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Rabadia JP, Desai TR, Thite VS. Plumeria acuminata: A Systematic in vivo Evaluation for Its Anti-ovulatory and Anti-Implantation Features. CURRENT DRUG THERAPY 2022. [DOI: 10.2174/1574885517666220426101516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Fertility control becomes necessary for under-developed and developing nations for the betterment of the economy, environment, and society. Plant Plumeria acuminata, “Temple tree or Frangipani”, of the Apocynaceae family has exhibited several activities similar to contraceptive medicine and is widely distributed in India.
Objective:
Present investigation aimed to study the anti-ovulatory and anti-implantation activities of ethanolic extract from P. acuminata leaves and roots in Wistar rats.
Methods:
Ethanolic extracts of P. acuminata leaves and roots were subjected to qualitative phytochemical analysis and acute toxicity test. Immature female rats were used to explore anti-ovulatory characteristics administering HCG as a standard ovulation-inducing drug. Mated females were used for exploring anti-implantation characteristics. Levonorgestrel and Ethinylestradiol were administered as standard anti-implantation drugs. Morphological, hematological, hormonal, and histological examinations were performed.
Results:
LD50 value i.e., 2000 mg/kg from acute toxicity test resulted in the selection of 100, 200, and 400 mg/kg dose values for both leaf and root extracts. Treatment with these brought ~2-54%, ~5-48%, and ~1-68% changes respectively in the hormonal, growth factors’ and cytokines’ profile. Ovarian histology revealed restricted follicle maturation and ovulation whereas uterine histology unveiled a ~5-28% decrease in the endometrium thickness making it unreceptive for implantation after treatment with PAL and PAR extracts.
Conclusion:
Anti-ovulatory and anti-implantation results obtained here can be attributed to the presence of plumericin, sterol as well as triterpene groups of phytochemicals from ethanolic extracts of leaves and roots, making them potent contestants for studies on future contraceptive medicines.
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Affiliation(s)
- Jay P Rabadia
- Department of Pharmacology, School of Pharmacy, R K University, Rajkot, Gujarat, India. 360020
- Sun Pharmaceutical Industries Limited, Vadodara, Gujarat, India. 390020
| | - Tushar R Desai
- Department of Pharmacology, School of Pharmacy, R K University, Rajkot, Gujarat, India. 360020
| | - Vihang S Thite
- Sun Pharmaceutical Industries Limited, Vadodara, Gujarat, India. 390020
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Fitzgerald SP, Bean NG. Population correlations do not support the existence of set points for blood levels of calcium or glucose - a new model for homeostasis. Physiol Rep 2018; 6:e13551. [PMID: 29333728 PMCID: PMC5789653 DOI: 10.14814/phy2.13551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/28/2017] [Indexed: 06/07/2023] Open
Abstract
The prevailing teaching regarding homeostasis, and in particular endocrine homeostasis, includes the fundamental concept of a "set point," which represents a target or optimum level defended by physiological control mechanisms. Analogies for the description and teaching of this concept have included thermostats and cruise controls. We previously demonstrated that such a set-point model of regulation implies that in population data of parameter set point/controlling hormone levels, correlations between the parameter and its controlling hormone must be in the direction of the response of the parameter to its controlling hormone, and that in thyroid homeostasis this relationship is not observed. In this work we similarly examined population correlations, extracted from the literature, for the parameters glucose and calcium, and their controlling hormones. We found 10 correlations. Most were highly significant (P < 0.01). All were in the direction of the response of the controlling hormone to the parameter. Therefore, none were consistent with the pattern implied by a set-point model of regulation. Instead all were consistent with an "equilibrium point" model of regulation, whereby ambient levels have no particular connotation to the individual, and result passively from the interplay of physiological processes. We conclude that glucose and calcium regulation, like thyroid regulation, are not centered on set points. This may reflect a general property of homeostasis. We provide an alternative mechanistic analogy, without a set point, for the heuristic description and teaching, of homeostasis.
