Menstrual Cycle Pattern Research Articles

Demographic and epidemiologic features of female adolescents in Turkey

To determine the average menarcheal age and menstrual cycle pattern, prevalence of dysmenorrhea, frequency of smoking, alcohol and drug use, sexual education level, and the gynecologic problems in female adolescents in Turkey. A questionnaire consisting of 43 questions were given to 13,665 high school girls between the ages 13-18 years. The results showed that average menarcheal age was 13.28 +/- 1.09 years and 77.8% of the girls had menstrual cycles between 20-35 days; 10,688 (78.1%) of the girls complained about pain during their menstruation and 25.6% frequently missed school for this reason. That notwithstanding, only 0.4% of the adolescents with dysmenorrhea had sought medical consultation. Out of 13,665 girls, 19.7% smoked cigarettes, 14.9% used alcohol, and 0.63% used other drugs. Although 50.8% of the students believed that their knowledge about sexuality was adequate, on evaluating the results, this was not confirmed. Girlfriends were found to be the most important source of sexual knowledge. The study indicated that 88.8% of the girls wanted to have sexual education at schools and 60.5% of those preferred to take such a lecture together with boys. The study also revealed that 10.5% of the girls previously consulted a gynecologist and menstrual disorders (26.1%) and dysmenorrhea (23.4%) were the most common complaints. The results showed that 68.7% of the girls preferred a woman gynecologist and 66.3% wanted to be alone with the doctor during examination. We provided data about demographic and epidemiologic features of Turkish female adolescents.

Basal body temperature curves and endocrine pattern of menstrual cycles in Down syndrome.

We examined the basal body temperature curves and the endocrine pattern of 20 cycles from women with Down syndrome with regular menstrual cycles. Data were compared with those obtained from an age-matched population of healthy women with regular menses. Growth hormone deficiency was excluded for women with Down syndrome by pharmacological tests. Women with Down syndrome showed a significantly higher incidence of anovulation and luteal defects than controls (p < 0.001). Overall, and in ovulatory cycles, estradiol and progesterone plasma levels were greater in controls than in women with Down syndrome. No difference was observed for gonadotropin and androgen circulating levels between the two groups. It is concluded that in women with Down syndrome with regular menses, ovulatory events were less frequent and often characterized by luteal defects. This could be ascribed to an impairment of both follicular and luteal functions. However, reproduction is possible in such patients.

Danazol concentrations in ovary, uterus, and serum and their effect on the hypothalamic-pituitary-ovarian axis during vaginal administration of a danazol suppository

To determine danazol concentrations in the ovary, uterus, and serum during daily vaginal administration of a danazol suppository and to examine its effect on the hypothalamic-pituitary-ovarian axis. Sampling of tissues after vaginal or oral administration of danazol and sampling of blood during control and danazol-administration menstrual cycles. Outpatient volunteers and inpatients at a public hospital. Thirty patients who were to undergo hysterectomy and oophorectomy because of uterine leiomyoma and eight regularly menstruating volunteers. Danazol was administered as a vaginal suppository (100 mg) or orally (400 mg). Danazol concentrations in the ovary, uterus, and serum, and serum E2 and P levels. Danazol concentrations in the ovary and uterus after daily vaginal administration of a suppository containing 100 mg danazol were comparable to those after daily oral administration of 400 mg danazol, but the serum danazol concentration was much lower. Menstrual cycle patterns of serum E2 and P levels were normal during daily vaginal administration of a danazol suppository. Daily administration of a suppository containing 100 mg danazol produces high ovarian and uterine concentrations but low serum concentrations, and no effect was detected on the hypothalamic-pituitary-ovarian axis.

