Regulation Of Menstrual Cycle Research Articles

Comparing the Effects of Agnugol and Metformin on Oligomenorrhea in Patients with Polycystic Ovary Syndrome: A Randomized Clinical Trial

Polycystic Ovarian Syndrome (PCOS) is the most common endocrinopathy and cause of oligomenorrhea in women. The present study was conducted with the aim to compare the effect of Agnugol and Metformin drugs on oligomenorrhea in patients with PCOS. This study was a clinical trial on 120 women with PCOS and had oligomenorrhea, referring to a gynaecology clinic Fatemieh, Hamadan city, Iran, 2015. Women were randomly divided into 2 groups using permutation blocks (getting the medications Agnugol and Metformin) and were treated with drugs Agnugol and Metformin for 3 months. Data collection included demographic questionnaire and check list was designed and completed before and at the end of interventions, by both groups. To analyse the data, descriptive statistics, chi-square tests, t-test, ANOVA with repeated measures was used. The mean and SD of age was 39.45±4.60 for women taking Agnugol and 38.466±0.84 for those taking Metformin. Based on the results between the subjects, the two groups were not significantly different in terms of menstruation length, cycle intervals, or the number of pads, meaning that the two drugs had similar effects on menstrual cycle regulation, menstruation length and the number of pads. More side effects were reported in the group using Metformin. Agnugol and Metformin drugs in the treatment of oligomenorrhea patients with PCOS have the same effect. Since Metformin is a chemical drug with side effects, Agnugol can be presented as its herbal alternative to treat oligomenorrhea.

A comparative study to illustrate the benefits of using ethinyl estradiol-cyproterone acetate over metformin in patients with polycystic ovarian syndrome

AimThis study was done to illustrate the clinical and biochemical effects of ethinyl estradiol-cyproterone acetate (EE-AC) and metformin in this disease. MethodsThis was a randomized control trial study, done on twenty-six female patients already diagnosed as cases of PCOS. Participants were divided into two study groups: group one (Group 1), received metformin of 500mg twice daily and the second group (Group 2), was given ethinyl estradiol–cyproterone acetate for 21 consecutive days followed by 7 days drug-free. The course of the treatment for both groups was continued for three consecutive months. ResultsGroup 1 showed a statistical significant increase in serum high density lipoprotein cholesterol (HDL-C) levels (P=0.006) and a decrease in the level of triglyceride (TG) (P=0.006). In addition, Group 1 had a significant reduction in the levels of very density lipoprotein cholesterol (VLDL-C) (P=0.006). Group 2 had a significant increase in serum TG levels (P=0.01), associated with a significant decrease in serum LDL-C (P=0.04). Serum testosterone was significantly reduced in group 1 (P=0.038). This was associated with an improvement in glucose tolerance test (GTT) and BMI in the same group (group 1). Group 2, had an improvement in the menstrual cycle control; hirsutism and acne. ConclusionThis study showed that metformin treatment is beneficial in improving serum lipids; glucose homeostasis and BMI, however, the ethinyl estradiol-cyproterone acetate is superior in improving the clinical manifestation of patients with PCOS, including menstrual cycle regulation, hyperandrogenic state.

Antioxidant activity and characterization of essential oil from Vitex agnus-castus L.

Vitex agnus-castus L. is a plant of the family of Verbenaceae, common in the Mediterranean area and Africa, and it's used for a wide range of biological activities. This plant has a wide range of biological activities such as regulation of menstrual cycle, acne, cytotoxic activity against human cancer cells, diuretic, sedative, among others [1 – 3]. The sample was collected in Angola and it was air-dried before the extraction, the essential oil was obtained by hydrodistillation for 2h, using a Clevenger-type apparatus with an yield of 1.6%. The chemical composition of the essential oil was determinate by gas chromatography (GC) and gas chromatography-mass spectrometry (GC-MS). The identities of the oil components were established from their GC retention indices, relative to C7-C25 n-alkanes, and by comparison computer matching with the Wiley mass spectra library, whenever possible, by co-injection with standards available in the laboratory. The mains components were α-pinene (85.0%); β-pinene (1.3%); 1,8-cineole (1.7%); α-copaene (1.4%); caryophylene (2.9%); α-cadinene (1.8%); germacrene-D (2.2%) β-cadinene (2.0%) account 98.3% of all compounds. We evaluate the antioxidant activity of the essential oil using the colorimetric method of the DPPH [4]. The result suggests a strong antioxidant activity for this species with an IC50 = 21.31 ± 0.819 and AAI = 1.848.