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Affiliation(s)
| | - Nigel G. Bean
- School of Mathematical Sciences and ARC Centre of Excellence for Mathematical and Statistical FrontiersUniversity of AdelaideAdelaideSouth AustraliaAustralia
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Grisendi V, Spada E, Argento C, Plebani M, Milani S, Seracchioli R, Volpe A, La Marca A. Age-specific reference values for serum FSH and estradiol levels throughout the reproductive period. Gynecol Endocrinol 2014; 30:451-5. [PMID: 24805832 DOI: 10.3109/09513590.2014.893572] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
High serum day 3 FSH levels are associated with poor ovarian reserve and reduced fertility, but the interpretation of FSH values according to age is still not univocal. The purpose of this study was to determine age-dependent reference values in women with regular menstrual cycles and FSH as a guide for specialists. The study was performed at the Department of Mother-Infant of a University-based tertiary care centre. One-hundred ninety-two healthy normal menstruating women were recruited for the study. All patients attended the department on menstrual cycle day 3 for a blood sample for FSH and estradiol determination. A linear relationship between FSH or estradiol serum levels and age was observed. The FSH level increased by 0.11 IU for every year of age (1 IU for every 9 years of age). The values of FSH and estradiol corresponding to the 5th, 25th, 50th, 75th, 95th centiles for any specific age have been calculated. Serum FSH levels need to be interpreted according to age-dependent reference values. Serum FSH levels on 95th centile for any age may represent a warning sign for reduced ovarian reserve.
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Affiliation(s)
- Valentina Grisendi
- Department of Mother-Infant, Institute of Obstetrics and Gynecology, University of Modena and Reggio Emilia , Modena , Italy
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Cidem M, Usta TA, Karacan I, Kucuk SH, Uludag M, Gun K. Effects of sex steroids on serum sclerostin levels during the menstrual cycle. Gynecol Obstet Invest 2013; 75:179-84. [PMID: 23429230 DOI: 10.1159/000347013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 01/02/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Previous studies on the effects of estrogen on sclerostin regulation were conducted in postmenopausal women in humans or animals following estrogen treatment or induced estrogen deficiency. The aim of this study was to evaluate the effects of sex hormones on serum sclerostin levels in premenopausal women with normal menstrual cycles. METHODS A prospective observational clinical study. 80 voluntary premenopausal women were recruited for the study. Data from 31 patients were available for the statistical analysis. Serum sclerostin, free estradiol, free testosterone, and progesterone levels were measured during the menstruation, late follicular and mid-luteal phases. The unique protocol IDs were BEAH FTR-4 and NCT01418924 at ClinicalTrials.gov ID. RESULTS Serum sclerostin values were 1.03 ± 0.58 ng/ml during the menstruation phase, 1.0 ± 0.36 ng/ml during the late follicular phase, and 1.18 ± 0.67 ng/ml during the mid-luteal phase (p = 0.543). There was no significant relationship between serum levels of sex steroids and sclerostin. CONCLUSIONS Previous studies have not investigated the impact of sex hormone fluctuations on serum sclerostin levels during the menstrual cycle. The present study shows that serum sclerostin levels were not affected by sex steroids in premenopausal women with normal menstrual cycles.
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Affiliation(s)
- Muharrem Cidem
- Department of Physical Medicine and Rehabilitation, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Hori T, Tsutsui T, Amano Y, Concannon PW. Ovulation day after onset of vulval bleeding in a beagle colony. Reprod Domest Anim 2013; 47 Suppl 6:47-51. [PMID: 23279464 DOI: 10.1111/rda.12076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 07/02/2012] [Indexed: 11/30/2022]
Abstract
This study investigated the duration of the interval between the onset of vulval bleeding at pro-oestrus and ovulation estimated from the plasma progesterone concentration in a large number of beagle bitches. The influence and association of individual variation, ageing and duration of the oestrous cycle were also investigated. The mean time of ovulation after the onset of vulval bleeding was 11.1 ± 0.2 days, but it widely ranged from 3 to 31 days. This timing was not influenced by age or duration of the oestrous cycle, and within-individual variation was small. As there has been no previous report in which the ovulation day was investigated by the age, these data may be very valuable.
