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Nelson K, Shirin S, Kalidasan D, Prior JC. Experiences of women living with Polycystic Ovary Syndrome: A pilot case-control, single-cycle, daily Menstrual Cycle Diary study during the SARS-CoV-2 pandemic. PLoS One 2023; 18:e0296377. [PMID: 38157371 PMCID: PMC10756515 DOI: 10.1371/journal.pone.0296377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
Polycystic Ovary Syndrome (PCOS) affects many people and is often distressing. Much medical literature about diagnosis and treatment exists, but little is known about PCOS menstrual cycle-related experiences except that cycles tend to be far-apart and unpredictable. Our purpose was to examine the menstrual cycle and daily life experiences in those with PCOS having approximately month-apart cycles compared with age and BMI-matched cohort controls using data from the Menstruation & Ovulation Study 2 (MOS2) during the first 1.5 years of SARS-CoV-2 pandemic. We hypothesized that those with PCOS would experience lower self-worth and more negative moods. This is a single-cycle prospective case-control study in community-dwelling women ages 19-35 years. Eight reported physician-diagnosed PCOS and were matched (1:3 ratio) with controls by age (within .6 years) and BMI (within .19 BMI units). Experiences were recorded daily (Menstrual Cycle Diary©, Diary). All kept daily morning temperatures to assess luteal phase lengths by the validated Quantitative Basal Temperature© analysis method. From 112 in MOS2, 32 women were compared: eight with PCOS versus 24 controls. Demographic, socioeconomic, comorbidities and lifestyle variables were not different between the two groups. Cycle lengths were similar in PCOS and controls (one PCOS and control each had oligomenorrhea; most lengths were 21-35 days, P = .593). Unexpectedly, luteal phase lengths were also similar between PCOS and controls (P = .167); anovulation occurred in 5 with PCOS, and in 9 controls. There were no significant Diary differences between the two groups except for greater "outside stress" in the PCOS group (P = .020). In contrast to our hypotheses, there were no significant differences in feelings of self-worth, anxiety nor depression. The SARS-CoV-2 pandemic was a stressful time for women. MOS2 captured granular menstrual cycles, ovulation and daily experiences in women with PCOS compared with age- and BMI-matched controls. These pilot data in women with milder PCOS are the first of more research required to understand the daily experiences in those living with PCOS.
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Affiliation(s)
- Kaitlin Nelson
- Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology and Metabolism, Department of Medicine, University of British Columbia, Vancouver, Canada
- BC Women’s Health Research Institute, Vancouver, Canada
- Experimental Medicine, MSc Programme, University of British Columbia, Vancouver, Canada
| | - Sonia Shirin
- Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology and Metabolism, Department of Medicine, University of British Columbia, Vancouver, Canada
- BC Women’s Health Research Institute, Vancouver, Canada
| | - Dharani Kalidasan
- Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology and Metabolism, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Jerilynn C. Prior
- Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology and Metabolism, Department of Medicine, University of British Columbia, Vancouver, Canada
- BC Women’s Health Research Institute, Vancouver, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, University of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Bann S, Goshtasebi A, Shirin S, Prior JC. A one-year observational cohort study of menstrual cramps and ovulation in healthy, normally ovulating women. Sci Rep 2022; 12:4738. [PMID: 35304559 PMCID: PMC8933502 DOI: 10.1038/s41598-022-08658-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
This is a prospective, observational community cohort study with the objective of investigating menstrual cramp occurrence related to ovulatory characteristics. Women reported cramp intensity on daily Menstrual Cycle Diary© records over one year. Ovulation and luteal phase lengths were assessed by validated Quantitative Basal Temperature© (QBT) analysis. Healthy, normal-weight, non-smoking community dwelling premenopausal women ages 21-41 years with two consecutive, normally ovulatory, normal-length menstrual cycles were enrolled. All 53 women, with 13.6 ± 2.8 cycles per woman, reported at least one cramp episode of median intensity 1.5 [0-4 scale; range 1.0-3.5], and 2.2 days' [range 1.0-10.2] duration. Within the 49 women who experienced all ovulatory cycle types (normal, short luteal length [SLL < 10 days] and anovulatory), median cramp intensity was greater in normal-length cycles having subclinical ovulatory disturbances (SLL and anovulatory; median 1.4 [range 0.0-2.8]) than in normally ovulatory cycles (median 1.2 [range 0.0-2.3]) (P = 0.023). Cramp Scores did not differ by ovulatory status within the 19 women having both normally ovulatory and anovulatory cycles (P = 0.222). Within-woman 1-year Cramp Scores were not different in anovulatory and normally ovulatory menstrual cycles but were more intense with ovulatory disturbances.
