Normal Menstrual Period Research Articles

Case 39-1978

Presentation of Case A 24-year-old woman was admitted to the hospital because of a bleeding disorder. The patient was in vigorous health. Six days before admission she donated 1 unit of blood. On the same day a normal menstrual period began. On the evening before entry she noticed oozing of blood from her gums while brushing her teeth. On the next day epistaxis occurred, and she came to the hospital. She had had infectious mononucleosis six years earlier. A cousin had diabetes mellitus; a maternal aunt and a maternal cousin had sarcoidosis. There was no family history of connective-tissue disease, . . .

Norethisterone oenanthate as an injectable contraceptive: use of a modified dose schedule.

Norethisterone oenanthate (NET-OEN) was given as an injectable contraceptive to 295 healthy women over 1606 woman-months. A modified injection schedule was used. There were no pregnancies, and the 12-month, life-table, use-related discontinuation rate was 39.1/100 users. Menstrual disturbance (10.8/100 women), minor side effects (13.5/100 women), and personal reasons (12.0/100 women) were the main causes of use-related discontinuation. There was no difference in use-related discontinuation rates between women receiving their first injection during a normal menstrual period and those receiving it immediately after a pregnancy. There were no serious side effects. The use of NET-OEN in certain groups of women is recommended, particularly in those in need of highly effective contraception, who cannot or do not wish to take oral contraceptives, who are lactating, or who are awaiting hospital admission for sterilisation.

Pregnancy testing. 2. Radioreceptor assay.

Of the various sensitive assays for human chorionic gonadotropin, the radioreceptor assay is now the most practical and should be used for the early diagnosis of pregnancy (35 days or less after the last normal menstrual period). Serial measurement of this hormone by the beta subunit radioimmunoassay provides a valuable guide to the management of trophoblastic disease.

Interruption of early pregnancy with a silastic device containing (15S)-15-methyl prostaglandin F 2α methyl ester: Efficacy and mode of action

The efficacy of an intravaginally placed silastic device containing (15S)-15-methyl prostaglandin F2α methyl ester (15-Me-PGF2α) in inducing abortion was evaluated in 20 pregnant women who were no more than 50 days beyond the first day of their last normal menstrual period. Eighteen pregnancies were interrupted successfully. In 1 woman in whom an intrauterine pressure gauge had been inserted, abortion failed to occur; in another woman who failed to abort, an ectopic pregnancy was later discovered. All women who aborted developed gastrointestinal symptoms; most had severe abdominal cramping pain necessitating narcotic analgesia. Following insertion of the prostaglandin-containing device, the levels of serum hCG fell rapidly, reaching about one-fourth the baseline level within 24 hours. The fall in plasma progesterone and estradiol levels was less pronounced; plasma 17α-hydroxy-progesterone levels—although quite variable—increased during the first 2 hours but by 24 hours had fallen to an average value of 27.4% of the baseline level. Plasma levels of 15-Me-PGF2α, measured in 6 patients, varied greatly.

Short-Term Effects of Norethisterone Oenanthate and Medroxyprogesterone Acetate on Glucose, Insulin, Growth Hormone, and Lipids

The effects on carbohydrate and lipid metabolism in 24 healthy female subjects of the long-acting steroid contraceptives norethisterone oenanthate (200 mg) (11 subjects) and depo-medroxyprogesterone acetate (150 mg) (13 subjects) were studied. The subjects were between the ages of 18 and 25 years, with a history of normal menstrual periods. Pretreatment levels of plasma cholesterol, plasma triglycerides, phospholipids, blood glucose, insulin, and growth hormone were compared with those obtained 3 weeks and 12 weeks after the initial injections. There were no statistically significant differences from the pretreatment levels in any of the values obtained at 3 weeks and 12 weeks in either group.