Relative Influence of Serum Follicle-Stimulating Hormone, Age and Other Factors on Ovarian Response to Gonadotrophin Stimulation

Objective To determine the relative value of the woman's age, basal follicle stimulating hormone (FSH), basal luteinising hormone (LH) and menstrual cycle pattern (all denned prior to treatment) in predicting the ovarian response to gonadotrophin stimulation for in vitro fertilisation. Design Open, descriptive cohort study. Patients One hundred and seventy-one consecutive ovulatory women undergoing their first cycle of in vitro fertilisation with ovarian stimulation after pituitary desensitisation. Interventions Measurement of basal (early follicular phase) and down-regulated concentrations of serum FSH and LH, and calculation of age at treatment and of median length of menstrual cycles and range of variation prior to treatment. Main outcome measures Duration and amount of gonadotrophin stimulation to achieve follicular maturity, number of mature follicles, peak serum oestradiol concentration and number of mature oocytes, were compared between banded values of variables studied. Results Increasing basal FSH concentrations were significantly associated with reducing oestradiol levels, numbers of mature follicles and oocyte yield even when the FSH levels were still within the normal range though above average (6 to 8.9 i.u./l). There were similar but weaker associations with FSH levels after down-regulation. There were also significant differences between women over and under 40 years old in their oestradiol levels, numbers of follicles and of oocytes. Analysis of variance showed significant independent association of basal FSH with both oestradiol and numbers of oocytes, but not of age, menstrual pattern, or serum LH concentrations. Conclusion Serum FSH is more sensitive than the woman's age in determining her ovarian responsiveness to stimulation. LH concentrations and menstrual cycle patterns are unhelpful.

Menstrual cycle patterns and risk of breast cancer.

Menstrual cycle characteristics may reflect underlying endocrine patterns that influence the risk of breast cancer. Most previous studies of menstrual function and breast cancer risk have used retrospective reports of menstrual bleeding, which may be unreliable. To examine this association, the authors conducted a mail survey among 997 women who had recorded menstrual events prospectively over as many as 50 years, beginning in 1934. Compared with women with a median menstrual cycle length of 26-29 days, women who had cycles of extreme length at ages 25-29 years had a nearly twofold increased incidence of breast cancer (for a median cycle length of less than 26 days, adjusted relative risk (RR) = 1.9, 95% CI 0.9-4.1; for > or = 34 days, RR = 1.9, 95% CI 0.9-3.9). Statistical adjustment was made for age, family history of breast cancer, parity, age at menopause, age at first pregnancy, and Quetelet index (weight (kg)/height (m)2). Adjusting for age and other potential confounders and restricting the analysis to women who did not use hormones, women who experienced either a lesser (< 150) or a greater (> 350) cumulative number of cycles had an increased incidence of breast cancer (adjusted RR = 1.9, 95% CI 0.3-10.6, and RR = 1.8, 95% CI 0.5-6.0, respectively) compared with women who experienced 150-350 cycles. The findings are discussed in the context of current hormonal theories of breast cancer etiology.

Relative influence of serum follicle stimulating hormone, age and other factors on ovarian response to gonadotrophin stimulation

To determine the relative value of the woman's age, basal follicle stimulating hormone (FSH), basal luteinising hormone (LH) and menstrual cycle pattern (all defined prior to treatment) in predicting the ovarian response to gonadotrophin stimulation for in vitro fertilisation. Open, descriptive cohort study. One hundred and seventy-one consecutive ovulatory women undergoing their first cycle of in vitro fertilisation with ovarian stimulation after pituitary desensitisation. Measurement of basal (early follicular phase) and down-regulated concentrations of serum FSH and LH, and calculation of age at treatment and of median length of menstrual cycles and range of variation prior to treatment. Duration and amount of gonadotrophin stimulation to achieve follicular maturity, number of mature follicles, peak serum oestradiol concentration and number of mature oocytes, were compared between banded values of variables studied. Increasing basal FSH concentrations were significantly associated with reducing oestradiol levels, numbers of mature follicles and oocyte yield even when the FSH levels were still within the normal range though above average (6 to 8.9 i.u./l). There were similar but weaker associations with FSH levels after down-regulation. There were also significant differences between women over and under 40 years old in their oestradiol levels, numbers of follicles and of oocytes. Analysis of variance showed significant independent association of basal FSH with both oestradiol and numbers of oocytes, but not of age, menstrual pattern, or serum LH concentrations. Serum FSH is more sensitive than the woman's age in determining her ovarian responsiveness to stimulation. LH concentrations and menstrual cycle patterns are unhelpful.

Physical exercise and reduced risk of breast cancer in young women.