Modeling endocrine regulation of the menstrual cycle using delay differential equations

This article reviews an effective mathematical procedure for modeling hormonal regulation of the menstrual cycle of adult women. The procedure captures the effects of hormones secreted by several glands over multiple time scales. The specific model described here consists of 13 nonlinear, delay, differential equations with 44 parameters and correctly predicts blood levels of ovarian and pituitary hormones found in the biological literature for normally cycling women. In addition to this normal cycle, the model exhibits another stable cycle which may describe a biologically feasible “abnormal” condition such as polycystic ovarian syndrome. Model simulations illustrate how one cycle can be perturbed to the other cycle. Perturbations due to the exogenous administration of each ovarian hormone are examined. This model may be used to test the effects of hormone therapies on abnormally cycling women as well as the effects of exogenous compounds on normally cycling women. Sensitive parameters are identified and bifurcations in model behavior with respect to parameter changes are discussed. Modeling various aspects of menstrual cycle regulation should be helpful in predicting successful hormone therapies, in studying the phenomenon of cycle synchronization and in understanding many factors affecting the aging of the female reproductive endocrine system.

Effectiveness of Metformin Treatment in the Teenager with Maturity-Onset Diabetes of the Young Type 3 and Oligomenorrhoea: A Case Presentation

Sulphonyloureas are a treatment of choice for Maturity-Onset Diabetes of the Young type 3 (MODY3) young patients with excellent results, although they should be used with a great caution. In adult MODY3 patients hypersensitive response to sulphonyloureas and a decreased response to metformin in compare to sulphonyloureas were reported. A case of teenager with MODY 3 and oligomenorhoea, successfully treated with metformin is presented. A fifteen and a half year-old girl was diagnosed with oligomenorrhoea. Due to detected glucosuria and blood glucose (BG) at 267 mg/dl she was referred to a pediatric endocrinologist. She did not present with typical diabetes mellitus (DM) symptoms, however she had a three generations family history positive for insulin-dependent DM. She presented with a good clinical condition. The underweight (Body mass index 18.7 kg/m2) and discrete hirsutism were observed. Glucosuria, ketonuria, BG above 200 mg/dl in 24‑h BG profile, and HbA1c 7.1% confirmed the diagnosis of DM, and insulinotherapy was initiated. Further diagnostics revealed high C-peptide levels and negative diabetes autoantibodies. Due to a low requirement of insulin and a presence of oligomenhorea, insulinotherapy was replaced with metformin. Three months after metformin introduction, HbA1c level normalized and menstruation cycles became regular. Genetic tests confirmed the diagnosis of MODY3 in the patient and her family. No pathology in the morphology and function of the kidneys was found. Due to the positive effect of metformin on regulation of menstrual cycles, and the continued high C-peptide level, the treatment with metformin has been continued. During the last three years follow-up, HbA1c levels fluctuated between 5.6-5.8% and menstrual cycles have been regular. Our case presents that metformin could be an adequate treatment for teenagers with MODY 3 and oligomenorhea/ PCOS with good results of diabetes control and benefits for ovarian function.

Cerebral Sinovenous Thrombosis Related to Iron Deficiency Anemia As a Result of Severe Menorrhagia: A Case Report

