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PubMed2002

Will iron supplementation given during menstruation improve iron status better than weekly supplementation?

To investigate the efficacy of two different iron supplements administered either on a weekly basis or during menstruation, a 16-week community experimental study was carried out among postmenarcheal female adolescent students in Kupang, East Nusa Tenggara, Indonesia. Forty eight students received a placebo tablet weekly, 48 other students got an iron tablet weekly and 41 students took an iron tablet for four consecutive days during their menstruation cycle. All subjects were given deworming tablets before supplementation. Haemoglobin, serum ferritin, height, weight, mid-upper arm circumference and dietary intake were assessed before and after intervention. The supplementation contributed to a significant improvement in the iron status of the intervention groups compared to the placebo group (P < 0.05). In the menstruation group, the haemoglobin concentrations of the anaemic subjects improved significantly (P < 0.05) while for the non-anaemic subjects, serum ferritin concentrations also increased significantly (P < 0.05). In the weekly group for anaemic and nonanaemic subjects, there was a significant increase in both haemoglobin and serum ferritin concentrations (P < 0.05). This study revealed that weekly supplementation of iron tablets continued for 16 weeks contributed a higher improvement to haemoglobin concentration, compared with supplementing iron tablets for four consecutive days during menstruation for four menstrual cycles. This suggests that weekly iron supplementation is preferable.

Adolescent↗

PubMedDate not supplied

The portrayal of the menstruating woman in menstrual product advertisements.

Because menstrual product advertisements act as mediators of a subset of meanings of femininity linked to menstruation, we performed a comparative conceptual analysis of these advertisements to explicate media-constructed realities of contemporary women. We sought to understand the portrayed women's definition of menstruation and their status as menstruating women. Textual and conceptual analyses led us to conclude that the portrayed women, in an attempt to avoid others' discovery of their menstruation, employed a complex menstrual management system, which often includes feminized menstrual products, to act as an antidote to a tainted state of femininity.

Adaptation, Psychological↗

PubMed1998

The effect of diclofenac on uterine artery blood flow resistance during menstruation in patients with and without a copper intrauterine device.

The aim was to evaluate the effect of diclofenac on uterine artery blood flow resistance during the first day of menstruation. A total of 28 regularly menstruating women were examined longitudinally with and without a copper intrauterine contraceptive device (IUD) by transvaginal colour Doppler ultrasonography. The uterine artery pulsatility index (PI) was first measured, after which 50 mg of diclofenac was infused i.v. After 15 min the PI was measured again. The patients evaluated their menstrual pain with a scoring system before and after the diclofenac infusion. The mean PI (SD) during menstruation was significantly lower with the IUD [2.13 (0.43)] than without [2.39 (0.62)], P = 0.05. The mean PI in nine patients who experienced advanced menstrual pain was also lower in the presence of the IUD [2.16 (0.42)] than without it [2.83 (0.78); P < 0.05]. Diclofenac was effective in revealing menstrual pain both with and without the IUD, and reduced the PI in the absence of an IUD [pre-treatment 2.39 (0.62) versus post-treatment 2.12 (0.45); P < 0.001], but had no effect when the IUD was present [pre-treatment 2.13 (0.43) versus post-treatment 2.10 (0.41)]. The results indicate that by inhibiting prostaglandin synthesis one can reduce the resistance to blood flow in the uterine arteries during menstruation. This does not hold true when an IUD is present, however, suggesting that the device might induce the production of vasoactive agents other than prostaglandins in the surrounding tissue.

Adult↗

PubMed2001

Reversible suppression of menstruation with progesterone antagonists in rhesus macaques.

BACKGROUND: A reliable means of menstrual suppression would greatly improve the quality of life for women. Information is lacking on the direct endometrial effects and appropriate dosages of new antiprogestins that may be useful for this purpose. METHODS: The current work evaluated three different systems in macaque monkeys. First, the range of doses of two relatively new antiprogestins, ZK 137 316 and ZK 230 211, that would block progesterone action directly on the endometrium in artificially cycled, spayed rhesus macaques; second, the direct endometrial effects of ZK 230 211, a type III antiprogestin; and third, investigation of whether endometrial-suppressive doses administered chronically to intact, cycling monkeys could be used for reversible, menstrual suppression. RESULTS: The results in naturally cycling animals showed that ZK 137 316 blocked menstruation in all animals, but doses of 0.05 mg/kg blocked ovulation in 55.5% of animals and doses of 0.1 mg/kg blocked ovulation in 66.6% of the animals. However, all doses of ZK 230 211 that blocked menstruation also blocked ovulation. All progesterone antagonist (PA)-treated animals, regardless of dose, maintained normal follicular phase concentrations of oestradiol and returned to normal menstrual cyclicity within 15--41 days post-treatment. Therefore ZK 137 316, depending on dose, can allow ovulation but block menstruation, while ZK 230 211, a much more potent PA, blocks both ovulation and menstruation at all effective doses. Both PAs block unopposed oestrogenic action on the endometrium through their antiproliferative effects. CONCLUSIONS: Reversible amenorrhoea can be achieved with these two PAs, and they can protect the endometrium from the effects of unopposed oestrogen whether or not ovulation is blocked. Chronic, low dose PA treatment may provide a new option for women who wish to suppress their menstrual periods.

