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Forty-four women with premenstrual syndrome kept a daily record of seven moods for two to four menstrual cycles. Principal components analysis of the mood scores for each woman showed a clear main component accounting for much of the variance (mean = 75%). Only in two cases was there evidence of a very minor second component. These results indicate that, for these moods, a single mood sum is a suitable measure to use when looking for premenstrual change. Inspection of simultaneous time plots, means and standard deviations supported the conclusion from the principal components analysis. Metcalf et al.' found the same pattern for all seven moods when they aggregated data across women. The present study shows that for individual women the moods rise and fall together so that the pattern found with aggregated data does reflect the pattern for individual women.

Placebo responsiveness was monitored in 29 women presenting with the premenstrual syndrome (PMS). Daily records were kept during six menstrual cycles (three control and three placebo)and weekly urine samples collected for the measurement of pregnanediol. Psychological and physical symptom cyclicity was analyzed by Fourier analysis. Placebo administration was associated with a significant amelioration of premenstrual symptoms in the group as a whole which persisted during the 3 months of treatment; marked variations in the placebo responsiveness of individuals; and a previously unreported and significant shift in the mean position of psychological symptoms to within a few hours of menstrual onset. The cause of this shift is discussed.Beobachtet wurde die Reaktion von 29 Frauen mit pramenstruellem Syndrom (PMS) auf die Gabe von Placebos. Es wurden Tagesprotokolle Uber sechs Menstruationszyklen hinweg (Kontrolle: dreiPlacebo: drei) gefUhrt und wochentlich Urinproben zur Messung von Pregnandiol genommen. Mit ...

What are the long-term effects of hysterectomy on the ovaries of normal women? Ninety-three women aged 29–44 years (median, 38 years) who had undergone hysterectomy for benign reasons 0·3–9·1 years prior to investigation, contributed urine samples twice weekly for a period of 53–149 days (median 102 days) for pregnanediol analysis. The interval between successive pregnanediol peaks and their increment over baseline were measured. The median peak interval was 27·3 days, and 93·3% of all intervals were of 21- to 35-days duration. Of the 337 peaks observed, 96·7% met the criteria previously used to define an ovulatory cycle. These are similar to the figures reported for menstruant women of comparable age. ANOVA showed no significant effect of age or time since hysterectomy on either the interval between peaks or peak increment (P > 0·10 in all cases). The evidence suggests that the ovaries of women who have no uterus behave like those of intact women. Journal of Endocrinology (1992) 135, 597–602

Seven moods and 5 physical symptoms have been observed daily throughout the course of 133 menstrual cycles, in 44 women with the premenstrual syndrome (PMS). The evidence suggests the existence of 2 symptom cyclicities, the first with symptoms appearing early in the luteal phase and reaching a maximum close to the end of the menstrual cycle, and the second with symptoms appearing late in the luteal phase and reaching a maximum on the first or second day of the new cycle. Only headaches followed the second pattern. Headaches, unlike the other PMS symptoms, were symmetrically distributed about day 0 in the menstrual cycle with 53.8% of the peak area occurring in the 10 days before the start of menstruation (95% range, 38.6–68.7%). By comparison, the premenstrual percentages for the 7 moods and for bloating, constipation, food craving and breast discomfort ranged from 77.8 to 93.4% (mean ± S.D., 84.3 ± 6.1%) indicating that these symptoms occur mainly in the premenstruum. It is concluded that headaches are a...

Urine for the analysis of pregnanediol was collected weekly for 3 months from 209 menstruant women aged 11-24 years who lived with their parents and from 59 women aged 17-23 years who had left the parental home. Menstrual cycles were classed as ovulatory if the 24-h pregnanediol output in the 12 days preceding menstruation was greater than or equal to 5 mumol on a single occasion or if the total excreted on 2 days, 1 week apart, was greater than or equal to 7 mumol. In the first group, ovulatory incidence increased with menarchal age. Unfailing ovulation occurred in 22.9, 25.0, 44.8, 42.9, 63.2, 71.8 and 82.6% of those who were less than 1, 1- less than 2, 2- less than 3, 3- less than 4, 4- less than 5, 5-8 and 9-12 years from menarche. Comparable figures for the women who lived in flats and hostels were 40.0% (menarchal age, 5-8 years) and 78.6% (9-12 years). It is concluded that a regular pattern of ovulatory menstrual cycles is established in most young women within 5 years of the menarche, and that departure from the family home is often associated with a regression to a juvenile pattern of anovulatory menstrual cycles.

Specimens of various polyphase Si3N4 materials fabricated in the Si-Mg-O-N system, and a commercial Si3N4 material were subjected to oxidation treatments prior to flexural strength determinations at 1400° C. It was demonstrated that a pre-oxidation treatment could significantly improve the high-temperature strength. The compositional change induced by oxidation which can decrease the volume fraction of the viscous phase present in these materials at high temperatures is believed to be responsible for the observed strengthening.