Epidemiologic evidence strongly suggests that cumulative exposure to ovarian hormones is a determinant of breast cancer risk. Because physical activity can modify menstrual cycle patterns and alter the production of ovarian hormones, it may reduce breast cancer risk; yet few epidemiologic studies have assessed this relationship. The major objective of this study was to determine whether young women (aged 40 and younger) who regularly participated in physical exercise activities during their reproductive years had a reduced risk of breast cancer. Using a case-control design, we conducted personal interviews of a total of 545 women (aged 40 and younger at diagnosis) who had been newly diagnosed with in situ or invasive breast cancer between July 1, 1983, and January 1, 1989, and a total of 545 control subjects. Case patients and control subjects were individually matched on date of birth (within 36 months), race (white), parity (nulliparous versus parous), and neighborhood of residence. Lifetime histories of participation in physical exercise activities on a regular basis were obtained during the personal interview. After adjustment for potential confounding factors, we found that the average number of hours spent in physical exercise activities per week from menarche to 1 year prior to the case patient's diagnosis was a significant predictor of reduced breast cancer risk (two-sided P for trend < .0001). The odds ratio (OR) of breast cancer among women who, on average, spent 3.8 or more hours per week participating in physical exercise activities was 0.42 (95% confidence limits [CLs] = 0.27, 0.64) relative to inactive women. The effect was stronger among women who had had a full-term pregnancy. Comparing most active (> or = 3.8 hours/wk of exercise) women to inactive women, the ORs were 0.28 (95% CL = 0.16, 0.50) for parous and 0.73 (95% CL = 0.38, 1.41) for nulliparous women. Most previously identified risk factors for breast cancer are reproductive and menstrual events that cannot be readily altered. The protective effect of exercise on breast cancer risk in the women whom we studied suggests that physical activity offers one modifiable lifestyle characteristic that may substantially reduce a woman's lifetime risk of breast cancer. Whether the protective effects of exercise on breast cancer risk are due to alterations in ovarian function and whether they extend into women's menopausal years need to be established. Our results suggest that implementation of regular physical exercise programs as a critical component of a healthy lifestyle should be a high priority for adolescent and adult women.

Intercorrelations between menstrual cycle patterns and body dimensions in Austrian women.

The relationships between 29 cephalic and post-cephalic body dimensions and the length and regularity of the menstrual cycle, as well as the duration of menstrual bleeding, have been investigated in 327 Austrian women. Five of the eight head measurements and seventeen of the 21 body measurements correlated statistically significantly with the individual menstrual variables. Measures of facial and post-cephalic robustness and the amount of subcutaneous fat tissue correlated negatively with the length of cycle, as well as with the difference between minimum and maximum cycle length, a measure of the cycle regularity. The post-cephalic height and length dimensions correlated significantly positively with bleeding duration. The results indicated a marked influence of body type, especially the amount of subcutaneous fat, on the length and regularity of the menstrual cycle.

Medical Chronobiology: Concepts and Applications

Chronobiology is the study of biologic rhythms and biologic time structure. Medical chronobiology, in particular, is concerned with circadian (24-h) and other bioperiodic influences on human diseases such as (1) their occurrence or variation in severity over the 24-h or other time scale, (2) response of patients to diagnostic procedures and tests and, (3) the effect of medical treatments. The symptoms of chronic diseases--allergic rhinitis, regular and variant type angina, rheumatoid and osteoarthritis, asthma, epilepsy, hypertension and ulcer disease, for example, commonly exhibit circadian, menstrual cycle (in women), and seasonal patterns. The life-threatening events of myocardial and cerebral infarction and cerebral hemorrhage also exhibit predictable-in-time patterns over 24 h and the year. In the clinic, bioperiodicities strongly influence the results of blood pressure assessment, cutaneous antigen testing and spirometric evaluation, to mention but a few. Bodily rhythms also affect the pharmacokinetics and dynamics of medications. A major goal of medical chronobiology is chronotherapeutics, the optimization of pharmacotherapies, taking into consideration rhythm-dependencies in the kinetics and dynamics of medications plus predictable-in-time variability in the manifestation and severity of human disease. The concepts of medical chronobiology are discussed in detail herein. Examples have been chosen for their relevance to clinical allergy and chest medicine.

