Follicular Phase Of Menstrual Cycle Research Articles

SAT378 Unusual Case of Hirsutism From Prolactinoma Induced Dihydrotestosterone Elevation

Abstract Disclosure: J. Ambalavanan: None. K. Alkwatli: None. L. Tranchito: None. D. Yogi-Morren: None. P.P. Rao: None. Introduction: Hirsutism, in women of reproductive age, is a clinical marker of hyperandrogenism. PCOS is the most common cause while non-classic congenital adrenal hyperplasia, adrenal/ovarian tumors are other causes. While various biomarkers of hyperandrogenism like total testosterone(T), 17-Hydroxyprogesterone(17-OHP), DHEA-S are obtained during evaluation, isolated elevation in dihydrotestosterone (DHT) is rarely seen. We present a unique case of hirsutism where elevated prolactin (PRL) levels from a prolactinoma led to an increase in DHT levels resulting in hirsutism. Case Report: A 31-year-old female presented to the endocrine clinic for hirsutism. Her symptoms included increased chin hair and loss of scalp hair. Symptoms were progressively worsening for a year. Initial biochemical evaluation by an endocrinologist in her home country was significant for subclinical hypothyroidism (SCH) with TSH of 8 mIU/ml (0.35-4.94), elevated PRL of 49 ng/ml(2.8-29.2) and elevated DHT of 871 pg/ml (24-368). T, 17-OHP, DHEA-S were normal. It was believed that her SCH was driving her high PRL and she was started on levothyroxine 12.5 mcg daily along with finasteride 2.5mg daily for high DHT. She denied galactorrhea, breast tenderness headache, vision changes, and menstrual abnormalities. Repeat biochemical testing was performed during the follicular phase of menstrual cycle, after stopping all her pills for 2 weeks. Labs were significant for PRL-102 ng/mL (4.5-26.8), TSH-3.49 mIU/mL (0.27-4.2), total T- 47 ng/dL (8-60), free testosterone - 0.9 ng/dL (0.13-1.03), 17- OHP-70.3 ng/dL (<206), androstenedione-1.7 ng/mL (0.3-3.3), DHT-272 pg/mL (24-208), DHEA-S-386.8 ug/dL (98.8-340), LH-9 mIU/mL, FSH-7.2 mIU/mL. Due to the high prolactin, MRI of the pituitary was obtained and showed a 1.1 cm pituitary adenoma with extension towards optic chiasm. Due to the macroadenoma, we started the patient on cabergoline 0.25 mg p.o. weekly. On repeat testing 1 month after cabergoline, her prolactin normalized to 2 ng/mL (4.5-26.8), dihydrotestosterone normalized to 175.2 pg/mL (24-208), DHEA-S normalized to 220.2 mcg/dL (98.8-340). Conclusion: Elevated DHT is a very rare cause of hirsutism. In our patient, the elevated PRL levels were associated with high DHT and DHEA-S level. Though the exact mechanism of is unclear, studies in rats have shown that prolactin has an activating effect on the 5 alpha reductase enzyme and increases DHT levels. Additionally, treatment of the high PRL levels resulted in normalization of DHT levels. The high DHEA-S was not thought to be a cause of hirsutism as it was normal in the initial labs. Moreover, peripheral conversion would have resulted in high T and androstenedione levels which were normal in our patient. In our review of literature, we could not find any similar reports in human beings and would like to educate the endocrine community of this possible association. Presentation Date: Saturday, June 17, 2023

Association of High Sensitivity C-Reactive Protein in Polycystic Ovary Syndrome

Objective: This study is aimed to see the level of high sensitivity C-reactive protein (hs-CRP) and its association with manifestations of polycystic ovary syndrome (PCOS). Design: This cross-sectional study was conducted over a period of one year (January 2017 to December 2018) in the department of Endocrinology of a University hospital. Participants: Fifty-five PCOS patients diagnosed on basis of revised Rotterdam diagnostic criteria 2003 and 50 age-matched healthy controls [PCOS vs. Control- BMI (kg/m2): 25.47±4.65 vs. 20.68±3.51, p<0.001]. Main outcome measures: hs-CRP level, manifestations of PCOS Methods: After relevant history and physical examinations, blood was taken in fasting state during follicular phase of menstrual cycle to measure total testosterone (TT), luteinizing hormone (LH), follicle stimulating hormone (FSH) and hs-CRP. Hormones were measured by chemiluminescent microparticle immuno-assay and hs-CRP by nephelometric technique. Results: hs-CRP (mg/L) was found significantly higher in PCOS patients [1.67 (0.69, 2.54) vs. 0.94 (0.30, 1.42), p=0.006] even after adjustment for age and BMI [OR (95% CI): 1.585 (1.093, 2.299), p=0.015]. Also hs-CRP status (>5 mg/L) was found significantly higher in them than that of controls; but only in non-obese (BMI <25 kg/m2) participants [7.27% vs. 0.0%, p=0.018]. hs- CRP showed no significant correlation and predictive association with any of the manifestations of PCOS including age, BMI, waist circumference, TT and LH/FSH ratio [p=NS for all] Conclusions: Patients with PCOS had significantly higher hs-CRP level and high hs-CRP status without any significant association with its manifestations. J Dhaka Med Coll. 2021; 30(2) : 142-148