AbstractAbstract 5143Cerebral sinovenous thrombosis (CSVT) is a rare condition with a wide spectrum of non-specific symptoms, which makes it occasionally difficult to diagnose. CSVT has been associated with various etiologies including dehydration, hypercoagulable states, neoplasmic invasion of a venous sinus, intracranial and systemic infections, use of oral contraceptives, puerperium and pregnancy. Although iron deficiency anemia (IDA) has been reported as a cause of CSVT in several pediatric cases, this association is extremely rare. To our knowledge, IDA-associated CSVT in teenagers has been rarely reported.Here, we present the case of a 13-year old female with complete thrombosis of the vein of Galen, the straight sinus, and the left internal cerebral vein related to iron deficiency anemia as a result of severe menorrhagia. She initially presented with three-week history of headaches, nausea and vomiting. She was initially diagnosed and treated for bacterial sinusitis by her primary pediatrician, without symptom relief. She then suffered a syncopal episode, reason why she was evaluated at our institution. Initial laboratories revealed a slightly increased PT (15. 6 secs), hemoglobin of 5. 1 g/dL, MCV 63. 6 and D-dimer 1. 31. Non-contrast brain CT demonstrated no evidence of stroke, hemorrhage or mass. However, an abnormal hyperdensity in the straight sinus, inferior sagittal sinus, vein of Galen, and deep cerebral veins, were suggestive of venous thrombosis. Findings were then confirmed by brain MRI/MRV/MRA and CT angiogram. A bleeding work-up performed based on her history of heavy menses was normal. Her ferritin level was significantly decreased (6 ng/mL). Iron supplementation was initiated as well as progestin-only hormonal therapy for menstrual cycle regulation. The patient's clinical status improved back to baseline during her 8-day admission. She was discharged home on anticoagulation with scheduled follow up. Brain MRI/MRV six months later showed patency of the cerebral veins and dural venous sinuses.IDA should be considered as an underlying cause of CSVT in pediatric patients, particularly in patients with other risk factors for thrombosis including dehydration, regardless of their age. Early recognition and management of CSVT is critical to minimize the possibility of permanent neurologic damage. Physicians should be aware of the non-specific signs and symptoms of CSVT and should have a high index of suspicion in patients with anemia. Disclosures:No relevant conflicts of interest to declare.

The effects of treatment with drospirenone/ethinyl oestradiol alone or in combination with metformin on elastic properties of aorta in women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a heterogeneous clinical condition. Oral contraceptive pills (OCPs) have conventionally been the mainstay of treatment for the amelioration of hyperandrogenism and regulation of menstrual cycles in women with PCOS. Metformin has beneficial effects on insulin resistance and endothelial functions. To our knowledge, the effect of metformin/OCP combination treatment on aortic stiffness has not been studied so far. The aim of this study was to investigate the effects of treatment with drospirenone/ethinyl oestradiol (E/E) alone or in combination with metformin on the elastic properties of the aorta in women with PCOS. Thirty-seven women with PCOS were enrolled in the study. The first treatment arm, which was treated with OCP alone, was described as the OCP group (19 patients, mean age: 23·2 ± 5·4); the other treatment arm, which was treated with OCP and metformin, was described as the combination group (18 patients, mean age: 23·0 ± 4·5). The elastic parameters of the aorta namely 'aortic strain', 'aortic distensibility', 'aortic diameter alteration' and 'aortic stiffness index' were calculated by the appropriate formulae. The hormonal profile, HOMA-IR score, basal insulin and glucose levels were studied in both groups. Before and after 6 months of treatment, echocardiographic measurements and laboratory tests were also obtained. After 6 months of treatment, significant weight loss and decrease in body mass index (BMI) were observed in the combination group (75·3 ± 13·3 kg to 72·3 ± 13·5 kg and 31·7 ± 7·3 kg/m² vs 30·4 ± 7·3 kg/m², P = 0·001 and P = 0·001, respectively). Conversely in the OCP group, BMI and weight were not significantly different after 6 months of treatment (68·8 ± 18·3 kg to 71·6 ± 21·2 kg and 26·4 ± 6·2 kg/m² to 27·4 ± 6·9 kg/m², P = 0·159 and P = 0·149, respectively). In addition, there were no significant differences in aortic strain, distensibility (7·7 ± 4·2 to 7·8 ± 3·6 and 7·2 ± 4·1 to 7·7 ± 3·6, P = 0·926 and P = 0·593, respectively) and stiffness index in the OCP group (8·8 ± 7·4 to 8·2 ± 6·7, P = 0·772). However, in the combination group, the adjusted values of the aortic stiffness index decreased significantly at the 6 months' follow-up (10·0 ± 1·5 to 6·7 ± 0·3, P = 0·021) and aortic distensibility and strain increased but not significantly (7·0 ± 4·3 to 9·3 ± 3·3 and 6·8 ± 3·9 to 9·4 ± 3·5, P = 0·163 and P = 0·071, respectively) at the 6 months' follow-up. We demonstrated an improvement in the elastic parameters of the aorta by adding metformin to OCP treatment. We suggest that metformin plus OCP treatment may decrease cardiovascular disease risk in women with PCOS.