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Affiliation(s)
- Sewon Bann
- MD Internal Medicine Postgraduate Program (2023), University of British Columbia, Vancouver, Canada.,Endocrinology and Metabolism, Centre for Menstrual Cycle and Ovulation Research (CeMCOR), University of British Columbia, 2775 Laurel Street, 4th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Azita Goshtasebi
- Endocrinology and Metabolism, Centre for Menstrual Cycle and Ovulation Research (CeMCOR), University of British Columbia, 2775 Laurel Street, 4th Floor, Vancouver, BC, V5Z 1M9, Canada.,BC Women's Health Research Institute, Vancouver, Canada
| | - Sonia Shirin
- Endocrinology and Metabolism, Centre for Menstrual Cycle and Ovulation Research (CeMCOR), University of British Columbia, 2775 Laurel Street, 4th Floor, Vancouver, BC, V5Z 1M9, Canada.,BC Women's Health Research Institute, Vancouver, Canada
| | - Jerilynn C Prior
- Endocrinology and Metabolism, Centre for Menstrual Cycle and Ovulation Research (CeMCOR), University of British Columbia, 2775 Laurel Street, 4th Floor, Vancouver, BC, V5Z 1M9, Canada. .,Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, Canada. .,BC Women's Health Research Institute, Vancouver, Canada. .,School of Population and Public Health, University of British Columbia, Vancouver, Canada.
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Using Circadian Rhythm Patterns of Continuous Core Body Temperature to Improve Fertility and Pregnancy Planning. J Circadian Rhythms 2020; 18:5. [PMID: 33024445 PMCID: PMC7518073 DOI: 10.5334/jcr.200] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective Review relationships among circadian clocks, core body temperature (CBT), and fertility in women. Methods Scoping literature review. Results Circadian clocks are a ubiquitous adaptation to the most predictable environmental events - the daily cycles of light and dark. Core body temperature (CBT) also follows a circadian rhythm. Additionally, CBT is tightly controlled by a combination of neuronal circuits that begin in the hypothalamus and involve many other portions of the brain as well as a wide range of peripheral mechanisms. In women with normal reproductive function, the diurnal temperature pattern for CBT is strongly influenced by the menstrual cycle of reproductive hormones, primarily estradiol and progesterone, which modulate the activity of hypothalamic neural circuits involved in body temperature control, resulting in an infradian CBT rhythm. Conclusions Analysis of CBT via continuous recording reveals patterns in the interactions of circadian and infradian CBT rhythms capable of accurately predicting the fertility window and hormonal patterns suggesting oligo-ovulation and subfertility. New wearable technologies can facilitate employment of hormone-associated changes in CBT for pregnancy planning and offer clinical insight to infertility and menopause.
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Women’s reproductive system as balanced estradiol and progesterone actions—A revolutionary, paradigm-shifting concept in women’s health. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.ddmod.2020.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Prior JC, Konishi C, Hitchcock CL, Kingwell E, Janssen P, Cheung AP, Fairbrother N, Goshtasebi A. Does Molimina Indicate Ovulation? Prospective Data in a Hormonally Documented Single-Cycle in Spontaneously Menstruating Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15051016. [PMID: 29783630 PMCID: PMC5982055 DOI: 10.3390/ijerph15051016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/09/2018] [Accepted: 05/12/2018] [Indexed: 11/16/2022]
Abstract
Approximately 33% of normal-length (21⁻35 days) cycles have subclinical ovulatory disturbances and lack sufficient progesterone, although their normal length ensures enough estrogen. Subclinical ovulatory disturbances are related to significant premenopausal spine bone loss (-0.86%/year). Molimina, non-distressing premenstrual experiences, may detect ovulation within normal-length cycles. This prospective study assessed the relationship between molimina and ovulation. After 1-cycle of daily diary and first morning urine collections, women answered the Molimina Question (MQ): "Can you tell by the way you feel that your period is coming?" and were invited to share (a) predictive premenstrual experience(s). A 3-fold increase in follicular-luteal pregnanediol levels confirmed ovulation. In 610 spontaneously menstruating women (not on hormonal contraception, mean age 31.5 ± 5.3, menarche age 12.7 ± 1.5, cycle length [CL] 29 days, MQ positive in 89%), reported premenstrual experiences which included negative moods (62%), cramps (48%), bloating (39%), and front (26%) or axillary (25%) breast tenderness. Of 432 women with pregnanediol-documented cycles, 398 (92%) were ovulatory (CL: 29 ± 5) and 34 (8%) had ovulatory disturbances (CL: 32 ± 14). Women with/without ovulatory cycles were similar in parity, body mass index, smoking, dietary restraint and the MQ; ovulatory-disturbed cycles were longer. Molimina did not confirm ovulation. A non-invasive, inexpensive ovulation indicator is needed to prevent osteoporosis.