Animals↗

PubMedDate not supplied

Endometriosis, retrograde menstruation and peritoneal inflammation in women and in baboons.

The aim of this review was to assess critically the importance of the frequency, quantity and quality of retrograde menstruation and its relationship to peritoneal inflammation. The basis was the current evidence in women and in baboons supporting the Sampson hypothesis that retrograde menstruation is a key factor in the pathogenesis of endometriosis. It is not proven that retrograde menstruation is a universal phenomenon occurring similarly in women with and without endometriosis. A more thorough understanding of the physiological, cytological and immunological events in peritoneal fluid, peritoneum, endometrium and uterus during menstruation in women with and without endometriosis is critical in order to understand the pathogenesis of this enigmatic disease.

Animals↗

PubMed1998

Mast cell regulation of human endometrial matrix metalloproteinases: A mechanism underlying menstruation.

Endometrial matrix metalloproteinases (MMPs), which increase dramatically at menstruation, are purported to cause the focal tissue breakdown at menstruation, but how their expression or activation is locally regulated is unknown. Mast cell activation occurs within perimenstrual endometrium, and we postulated that mast cell products would regulate endometrial MMPs. We have examined the interaction between human mast cells and endometrial stromal cells with regard to MMP production and activation. The human mast cell line (HMC-1) in coculture with stromal cells stimulated stromal cell proMMP-1 and proMMP-3, and to a lesser extent proMMP-2 production, with increasing stimulation as mast cell number increased. Mast cell-conditioned medium also increased both protein and mRNA for stromal proMMP-1 and proMMP-3, this being abrogated by preadsorption of mast cell-conditioned medium with antisera to interleukin-1 and tumor necrosis factor alpha. Mast cell-conditioned medium added to stromal cell culture medium in vitro along with added heparin (which stabilizes tryptase activity) resulted in the appearance of molecular weight forms indicative of active MMP-3 and MMP-1. Thus activated mast cells within the endometrium prior to menstruation have the potential to stimulate MMP production by endometrial stromal cells and to initiate precursor activation, and are likely to account for the local nature of endometrial MMP action resulting in foci of tissue breakdown at menstruation.

Animals↗

PubMedDate not supplied

Sexual intercourse during menstruation and self-reported sexually transmitted disease history among women.

OBJECTIVES: The purpose of this study was to examine the practice of sexual intercourse during menstruation and the relationship of this practice to the experience of sexually transmitted diseases (STD) among women in the United States. METHODS: Logistic regression technique was used to conduct an analysis of population-based data from a national sample of 1586 sexually active 20- to 37-year-old women to examine the patterns of sexual intercourse during menstruation and its relationship with STD outcome. RESULTS: More than one fourth of the women reported that they usually have vaginal intercourse during their menses, and 16% reported that they had had vaginal intercourse during their last menstrual period. Proportions of women engaging in this practice were higher among those who reported greater frequency of intercourse and larger numbers of lifetime sex partners. Almost half the women who had intercourse more than twice a week and more than one third of the women who had more than seven lifetime sex partners reported that they usually have vaginal intercourse during menses. The findings suggest that this practice is relatively more common among the better educated, young, white women and their sex partners. Most interestingly, despite the fact that sex during menses is most common among women in relatively low-risk groups, we were able to observe a strong statistical association between sexual intercourse during menstruation and self-reported STD history. CONCLUSIONS: Sexual intercourse during menstruation may emerge more consistently as a risk factor for the heterosexual transmission of HIV or other sexually transmitted pathogens in future studies. If future epidemiologic studies continue to bolster this finding, then public health efforts should promote abstinence during the female menstrual period and target those groups of women among whom this practice is prevalent.

Adult↗

PubMed1993

Endometrial fibrinolytic enzymes in women with normal menstruation and dysfunctional uterine bleeding.