Leptin and adiponectin in the female life course

Dilated cardiomyopathy can be the end-stage form and common denominator of several cardiac disorders of known cause, such as hypertensive, ischemic, diabetic and Chagasic diseases. However, some individuals have clinical findings, such as an increase in ventricular chamber size and impaired contractility (classical manifestations of dilated cardiomyopathy) even in the absence of a diagnosed primary disease. In these patients, dilated cardiomyopathy is classified as idiopathic since its etiology is obscure. Nevertheless, regardless of all of the advances in medical, pharmacological and surgical procedures, the fate of patients with dilated cardiomyopathy (of idiopathic or of any other known cause) is linked to arrhythmic episodes, severe congestive heart failure and an increased risk of sudden cardiac death. In this review, we will summarize present data on the use of cell therapies in animal models of dilated cardiomyopathies and will discuss the few clinical trials that have been published so far involving patients affected by this disease. The animal models discussed here include those in which the cardiomyopathy is produced by genetic manipulation and those in which disease is induced by chemical or infectious agents. The specific model used clearly creates restrictions to translation of the proposed cell therapy to clinical practice, insofar as most of the clinical trials performed to date with cell therapy have used autologous cells. Thus, translation of genetic models of dilated cardiomyopathy may have to wait until the use of allogeneic cells becomes more widespread in clinical trials of cell therapies for cardiac diseases.

Extent of acupuncture practice for infertility in the United Kingdom: experiences and perceptions of the practitioners

To investigate acupuncture practitioners' experience and perceptions of supporting patients presenting with fertility issues. Questionnaire survey. British Acupuncture Council. British Acupuncture Council acupuncture practitioners. Questionnaire designed for the study, by post and online. Questions on education and training, size and nature of practice, liaison with conventional care, and perceptions about use of acupuncture for fertility issues. Questionnaires were sent to 2,580 practitioners. Of 861 responses, 15% of practitioners supporting fertility issues said this constituted a large proportion of their case load. Eighty percent of practitioners reported most fertility work was related to assisted conception. More than 60% had specialist training. Practitioners' perceived benefits included stress reduction, relaxation, regulation of menstrual cycle, and emotional support. Emotional burden on both patients and practitioners was recognized and the limits of therapy. Point-specific acupuncture protocols were common (70%). Thirteen percent reported problems working with physicians. Use of acupuncture for male fertility issues was uncommon. A minority of acupuncturists have become specialists in supporting fertility issues. The use of an acupuncture protocol is common but does not conform to traditional acupuncture as it is taught and practiced for other conditions.

Hormone Replacement Therapy advertising: sense and nonsense on the web pages of the best-selling pharmaceuticals in Spain

BackgroundThe balance of the benefits and risks of long term use of hormone replacement therapy (HRT) have been a matter of debate for decades. In Europe, HRT requires medical prescription and its advertising is only permitted when aimed at health professionals (direct to consumer advertising is allowed in some non European countries). The objective of this study is to analyse the appropriateness and quality of Internet advertising about HRT in Spain.MethodsA search was carried out on the Internet (January 2009) using the eight best-selling HRT drugs in Spain. The brand name of each drug was entered into Google's search engine. The web sites appearing on the first page of results and the corresponding companies were analysed using the European Code of Good Practice as the reference point.ResultsFive corporate web pages: none of them included bibliographic references or measures to ensure that the advertising was only accessible by health professionals. Regarding non-corporate web pages (n = 27): 41% did not include the company name or address, 44% made no distinction between patient and health professional information, 7% contained bibliographic references, 26% provided unspecific information for the use of HRT for osteoporosis and 19% included menstrual cycle regulation or boosting feminity as an indication. Two online pharmacies sold HRT drugs which could be bought online in Spain, did not include the name or contact details of the registered company, nor did they stipulate the need for a medical prescription or differentiate between patient and health professional information.ConclusionsEven though pharmaceutical companies have committed themselves to compliance with codes of good practice, deficiencies were observed regarding the identification, information and promotion of HRT medications on their web pages. Unaffected by legislation, non-corporate web pages are an ideal place for indirect HRT advertising, but they often contain misleading information. HRT can be bought online from Spain, without a medical consultation or prescription constituting a serious issue for public health. In our information society, it is the right and obligation of public health bodies to ensure that such information is not misleading.