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Affiliation(s)
- Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, Vancouver, BC V5Z 1M9, Canada.
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
- School of Population and Public Health, University of British Columbia; Vancouver, BC V6T 1Z3, Canada.
- BC Women's Health Research Institute, Vancouver, BC V6H 3N1, Canada.
| | - Chiaki Konishi
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC H3A 0G4, Canada.
| | | | - Elaine Kingwell
- Centre for Menstrual Cycle and Ovulation Research, Vancouver, BC V5Z 1M9, Canada.
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada.
| | - Patti Janssen
- Centre for Menstrual Cycle and Ovulation Research, Vancouver, BC V5Z 1M9, Canada.
- School of Population and Public Health, University of British Columbia; Vancouver, BC V6T 1Z3, Canada.
- BC Women's Health Research Institute, Vancouver, BC V6H 3N1, Canada.
| | - Anthony P Cheung
- Centre for Menstrual Cycle and Ovulation Research, Vancouver, BC V5Z 1M9, Canada.
- Division of Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver, BC V6T 2A1, Canada.
- Grace Fertility Centre, Vancouver, BC V5Z 1G1, Canada.
| | - Nichole Fairbrother
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 2A1, Canada.
| | - Azita Goshtasebi
- Centre for Menstrual Cycle and Ovulation Research, Vancouver, BC V5Z 1M9, Canada.
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Prior JC, Hitchcock CL, Vigna YM, Seifert-Klauss V. Premenopausal Trabecular Bone Loss is Associated with a Family History of Fragility Fracture. Geburtshilfe Frauenheilkd 2016; 76:895-901. [PMID: 27582584 DOI: 10.1055/s-0042-103751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Although a fragility fracture family history (FFFH+) has repeatedly been shown to be associated with lower bone mineral density (BMD), its relationship to human BMD change is unclear. Animal research, however, documented that different purebred strains within rodent species have wide ranges in rates of bone acquisition during growth as well as in change post-ovariectomy. Our objective was to compare the rate of premenopausal spinal trabecular BMD change between women with and without a general family history of fragility fracture. PARTICIPANTS AND METHODS Healthy premenopausal community women participated in prospective observational studies at two academic medical research centres: Vancouver, Canada (n = 66) and Munich, Germany (n = 20). The primary outcome was annual spinal BMD change, measured by quantitative computed tomography (QCT). The two studies employed similar methodologies for assessing QCT and FFFH. RESULTS Volunteer community participants had a mean age of 36.0 (SD, 6.9) years, body mass index 22.5 (2.4) and baseline QCT of 150.2 (22.5) mg/cm3 trabecular bone. The rates of BMD change were similar in both cities: - 3.5 (5.1)/year Vancouver, - 2.0 (3.4)/year Munich (95 % CI of difference: - 3.9, 0.9). Over a third of the women (31 of the 86, 36 %) reported FFFH+. Those with and without a FFFH were similar in demographics, nutrition, exercise, menstrual cycle and luteal phase lengths and physiological measures (serum calcium, osteocalcin and estradiol). However, women with FFFH+ lost trabecular BMD more rapidly: FFFH+, - 4.9 (5.0), FFFH-, - 2.2 (4.4) mg/cm3/year (95 % CI diff - 0.7 to - 4.8, F1.83 = 7.88, p = 0.006). FFFH+ explained 7.7 % of the variance in QCT volumetric trabecular spinal bone change/year in these healthy premenopausal women. CONCLUSION This study shows for the first time that having a history of a fragility fracture in a family member is associated with a greater rate of premenopausal spinal trabecular bone loss.