CORRECTION OF HORMONAL DISORDERS IN WOMEN WITH ABNOMAL UTERINE BLEEDING AND CHRONIC PSYCHO-EMOTIONAL STRESS

The aim of the research was to evaluate the effectiveness of the optimized treatment in the correction of hormonal disorders in women with abnormal uterine bleeding (AUB) and chronic psycho-emotional stress.
 Materials and methods. 100 women of reproductive age with AUB and chronic psycho-emotional stress were examined. I group included 50 patients who received complex optimized treatment, II group included 50 persons who received standard treatment. The control group included 30 healthy women without AUB and chronic psycho-emotional stress. The standard approach provided for diagnostic and therapeutic measures in accordance with the recommendations of the order of the Ministry of Health of Ukraine N 353 dated 13.04.2016. Inclusion criteria: AUB, age 18-45 years, satisfactory condition of the sample of the material from the uterine cavity for histological examination, chronic psychogenic stress, patient consent. Exclusion criteria: pregnancy, premenstrual dysphoric disorder, acute pelvic inflammatory disease, mental disorders, blood diseases associated with coagulation disorders, hypothyroidism, hyperthyroidism, hormonal adrenal tumors, chronic intestinal diseases, severe somatic pathology. Optimized treatment additionally included recommendations for lifestyle changes, melatonin, vitamin D, medicament’ correction of iron deficiency without anemia. Estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, progesterone, prolactin, and cortisol levels were determined in all subjects.
 Results of the research. In the follicular phase of menstrual cycle after the standard treatment there is a positive dynamics of progesterone and FSH levels in the patients in the I and II groups whose concentrations reached the control group. However, LH level in patients in both groups and estradiol amount in the II group differed significantly from those in healthy women. After optimized treatment, the levels of prolactin and cortisol reached the amount of healthy women, while after the standard treatment the prolactin concentration was increased by 17.22 % (p=0.049), cortisol – by 43.84 % (p<0.001) compared with controls. In the luteal phase, the greatest correction of estradiol and progesterone concentrations in the I and II groups and prolactin level in women in the I group were determined. However, the amount of prolactin in patients of the II group remained high, exceeding the rate of healthy women by 33.64 % (p=0.007), while in the I group it corresponded to the control value. No significant changes in the concentration of FSH, LH and testosterone on the background of treatment in women of the two groups were observed, as their levels corresponded to the control group. FSH and LH levels in patients before and after the standard and optimized treatment were at the lower limit of healthy persons.
 Conclusions. The use of standard and optimized approaches in the management of patients with abnormal uterine bleeding and chronic psycho-emotional stress has been successful in normalizing in female sex hormones, but the standard approach has demonstrated an insufficient correction of stress-induced hormone levels, in contrast, the optimized treatment led to a more effective correction of all hormonal disorders.

Examining Vascular Responses to Passive Movement in Premenopausal Females: Comparisons Across Sex and Menstrual Cycle Phase

PurposeVascular responses to passive movement represent a novel assessment of vascular function and serves as a critical component for adequate blood flow regulation during exercise. Although alterations to estradiol (E2) throughout the menstrual cycle, as well as sex differences, are known to impact vascular function, limited research exists in determining whether vascular responses to passive movement are altered in premenopausal females when compared across sex or menstrual cycle phase. We hypothesized that there would be no differences in leg blood flow responses to passive leg movement (PLM) in premenopausal females when compared to age‐matched males or when evaluated across follicular menstrual cycle phases, when E2 fluctuates the most.MethodsVascular responses to one‐minute of PLM were assessed in eleven premenopausal females (n = 21; 23 ± 4 yrs) and age‐matched males (n = 21; 24 ± 4 yrs). All the females completed the PLM assessment during the early (EF) and late follicular (LF) phase of their menstrual cycle, based on self‐reporting of menses. Lower limb microvascular function was assessed during PLM via changes in leg blood flow measured as peak change from baseline (LBFΔPEAK) and area‐under‐the‐curve (LBF AUC). Thigh volume, a known modulator of PLM responses, was also assessed in the passively moved limb in all participants via anthropometric measurements. Blood samples were obtained at rest from the antecubital vein of the arm to determine differences in E2 between the EF and LF phases of the menstrual cycle.ResultsThigh volume differed significantly between the females and age‐matched males (F: 4.9 ± 1.5 L; M: 8.2 ± 1.6 L; p < 0.01) and, when examined in all participants, thigh volume was significantly correlated to PLM‐induced hyperemia evaluated as both LBFΔPEAK (r = 0.6; p < 0.01) and LBF AUC (r = 0.4; p = 0.014). When the group differences in thigh volume were accounted for in the PLM analysis by employing thigh volume as a co‐variate, no significant differences in LBFΔPEAK (F: 542 ± 444; M: 794 ± 444 ml; p = 0.15) and LBF AUC (F: 164 ± 227; M: 249 ± 227 ml; p = 0.3) were revealed. The females reported no significant differences in PLM‐induced blood flow responses across menstrual cycle phases (EF vs LF) evaluated as LBFΔPEAK (EF: 385 ± 186; LF: 386 ± 154 ml; p = 0.9) or LBF AUC (EF: 123 ± 100; LF: 58 ± 84 ml; p = 0.11). Plasma E2 levels were significantly higher in females in the LF phase (215 ± 149 pg/ml) when compared to the EF phase (149 ± 98 pg/ml) of the menstrual cycle (p = 0.01).ConclusionThis study revealed no differences in PLM‐induced LBF responses in premenopausal females when compared to age‐matched males or when assessed across follicular menstrual cycle phases.