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Affiliation(s)
- T Hori
- Department of Reproduction, Nippon Veterinary and Life Science University, Tokyo, Japan.
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Hypoestrogenic "inactive phases" at the start of the menstrual cycle: changes with age and reproductive stage, and relationship to follicular depletion. Fertil Steril 2012; 98:1246-53.e1-3. [PMID: 22901850 DOI: 10.1016/j.fertnstert.2012.07.1101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 06/01/2012] [Accepted: 07/10/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate hypoestrogenic "inactive phases" (IP) in the follicular phase of the menstrual cycle, with respect to age, reproductive stage, and follicular depletion. DESIGN Analysis of prospectively collected menstrual bleed and estrone-3-glucuronide data. SETTING Center for Population and Health, Georgetown University. PATIENT(S) White women (n = 88, aged 25-59 years, mean = 44.7 years) from the population-based Biodemographic Models of Reproductive Aging (BIMORA) project. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The IP durations by age and reproductive stage. Estimated follicular depletion rate based on IP durations. RESULT(S) Mean IP duration and variability decreased and then increased with age/reproductive stage. The proportion of very short (≤ 1 day) IP durations increased and then decreased with age/stage. Long IPs occurred most, but not exclusively, in the oldest age/latest stage. Follicular depletion rate estimates were a plausible 2%-4% per year of age, but these models were a poor fit because IP durations did not consistently increase across ages/stages. CONCLUSION(S) Follicular depletion models alone do not explain the observed pattern of IPs. Our data suggest that IPs reflect both follicular depletion and hyperstimulation in premenopausal and perimenopausal women. Knowledge of underlying IP patterns in the menstrual cycle could inform decisions about hormone sampling and contraception during the perimenopause.
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Johnson S, Ellis J, Godbert S, Ali S, Zinaman M. Comparison of a digital ovulation test with three popular line ovulation tests to investigate user accuracy and certainty. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2011; 5:467-473. [PMID: 23484745 DOI: 10.1517/17530059.2011.617737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To determine the accuracy and certainty with which volunteers interpreted results of a digital ovulation test, Clearblue digital ovulation test (CB-DOT), compared with three home use non-digital visual ovulation tests: Clearblue ovulation test (CB-OT), First Response (FR) and Answer (AN). METHODS A total of 72 female volunteers aged 18 - 45 years interpreted test results from each of the four ovulation tests to determine the day of the luteinising hormone surge in 40 individual menstrual cycles. We used urine previously collected from 25 volunteers. The accuracy with which volunteers interpreted the test results was calculated by comparing their results with results obtained by trained technicians using a blinded test regime. For each of the four tests, volunteers were also asked to rate seven attributes of certainty and eight attributes of preference. The primary objective was to compare the accuracy with which volunteers read results from CB-DOT when compared to three visual-based line ovulation tests. RESULTS A significantly higher percentage of volunteers/technicians agreed on the interpretation of the results from CB-DOT (97.3%) than for CB-OT (83.5%; p = 0.0153), AN (73%; p = 0.0011) or FR (64.3%; p = 0.0001). CB-DOT was also found to have significantly better Likert scores than CB-OT, FR and AN for all seven attributes of certainty and was the test that 97.2% of volunteers preferred. CONCLUSIONS Women can misread the results of line ovulation tests. Over 97% of volunteers correctly read the result of CB-DOT. CB-DOT was also the test that women read with most certainty and the test that most users preferred.