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Affiliation(s)
- J C Prior
- Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada; Dept. of Medicine, University of British Columbia, Vancouver, BC, Canada; Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - C L Hitchcock
- Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - Y M Vigna
- Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - V Seifert-Klauss
- Frauenklinik und Poliklinik, Gynecologic Endocrinology and Interdisciplinary Osteoporosis Center (IOZ), Klinikum rechts der Isar, TUM Munich, Germany
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Wark JD, Henningham L, Gorelik A, Jayasinghe Y, Hartley S, Garland SM. Basal Temperature Measurement Using a Multi-Sensor Armband in Australian Young Women: A Comparative Observational Study. JMIR Mhealth Uhealth 2015; 3:e94. [PMID: 26441468 PMCID: PMC4704931 DOI: 10.2196/mhealth.4263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 07/27/2015] [Accepted: 08/05/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The menstrual cycle is a key marker of health in women of reproductive age. Monitoring ovulation is useful in health studies involving young women. The upward shift in basal body temperature, which occurs shortly after ovulation and continues until the next menses, is a potentially useful marker of ovulation, which has been exploited in clinical and research settings. OBJECTIVE We investigated the utility of BodyMedia SenseWear (BMSW) in monitoring ovulation in young women by analyzing the correlation and agreement of basal temperatures measured using BMSW and a digital oral thermometer. METHODS Kappa statistics were used to determine the agreement in ovulation detection between the two devices, for each participant, under each form of analysis. Participants also completed an online questionnaire assessing the acceptability of both devices. RESULTS We recruited 16 participants with 15 of them providing analyzable data (11 OCP non-users, 4 OCP users). Weak to moderate correlations were observed between thermometer and BMSW temperature measurements averaged over 5 different time intervals. However, no agreement between methods was observed using Bland-Altman plots. There was a significant difference in the range of temperatures that each device recorded (thermometer: 35.3-37.2°C, BMSW: 29.7-36.7°C) with BMSW temperatures significantly lower than thermometer temperatures: mean 34.6°C (SD 1.2) versus 36.4°C (SD 0.3) respectively, P<.001. Poor agreement was observed between devices under quantitative analysis of ovulation while fair agreement was observed under visual analysis. Under both quantitative and visual analysis, there was 0% agreement for evidence of ovulation. CONCLUSIONS This study demonstrated the importance of evaluating biomeasures collected using mobile monitoring devices by comparison with standard methods. It revealed a relatively poor correlation between BMSW and oral thermometer temperature readings and suggested that BMSW is unlikely to detect an upward shift in basal body temperature. Participant behavior suggested poor compliance in the use of BMSW for basal temperature measurement and that the basal body temperature method may not be suitable for use in unselected samples of young women. There is a need for research tools for monitoring ovulation that are simple, self-administered, and inexpensive, yet appealing to young women.
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Affiliation(s)
- John D Wark
- University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Parkville, Australia.
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Prior JC, Naess M, Langhammer A, Forsmo S. Ovulation Prevalence in Women with Spontaneous Normal-Length Menstrual Cycles - A Population-Based Cohort from HUNT3, Norway. PLoS One 2015; 10:e0134473. [PMID: 26291617 PMCID: PMC4546331 DOI: 10.1371/journal.pone.0134473] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 07/10/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ovulatory menstrual cycles are essential for women's fertility and needed to prevent bone loss. There is a medical/cultural expectation that clinically normal menstrual cycles are inevitably ovulatory. Currently within the general population it is unknown the proportion of regular, normal-length menstrual cycles that are ovulatory. Thus, the objective of this study was to determine the population point prevalence of ovulation in premenopausal, normally menstruating women. The null hypothesis was that such cycles are ovulatory. METHODS This is a single-cycle, cross-sectional, population-based study-a sub-study of the HUNT3 health study in the semi-rural county (Nord Trøndelag) in mid-Norway. Participants included >3,700 spontaneously (no hormonal contraception) menstruating women, primarily Caucasian, ages 20-49.9 from that county. Participation rate was 51.9%. All reported the date previous flow started. A single, random serum progesterone level was considered ovulatory if ≥9.54 nmol/L on cycle days 14 to -3 days before usual cycle length (CL). RESULTS Ovulation was assessed in 3,168 women mean age 41.7 (interquartile range, [IQR] 36.8 to 45.5), cycle length 28 days (d) (IQR 28 to 28) and body mass index (BMI) 26.3 kg/m2 (95% CI 26.1 to 26.4). Parity was 95.6%, 30% smoked, 61.3% exercised regularly and 18% were obese. 1,545 women with a serum progesterone level on cycle days 14 to -3 were presumed to be in the luteal phase. Of these, 63.3% of women had an ovulatory cycle (n = 978) and 37% (n = 567) were anovulatory. Women with/ without ovulation did not differ in age, BMI, cycle day, menarche age, cigarette use, physical activity, % obesity or self-reported health. There were minimal differences in parity (96.7% vs. 94.5%, P = 0.04) and major differences in progesterone level (24.5 vs. 3.8 nmol/L, P = 0.001). CONCLUSION Anovulation in a random population occurs in over a third of clinically normal menstrual cycles.