Comparison of the Effect of Hot and Thermo-Neutral Environments on Fat Oxidation during Post-Exercise Recovery in Exercise-Trained Obese Women: A Preliminary Report

Exercise training is recommended to promote energy expenditure. Fat utilization occurs during exercise and continues for an extended period of time after the exercise session. The environmental temperatures can influence whole body substrate oxidation. The present study aimed to address the impacts of environmental temperature on fat oxidation during post-exercise recovery in exercise-trained obese women. Eleven sedentary obese women (age: 18 - 50 y, BMI: 27.5 - 40 kg/m2) with regular menstruation participated in the study. All subjects underwent a 4-week moderate-intensity aerobic exercise program. After training, each subject completed 2 occasions of post-exercise recovery testing in hot (31 - 32 °C) and thermo-neutral (22 - 23 °C) conditions in a randomized crossover fashion with 3 - 4 days of washout period. Two exercise bouts preceding each recovery condition were identically performed for 60 min at 60 % of heart rate reserve (HRreserve) in the thermo-neutral condition. Both experiments were conducted during the follicular phase of menstrual cycle. Substrate oxidations were determined during 1 h of post-exercise recovery using indirect calorimetry. The results showed that the fat oxidation during recovery in thermo-neutral environment (52.8 ± 26.5 mg.kg-1.h-1) was significantly greater than recovery in hot environment (32.3 ± 27.9 mg.kg-1.h-1, p = 0.0002). Total energy from substrate oxidation was not different between hot and thermo-neutral environments. Thus, in obese women with 4-week exercise training, recovery in the thermo-neutral condition has a higher fat oxidation than in the hot condition. This result may be implicated in weight management for temperature of choice to recover after routine exercise training sessions.
 HIGHLIGHTS
 
 Fat oxidation was greater during recovery in thermo-neutral environment after moderate-intensity exercise in trained obese women
 Recovery carbohydrate oxidation was greater in hot environment than in thermo-neutral environment after moderate-intensity exercise
 Energy expenditure from substrate oxidations during recovery in both thermo-neutral and hot environments were similar
 
 GRAPHICAL ABSTRACT

Follicular phase of menstrual cycle is related to higher tendency to suffer from severe injuries among elite female futsal players

ObjectiveTo describe the injury incidence according to each phase of menstrual cycle (MC) in professional futsal players along two consecutive season and, secondly, to compare the injury incidence and frequency between different phases of the MC. DesignProspective cohort study. SettingsElite futsal players. Participants179 players. Main outcome measurePlayers were registered along two consecutive seasons. Results191 injuries were reported throughout both seasons. The injury incidence was 30.63 days-off during the follicular phase, 23.6 during ovulatory phase and 17.59 days-off in luteal phase, showing higher incidence during the follicular phase. No statistical differences (p > 0.05) were reported for any variable comparing among the three phases of MC. ConclusionsThis study suggests the relevance to track the MC, but reduces its possible relationship or influence on the injury distribution during each phase of the MC. The knowledge of injury incidence, burden and etiology is a key factor to design injury prevention programs with the focus on the most common injuries, where MC could be included as a complementary factor.

Luteinizing Hormone to Follicle-Stimulating Hormone Ratio Significantly Correlates With Androgen Level and Manifestations Are More Frequent With Hyperandrogenemia in Women With Polycystic Ovary Syndrome