OBJECTIVE: To study fibrinolysis in the endometrium in women with normal menstruation and dysfunctional uterine bleeding (DUB). DESIGN: Tissue plasminogen activator activity (t-PA) and antigen (t-PAAg) and plasminogen activator inhibitor Type 1 antigen (PAI-1) were measured in homogenates of endometrium sampled between 24 and 36 h after the onset of menstruation. SUBJECTS: Women complaining of menorrhagia who had negative findings at clinical examination and curettage had their menstrual blood loss (MBL) measured from the third cycle after D&C. Those with MBL greater than 80 ml per cycle formed the DUB group. MEASUREMENTS: Fibrinolytic enzyme antigen levels were measured with ELISAs. Tissue plasminogen activator activity was assayed by measuring the rate of conversion of Glu-plasminogen to plasmin, using a chromogenic plasmin substrate. CONCLUSIONS: There is a strong positive correlation between endometrial t-PA activity on the second day of menstruation and measured menstrual loss (P < 0.05). Concentrations of endometrial t-PAAg and PAI-1 antigen are higher in women with DUB compared with normal women during menstruation.

Endometrium↗

PubMed1977

Menstruation and control of diabetes.

Seventy per cent of the patients aged 45 years or under and suffering from diabetic ketoacidosis who were seen in one diabetic clinic over five years were women. The association of menstruation with ketoacidosis was assessed over two and a half years, and it was found that menstruation was associated with ketoacidosis more often than would be expected by chance (P less than 0-01). Two hundred women were interviewed and 76 observed that menstruation changed their diabetic control. Fifty-three found that control deteriorated and hyperglycaemia occurred, while 23 found that control improved and hypoglycaemia was a common problem. Menstruation appears to be an important factor in influencing control of diabetes. The mechanism of the changes observed has not yet been determined, but it seems to be a subject worthy of further investigation.

Adolescent↗

PubMed2005

Association of asthma and hay fever with irregular menstruation.

BACKGROUND: There is some evidence that asthmatic women are more likely to have abnormal sex hormone levels. A study was undertaken to determine whether asthma and allergy were associated with irregular menstruation in a general population, and the potential role of asthma medication for this association. METHODS: A total of 8588 women (response rate 77%) participated in an 8 year follow up postal questionnaire study of participants of the ECRHS stage I in Denmark, Estonia, Iceland, Norway, and Sweden. Only non-pregnant women not taking exogenous sex hormones were included in the analyses (n = 6137). RESULTS: Irregular menstruation was associated with asthma (OR 1.54 (95% CI 1.11 to 2.13)), asthma symptoms (OR 1.47 (95% CI 1.16 to 1.86)), hay fever (OR 1.29 (95% CI 1.05 to 1.57)), and asthma preceded by hay fever (OR 1.95 (95% CI 1.30 to 2.96)) among women aged 26-42 years. This was also observed in women not taking asthma medication (asthma symptoms: OR 1.44 (95% CI 1.09 to 1.91); hay fever: OR 1.27 (95% CI 1.03 to 1.58); wheeze preceded by hay fever: OR 1.76 (95% CI 1.18 to 2.64)). Irregular menstruation was associated with new onset asthma in younger women (OR 1.58 (95% CI 1.03 to 2.42)) but not in women aged 42-54 years (OR 0.62 (95% CI 0.32 to 1.18)). The results were consistent across centres. CONCLUSIONS: Younger women with asthma and allergy were more likely to have irregular menstruation. This could not be attributed to current use of asthma medication. The association could possibly be explained by common underlying metabolic or developmental factors. The authors hypothesise that insulin resistance may play a role in asthma and allergy.

Adult↗

PubMedDate not supplied

Iron deficiency and smoking. Comparative criteria for buccal mucosa keratinization in menstruating and postmenopausal women.

OBJECTIVE: To compare the degree of keratinization of buccal mucosa between nonsmoking menstruating and postmenopausal women without oral complaints whose iron status was established. STUDY DESIGN: Samples collected from 26 nonsmoking, regularly menstruating women (mean age, 26 years) and 18 nonsmoking, postmenopausal women without oral complaints (mean age, 57 years) were stained according to the method of Papanicolaou. Keratinization was evaluated by the karyopyknotic index (KI). Iron status was assessed with blood ferritin levels. RESULTS: Mean ferritin values of menstruating and postmenopausal women were statistically significantly different (mean ferritin value = 28.97 micrograms/L and 103.69 micrograms/L, respectively). The difference in the degree of keratinization of buccal mucosa between menstruating women (mean KI = 16.03%) and postmenopausal women (mean KI = 13.16) was statistically nonsignificant. CONCLUSION: Our results indicate that the degree of keratinization of buccal mucosa does not show any alteration after menopause.