Intramuscular prostaglandin (15S)-15-methyl PGF2α (THAM) in midtrimester abortion

Elective termination of second trimester pregnancies in 63 patients by means of intramuscular prostaglandin (15S)-15-Methyl PGF2α (THAM) is reported. In 44 of 61 cases with a successful outcome the duration of pregnancy calculated from a last normal menstrual period was between 13 and 17 weeks. An overall success rate of 96.8 percent was achieved; and this agent and method warrant further clinical evaluation.

Ovarian function during treatment with lynoestrenol 0.5 mg daily.

Twenty-four women, all with normal ovulatory menstrual periods, were studied during in total 64 cycles on lynoestrenol 0.5 mg daily and during 11 control cycles. The 24-hour urines were collected for assay of total oestrogens on the 21st, 22nd and 23rd days of viz. the 1st, 4th, 6th and 12th cycles and for pregnanediol on the 22nd and 23rd days of the same cycles. Oestrogen excretion was at the same level during treatment and control cycles. All the control cycles and 9 and 14 % respectively of the treatment cycles were ovulatory judging by the plasma progesterone and the pregnanediol excretion. On the basis of the latter parameter there was a certain luteal activity during 36 % of the treatment cycles. In all cycles but one, however, the plasma progesterone and the pregnanediol excretion were lower than during the control cycles. It must be assumed, therefore, that lynoestrenol in a dose of 0.5 mg daily inhibits the ovulation or function of the corpora lutea in practically all cases.

Abdominal pregnancy with complete ureteral obstruction: A case report

J. H. was a 23-year-old black woman, gravida 3, para 2, who was first seen in the emergency room on Feb. 28, 1972, complaining of right lower quadrant pain, nausea, vomiting, and a 12 pound weight loss over a two-month period. Her last normal menstrual period had begun on Oct. 11, 1971. Three days of spotting occurred on NOV. I2 to 15, 1971. She had been treated for a urinary tract infection three weeks prior to her visit to the emergency room. Pelvic examination revealed a uterus compatible in size with 16 weeks’ gestation. There was tenderness and guarding in the right lower quadrant, but no mass was palpated in either adnexal region. Laboratory data showed a hemoglobin of 10.6 Gm., white cell count of 13,500, and a catheterized urine which contained 35 to 40 white blood cells per high-power field and many bacteria. The Gravindex test was positive. After admission for observation, a placental scan demonstrated the placenta to be in the right posterolateral portion of the true pelvis. Over the next seven days her pain and urinary infection subsided, and she was discharged with antibiotic therapy. Four days after discharge, she returned to the clinic complaining of recurrent right lower quadrant pain, anorexia, swelling of her feet, and diminished output of urine. The patient was afebrile, lethargic, and incapable of answering questions clearly. The abdomen was slightly distended and there was abdominal tenderness which was most marked in the right lower quadrant. Pitting edema of the lower extremities was present. A marked change in the pelvic examination from her previous admission was noted. The contour of the uterus could not be identified, and both adnexal regions contained a soft, tender, immobile mass which was not separable from the cervix. No fetal tones could be detected with the Doptone. An admission diagnosis of possible abdominal

Tuboovarian abscess associated with laparoscopic tubal cauterization and the intrauterine contraceptive device

A case which reaffirms the suspicion that tubal cauterization preceded by IUD removal and subsequent curettage can lead to adnexitis and pelvic abscess is presented. A 35-year-old white woman was admitted to a hospital emergency room with the acute onset of right adnexal pain. Her last normal menstrual period had started 5 days before her admission. She had been wearing an IUD for 5 years and because of progressively increasing menorrhagia and dysmenorrhea her request that the IUD be removed was granted. The patients pain improved and since she expressed interest in a sterilization procedure she was subjected to examination under anesthesia curettage and laparoscopy for both the determination of the etiology of the adnexal pain and the tubal cauterization. At the time of laparoscopy the right ovary appeared to have a ruptured cyst in its distal pole. Uneventful bilateral tubal cauterization and division were carried out. Histologic examination of the curettings was done and the patient was discharged on Postoperative Day 1 with the diagnosis of a ruptured functional right ovarian cyst. She was readmitted 17 days after laparoscopy with right adnexal pain and fever. Examination revealed an 8 cm right tuboovarian abscess. Total abdominal hysterectomy bilateral salpingo-oophorectomy and appendectomy were carried out. (The appendix was involved in the abscess formation.) After experience with this case it is the authors policy to remove IUDs 1 menstrual interval prior to anticipated laparoscopic tubal cauterization. When this is not possible the patient is given prophylactic antibiotics during the procedure and in the immediate postoperative period.