Background: Altered luteinizing hormone to follicle-stimulating hormone (LH-FSH) ratio and hyperandrogenism are two important pathophysiological characteristics of polycystic ovary syndrome (PCOS). The aim of this study was to evaluate the relationship of LH-FSH ratio with androgen in women with PCOS. Methods: This cross-sectional study included 550 newly detected reproductive aged women with PCOS (mean ± standard deviation (SD): age 23.14 ± 4.80 years; body mass index (BMI) 27.64 ± 5.34 kg/m 2 ) according to revised Rotterdam criteria. Relevant clinical history, physical examination and ultrasonogram of ovaries were done for each participant. Fasting serum LH, FSH and total testosterone (TT) were measured by chemiluminescent microparticle immunoassay from blood collected during follicular phase of menstrual cycle. Results: More than two-thirds (n = 389, about 71%) had altered LH-FSH ratio (cut-off > 1.0) and about 43% (n = 234) had hyperandrogenemia (TT > 46 ng/dL). Frequency of none of the clinical variables or ovarian morphology differed statistically between the groups with or without altered LH-FSH ratio (NS for all). Serum TT and LH-FSH ratio were positively correlated (r = 0.139, P = 0.001). However, menstrual irregularity (P = 0.002), polycystic ovaries (P = 0.045), diabetes mellitus (P = 0.017), obesity (P = 0.009) and hirsutism (P < 0.001) were higher in frequency in the hyperandrogenic group. Serum TT had predictive association with altered LH-FSH ratio (odds ratio (OR) (95% confidence interval (CI)): 1.09 (1.02 - 1.16), P = 0.02) and LH-FSH had predictive association with hyperandrogenemia (OR (95% CI): 1.15 (1.03 - 1.28), P = 0.02) in women with PCOS. Conclusions: Serum LH-FSH ratio and androgenemia significantly correlate in women with PCOS. However, manifestations are more frequent with hyperandrogenemia rather than altered LH-FSH ratio. J Endocrinol Metab. 2021;11(1):14-21 doi: https://doi.org/10.14740/jem716

Luteinizing Hormone to Follicle-Stimulating Hormone Ratio Significantly Correlates With Androgen Level and Manifestations Are More Frequent With Hyperandrogenemia in Women With Polycystic Ovary Syndrome

Background: Altered luteinizing hormone to follicle-stimulating hormone (LH-FSH) ratio and hyperandrogenism are two important pathophysiological characteristics of polycystic ovary syndrome (PCOS). The aim of this study was to evaluate the relationship of LH-FSH ratio with androgen in women with PCOS. Methods: This cross-sectional study included 550 newly detected reproductive aged women with PCOS (mean ± standard deviation (SD): age 23.14 ± 4.80 years; body mass index (BMI) 27.64 ± 5.34 kg/m 2 ) according to revised Rotterdam criteria. Relevant clinical history, physical examination and ultrasonogram of ovaries were done for each participant. Fasting serum LH, FSH and total testosterone (TT) were measured by chemiluminescent microparticle immunoassay from blood collected during follicular phase of menstrual cycle. Results: More than two-thirds (n = 389, about 71%) had altered LH-FSH ratio (cut-off &gt; 1.0) and about 43% (n = 234) had hyperandrogenemia (TT &gt; 46 ng/dL). Frequency of none of the clinical variables or ovarian morphology differed statistically between the groups with or without altered LH-FSH ratio (NS for all). Serum TT and LH-FSH ratio were positively correlated (r = 0.139, P = 0.001). However, menstrual irregularity (P = 0.002), polycystic ovaries (P = 0.045), diabetes mellitus (P = 0.017), obesity (P = 0.009) and hirsutism (P &lt; 0.001) were higher in frequency in the hyperandrogenic group. Serum TT had predictive association with altered LH-FSH ratio (odds ratio (OR) (95% confidence interval (CI)): 1.09 (1.02 - 1.16), P = 0.02) and LH-FSH had predictive association with hyperandrogenemia (OR (95% CI): 1.15 (1.03 - 1.28), P = 0.02) in women with PCOS. Conclusions: Serum LH-FSH ratio and androgenemia significantly correlate in women with PCOS. However, manifestations are more frequent with hyperandrogenemia rather than altered LH-FSH ratio. J Endocrinol Metab. 2021;11(1):14-21 doi: https://doi.org/10.14740/jem716

Mathematical modeling of temperature variation in breast tissue with and without tumor/cyst during menstrual cycle

The thermoregulation of human female body is influenced by hormonal and physiological changes in the body during the menstrual cycle. The fluctuation of estrogen and progesterone hormones, release in the follicular phase and the luteal phase of menstrual cycle, respectively play an important role in the growth of breast ducts and lobules (milk glands). The imbalance of these hormones causes breast tumors/cysts. The body core temperature, blood perfusion and metabolism rate are higher in the luteal phase than the follicular phase of menstrual cycle. In the present work, a tumor/cyst is assumed to be in the glandular layer. A two-dimensional Pennes bioheat equation is solved to find the temperature variation in breast tissue with and without tumor/cyst during the menstrual cycle by using the finite element method. The results show that the temperature of each layer of breast tissue in the luteal phase is higher than the follicular phase in the case of normal breast, tumorous breast and breast with cyst.

Testosterone Responses to Intensive, Prolonged Endurance Exercise in Women.

Objective:To examine the response of testosterone in women to an intensive, prolonged endurance exercise bout that mimicked a competitive event.Methods:Ten healthy eumenorrheic women ran to exhaustion at ~100% of their ventilatory threshold in their follicular menstrual cycle phase. Testosterone measures were assessed pre-exercise, immediately, 30 min, 60 min, 90 min, and 24 h post-exercise.Results:At exhaustion (75.1 ± 7.0 min), total (56%), free (36%), and bioavailable testosterone (50%) were increased from pre-exercise values (p< 0.05). At 24 h post-exercise, these measures were decreased from pre-exercise values (−21%, −31%, −18%, respectively; p < 0.05). Effect sizes for these changes ranged from medium to large in magnitude.Conclusion:Testosterone was elevated in the early recovery period following exhaustive endurance exercise but was reduced by 24 h afterward. These outcomes are comparable to responses seen in men when sex-based concentration differences are considered.

