First Day Of Menstrual Bleeding Research Articles

Intravenous immunoglobulin and prednisolone to women with unexplained recurrent pregnancy loss after assisted reproductive technology treatment: a protocol for a randomised, double-blind, placebo-controlled trial

IntroductionRecurrent pregnancy loss (RPL), defined as two or more consecutive pregnancy losses in the first trimester, affects around 5% of fertile women. The underlying causes remain unknown in up to...

Catamenial pneumothorax after multiple failed in vitro fertilization cycles: Case report

Introduction. Catamenial pneumothorax is spontaneous pneumothorax occurring within 72?96 h before and after menstrual bleeding. It is frequently associated with thoracic endometriosis. However, certain cases are not associated with any identifiable thoracic pathology. Case report. A 42-year-old woman with a history of pelvic endometriosis presented with sudden cough and shortness of breath on the first day of menstrual bleeding. Chest radiography revealed a complete right pneumothorax. The patient had previously undergone 7 failed in vitro fertilization cycles. Video-assisted thoracoscopic surgery showed pulmonary bullous lesions and a diaphragmatic fenestration. Atypical resection of the pulmonary apex was performed by an endostapler. Diaphragm plication was performed using Ethibond sutures. Definitive histopathological examination of the pulmonary tissue was negative for endometriosis. A postoperative course of gonadotropin-releasing hormone (GnRH) agonist triptorelin was administered during a period of 6 months. The patient's postoperative recovery was uneventful, without recurrence of pneumothorax to this day. Conclusion. There is a possibility that ovarian hyperstimulation caused the rupture of the pulmonary bullae. The patient may have developed endometriotic diaphragmatic fenestrations, activated by ovarian hyperstimulation, leading to pneumothorax. Early diagnosis and timely surgical treatment dealing with all thoracic pathology, as well as adjuvant hormonal treatment, may reduce the recurrence rate of catamenial pneumothorax.

Artificial insemination in black-handed spider monkey ( Ateles geoffroyi)

Artificial insemination (AI) was performed in spider monkeys; these primates are vulnerable to extinction and usually do not reproduce spontaneously in captivity. Uterine cycles were followed by daily assessment of vaginal cytology, and corroborated a posteriori by concentrations of 17-β estradiol and progesterone, measured by radioimmunoassay (RIA), in fecal samples collected once daily. Five females between 13 to 27 years old were inseminated intravaginally (with fresh semen) twice each during the periovulatory phase (Days 9–12 of the menstrual cycle; Day 0, first day of menstrual bleeding), from September to the first 3 weeks of November (most fertile months). Transcervical AI was not useful in this primate because the liquid portion of the semen completely solidified instead of liquefying as in other primates. Pregnancies were apparently achieved in 5 of 14 attempts. One female became pregnant after the first round of inseminations, delivered a healthy infant, was inseminated and got pregnant again (subsequently aborted). One female aborted, apparently due to an intramural uterine leiomyoma. Another two females stopped menstruating for a few months, then restarted menstruating (these females may have been pregnant and aborted). In conclusion, in spider monkeys: (1) captivity-induced stress did not inhibit reproduction; (2) fecal steroid hormones were useful to assess cyclicity; (3) the semen coagulum, which apparently is a tightly packed and large reservoir of spermatozoa, must not be discarded but used in AI; (4) old female spider monkeys did not have cessation of reproductive function.

Cyclical excitability of the motor cortex in patients with catamenial epilepsy: A transcranial magnetic stimulation study

The pathophysiology of catamenial epilepsy is still unclear. Therefore, we investigated the cortical excitability of women with catamenial epilepsy during different phases of the menstrual cycle. Using transcranial magnetic stimulation, six patients suffering from catamenial epilepsy were investigated during ovulatory cycles. On days 8, -14, -7 and 2 of the cycle (day 1 being the first day of menstrual bleeding), resting motor threshold (RMT), cortical silent period (CSP), intracortical inhibition (ICI) and intracortical facilitation (ICF) were investigated. The non-parametric Friedman-test for multiple comparisons and Wilcoxon signed rank test were used for statistical analysis. Five patients suffered from focal epilepsy (three right hemispheric, one bitemporal, one unknown origin) and one patient had idiopathic generalized epilepsy. All patients experienced perimenstrual seizure clustering and two also showed an increased seizure frequency during the luteal phase. In the right hemispheres there was a significant change of CSP duration in the course of the menstrual cycle (chi(2)=8.3, P=0.041), due to a shorter CSP during the luteal phase (Z=-2.0, P=0.043) and menstruation (Z=-2.2, P=0.028) as compared to the follicular phase. There was no significant variation of CSP in the left hemispheres. RMT, ICI and ICF showed no significant changes in the course of the menstrual cycle. The CSP changes suggest a decreased inhibition involving GABA-ergic neurotransmission during the luteal phase and menstruation. These TMS alterations correlated with the clinical course of the epilepsies and were found in the hemispheres containing the majority of the epileptogenic zones.

The effect of the menstrual cycle on optic nerve head analysis in healthy women

To determine the effect of the menstrual cycle on optic nerve head topographic analysis in normally menstruating, healthy women. The study included single eyes selected randomly from each of 52 healthy women with regular menstrual cycles. All subjects underwent a complete ocular examination. Optic nerve head topographic analyses were performed using a confocal scanning laser ophthalmoscope, the Heidelberg Retinal Tomograph II (HRT II, software version 1.6). The analyses were repeated three times during the menstrual cycle: in the follicular phase (days 7-10 of the cycle), at ovulation, and in the late luteal phase (days 1-3 before menstrual bleeding). Serum oestradiol, progesterone and luteinizing hormone levels were measured at each menstrual phase. Fourteen subjects were excluded from the study. The mean age of the subjects (n = 38) was 25.6 +/- 3.7 years (range 21-34 years). Blood oestradiol levels were significantly lower in the late luteal phase (35.8 pg/ml) (p < 0.0001). The mean disc area of the subjects was 1.94 +/- 0.33 mm(2). The neuroretinal rim area decreased significantly during the luteal phase (p < 0.001). However, the linear cup : disc ratio, cup : disc area ratio and the cup area were significantly higher during the luteal phase (p < 0.001). These observations raise the possibility that sex hormone fluctuations which occur during a normal menstrual cycle in healthy women significantly alter neuroretinal rim area and cup variables of the optic nerve head. These findings should be taken into consideration in the clinical follow-up of young women with glaucoma.

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.

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.

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.