To assess ovarian function plasma luteinizing hormone and follicle stimulating hormone urinary estrogen and urinary pregnanediol levels were measured weekly for 4 weeks in 34 women (aged 45-57) who had withdrawn from oral contraceptives (OCs). 14 patients were classified as premenopausal after a rise in urinary pregnanediol excretion occurred suggesting ovulation had occurred. 13 were classified as postmenopausal on the basis of elevated serum gonadotropins and persistently low urinary estrogen and pregnanediol excretion. However 1 of the women later showed hormonal evidence of ovulation indicating fluctuation in ovarian function. 7 patients were classified as indeterminate; their hormone profiles made ovarian function hard to assess. All patients excreting more than 45 nmal of estrogen/day had a spontaneous menstrual period within 45 days of stopping OCs. This suggests that women who are potentially fertile at 1 month after discontinuing OCs can be identified with an early morning urine sample; a slight improvement in accuracy is obtained if sampling is also carried out after 3 weeks. However because of the 1 woman in this study who was thought to be postmenopausal but later turned out to have increased pregnanediol excretion suggesting ovulation caution is advised in diagnosing menopause on the basis of hormone studies alone.

In normal women reproductive capacity diminishes with age; the decline has been detected before the start of the menopausal transition. It is known that in premenopausal women most menstrual cycles are ovulatory. An investigation was set up to examine the possibility that there is an age-related decline in the ability of the corpus luteum to secrete progesterone at this time. Once-weekly urine samples for the measurement of pregnanediol were collected from 100 women aged 20–48 years, all of whom had regular 20- to 35–day menstrual cycles (1124 samples collected during the course of 312 menstrual cycles of which 96·8% were ovulatory). Pregnanediol excretion rates parallel the levels of progesterone in plasma. Examination of the rank correlation between age and pregnanediol excretion identified a significant negative correlation during the early and mid-follicular phases, but failed to detect any age-related change during the luteal phase. The evidence does not support the concept of an age-related increase in luteal phase defects before the start of the menopausal transition. J. Endocr. (1988) 119, 153–157

An increased daily excretion of pregnanediol, relative to that early in the menstrual cycle, is often taken to be evidence that a woman has ovulated. This paper assesses the value of alternative procedures for this purpose. Urine, plasma and saliva samples were collected during a 24-h period from 20 women during the follicular phase and from 20 women during the luteal phase. The 24-h excretion of pregnanediol was compared with (1) the concentration of progesterone in plasma, (2) the concentration of progesterone in saliva, (3) the concentration of pregnanediol in small urine samples, (4) the rate of excretion of pregnanediol and (5) the ratio of pregnanediol to creatinine in small urine samples. Each analyte increased substantially during the luteal phase. The median increases (ratio of luteal to follicular phase values) were 14·8, 3·2, 10·6, 11·9 and 11·1 respectively. By comparison, the median increase in 24-h pregnanediol output was 9·2. When the other analytes were used instead of the 24-h excretion of pregnanediol to assess the possibility of ovulation, the incidence of misclassifications (follicular samples classed as luteal and luteal samples classed as follicular) was 0, 12·8, 5·9, 2·0 and 1·0% respectively. It was concluded that the most satisfactory alternative to the measurement of 24-h pregnanediol output for the biochemical assessment of ovulation based on progesterone production was the measurement of the concentration of progesterone in plasma; the least satisfactory alternative was determination of the concentration of progesterone in saliva. If blood was not available, measurement of the ratio of pregnanediol to creatinine in a small urine sample was the preferred method. J. Endocr. (1984) 100, 75–80

The administration of human chorionic gonadotrophin (HCG) to dexamethasone-suppressed men caused parallel changes in the concentration of plasma testosterone and in the urinary output of androsterone+aetiocholanolone, total 17-oxosteroids and oestrogens. Discrepant results occurred in only four of the thirty-seven men tested. With these exceptions, the response to HCG could by followed as well by measuring androsterone+aetiocholanolone, 17-oxosteroid or oestrogen excretion rates as by following plasma testosterone levels. The most sensitive index of response was the rate of appearance of oestrogens in urine, and the next that of androsterone+aetiocholanolone.

Hysterectomy is sometimes recommended for the treatment of women with the premenstrual syndrome (PMS). Do the symptoms of PMS disappear when the uterus is removed?The moods and physical symptoms ex...

Reply to a critique of an earlier article by the authors noting a higher incidence of anovulatory menstrual cycles among women under age 25 than among older women and concluding that young women may reach peak fertility before their their peak ovulatory efficiency. It was noted that a cohort effect could be the cause. The authors acknowledge this possibility but that at present the influence of environmental factors is a matter of speculation but if real their effects are small compared to occupation and living conditions. In the study under discussion the incidence of ovulation in 108 New Zealand women aged 20-24 years were monitored during 3 consecutive menstrual cycles. In this group women who were students ovulated less often and less consistently than nonstudents and those living in flats or hostels ovulated less often than those living with relatives. The differences were substantial and sufficient to account for the lower incidence of ovulatory cycles observed in these women compared to women aged 30-39. In the student group 75.5% of those living in families ovulated without fail compared with an incidence of only 44.9% in the rest of the group. This difference is highly significant and occurred in women of comparable age and socioeconomic status and cannot be explained by postulating a cohort effect.