Features of hormonal homeostasis in women of reproductive age with uterine leiomioma in the dynamics of treatment

Objective of the study was to determine the characteristics of hormonal homeostasis in women with uterine leiomyoma in the course of treatment.Materials and methods. The hormonal status of 60 women with uterine leiomyoma at the age of 26–45 years was studied. 30 women received treatment with a progesterone receptor antagonist – mifepristone 50 mg per day for 3 months, 30 women received therapy with a gonadotropic-releasing hormone agonist goserelin 3.6 mg per day for 3 menstrual cycles. The control group consisted of 20 healthy women of reproductive age.Results. Uterine leiomyoma was associated with the absence of a preovulatory peak of luteinizing hormone and follicle-stimulating hormone against the background of relative increase of estradiol in the follicular phase of menstrual cycle and progesterone increase in the periovulatory period. Subclinical hypothyroidism was established in 23.3% of women with uterine leiomyoma, and hyperandrogenism of mixed genesis in 13.3% of women with uterine leiomyoma. A relative increase of cortisol was noted in 21.7% of patients with uterine leiomyoma, that is indicates on the chronic stress as one of the triggers for pathogenesis of hormonal disorders due to uterine leiomyoma. Mifepristone did not affect the serum concentrations of sex hormones and gonadotropins, that is indicates the drug effect is at the local level only. Gonadotropic-releasing hormone agonists leads to inhibition of the pituitary-ovarian axis, manifested by changes in hormonal homeostasis in the form of temporary hypoestrogenia and hypoprogesteronemia against the background of a significant decrease of gonadotropins, which is reversible and allows to use these drugs to restore reproductive function in women with uterine leiomyoma. Conclusions. The established changes in hormonal homeostasis are determined by the peculiarities of the combination of concomitant endocrine pathology and functional state of the reproductive system, and hyperproliferative process arises as a result of the endocrine system dysfunction. Mifepristone does not change hormonal homeostasis, and goserelin leads to a hypoestrogenism and hypoprogesteronemia, which is temporary and reversible

Expression of nerve growth factor (NGF) in endometrium as a potential biomarker for endometriosis – Single tertiary care centre study

Objectiveto identify novel biomarkers for peritoneal endometriosis in eutopic endometrium thus giving an oportunity for non-invasive diagnosis. DesignA cross-sectional single-center study Settingtertiary care hospital Patients49 patients subjected to laparoscopy because of suspected endometriosis, 33 patients out of the group qualified to the study had sufficient endometrial tissue taken and were in their follicular phase of menstrual cycle. Interventionsbiopsy sampling of eutopic endometrial tissue during diagnostic or diagnostic and terapeutic laparoscopy, questionaires, Main Outcome Measure(s)qRT-PCR to evaluate the mRNA expression of selected candidate marker genes in endometrium: ARO1 (aromatase), CXCL8 (interleukin 8), NGF (nerve growth factor), VEGF-A (vascular endothelial growth factor A), PDGF-A (platelet-derived growth factor A). ResultsmRNA expression of ARO1, CXCL8, VEGF-A and PDGF-A did not differ significantly between women with and without endometriosis. NGF mRNA expression was decreased in women with endometriosis. ConclusionsObserved preliminary results suggest a possible role of NGF in early diagnosis of peritoneal endometriosis. The role of NGF changes in eutopic endometrium of patients with peritoneal endometriosis needs further evaluation.

OR31-05 Emergence of Ovarian Hyperandrogenism and Luteal Insufficiency Following ESR1 Knockdown in the Mediobasal Hypothalamus of Adult Female Rhesus Monkeys