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Affiliation(s)
- Jerilynn C. Prior
- Centre for Menstrual Cycle and Ovulation Research, University of British Columbia, Vancouver, Canada
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Marit Naess
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway
| | - Siri Forsmo
- Centre for Menstrual Cycle and Ovulation Research, University of British Columbia, Vancouver, Canada
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
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Li D, Hitchcock CL, Barr SI, Yu T, Prior JC. Negative Spinal Bone Mineral Density Changes and Subclinical Ovulatory Disturbances—Prospective Data in Healthy Premenopausal Women With Regular Menstrual Cycles. Epidemiol Rev 2013; 36:137-47. [DOI: 10.1093/epirev/mxt012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chaudhry S, Berkley C, Warren M. Perimenopausal Vaginal Bleeding: Diagnostic Evaluation and Therapeutic Options. J Womens Health (Larchmt) 2012; 21:302-10. [DOI: 10.1089/jwh.2011.2949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mumford SL, Schisterman EF, Gaskins AJ, Pollack AZ, Perkins NJ, Whitcomb BW, Ye A, Wactawski-Wende J. Realignment and multiple imputation of longitudinal data: an application to menstrual cycle data. Paediatr Perinat Epidemiol 2011; 25:448-59. [PMID: 21819426 PMCID: PMC4059763 DOI: 10.1111/j.1365-3016.2011.01204.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Reproductive hormone levels are highly variable among premenopausal women during the menstrual cycle. Accurate timing of hormone measurement is essential, especially when investigating day- or phase-specific effects. The BioCycle Study used daily urine home fertility monitors to help detect the luteinising hormone (LH) surge in order to schedule visits with biologically relevant windows of hormonal variability. However, as the LH surge is brief and cycles vary in length, relevant hormonal changes may not align with scheduled visits even when fertility monitors are used. Using monitor data, measurements were reclassified according to biological phase of the menstrual cycle to more accurate cycle phase categories. Longitudinal multiple imputation methods were applied after reclassification if no visit occurred during a given menstrual cycle phase. Reclassified cycles had more clearly defined hormonal profiles, with higher mean peak hormones (up to 141%) and reduced variability (up to 71%). We demonstrate the importance of realigning visits to biologically relevant windows when assessing phase- or day-specific effects and the feasibility of applying longitudinal multiple imputation methods. Our method has applications in settings where missing data may occur over time, where daily blood sampling for hormonal measurements is not feasible, and in other areas where timing is essential.
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Affiliation(s)
- Sunni L. Mumford
- Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD
| | - Enrique F. Schisterman
- Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD
| | - Audrey J. Gaskins
- Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD
| | - Anna Z. Pollack
- Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD
| | - Neil J. Perkins
- Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD
| | - Brian W. Whitcomb
- Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts at Amherst, Amherst, MA
| | - Aijun Ye
- Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD
| | - Jean Wactawski-Wende
- Department of Social and Preventive Medicine, University at Buffalo, State University of New York, Buffalo, NY, USA
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Fluid Retention over the Menstrual Cycle: 1-Year Data from the Prospective Ovulation Cohort. Obstet Gynecol Int 2011; 2011:138451. [PMID: 21845193 PMCID: PMC3154522 DOI: 10.1155/2011/138451] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 05/18/2011] [Accepted: 05/31/2011] [Indexed: 11/18/2022] Open
Abstract
We report menstrual and mid-cycle patterns of self-reported “fluid retention” in 765 menstrual cycles in 62 healthy women. Self-reported “fluid retention,” commonly described as bloating, is one element of the clinical assessment and diagnosis of premenstrual symptoms. These daily diary data were collected as part of an observational prospective one-year study of bone changes in healthy women of differing exercise characteristics. Ovulation was documented by quantitative basal temperature analysis, and serum estradiol and progesterone levels were available from initial and final cycles. Fluid retention scores (on a 0–4 scale) peaked on the first day of menstrual flow (mean ± SE : 0.9 ± 0.1), were lowest during the mid-follicular period, and gradually increased from 0.22 ± 0.05 to 0.50 ± 0.09 over the 11 days surrounding ovulation. Mid-cycle, but not premenstrual, fluid scores tended to be lower in anovulatory cycles (ANOVA P = 0.065), and scores were higher around menstruation than at midcycle (P < 0.0001). Neither estradiol nor progesterone levels were significantly associated with fluid retention scores. The peak day of average fluid retention was the first day of flow. There were no significant differences in women's self-perceived fluid retention between ovulatory and anovulatory cycles.