Colorectal cancer in Northeast Italy: reproductive, menstrual and female hormone-related factors

The role of reproductive and menstrual factors and a few medical conditions linked to female hormones in the aetiology of colorectal cancer was investigated in a case-control study conducted in Pordenone province in northeastern Italy, on 89 women with colorectal cancer and 148 controls admitted to hospital for a wide spectrum of acute, non-digestive nor neoplastic disorders. After adjustment for age and social class, parous women, as compared to nulliparous ones, were significantly protected against colorectal cancer (odds ratio, OR = 0.4, [95% confidence interval, CI:0.2-0.8]) and the risk appeared to decrease with successive pregnancies up to five or more (0.2, [0.04-0.6]). Compared to women who had their first birth at age 24 or less, the OR for those who had it at 30 or older was 2.0, but the inverse trend in risk was not significant. However, among parous women only, age at first birth, but not parity, seemed to retain a certain influence. Late age at menopause seemed to decrease colorectal cancer risk (OR for menopause at age ≥50 vs. <45 = 0.4, [0.2–1.0]X12 (trend) = 3.66). Conversely, age at last birth, number of abortions, years between marriage and first birth, age at menarche, pattern of menstrual cycle and occurrence of a few medical conditions potentially linked to female hormones were similarly reported by cases and controls. Due to the very limited number of oral contraceptive (OC) users (9 controls but only 1 case), and the lack of oestrogen replacement therapy users, the influence of exogenous female hormones on colorectal cancer could not be analysed meaningfully.

Menstrual-cycle patterns in energy and macronutrient intake

For 14 subjects drawn from the Beltsville One-Year Dietary Intake Study, patterns of energy, protein, fat, carbohydrate, protein/1000 kcal, fat/1000 kcal, and carbohydrate/1000 kcal were examined across pre- and postmenstrual periods. Individual subjects contributed data for one to four menstrual periods. Energy, fat, and fat/1000 kcal intakes were significantly higher in the 10 premenstrual days than in the 10 postmenstrual days. After elimination of effects attributable to between-subject differences and to balance periods included in the Beltsville study, fitted sine curves explained 14% and 25% of the variance in energy and fat intakes, respectively, across 14 premenstrual and 14 postmenstrual days, and 20% of the variance in fat/1000 kcal. Independent patterns were identified in absolute and relative protein intake. No patterns were discerned for carbohydrate. Physiological or behavioral factors appear to influence both total food intake (energy intake) and food selection (macronutrients/1000 kcal) across the menstrual cycle.

Assessing reproductive status in orang‐utans by using urinary estrone

AbstractThe aim of this work was to compare normal menstrual cycle patterns of urinary estrone excretion in orang‐utans with those of an orang‐utan in her late 40s, an orang‐utan before and after rehabilitation for anorexia, and an orang‐utan during prolonged lactation. A detailed menstrual and sexual activity record was kept for each orang‐utan subject. Urine samples for estrone radioimmunoassay were collected daily for two cycles whenever possible. “Mawas,” in her late 40s, was monitored for two cycles in each of 3 successive years. While the normal pattern of estrone excretion was initially seen, some of the later cycles were shorter and appeared to lack the large luteal‐phase peak. “Puspa,” anorexic and amenorrhoeic at the age of 9½ years, had very low urinary estrone concentrations. After rehabilitation, followed by a late menarche, she had regular menstrual cycles with a normal estrone excretion pattern. She gave birth to a normal infant in 1990. “Puteri,” who had been lactating for 2 years, had consistently low estrone concentrations during an 8‐week monitoring period, with no evidence of cyclic variation in estrone excretion. Daily urinary estrone measurements, together with observation, were found to be useful in assessing the reproductive status of orangutans.