Diminished estradiol (E2) negative feedback action by neuronal ESR1 in the arcuate nucleus (ARC) of the mediobasal hypothalamus (MBH) is hypothesized to cause gonadotropin-releasing hormone (GnRH) hypersecretion, and thus LH excess, contributing to ovarian hyperandrogenism in polycystic ovary syndrome (PCOS). In primates, including humans, however, the mediating estrogen receptor is unknown. Thus, to test the hypothesis that diminished E2 action on ARC ESR1 contributes to female primate ovarian hyperandrogenism, eleven, ovary intact, adult female rhesus macaques, pair housed with female peers, received five 12µl MRI-guided MBH infusions into the rostral-to-caudal extent of both right and left ARC. Each infusion comprised gadolinium contrast agent and ~3-4 x 1010 adeno-associated virus 8 (AAV8) particles containing either a shRNA specific for ESR1 (n=6, ERaKD) or scrambled shRNA (n=5, control). Mid-surgery MRI scans identified targeting accuracy. 2-2.5 years following AAV8 infusion, EIA-determined P4 values were obtained from twice weekly serum samples; samples obtained during the follicular phase of menstrual cycles or anovulatory periods were submitted to liquid chromatography, tandem mass spectrometry (LCMS) for additional steroid hormones. LCMS-determined values were also obtained 0 hours (h) and 24 h following an IM injection of 200IU hCG. Both ERaKD (28.5 ± 1.3 days, mean ± SEM) and control (34.0 ± 3.3 days) female groups exhibited comparably regular menstrual cycles. ERaKD exhibited higher circulating levels of LH (2.8 ± 0.2 ng/ml, p=0.03), androstenedione (A4, 0.43 ± 0.03 ng/ml, p=0.03) and testosterone (T, 0.23 ± 0.03 ng/ml, p=0.09), and LH/FSH ratio (1.7 ± 0.2, p=0.05) compared to controls (LH, 2.1 ± 0.4; A4, 0.30 ± 0.05; T, 0.18 ± 0.01 ng/ml; LH/FSH 1.3 ± 0.2). Following an ovarian androgen-stimulating hCG injection, ERaKD 24-h peak levels for T (0.28 ± 0.01 ng/ml) were higher (p=0.03) compared to controls (0.21 ± 0.01 ng/ml). In addition, luteal insufficiency emerged in ERaKD females, with mean (2.4 ± 0.3 ng/ml), peak (3.6 ± 0.4 ng/ml) and area-under-the-curve (AUC, 23.2 ± 4.2 ng/ml/days) P4 values diminished compared to controls (mean, 3.6 ± 0.1, p=0.01; peak 5.7 ± 0.1 ng/ml, p=0.01; AUC, 43.7 ± 6.7 ng/ml/days, p=0.03). Taken together, these results suggest that knockdown of ARC ESR1 disrupts Gn stimulation of ovarian function, contributing to female monkey ovarian hyperandrogenism and menstrual cycle impairment emulating PCOS in women.

EVALUATION OF CHANGES IN CARDIORESPIRATORY FUNCTIONS DURING DIFFERENT PHASES OF THE MENSTRUAL CYCLE IN YOUNG WOMEN

Introduction: Menstrual cycle or menstruation involved discharge of sanguinous fluid and a sloughing of uterine wall. In women menstruation occurs at regular intervals on an average of 28 days, although most women gave a history of regular intervals of 28 to 30 days. About 10% -15% of women showed cycle at the precise 28 ± 2 days intervals when menstrual calendar was utilized. Normally in young women in different phases of ovarian cycles the plasma levels of estrogen vary. Ovulation occurs in the first 12-13th day of menstrual cycle, which is termed estrogen surge and second occurs in mid-luteal phase. During mid cycle or follicular phase of menstrual cycle the plasma concentration of progesterone is very low about 0.9 ng/mL. its level starts rising owing to secretion from the granulose cells. During luteal phase progesterone level reaches its peak value of 18 ng/mL and its level fall to a minimum value toward the end of the cycle. Estrogen affects local and systemic vasodilation. The menstrual cycle envelops two fundamental stages, the follicular stage (FP) and the luteal stage (LP). The follicular stage can part advance into two substages; the early FP, which is characterised with moo concentrations of both the key hormones estrogen and progesterone; and the mid FP where estrogen is tall autonomously from progesterone. The LP is epitomized by tall concentration of both estrogen and progesterone. These two fundamental stages are isolated by a soak surge in luteinizing hormone activating ovulation. These recurrent changes are said to be frequency unsurprising while long time. Aim: The main aim of this study is to evaluate the Cardiorespiratory functions changes during different Phases of Menstrual Cycle. &#x0D; Material and methods: In this study, 20 with normal weight, 20 with obese and 20 with overage were included and taken them as a sample size. In this study all the young women those were recruited as a sample size are unmarried, undergraduate female student with the between the age group of 18-22years, having regular 28+6 days menstrual cycle for at least last 6months prior to this study. For the collection of data all the participants were instructed to attend the physiology lab department during each of three different phases. Day-2 during menstrual phase, Day-7, during follicular phase and Day-22 during luteal phase and the following parameters were recorded as Anthropometric measurements, measuring of pulse rate and blood pressure and cardiac efficiency test.&#x0D; Result: In general, work out proficiency changed essentially amid the distinctive stages of the menstrual cycle with the most elevated amid luteal stage and least amid menstrualo stage. There was no critical contrast in impact test amid menstrual stage, follicular stage and luteal stage of menstrual cycle among three bunches of people.&#x0D; Conclusion: We have watched noteworthy increment in cardiac and respiratory proficiency within the luteal stage of the menstrual cycle in ordinary weight people. Lower wellness levels were watched in overweight and stout females. In this manner hone of customary work out and admissions of solid slim down which offer assistance in lessening the weight and in turn the BMI will offer assistance in improving the physical wellness of the people.&#x0D; Keywords: Cardiorespiratory, Menstrual cycle, expiratory blast test