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Affiliation(s)
- Sarah Johnson
- SPD Development Company Limited, Priory Business Park, Bedford, MK44 3UP , UK +44 0 1234 835 486 ; +44 0 1234 835 006 ;
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Abstract
Human female reproductive aging consists of multiple processes and interacts with other physiological systems in unique ways. Here we discuss eight recent longitudinal, epidemiologic studies of female reproductive aging that include endocrine data to highlight their contributions to our understanding of these various aging processes and their interactions. Specifically, we review data on ovarian and nonovarian reproductive aging processes and reproductive staging. We consider these data in the context of longitudinal research design and research goals, identify limitations of the studies but also ways in which existing longitudinal data can further our understanding of aging processes, and make recommendations for future studies of female reproductive aging.
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Affiliation(s)
- Rebecca J Ferrell
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Abstract
Perimenopause marks a time of change in a woman's hormonal environment, which is apparent from the resultant irregular periods and vasomotor symptoms. These symptoms can start in the early 40s and continue through to the early 50s. Migraine is also affected by hormonal fluctuations, particularly the natural decline in estrogen in the late luteal phase of the menstrual cycle. This effect of estrogen "withdrawal" on migraine appears to become more predominant during perimenopause. Despite the increased prevalence of headache and migraine in women in their 40s, migraine is underdiagnosed in this population. In women attending with symptoms suggestive of perimenopause, it is important to ask about headache symptoms. Once diagnosed, a number of strategies can be used to manage both perimenopausal migraine and menopausal symptoms effectively, with the potential to reduce the associated morbidity.
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Affiliation(s)
- E Anne MacGregor
- The City of London Migraine Clinic, 22 Charterhouse Square, London EC1M 6DX, United Kingdom.
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Abstract
The focus of this chapter is the relationship between the onset of depression in women and the reproductive events of the menopause transition. Epidemiologic studies have documented that the majority of women do not become depressed during the menopause transition. However, recent longitudinal studies suggest that in some women, the reproductive events related to the menopause transition could play a role in the onset of depression. No abnormality of ovarian hormones has been identified that distinguishes women with depression from those who remain asymptomatic during the menopause transition. Nonetheless, several findings suggest a role of ovarian hormones in the onset of these depressions. First, episodes of depression cluster during the stage of the menopause transition that is accompanied by estradiol withdrawal. Second, randomized controlled trials have documented the short-term (3-6 weeks) antidepressant efficacy of estradiol in depressed perimenopausal women. Third, experimentally induced estradiol withdrawal triggers mood symptoms in some women. Thus, although depression is not a uniform accompaniment of the menopause transition, in some women, age-related changes in ovarian estrogen production may alter central nervous system function and predispose them to develop depression.
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Affiliation(s)
- Peter J Schmidt
- Behavioral Endocrinology Branch, National Institute of Mental Health, Department of Health & Human Services, Bethesda, Maryland, USA.