Effects of Ovarian Tissue Reduction on the Menstrual Cycle: Persistent Normalcy after Near-Total Oophorectomy1

These experiments were designed to evaluate whether removal of approximately 95% visible ovarian tissue would interrupt the short- or long-term regulation of cyclic ovarian function. On cycle Days 2 4 (onset of menses = Day 1), the entire left ovary and approximately 90% of the right ovary were removed from three cycling cynomolgus monkeys. After approximately 95% ovariectomy, there was an acute elevation of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which lasted 11 +/- 2 days. A midcycle-like gonadotropin surge occurred 20 +/- 3 days following approximately 95% ovariectomy; the next menses occurred 19 +/- 1 days later. Follicular phase patterns of estradiol preceded the midcycle gonadotropin surge, and luteal phase progesterone levels indicated subsequent ovulation. Two of three monkeys resumed normal menstrual cyclicity in the following cycle with follicular phase, luteal phase, and menstrual cycle lengths similar to pretreatment levels. Histological examination of the ovarian remnant removed on Day 21 of the next cycle revealed a morphologically normal corpus luteum and many small follicles. A second group of 6 rhesus monkeys also underwent approximately 95% ovariectomy for long-term evaluation of menstrual cyclicity; typical 28-day menstrual cycle patterns were observed in 4 of the 6 monkeys for 5 mo, with 2 of these 3 animals maintaining regular menstrual cycles for 1 yr. In summary, our data suggest that normal ovarian function, i.e. recruitment, selection, and dominance of the ovulatory follicle, ovulation, and subsequent corpus luteum function, is maintained with only approximately 5% of functional ovarian tissue remaining.(ABSTRACT TRUNCATED AT 250 WORDS)

Menstrual and reproductive factors and the risk of myocardial infarction in women under fifty-five years of age

The relationship between menstrual and reproductive factors and subsequent risk of coronary heart disease was investigated in a hospital-based case-control study of 202 women with acute myocardial infarction and 374 control subjects admitted for a wide spectrum of acute conditions unrelated to any of the established risk factors for ischemic heart disease. No consistent association was observed with age at menarche or menopausal status, but women with a lifelong irregular menstrual cycle pattern were at significantly elevated risk of myocardial infarction (relative risk = 1.8, 95% confidence interval = 1.1 to 2.9). No clear trend in risk was evident with the number of livebirths, miscarriages, or induced abortions. However, women whose first pregnancy or livebirth occurred before age 20 years showed elevated risks of subsequent myocardial infarction compared with nulliparous ones (relative risks = 2.3; 95% confidence interval = 1.1 to 4.9), and there was a significant trend of increasing risk with earlier first birth. These associations were evident in both younger and middle-age women and were not explained by allowance for several identified potential confounding factors.

Cyclic administration of an LHRH analogue and of progesterone in risk patients to oral contraceptives

Fifty-five cycles of 9 patients with normogonadotropic ovarian function having risks against oral contraceptives (OCs) and intrauterine devices (IUDs) were treated for contraception with buserelin in a dosage of 300 to 450 /ug per day i.n. from day 5 to day 26 of the cycles. Additionally, progesterone (P) in a dosage of 75 mg per day was given by intravaginal suppositories from day 20 to day 26 of the cycle followed by a 7-day drug-free interval. Serum levels of LH, FSH and estradiol-17β (E 2) showed a wide variability. However, most E 2 levels were in the early or middle follicular phase range. Mean serum P levels monitored during P replacement were found to be in the secretory phase range. Pattern of menstrual cycles was regular in all patients except one whose menstrual bleedings were already disturbed prior to treatment. This mode of contraception was well accepted, no side effects were observed, no pregnancy occurred. In conclusion, contraception by low-dose intranasal application of buserelin combined with transvaginal P replacement seems to be a useful approach for contraception in patients at risk for both OCs and IUDs.

The effects of moderate physical activity on menstrual cycle patterns in adolescence: Implications for breast cancer prevention

Girls who engage in strenuous physical activity are often amenorrheic and have recently been reported to be at a reduced risk of breast cancer. To determine whether moderate amounts of exercise affect menstrual cycle patterns and ovulatory frequency in young postmenarcheal girls, the menstrual cycles and physical activity patterns of 168 high school girls were monitored for a 6 month period. Anovulatory cycles were associated with later age at menarche, fewer elapsed years since menarche and greater levels of energy expended per week in physical activity. After adjusting for age at menarche and years since menarche, there was a significant dose-related trend in the risk of anovular menstrual cycles associated with increasing levels of physical activity (1-sided P = 0.03). Major determinants of average cycle length were weekly average energy expenditure (less than or equal to 750 kcal wk-1 associated with cycles that were on average 2.4 days longer), age at menarche (an increase of 0.7 days per year of age) and race (Asians having cycles about 1.9 days longer than Caucasians). Because a major determinant of breast cancer risk may be the cumulative number of ovulatory cycles, these data suggest that regular participation in moderate physical activity, by reducing the frequency of ovulatory cycles in adolescence, may provide an opportunity for the primary prevention of breast cancer.