Mild iron deficiency may affect female endurance and behavior

The function of central nervous system (CNS) processes is highly dependent on iron containing enzymes and proteins. Therefore, even mild iron deficiency (ID) may result in decreased endurance, increased irritability and withdrawal behavior among women. The current study was designed to assess the effects of iron status on perceived energy level along with its electroencephalographical (EEG) correlates and cognitive capacity of young women, since this group is at particular risk of experiencing depleted iron stores and iron deficiency anemia.The study group consisted of 23 non-anemic women of reproductive age (20–32 years) during their follicular phase of menstrual cycle. All participants were moderately physically active with a mean weekly energy expenditure of 1110 ± 450 Metabolic Equivalent of Task per minute-(MET/min). The group's electroencephalographic (EEG) alpha asymmetry and psychometric data - intelligence, anxiety level and temperamental traits (activity, briskness, sensory sensitivity, emotional reactivity, perseveration and endurance) were assessed and compared between iron deficient (serum ferritin <12 μg/l) and iron sufficient (serum ferritin ≥12 μg/l) females.Participants with depleted iron stores reported lower levels of activity (p = .004; partial η2 = 0.34) and endurance (p = .038, partial η2 = 0.25), temperamental traits, and presented increased relative left EEG alpha activity in prefrontal regions (p = .004; partial η2 = 0.63), which is a characteristic EEG pattern for withdrawal tendencies. Iron-depleted females did not differ in anxiety and general intelligence scores from those which were iron sufficient, however needed more time (median difference: 3 min, p = .004; partial η2 = 0.53) to complete an administered intelligence test, which may reflect lowered endurance during a cognitive-demanding task.These data provide proof that that even mild iron deficiency may be connected with CNS function and lead to decreased endurance, or at least cognitive endurance, which may be a risk-factor for mood disorders. Therefore, more attention should be paid to preventing even mild iron deficiency, particularly among young women.

The influence of the menstrual cycle on acute and persistent pain after laparoscopic cholecystectomy

Fluctuations of female sex hormones during menstrual cycle influence pain perception. Endogenous pain inhibition is impaired in follicular phase of menstrual cycle. We tested the primary hypothesis that the women having surgery during their follicular phase have more acute pain and require higher opioids than those in the luteal phase, and secondarily we tested that women who have surgery during their follicular phase have more incisional pain at 3 month postoperatively. 127 adult females having laparoscopic cholecystectomy were randomized to have surgery during the luteal or follicular phase of their menstrual cycle. Standardized anesthesia and pain management regimen was given to all patients. Pain and analgesic consumption were evaluated in post-anesthesia care unit and every 4h in the first 24h. Adverse effects were questioned every 4h. Time to oral intake and ambulation were recorded. Post-surgical pain, hospital anxiety, depression scale, SF-12 questionnaire were evaluated at 1 and 3 month visits. There was no difference in acute pain scores and analgesic consumption through the 24h period, Visual Analog Scale at 24h was 1.5±1.5cm for follicular group 1.4±1.7cm for luteal group (p=0.57). Persistent postoperative pain was significantly more common one and at three month, with an incidence was 33% and 32% in the patients at follicular phase versus 16% and 12% at luteal phase, respectively. The Visual Analog Scale at one and at three month was 1.6±0.7cm and 1.8±0.8cm for follicular group and 2.7±1.3cm and 2.9±1.7cm in the luteal group (p=0.02), respectively. There were no significant differences between the groups with respect to anxiety and depression, SF-12 scores at either time. Nausea was more common in follicular-phase group (p=0.01) and oral feeding time was shorter in follicular phase (5.9±0.9h) than in luteal phase (6.8±1.9h, p=0.02). Although persistent postoperative pain was significantly more common one and three months after surgery the magnitude of the pain was low. Our results do not support scheduling operations to target particular phases of the menstrual cycle.

Ovarian stromal blood flow changes after laparoscopic ovarian drilling (LOD) in women with polycystic ovary s)

Is to compare the changes in the ovarian stromal blood flow &amp; some hormonal profile (LH,T,FSH &amp; LH/FSH ratio) after laparoscopic ovarian diathermy in women with PCOS. In the ovarian stromal blood flow with serum concentrations of follicle stimulating hormones, luteinizing hormone and testosterone were measured at early follicular phase of menstrual cycle before and first cycle after laparoscopic ovarian diathermy. The ovulation was also evaluated by folliculometry at the first menstrual cycle after operation.After laparoscopic ovarian drilling, there was statistically significant reduction in ovarian stromal blood flow (peak systolic velocity significantly decreased,while resistance index and pulsatiltyindex significantly increased) as well as serum levels of testosterone,luteinizing hormones and LH/ FSH ratio all significantly decreased. These changes were significantly more in those who ovulated after laparoscopic ovarian diathermy. The measurement of ovarian stromal blood flow by 2D power Doppler for women with anovulatory polycystic ovary syndrome undergoing laparoscopic ovarian drilling may provide a useful tool in evaluating the outcome of laparoscopic ovarian diathermy.

Polycystic Ovary Syndrome in Bipolar Affective Disorder: A Hospital-based Study.