It is claimed that the exposure of women to oestrogens unopposed by progesterone increases the risk of breast cancer. Despite indirect evidence in support of this claim, the impracticability of monitoring oestrogen and progesterone levels in large numbers of women for prolonged periods of time has meant that no direct demonstration of the effect has been made. A possible technique is suggested. The ratio (R) of oestrogens to pregnanediol in urine has been used as an index of oestrogen exposure relative to progesterone. Samples were collected at weekly intervals on 700 occasions from 30 perimenopausal women, and on 519 occasions from 66 women with a history of regular menstrual cyclicity. Unusually prolonged episodes of unopposed high oestrogen excretion (R ≥ 100 for ≥ 2 successive weeks) were observed on 30 occasions in 15 of the perimenopausal women and on four occasions in the other women. In the perimenopausal group, these episodes occurred in 46·9% of the 32 menstrual cycles which were longer than 50 days compared with 6·9% of the 72 cycles which were shorter than 35 days (P < 0·001). The association of prolonged episodes of unopposed high oestrogen excretion with long menstrual cycles suggests the possibility of using menstrual cycle length as an index of oestrogen exposure during the menopausal transition. J. Endocr. (1985) 104, 137–141

In the assessment of ovarian activity, testicular response in human chorionic gonadotrophin (HCG), and placental and fetal viability during pregnancy, measurements made on small samples of urine may be used to monitor changes in 24h steroid output; the collection of 24h urine specimens is not necessary. For women, 24h output approximately 10 R (R, steroid/creatinine in small urine samples; concentrations expressed in SI units of amount). For men, 24h output approximately 14 R.

Urine samples were collected once weekly for two to four months from 622 normal women. Menstrual cycles were considered to be ovulatory if the 24 h pregnanediol output in the 12 days preceding menstruation was greater than or equal to 5 mumol on one occasion, or if the total excreted on two occasions, one week apart, was greater than or equal to 7 mumol. The incidence of ovulatory cycles increased from 48% in girls aged 10-14 yr to 72% by 20-24 yr, reached a plateau of 98% in women aged 30-39 yr, then declined with the approach of the menopause to 66% in women over the age of 50 yr. In women who were 5-8 yr from the menarche, departure from the parental home was associated with a decline in ovulatory incidence (84% for women living with parents, cf 46% for women living in flats and hostels; p less than 0.01). A similar decline was noted in women over the age of 40 yr who had experienced a break in a previously regular pattern of menstrual cycles (98% for women with regular cyclicity, cf 58% for women with variable cyclicity; p less than 0.001). Hormone patterns consistent with the occurrence of ovulation were seen at all stages from 120 days after the menarche to seven days before the menopause.

In normal women the menopausal transition starts typically with a sudden break in regular menstrual cyclicity: gonadotrophin levels escape from the cyclical pattern characteristic of fertile women and increasingly rise into the postmenopausal range. An investigation was undertaken to determine whether this rise precedes the first appearance of ovarian dysfunction. Weekly urine samples for the measurement of FSH, LH and pregnanediol were collected from 100 women, all of whom had regular 20- to 35-day menstrual cycles (504 samples from 48 women aged 20–39 years and 620 samples from 52 women aged 40–48 years; 96·8% of these cycles were shown to be ovulatory). Excretion rates of FSH in excess of 5 i.u./24 h occurred more often in women aged ≥ 40 years than in younger women (incidence, 31·5 cf. 19·5%; P < 0·001). The difference was greatest at the time of the perimenstruum (7-day incidence, 32·5 cf. 13·9%) and declined to insignificance during the mid-cycle gonadotrophin surge (7-day incidence, 44·2 cf. 34·8%). Examination of the rank correlation between age and gonadotrophin excretion confirmed the age-related rise in FSH and identified a lesser but significant perimenstrual rise in LH. For both FSH and LH these changes were small compared with the increases observed in nine women presumed to have reached the menopausal transition during the trial (incidence FSH ≥ 5 i.u./24 h, 60·6%; incidence LH ≥ 5 i.u./24 h, 48·6%). It is concluded that in fertile women there is evidence of an age-related rise in FSH which is distinct from the changes occurring at the start of the menopausal transition. J. Endocr. (1985) 105, 357–362)

Plasma follicle stimulating hormone (FSH) and luteinising hormone (LH) concentrations, and pregnanediol and oestrogen excretion rates, were measured in a perimenopausal woman from the first appearance of oligomenorrhoea until the onset of severe and persistent hot flushes two years later. Postmenopausal episodes characterised by hot flashes, amenorrhoea, high FSH levels (greater than or equal to 5IU/L) and low urinary oestrogens (less than or equal to 50 nmol/24hr), were followed by menstrual cycles in which the FSH levels were low (less than 5 IU/L) and there was an ovulatory pattern of oestrogen and pregnanediol excretion. An unusual association of high urinary oestrogens (greater than or equal to 50 nmol/24hr) with high gonadotrophin levels was observed on several occasions. The transient postmenopausal episodes were biochemically and symptomatically indistinguishable from the permanent amenorrhoea of postmenopausal women.