The pattern of early menstrual cycles in Nigerian girls.

Between October 1980 and June 1981 a total of 2528 recorded menstrual cycles were collected from 422 girls in four girls' secondary schools at Enugu and Nuskka in Anambra State, Nigeria. The mean and standard deviation for all cycles were 30.9 and 18.60 days, respectively. The results support the findings from other parts of the World that menstrual cycles are highly irregular during the first few years after menarche and that the variability of these cycles decreases as menstrual life continues. A comparison between the pattern of irregularity indicated in our study and those of earlier studies in North America and Europe at different time points suggests that socio-economic development, with its attendant improvements in nutrition and the elimination of infectious diseases, may be helping to bring about a reduction in the variability of early menstrual cycles, the reduction being particularly significant in respect of very long cycles.

Pattern of menstrual cycles and incidence of congenital malformations

An analysis has been made of the general reproductive characteristics of mothers, including the temperature curves of preconception and conception cycles, in a prospective study which ended in the birth of 22 malformed infants and 894 normal infants. The differences observed have shown that the mothers of malformed infants had their first menstrual period at a later age (13.4 vs 12.8 years), their menstrual cycles were more often irregular (77% vs 40%) and lasted longer (32.9 vs 30.1 days). Moreover, they had a longer hypothermic phase during both their preconception cycle (21.7 vs 17.6 days) and during their conception cycle (24.0 vs 18.1 days), as well as a longer temperature rise during their conception cycle (3.7 vs 3.0 days). By taking into account the relation between these variables, we have been able to show that increased risk of malformation is associated with increase in the length of the hypothermic phase and the temperature rise of the conception cycle.

Clinical and biologic antecedents of the amenorrhea/hyperprolactinemia syndrome: a case-control study

Clinical, reproductive, and biologic antecedents of women with the amenorrhea/hyperprolactinemia (A/H) syndrome, most with pituitary prolactinomas, and matched healthy subjects were examined in a case-control study. Women with A/H had more frequent irregularity in early menstrual cycle patterns and excess facial hair, had less frequent catamenial symptoms, and were heavier at the time of study when compared with control subjects. The patients reported a more frequent history of thyroid disease and chest trauma. There were no significant differences between the patients and control subjects with respect to prior use of oral contraceptives, estrogens, psychotropic drugs, alcohol, or other substances known to alter serum prolactin levels, nor were there significant differences in the family history of gynecologic conditions or malignancies or the syndromes of multiple endocrine neoplasia. The implications of these findings are discussed.

Menstrual cycle patterns and the risk of breast disease

The relationship between menstrual cycle patterns and the risk of breast disease was evaluated using data from a hospital-based case-control study of 288 women with benign breast disease (203 chronic cystic diseases and 85 benign tumours), 317 with breast cancer and 602 age-matched controls with a spectrum of acute conditions unrelated to any of the established or potential risk factors for breast disease. A lifelong irregular menstrual pattern [defined as frequent occurrence of menstrual-like episodes of bleeding less than 21 or more than 35 days apart) was negatively associated with the risk of benign breast lesions (relative risk, RR = 0.6, with 95% confidence interval = 0.4–1.0) and of breast cancer (RR = 0.4, with 95% confidence interval = 0.3–0.8]. This inverse association could not be explained by any of the identified potential confounding factors, including the major risk factors for breast disease. The findings of this study, showing that a lifelong history of irregular (and hence more likely anovular) cycles was less frequent among women with benign and malignant breast diseases, support the hypothesis that frequent ovular cycles might be more carcinogenic than anovular ones.