Clinical evaluation of an oral progestin contraceptive, R-2323, 5mg, administered at weekly intervals

A new contraceptive compound, R-2323, was tried as a “weekly pill”. The pregnancy rate at 12 months was 3.7 considering only method failures. The most important ill effect was alterations in bleeding patterns, with a predominance of cycle irregularity. Oligomenorrhea was present in 58% of the cycles after 6 months of use, and this symptom was responsible for a discontinuation rate of 10 percent at the end of a year. Polymenorrhea and intermenstrual bleeding were less frequent and caused a discontinuation rate of 6 percent in a year of use. Chloasma, acne and hirsutism increased in frequency with time of use, and even though these problems affected relatively few patients, almost all of those with these problems discontinued. These three symptoms together caused almost as many discontinuations as excessive bleeding. Endometrial biopsies taken during treatment showed both proliferative and secretory endometria in the group receiving 2.5 mg a week and were predominantly proliferative in the group with 5 mg. In addition, 4 women had atrophie endometria. Nevertheless, amenorrheic patients recovered normal menstrual periods 1 to 4 months after discontinuation, and fertility was recovered in less than 6 months in 76 percent of the cases. Plasma estrogen levels were normal for the follicular phase of the cycle even in amenorrheic patients after 10 to 18 months of use of 5 mg per week of R-2323.

The efficacy and acceptability of the ″prostaglandin impact″ in inducing complete abortion during the second week after the missed menstrual period

Twenty-two pregnant patients were exposed, 12±1 days after their missed menstrual period, to a single intrauterine dose of 5mg PG F2 α, to provoke a PG ″Impact″ (PGI) and through it legal abortion. The PGI, delivered through the cervix during 10 minutes, induced 83±9mm Hg contracture in 20±3 minutes. Cyclic IUP reached 102±10mm Hg only in 116±14 minutes, it was then sustained for about 2 hours and subsequently declined. During the evolution of IUP uterine bleeding appeared, progesterone (P) and estradiol 17 β (E 2) started to decrease and continued decreasing. At 24 hours after PGI, P-withdrawal was 44% (P<0.05), bleeding continued and cervical dilatation approximated 1cm. Subsequently uterine bleeding (containing tissue fragments) continued and out of 22 women 20 aborted completely. After 3–5 days bleeding declined, the pregnancy tests became negative and normal menstrual periods one month after PGI provided the desired end points of the study. Complete abortions, simulating the symptoms of delayed menstrual periods, had a high Abortion Score of 95 and in the sedated patients the side effects were infrequent, mild and acceptable. This clinical outcome encourages extensive field trials. None of the patients aborted during the short lived period of exogenous PG stimulation. However, the continued steroid withdrawals indicated that PGI damaged the endocrine function of the ovum and the luteotrophic support of the corpus luteum. Therefore, if it was PG which completed abortion eventually, it had to be the endogenous compound, having become effective in physiological concentrations, due to the threshold-lowering action of P-withdrawal.

Breast thermograms in ovulatory and anovulatory menstrual cycles.