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Seifert-Klauss V, Prior JC. Progesterone and bone: actions promoting bone health in women. J Osteoporos 2010; 2010:845180. [PMID: 21052538 PMCID: PMC2968416 DOI: 10.4061/2010/845180] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 07/31/2010] [Accepted: 08/26/2010] [Indexed: 12/26/2022] Open
Abstract
Estradiol (E(2)) and progesterone (P(4)) collaborate within bone remodelling on resorption (E(2)) and formation (P(4)). We integrate evidence that P(4) may prevent and, with antiresorptives, treat women's osteoporosis. P(4) stimulates osteoblast differentiation in vitro. Menarche (E(2)) and onset of ovulation (P(4)) both contribute to peak BMD. Meta-analysis of 5 studies confirms that regularly cycling premenopausal women lose bone mineral density (BMD) related to subclinical ovulatory disturbances (SODs). Cyclic progestin prevents bone loss in healthy premenopausal women with amenorrhea or SOD. BMD loss is more rapid in perimenopause than postmenopause-decreased bone formation due to P(4) deficiency contributes. In 4 placebo-controlled RCTs, BMD loss is not prevented by P(4) in postmenopausal women with increased bone turnover. However, 5 studies of E(2)-MPA co-therapy show greater BMD increases versus E(2) alone. P(4) fracture data are lacking. P(4) prevents bone loss in pre- and possibly perimenopausal women; progesterone co-therapy with antiresorptives may increase bone formation and BMD.
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Affiliation(s)
- Vanadin Seifert-Klauss
- Frauenklinik der Technischen Universität München (TUM), Klinikum Rechts der Isar, Ismaninger Str., 22 81675 Muenchen, Germany
| | - Jerilynn C. Prior
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of British Columbia and Centre for Menstrual Cycle and Ovulation Research (CeMCOR), 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9
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Bedford JL, Prior JC, Barr SI. A prospective exploration of cognitive dietary restraint, subclinical ovulatory disturbances, cortisol, and change in bone density over two years in healthy young women. J Clin Endocrinol Metab 2010; 95:3291-9. [PMID: 20427503 DOI: 10.1210/jc.2009-2497] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Cross-sectional studies have found associations among elevated cognitive dietary restraint (CDR), increased ovulatory disturbances, and lower bone mass, possibly mediated by cortisol. OBJECTIVE To determine whether healthy young women with higher CDR have more menstrual cycles with subclinical ovulatory disturbances (SOD), elevated 24-h urinary free cortisol (UFC), and less positive 2-yr areal bone mineral density change (Delta-aBMD). DESIGN, SETTING, AND PARTICIPANTS We conducted a 2-yr longitudinal study of 123 healthy, community-dwelling, nonobese, regularly menstruating women aged 19-35 yr. MAIN OUTCOME MEASURES Key variables were Three Factor Eating Questionnaire Restraint score, percent of cycles with anvoluation and/or luteal phase length <10 d (%SOD), UFC, and Delta-aBMD at the lumbar spine (L1-L4), total hip, and whole body. Anthropometrics, general stress, physical activity, and energy intake were measured. Adjusting for potential confounders, differences were examined by general linear modeling using median split of CDR score and %SOD. RESULTS Women with higher CDR had higher %SOD (56 vs. 34%, P < 0.001) and higher UFC (28.0 vs. 24.0 microg/d, P = 0.021). Delta-aBMD did not differ by CDR. Women with higher %SOD had less positive Delta-aBMD at L1-L4 (0.7 vs. 1.9%, P = 0.034) and hip (-0.6 vs. 0.9%, P = 0.001), and higher CDR score (8.7 vs. 7.1, P = 0.04). Physical activity, general stress, body mass index, and energy intake did not explain differences by CDR or %SOD. UFC was not associated with %SOD or Delta-aBMD. CONCLUSION Women with more frequent SOD reported higher CDR and experienced less positive Delta-aBMD. Although women with higher CDR had higher UFC, the mechanism linking CDR, SOD, and aBMD is not clear.
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Affiliation(s)
- Jennifer L Bedford
- Human Nutrition, The University of British Columbia, Vancouver, British Columbia, Canada V6T 1Z4
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