Adult↗

PubMed2002

Safety of tissue plasminogen activator for acute stroke in menstruating women.

BACKGROUND: Menses is a theoretical contraindication to intravenous tissue plasminogen activator (tPA) treatment. We sought to establish the safety of intravenous tPA in the treatment of acute ischemic stroke in women who are actively menstruating. SUMMARY OF REPORT: We provide a case report and review of the National Institute of Neurological Disorders and Stroke (NINDS) database for women coded as actively menstruating. Nine subjects were coded as actively menstruating in the NINDS trial (4 placebo and 5 in the treatment). One subject in the treatment group who had a 1-year history of dysfunctional uterine bleeding required emergent uterine artery ligation. We also report a case of a woman requiring transfusion after intravenous tPA administration for acute ischemic stroke. CONCLUSIONS: Intravenous tPA may be administered relatively safely in women who are menstruating and should be used with caution in women with a history of dysfunctional uterine bleeding. Potential patients should be advised that they might require transfusion for increased menstrual flow.

Acute Disease↗

PubMed2003

Elafin in human endometrium: an antiprotease and antimicrobial molecule expressed during menstruation.

Elafin is an antiproteinase and antimicrobial molecule that is expressed at epithelial sites (for example, cervix). This study details the expression and regulation of elafin in the human endometrium. Elafin mRNA and protein expression were examined in endometrium throughout the menstrual cycle and in first-trimester decidua. Real-time quantitative PCR showed that expression of elafin mRNA peaked during menstruation. Elafin protein was localized to leukocytes scattered in the endometrial stroma during the late secretory and menstrual phases. Faint immunostaining was also present in glandular epithelium at these cycle stages. Immunofluorescent colocalization of elafin with neutrophil elastase confirmed that elafin was expressed by endometrial neutrophils around the time of menstruation. This is consistent with the expression profile observed from immunohistochemical studies. Primary endometrial epithelial cells were treated with proinflammatory molecules, and elafin mRNA was studied. A combination of the proinflammatory mediators, IL-1 beta and TNFalpha, increased elafin mRNA levels by 4.6-fold. These results show that endometrium expresses elafin in a menstruation-dependent manner. This is attributable to the presence of infiltrating leukocytes and increased inflammatory signaling. Elafin will regulate proteolytic enzymes during menstruation and will contribute to the innate defense against uterine infection.

Adult↗

PubMed2002

In vivo evidence for active matrix metalloproteinases in human endometrium supports their role in tissue breakdown at menstruation.

Human endometrium remodels extensively during each reproductive cycle culminating in loss of most functionalis tissue at menstruation. Evidence suggests that menstruation results from the action of the matrix metalloproteinases (MMP), enzymes secreted in latent forms. MMP activation is thus an important regulatory step. It has not been established that MMPs are active within menstrual endometrium in vivo. We used in situ zymography to demonstrate active forms of MMPs in human endometrium across the normal menstrual cycle. Both gelatinase and collagenase activities were detected in most endometrial tissues. Semiquantitation demonstrated a substantial and significant increase in both gelatinase and collagenase activity in menstrual samples compared with those at any other time of the cycle. Gelatinase activity was both associated with cells and extracellular. All collagenase activity was extracellular. Immunoreactive MMP-2 and MMP-9 colocalized with active gelatinase, although much immunoreactive gelatinase was inactive. Some gelatinase activity colocalized with CD45(+) leukocytes. Menstruation is initiated at discrete foci, and active MMPs were similarly at foci within the tissue. This is the first in vivo evidence for increased active MMPs in menstrual endometrium compared with other stages of the cycle. These findings position the MMPs for a critical role in the matrix degradation at menstruation.

Collagenases↗

PubMed1997

Skeletal involvement in female acromegalic subjects: the effects of growth hormone excess in amenorrheal and menstruating patients.