Impact of use of combined oral contraceptive pill on the quality of life of Japanese women

To evaluate the impact of combined oral contraceptive pill (OC) use on quality of life (QOL) among Japanese women, we performed a prospective study using the Japanese version of the World Health Organization Quality of Life (WHOQOL) questionnaire. Women who consulted Chayamachi Lady's Clinic to get a prescription for OC for the first time were recruited for our questionnaire study and asked to complete the WHOQOL questionnaire twice, before taking OC and more than 3 months after beginning OC use. Two hundred and seventeen women responded to our questionnaire before taking OC and 110 patients completed the questionnaire. The patients were divided into six groups based on the reason they wanted to take OC: contraception, relaxation of dysmenorrhea, regulation of menstrual cycles, improvement of acne, remission of menorrhagia, and improvement of premenstrual tension syndrome (PMS). WHOQOL scores showed significant improvement in all domains of the dysmenorrhea group, all domains but the social of over all participants, the social and overall domain of the irregular cycle group, physical, environmental, and overall domain of the acne group, and psychological and overall domain of the PMS group. The WHOQOL score worsened in the social domain of the contraception group; however, the score in the overall domain of that group improved. These results indicate that OC can provide higher QOL for women with problems involving menstrual pain and/or hormonal abnormalities. However, those using OC for contraception only were found to be unsatisfied with taking OC in a relationship with their partners.

Therapeutic options in the polycystic ovary syndrome

SummaryThe polycystic ovary syndrome is the most common endocrine disorder affecting women. It is a heterogeneous familial condition of uncertain aetiology. The diagnosis is made by the detection of polycystic ovaries on ultrasound examination and the occurrence of single or multiple clinical features such as menstrual cycle disturbances, obesity, acne, hirsutism, alopecia and biochemical abnormalities such as hypersecretion of luteinising hormone and testosterone. In a significant number of women with this condition there is impaired insulin metabolism. Women with the polycystic ovary syndrome are at an increased risk of developing diabetes and possibly cardiovascular disease in later life. The management should be symptom-orientated. Menstrual cycle regulation may be attained with the combined oral contraceptive pill or cyclical progestogen therapy. In obese women, with the loss of weight, the symptoms and endocrine profile are generally improved. Short-term treatment with metformin may be useful in women with insulin resistance. Hyperandrogenism may be treated with the contraceptive pill containing cyproterone acetate or with short-term low-dose anti-androgen therapy, together with effective contraception. Ovulation may be induced with clomiphene citrate with careful monitoring, failing which low-dose gonadotrophin therapy or laparoscopic ovarian diathermy are effective options.