Background:Preliminary studies suggest a multidimensional relationship of mood pathology with endocrine disturbances. Studies have found an increased risk of mood disorders in polycystic ovary syndrome (PCOS), and conversely, many of the medications commonly used in the treatment of bipolar affective disorder (BPAD) can have deleterious effects on blood levels of reproductive hormones and consequently on the hypothalamic–pituitary–gonadal (HPG) axis and reproductive function. Furthermore, there is evidence of reproductive dysfunction in women with BPAD before treatment.Objectives:To assess the comorbidity of PCOS in patients of BPAD and to study risk factors associated with this comorbidity.Materials and Methods:Two hundred female patients with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition diagnosis of BPAD, between ages of 15 and 45 years, were evaluated by an endocrinologist. Patients reporting menstrual disturbances or having any stigmata of PCOS were further subjected to hormonal analysis, which included luteinizing hormone, follicle-stimulating hormone, prolactin, and testosterone, in the early follicular phase of menstrual cycle. Diagnosis of PCOS was made as per the NIH criteria.Results:Of 200 patients, 46 (23%) were diagnosed as having PCOS. Forty-five percent (n = 90) reported menstrual disturbances while 27% (n = 54) had polycystic ovaries on ultrasonography. 19.2% of the patients diagnosed as PCOS had a history of valproate intake while 27.90% patients had no such history (P = 0.15). No significant difference (P = 0.07) was found in the prevalence of PCOS among various drug groups (including group on multiple mood stabilizers).Conclusion:A higher prevalence of PCOS is seen in BPAD, irrespective of pharmacotherapy, suggesting a common link between the disorders which might be in the form of disturbance in HPG axis.

Pain sensitivity and cardiovascular reactivity to the experimental induced cold pressor pain during different phases of menstrual cycle in young Indian females

Background: Many previous research studies have shown a higher prevalence of chronic pain conditions as well as more pain sensitivity or lesser pain thresholds (PTh) among women as compared to men. It might be related to the effect of female reproductive hormones, as these hormones produce its effect on various aspects of physiological systems. Aims and Objectives: The aim of this study is to find the differences in the pain responses as well as cardiovascular reactivity during cold pressor test in different phases of menstrual cycle. Materials and Methods: Following physical parameters were measured in 75 apparently healthy young Indian females during the three phases of menstrual cycle and utilized for data analysis: Response to cold-induced experimental pain in the form of PTh, pain tolerance (PTo), pain rating on visual analogous scale, pulse reactivity (PRe), systolic blood pressure reactivity (SBPRe), and diastolic BPRe (DBPRe). Results: Mean PRe was significantly higher during luteal phase as compared to menstrual as well as follicular phase. Mean SBPRe and mean DBPRe were found to be significant higher during luteal phase as compared to the menstrual and follicular phase. Mean PTh and mean PTo were significantly higher during follicular phase as compared to menstrual as well as luteal phase. Conclusion: This is concluded from above findings that the pain responses vary across the menstrual cycle as shown by higher PTh and tolerance during follicular phase of menstrual cycle. The cardiovascular reactivity to cold pressor pain also varies. The hormonal fluctuation and the differences in the physiological responses, mainly autonomic nervous system reactivity due to these fluctuations, would be the underlying mechanism for these findings.

The influence of the menstrual cycle on acute and persistent pain after laparoscopic cholecystectomy

Background and objectivesFluctuations of female sex hormones during menstrual cycle influence pain perception. Endogenous pain inhibition is impaired in follicular phase of menstrual cycle. We tested the primary hypothesis that the women having surgery during their follicular phase have more acute pain and require higher opioids than those in the luteal phase, and secondarily we tested that women who have surgery during their follicular phase have more incisional pain at 3 month postoperatively. Methods127 adult females having laparoscopic cholecystectomy were randomized to have surgery during the luteal or follicular phase of their menstrual cycle. Standardized anesthesia and pain management regimen was given to all patients. Pain and analgesic consumption were evaluated in post-anesthesia care unit and every 4h in the first 24h. Adverse effects were questioned every 4h. Time to oral intake and ambulation were recorded. Post-surgical pain, hospital anxiety, depression scale, SF-12 questionnaire were evaluated at 1 and 3 month visits. ResultsThere was no difference in acute pain scores and analgesic consumption through the 24h period, Visual Analog Scale at 24h was 1.5±1.5cm for follicular group 1.4±1.7cm for luteal group (p=0.57). Persistent postoperative pain was significantly more common one and at three month, with an incidence was 33% and 32% in the patients at follicular phase versus 16% and 12% at luteal phase, respectively. The Visual Analog Scale at one and at three month was 1.6±0.7cm and 1.8±0.8cm for follicular group and 2.7±1.3cm and 2.9±1.7cm in the luteal group (p=0.02), respectively. There were no significant differences between the groups with respect to anxiety and depression, SF-12 scores at either time. Nausea was more common in follicular-phase group (p=0.01) and oral feeding time was shorter in follicular phase (5.9±0.9h) than in luteal phase (6.8±1.9h, p=0.02). ConclusionsAlthough persistent postoperative pain was significantly more common one and three months after surgery the magnitude of the pain was low. Our results do not support scheduling operations to target particular phases of the menstrual cycle.