Bone involvement is a common clinical feature in acromegalic patients, though previous studies gave divergent results possibly because of the different gonadal status of the patients studied. To study the influence of estrogen milieu in these patients, we evaluated 23 acromegalic patients with active disease, subdivided into two groups: menstruating and amenorrheal patients, comparable for duration and activity of disease. Forty-two matched women served as controls. Skeletal involvement was studied by measuring: (a) the main biomarkers of bone turnover: serum alkaline phosphatase total activity (AP), bone GLA protein (BGP), serum carboxy-terminal propeptide of type I collagen (PICP), serum type I cross-linked N-telopeptide (ICTP), and urinary pyridinoline and deoxypyridinoline corrected for creatinine (Pyr/Cr, D-Pyr/Cr) and urinary calcium/creatinine ratio (Ca/Cr); (b) bone mineral density (BMD), as measured by quantitative computed tomography both at lumbar spine and distal radius, and by dual X-ray absorptiometry both at lumbar spine and at three femoral sites (Ward's triangle, femoral neck, and great trochanter). AP, BGP, ICTP, Pyr/Cr, D-Pyr/Cr were significantly higher in patients than in controls, independent of the menstrual pattern. Higher PICP levels were found in the whole group and in menstruating acromegalics when compared with control women; no difference was found in amenorrheal patients, who in turn showed higher urinary Ca/Cr values. When patients were considered all together, BMD at spine, femoral neck, and trochanter was higher than in controls. In contrast, when the gonadal status was taking into account and, menstruating and amenorrheal subjects were considered separately, BMD at spine, but not in other sites, was significantly higher in menstruating patients than in controls. In contrast, no difference of BMD values at any site was observed between amenorrheal patients and controls. The mean BMD Z scores allowed us to detect an unequal involvement of different skeletal sites. Our results show that bone turnover is increased in acromegalic women and suggest that GH anabolic effect on bone is more evident in the presence of estrogens and that different skeletal sites may be affected differently by hormone excess.

Acromegaly↗

PubMed2002

Matrix metalloproteinases and their specific tissue inhibitors in menstruation.

The timely breakdown of extracellular matrix is essential for menstruation. Matrix metalloproteinases, which are able to degrade virtually all components of the extracellular matrix, are spatiotemporally expressed in the cyclic endometrium. The expression of most matrix metalloproteinases is regulated transcriptionally and their proteolytic activities are precisely controlled. The balance between matrix metalloproteinases and their specific tissue inhibitors is believed to be crucial for menstruation. This review focuses on the roles of matrix metalloproteinases and their tissue inhibitors in the initiation of menstruation and on the regulation of matrix metalloproteinase expression and activation. For example, the function of matrix metalloproteinases and their tissue inhibitors in endometrial re-epithelialization and angiogenesis during endometrial regeneration, when cell migration is facilitated to ensure endometrial repair, is discussed. This and other processes, although not fully resolved, serve to illustrate the involvement of matrix metalloproteinases and their tissue inhibitors in the process of menstruation.

Animals↗

PubMed1981

[Influence of menstruation on epilepsy].

From 3.457 epileptic patients, 1.574 females from 12 to 50 years old, considered probably in ovulatory age, were studied regarding the influence of menstruation upon epileptic fits. The females were compared with a group of epilepsies in general and with a group of male epileptic patients (476 cases) of same age exhibiting monthly seizures, a rhythm similar to the menstrual cycle in woman. The results led the author to the following conclusions: 1) In 353 epileptic females (22,4%) the epilepsy was influenced by the menstruation. 2) The exacerbation of fits predominate in the premenstrual and menstrual periods. 3) No significant differences was observed when compared females in ovulatory age exhibiting monthly seizures (14%) with male of similar age and similar frequency of seizures (16%); this fact is against the correlation between the cyclical events represented by epileptic fits and menstruation. 4) Focal non-temporal abnormalities predominate in the females that was influenced by menstruation.

Adolescent↗

PubMed2006

[Volt-ampere characteristics of Yuan points of three yin channels of hand in women before, during and after menstruation].

OBJECTIVE: To observe the changes of volt-ampere characteristics of Yuan-Primary acupoints in women before, during and after menstruation, and to find out the relationships between Qi-blood in human body and volt-ampere characteristics of acupoints, so as to develop a new method for quantitative analysis on changes of Qi-blood. METHODS: A high-sensitive detection system of volt-ampere characteristics of acupoint was applied to detecting the volt-ampere characteristics of Taiyuan (LU 9), Daling (PC 7) and Shenmen (HT 7) in healthy women before, during and after menstruation. RESULTS: The resistances on LU 9, PC 7 and HT 7 with some certain scan currents were quite different among the women before, during and after menstruation. For such changes, PC 7 was of the most obvious change, LU 9 was of the less and HT 7 was of the least. The total ratio of the scanning spots with significantly increasing changes of resistances on these three acupoints along with the menstrual process was 70.6%. CONCLUSION: The volt-ampere characteristics of acupoints vary with the menstrual process, which is of the acupoint specificity. The resistances on the acupoints increase with the menstrual process, and such results may be due to the blood loss during menstruation. The volt-ampere characteristics can be used as a quantitative index to study on the change of Qi and blood.

Acupuncture Points↗