Pharmacist Refusals: A New Twist on the Debate Over Individual Autonomy

By all accounts, the battle over contraception and abortion rights has expanded into new and increasingly content ious territory: the pharmacy. According to The l/Vashington Post, for example, an increasing number of clashes are occurring in drugstores across the country. 1 Web searches reveal, however, that the same incidents are covered repeatedly, whereas new occurrences seem to be few and far between.Za What's all the fuss about? The real key is not the scope of the debate, but the debate itself, which has found abortion activists and abortion opponents taking surprising and uncharacteristic stances. With their eyes often on a larger political picture, each side provides its own twist to the underlying question: What are the legal and ethical obligations of a pharmacist to dispense pharmaceuticals that he or she is morally opposed to? The background of the debate involves individual pharmacists who, citing religious and moral grounds, have refused to dispense emergency contraceptives or birth control to women with valid prescriptions. In some instances, women have been publicly berated and humiliated by the pharmacist; in other cases, the pharmacist has gone so far as to hold the prescription hostage, refusing even to transfer the prescription to another pharmacy. Because emergency contraception is extremely time sensitive, generally requiring ingestion within 72 hours after intercourse to be effective, such delay tactics have meant that certain women could not receive their prescriptions in time to prevent pregnancy. In response, women's rights groups have strongly called for legislation to guard against what they proclaim is an assault on the right to choose. Religious groups and others have been equally vocal in lobbying for laws to protect pharmacists' moral and religious prerogative not to participate in actions they view as ranging from immoral to murderous. For these reasons, the pharmacist refusal debate has often been entwined in the abortion debate. The debates are nevertheless distinct. Most saliently, the battle over pharmacist refusals extends beyond abortion, encompassing birth control pills, even when not taken for contraceptive purposes but instead for health reasons, such as the regulation of a woman's menstrual cycle or endometriosis. Such distinction notwithstanding, the pharmacist refusal debate has largely been fueled by the interests driving the abortion debate. The ethical ramifications of pharmacist refusals are therefore made all the more interesting by the ironic positions taken by each side. A hallmark of the women's rights movement has for decades been the sanctity of an individual's right to autonomy. Abortion opponents have simultaneously advocated for legislation that would bar the activity in question. In the pharmacy refusal debate, however, the roles are reversed. Here, abortion opponents vociferously

Differential Menstrual Cycle Regulation of Hypothalamic-Pituitary-Adrenal Axis in Women with Premenstrual Syndrome and Controls

Differential Menstrual Cycle Regulation of Hypothalamic-Pituitary-Adrenal Axis in Women with Premenstrual Syndrome and Controls

International Politics, Ectocarpus, Valonia, Halicystis, and Acetabularia

Progesterone is essential for pregnancy maintenance and menstrual cycle regulation. Hormone action has been primarily ascribed to the well-characterized classical signaling pathway involving ligand binding, activation of nuclear progesterone receptors (PRs), and subsequent activation of genes containing progesterone response elements (PREs). Recent studies have revealed progesterone actions via non-classical signaling pathways, often mediated by non-genomic signaling. Progesterone signaling, in conjunction with growth factor signaling, impacts on the function of growth factors and regulates important physiological actions such as cell growth and remodeling, as well as apoptosis. This review focuses on non-classical progesterone signaling pathways, both including and excluding PR, and highlights how research in this area will provide a better understanding of progesterone actions and may inform novel therapeutic strategies.

Increased insulin-like growth factor-I levels in women with polycystic ovary syndrome, and beneficial effects of metformin therapy

We aimed to investigate whether metformin would reverse the endocrinopathy of polycystic ovary syndrome (PCOS), allowing resumption of cyclic ovulation and regular menses, and whether metformin causes any change in the serum concentration of insulin-like growth factor-I (IGF-I) in patients with PCOS. Fifty-eight women with PCOS participated in the study and received metformin at a dose of 850 mg three times a day (total 2550 mg) for 16 weeks. Serum concentrations of luteinizing hormone, follicle stimulating hormone, estradiol, free testosterone, total testosterone, 17-hydroxyprogesterone, dehydroepiandrosterone sulfate, fasting insulin, IGF-I, sex hormone binding globulin and insulin-like growth factor binding protein-1 (IGFBP-1) were evaluated before and after metformin treatment. Patients were divided into two groups as responders and non-responders according to the achievement of regular menstrual periods. The mean IGF-I levels decreased significantly on metformin therapy. After 16 weeks of metformin treatment, 55.17% of PCOS patients achieved regular menses. Only the change in serum levels of progesterone and IGF-I on metformin were statistically significant between responders and non-responders; metformin-induced decremental change in IGF-I levels were greater in responders. In conclusion, we observed that elevated IGF-I levels may have a crucial role in many consequences of PCOS in addition to hyperinsulinemia. By decreasing insulin and IGF-I levels, metformin therapy offers additional beneficial effects in resumption of regular menses. Thus, in PCOS patients with elevated levels of IGF-I, metformin may be considered as an appropriate agent to be used for the regulation of menstrual cycles.

Differential menstrual cycle regulation of hypothalamic-pituitary-adrenal axis in women with premenstrual syndrome and controls.

