotrophins was not investigated in the present study. The aetiology of this syndrome is not yet known, but it might be of interest that 2 out of our 3 patients had received long-term treatment with combined oestrogen-gestagen preparations during the years before the diagnosis was made.

OVARIAN RESPONSE TO EXCESSIVE DOSES OF HUMAN MENOPAUSAL GONADOTROPHIN IN TWO PATIENTS WITH PRIMARY PITUITARY INSUFFICIENCY

ABSTRACT Two patients with primary pituitary insufficiency were treated with excessive doses of HMG only for 10 and 14 days. The total dose was 3360 IU and 6320 IU FSH, respectively. The excretion of total oestrogens and pregnanediol was determined daily before, during and after the treatment. Furthermore, the excretion of total gonadotrophins was determined on a few occasions after the treatment with HMG was discontinued. It was confirmed that patients with primary pituitary insufficiency need a high dose of HMG (800 IU and 2560 IU FSH) before any oestrogen is excreted. In spite of the extreme stimulation and the resulting high oestrogen excretion, the ovaries were not enlarged at any time during the observation period. It is concluded that the administration of both HMG and HCG is necessary for the development of a hyperstimulation syndrome. Furthermore, it was shown that the excretion of oestrogens continued to increase for a couple of days after the treatment with HMG was stopped. At the same time it was found that the excretion of total gonadotrophins remained elevated for about 8–10 days after the last dose of HMG had been given. These findings indicate that HMG has a prolonged effect. Therefore, it has been proposed to change the commonly used scheme of treatment with HMG-HCG in such a manner that HGG is given 2–3 days after the last dose of HMG in order to reduce the risk of hyperstimulation.

EFFECTS OF DAILY ADMINISTRATION OF A RETROSTEROID ON THE PLASMA LEVELS OF PROGESTERONE AND ON THE URINARY EXCRETION OF LUTEINIZING HORMONE AND TOTAL OESTROGENS

SummaryFollowing one control cycle, four women were treated with 4 mg. daily of the retrosteroid Ro 6‐3129 during two menstrual cycles. Judged by the plasma levels of progesterone and the urinary excretion of LH and total oestrogens, the control and treatment cycles were ovulatory.One apparently normal pregnancy and one very early spontaneous abortion occurred. There was a tendency to a reduction of the length of the follicular phase of the treatment cycles, possibly related to the medication.

SIALIC ACID CONTENT AND SPERM PENETRATION OF CERVICAL MUCUS IN RELATION TO TOTAL URINARY OESTROGEN EXCRETION AND PLASMA PROGESTERONE LEVELS IN OVULATORY WOMEN

In 6 regularly menstruating women ages 23 to 34 years daily measurements of sialic acid (SA) content and sperm penetration into the cervical mucus (CXM) were related to the total urinary estrogen excretion and plasma progesterone levels during 1 ovulatory cycle. In 4 women of known fertility and in 1 normally menstruating woman the peak in sperm penetration and the dip in sialic acid content occurred almost simultaneously with the ovulatory peak in urine and preceded the probable ovulation by 1 day. Sperm capacitation appears to be necessary for fertilization in the human. The occurrence of peak sperm penetration before ovulation would thus result in a period of time for capacitation to take place. In 1 woman who had been barren for several years the steroid patterns were normal but the peak of sperm penetration and the dip in sialic acid content occurred 1 day after ovulation. The possible significance of this observation is noted especially since her husbands sperm samples were considered normal. Techniques of the daily sample-collecting of CXM urine and venous blood samples are given; SA technique is given. Sperm penetration tests were done using the capillary method. No free SA was found in any sample of CXM. Data are in agreement with those reported by others.

EFFECTS OF CONTINUOUS DAILY ADMINISTRATION OF 0.3 mg OF NOREHTINDRONE ON THE PLASMA LEVELS OF PROGESTERONE AND ON THE URINARY EXCRETION OF PREGNANEDIOL AND TOTAL OESTROGENS

ABSTRACT Daily determinations of the plasma level of progesterone and the urinary excretion of total oestrogens and pregnanediol were performed in 7 subjects during one control cycle, followed by three months of daily continuous treatment with 0.3 mg of norethindrone (NET). The control cycles were ovulatory according to the parameters investigated. During treatment there was a tendency to cyclically increased oestrogen excretion, this being most marked in cycles with very depressed progesterone-pregnanediol levels. All the subjects showed signs of cyclical luteal activity. In most cases, the levels of progesterone and pregnanediol were lower than during the corresponding control cycles. It is suggested that this might be due to deficient corpus luteum function. The drug had no thermogenic effect. The length of the treatment cycles varied between 22 and 49 days. Only two of the women showed intermenstrual bleeding. It seems that 0.3 mg of NET has a weaker effect on the hormone levels than 0.5 mg of NET, but a stronger effect than 0.5 mg of chlormadinone acetate.

Effects of continuous daily administration of 0.5 mg of chlormadinone acetate on the plasma levels of progesterone and on the urinary excretion of luteinizing hormone and total oestrogens.

ABSTRACT Daily determinations of the plasma level of progesterone and the urinary excretion of luteinizing hormone (LH) and total oestrogens were performed in 6 subjects during one control cycle, immediately followed by three cycles of daily treatment with 0.5 mg of chlormadinone acetate continuously. The control cycles were ovulatory according to the parameters investigated. Two of the women showed a normal LH excretion pattern in all treatment cycles. The four other subjects also had periodical variations in the LH excretion but no distinct midcycle peaks occurred. The mean oestrogen excretion was increased in all three treatment cycles but the difference was satistically significant only in the last two cycles. Compared with the treatment cycles, the sum of progesterone values was significantly decreased in the first two cycles. Chlormadinone acetate in this dose had no thermogenic effect. Three of the subjects showed bleeding irregularities which had no clear connection with the hormone variations measured in the study. It is suggested that the low levels of progesterone might be due to a defective corpus luteum function.

Effects of continuous daily administration of 0.5 mg of norethindrone on the plasma levels of progesterone and on the urinary excretion of luteinizing hormone, pregnanediol and total oestrogens.

ABSTRACT Daily determinations of the plasma level of progesterone and the urinary excretion of LH, total oestrogens and pregnanediol were performed in 4 subjects during one control cycle, immediately followed for 2 or 3 months of daily treatment with 0.5 mg of norethindrone continuously. The control cycles were ovulatory according to all the parameters investigated. During treatment the mid-cycle LH peak disappeared in all cases while the basal LH excretion showed considerable day to day variations. The excretion of total oestrogens was increased in all subjects but did not show the normal biphasic pattern. Periods of increased oestrogen excretion also appeared in the subjects with consistently low progesterone and pregnanediol levels during the treatment. In two cases, all signs of luteal activity immediately disappeared after the commencement of treatment. The other cases had one and three periods of increased progesterone and pregnanediol levels respectively. However, these periods were shorter than those of the control cycles. One of the subjects had regular menstrual bleeding while the other three had more or less irregular vaginal flows, often appearing during elevated but declining oestrogen excretion.