The pattern of heat emanation from normal breasts as recorded by thermography has been previously reported to be individually specific. An earlier study reported in 1968 revealed a recognizable pattern of heat emanation for an individual but minor fluctuations in over-all heat one week prior to menses. Our study was conducted to determine whether the thermogram would change with hormonal fluctuations in a normal menstrual period, and whether there would be a change with medically controlled anovulatory cycles. In our series of nine student radiographers with normal regular menstrual periods there was no change in the pattern of the breast thermograms from day 1 of the cycle to day 28 and no change in the over-all heat. In addition, a study was made of women on birth control medication. Again there was no change in the breast thermogram from menstrual period to menstrual period. One woman had thermograms before starting anovulatory medication and for two subsequent months on the medication. There was no change in the thermographic pattern or general heat emanation. This combined study of women with ovulatory and anovulatory menstrual cycles demonstrated the lack of fluctuations during the menstrual cycle and reinforces the finding of individually specific thermographic patterns.

Fetal maturity: Amniotic fluid analysis correlated with neonatal assessment

The birth weights and gestational age assessments, in weeks of neonates have been compared with the creatinine level and the percentage of orange-staining cells in the amniotic fluid. In an attempt to verify the accuracy of these tests, two groups were analyzed, the first with the use of the last normal menstrual period as obtained by maternal history and the second with the use of the clinical assessment of the neonate within 24 hours of birth. Correlation was also carried out with birth weight. The accuracy of creatinine concentration and orange-staining cells is not disturbed in high-risk pregnancies. The creatinine level is more accurate for both gestational age and baby weight than the percentage of orange-staining cells. When the gestational age is around 36 weeks, creatinine values are reliable; if the gestational age is 38 weeks or more, the orange-staining cell count is more accurate. The clinical assessment of gestational age is very accurate and helpful. It improves the results obtained by correlation of the gestational age with the percentage of orange-staining cells.

Spironolactone Therapy and Amenorrhea

Administration of spironolactone in standard dosage to nine women with mild renal disease resulted in amenorrhea in six and marked menstrual irregularity in a seventh. Discontinuation of therapy resulted in normal menstrual periods within two months in every patient. The drug action causing this side effect may be responsible for previously reported gynecomastia, but this action is unknown. The high incidence of amenorrhea in this group may be due to increased drug susceptibility or decreased drug elimination in patients with kidney disease.

CONTRACEPTIVE AND ENDOMETRIAL EFFECTS OF MEDROXYPROGESTERONE ACETATE

Present means of contraception are not satisfactory for all women. This study reports on the contraception efficacy and menstrual abnormalities of medroxyprogesterone acetate (Depo-Provera), which was given in an intramuscular dose of 150 mg. every 3 months for 1 year. None of the 14 patients who received the full 12 months of therapy became pregnant. The occurrence of spotting and bleeding was erratic, but each tended to decrease as the treatment continued. After cessation of treatment, most patients had two or three “normal menstrual periods,” which biopsy proved to be from a proliferative endometrium. All patients had a secretory endometriurn within 12 months after the last injection, or within 9 months after the effects of the last injection had presumably worn off. Irregular bleeding, spotting, and relatively prolonged anovulation are the main disadvantages of this form of therapy. The chief advantage is the infrequent need for injection; patients need to be concerned with birth control only 1 day every 3 months.

Contraceptive and endometrial effects of medroxyprogesterone acetate

The contraceptive efficacy and menstrual abnormalities of long-acting medroxyprogesterone acetate, injected intramuscularly at doses of 150 mg. every 3 months for 1 year, were studied in 14 women (mean age 33 years, mean parity 4.6). No pregnancies were reported and there were no significant changes in weight or blood pressure. All Papanicolaou smears, taken initially and at 6 and 12 months, were normal and there were no reports of emotional instability, nausea, vomiting, or breast soreness. Results of endometrial biopsies, taken at 6,9, and 12 months are given. The occurrence of spotting and bleeding was erratic (spotting for as long as 20-38 days in a 3-month period), but both tended to decrease as the treatment continued. After cessation of therapy, most patients had 2 or 3 "normal menstrual periods," which biopsy proved to be from a proliferative endometrium. All patients had a secretory endometrium within 12 months after the last injection, or within 9 months after the effects of the last injection had presumably worn off. Disadvantages to MA include fear of injection, irregular bleeding and spotting, and prolonged anovulation after therapy discontinuation. The chief advantage is the infrequent need for injection; patients need to be concerned with birth control only 1 day every 3 months.