Previous studies in animals indicate that reproductive steroids are potent modulators of the hypothalamic-pituitary-adrenal (HPA) axis, a physiologic system that is typically dysregulated in affective disorders, such as major depression. Determination of the role of reproductive steroids in HPA axis regulation in humans is of importance when attempting to understand the pathophysiology of premenstrual syndrome (PMS), a disorder characterized by affective symptoms during the luteal phase of the menstrual cycle. We performed two studies using treadmill exercise stress testing to determine the effect of menstrual cycle phase and diagnosis on the HPA axis in women with PMS and controls and the role of gonadal steroids in HPA axis modulation in control women. The results of these studies indicate that women with PMS fail to show the normal increased HPA axis response to exercise during the luteal phase and that progesterone, not estradiol, produces increased HPA axis response to treadmill stress testing in control women. These data demonstrate that women with PMS, when symptomatic, appear to have an abnormal response to progesterone and, furthermore, do not display the HPA axis abnormalities characteristic of major depression.

Effect of Reproductive Hormones on Ovarian Epithelial Tumors: II. Effect on Angiogenic Activity

Menstrual cycle activity predisposes to ovarian epithelial tumors based on numerous epidemiological studies. We showed that the hormones involved in menstrual cycle regulation modulate cell cycle activity in these tumors in an accompanying paper. We investigated whether such hormones could also influence angiogenesis, an important determinant of tumor progression, in the same tumors. Treatment with progesterone (P4) stimulated VEGF protein secretion in 4 of 5 ovarian carcinoma cell lines examined. Northern blot analyses performed in MCV50 cells showed that this effect was accompanied by increased VEGF mRNA levels. P4 also stimulated VEGF promoter activity in these cells. Estradiol (E2) showed a similar, but substantially smaller effect on VEGF secretion which was additive to that of P4. Conditioned medium from P4-treated cells strongly stimulated angiogenesis on chicken chorio-allantoic membranes. Incubating the conditioned medium with a neutralizing anti-VEGF antibody, but not with non-specific immunoglobulins abolished this effect. Angiogenic activity was not altered by treatment of the membranes with P4 directly. We conclude that P4 can stimulate angiogenic activity via induction of VEGF secretion in some ovarian epithelial tumors. Therapeutic use of progestins may be most effective when administered in combination with an anti-angiogenic agent, at least against a subset of ovarian carcinomas.

The Female Athlete: Some Gynecologic Considerations

SUMMARY The association between exercise and menstrual cycle regulation is multifactorial and complex. Competitive athletes have several contributing factors to their hypothalamic-ovarian dysfunction: intensity of physical exercise, decreased body fat, inappropriate dieting, and stress. The consequences of amenorrhea include osteoporosis, increased risk of fracture, deleterious lipid changes, and infertility. Athletes have special considerations when choosing contraception. Prevention of breast injury and irritation is a concern for many athletes. The literature to date on athletic amenorrhea is limited by poor study design and too few subjects. Future studies should include prospective, randomized, controlled, multicenter studies in order to achieve significant results.

Peritoneal fluid leptin concentration in infertile patients

Leptin may play a role in the regulation of menstrual cycle acting either directly on ovaries or at the level of the hypothalamic–pituitary axis. Peritoneal fluid is a biologically active environment that influences ovarian function but, on the other hand, concentration of many substances in peritoneal fluid can reflect the functional status of ovaries. In our study, we estimated leptin concentration in peritoneal fluid in relation to serum leptin concentration in infertile patients. A study group consisted of 31 infertile patients that underwent laparoscopy. In 15 patients, laparoscopy did not solve the problem and they were grouped as unexplained infertility, in eight patients we found endometriosis and eight patients were diagnosed as polycystic ovary syndrome (PCOS). We found significantly higher peritoneal fluid leptin concentrations in patients with unexplained infertility and endometriosis compared to those with PCOS. The plasma leptin concentration did not differ between the groups studied. There was no correlation between peritoneal fluid and plasma leptin concentrations in any patient group. Taking into account our results, the role of leptin in reproduction should be emphasized but further investigation is needed to determine its mechanism of action.