Hashimoto's Thyroiditis and Turner's Syndrome

The association between Turner's syndrome and hypothyroidism has been described on several occasions. In the reported cases, the X-isochromosome X karyotype has been observed in patients with Hashimoto's thyroiditis whereas the typical XO karyotype of Turner's syndrome has been associated with nongoitrous or primary hypothyroidism.^1-5 This report describes a patient with Hashimoto's thyroiditis who was found to be chromatin negative and to have a 45-XO karyotype. She has the typical features of Turner's syndrome with the exception of a normal menstrual history. <h3>Patient Summary</h3> The patient (00-32-50), a 64-year-old white woman, was seen in the Endocrine Clinic at Ben Taub General Hospital for management of hypothyroidism. She was noted to have many of the clinical features of Turner's syndrome, but gave a history of normal menstrual periods between the ages of 14 and 42 years. Although she was married for the last seven of her theoretically fertile years,

THERAPEUTIC DEFIBRINATION IN THE TREATMENT OF THROMBOTIC DISEASE

' Arvin ', the purified active fraction of the venom of Agkistrodon rhodostoma, the Malayan pit-viper, produced controlled defibrination in nine patients in whom anticoagulant therapy was indicated. Plasma-fibrinogen concentrations rapidly fell to less than 40 mg. per 100 ml. plasma and remained low during therapy. Fibrinogen concentrations increased slowly after therapy and usually took about 3 weeks to reach pretreatment values. The concentrations of other coagulation factors and platelet numbers and function remained normal during the administration of arvin. Split products of fibrinogen or fibrin appeared in the blood during the first 36 hours of therapy, but were not demonstrated thereafter. Apart from one patient who developed urticaria, there were no complications of therapy. In particular, hæmorrhage did not occur in any patient and two had normal menstrual periods while defibrinated. In seven patients with venous thrombosis there was rapid resolution of signs and symptoms after arvin therapy. This occurred despite the presence of thrombosis in three patients for 5 weeks or more which had failed to respond to conventional anticoagulants. Two patients who developed thrombosis while receiving oral anticoagulant drugs also responded to arvin therapy. These preliminary results indicate that controlled defibrination may offer a promising new approach to the treatment of thrombotic disease.

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL; CASE 60-1964.

Presentation of CaseA thirty-four-year-old gravida 2, para 2, divorcee was admitted to the hospital because of pain in the abdomen.Twenty-three days earlier, two days after the onset of a normal menstrual period, pain in both lower quadrants of the abdomen developed suddenly; the pain was crampy and was unrelated to the ingestion of food or to emptying of the bladder or bowel. A similar pain had occurred at the time of the previous menstrual period. The pain persisted, and four days later she entered the Emergency Ward, where pelvic examination revealed a tender mass, 4 by 4 cm., . . .

Diamine oxidase in human pregnancy: Plasma diamine oxidase in nonpregnant and normal pregnant patients

Plasma diamine oxidase was measured in 72 nonpregnant patients and during normal pregnancy with the use of a recently developed radioassay procedure. The mean level of plasma diamine oxidase in the normal nonpregnant state was found to be 3.4 units with a standard deviation of plus or minus 1.5 units. In the group of nonpregnant patients with a variety of disease states, there were 5 instances, including 3 cases of Laennec's cirrhosis, in which the plasma titer of the enzyme was considerably greater than the mean for the group. A sharp rise in plasma diamine oxidase occurred in pregnant patients approximately 5 to 6 weeks following the last normal menstrual period and rapidly reached a plateau where it remained until parturition. The plasma enzyme activity following parturition did not reach normal nonpregnancy levels for approximately 10 to 14 days, and the rate of decline was not influenced by the removal of the uterus. The large maternal to fetal ratio of plasma diamine oxidase, as well as the normal nonpregnancy levels in a case of choriocarcinoma, suggested that the source of the enzyme is the maternal placenta.