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Atypical estradiol secretion and ovulation patterns caused by luteal out-of-phase (LOOP) events underlying irregular ovulatory menstrual cycles in the menopausal transition. Menopause 2009; 16:50-9. [PMID: 18978637 DOI: 10.1097/gme.0b013e31817ee0c2] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The menopausal transition is characterized by irregular menstrual cycles and unpredictable hormone levels, including dramatic swings in estradiol (E2). An increasing number of studies have found variable high E2 and low luteal phase progesterone occur with progression of Stages of Reproductive Aging Workshop (STRAW)stage, but the cause remains unclear. To explore the causes of the erratic changes in E2, individual within-cycle secretion patterns of E2, progesterone, follicle-stimulating hormone, luteinizing hormone, inhibin A, and inhibin B were explored in detail. DESIGN Blood samples taken three times per week over 1 1/3 menstrual cycles from 77 women aged 21 to 55 classified as mid-reproductive age (STRAW stages 5 and 4; n = 21), late-reproductive age (STRAW stages 4 and 3; n = 16), early menopausal transition (STRAW stage 2; n = 17), and late menopausal transition (STRAW stage 1; n = 23) were analyzed. RESULTS Eleven of the 29 (37%) early and late menstrual transition ovulatory cycles exhibited a specific pattern of E2 secretion that was characterized by a second increase in E2 during the mid- and late luteal phases and that continued to a peak during the subsequent menstrual phase. This second rise and fall in E2 was typical in appearance of a normal follicular phase, except that it was superimposed on an existing ovulatory cycle(specifically during the luteal and menstrual phases). The pattern was therefore referred to as a luteal out-of-phase(LOOP) follicular event. In four of these LOOP cycles, a luteinizing hormone peak and ovulatory episode followed the second E2 peak early in the subsequent cycle. Compared with the typical ovulatory cycles, the cycles with LOOP events exhibited lower luteal phase progesterone, higher early cycle follicle-stimulating hormone, and lower early cycle inhibin B. They were also associated with abnormally short (<21 d) or long (>40 d) cycle length. CONCLUSIONS Many of the marked increases in ovulatory cycle E2 and cycle irregularities during the menopausal transition may be due to LOOP events and appear to be triggered by prolonged high follicular phase follicle-stimulating hormone levels.
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Johnson SR, Miro F, Barrett S, Ellis JE. Levels of urinary human chorionic gonadotrophin (hCG) following conception and variability of menstrual cycle length in a cohort of women attempting to conceive. Curr Med Res Opin 2009; 25:741-8. [PMID: 19196217 DOI: 10.1185/03007990902743935] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To define the variability of menstrual cycle length and contribution of follicular and luteal phases to overall cycle variability, and to examine the rise in urinary hCG in early pregnancy. METHODS Menstrual cycle study. Urine samples from 101 women (recruited from two south-east counties in the UK) were assayed to determine day of luteinising hormone (LH) surge, lengths of follicular and luteal phases and correlations with total menstrual cycle length. HCG study. Daily urine samples collected from 86 women prior to conception until 43 days post-conception were assayed for hCG and examined versus time since LH surge, determined using fertility test kits. RESULTS Mean menstrual cycle length was 27.7 +/- 3.4 days, mean follicular phase length was 14.5 +/- 3.4 days and mean luteal phase length was 13.2 +/- 1.9 days. Total cycle lengths varied between and within women. There was a significant correlation (r(2) = 0.70) between follicular phase length and total cycle length; luteal phase length was less variable and showed no association with total cycle length. Concentrations of hCG were significantly similar between women when referenced against the day since LH surge. Three thresholds were determined to indicate time since conception as 1-2 weeks, 2-3 weeks and 3+ weeks. CONCLUSIONS Total cycle length variation is mainly determined by follicular phase variation and predicting menses onset to estimate time of pregnancy testing is unreliable. Evaluating concentrations of hCG relative to LH surge results in consistent increases between women up to 21 days after conception. Therefore, urinary hCG concentration can be used to accurately estimate time since conception.
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Hormonal changes and biomarkers in late reproductive age, menopausal transition and menopause. Best Pract Res Clin Obstet Gynaecol 2009; 23:7-23. [DOI: 10.1016/j.bpobgyn.2008.10.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Epidemiologic studies have documented that the majority of women do not become depressed during the menopause transition. However, recent longitudinal studies suggest that in some women, the events related to the menopause transition could play a role in the onset of depression. In this article we review evidence suggesting a relationship between the menopause transition and depression. Additionally, we describe several findings that suggest a role of ovarian hormones in the onset of these depressions, including the clustering of episodes of depression during the stage of the menopause transition that is accompanied by estradiol withdrawal, and the therapeutic effects of short-term estradiol in depressed perimenopausal women. Finally, we discuss possible causes of affective disturbances during the menopause transition.
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Affiliation(s)
- Veronica Harsh
- National Institute of Mental Health, Section on Behavioral Endocrinology
| | | | | | - Peter J. Schmidt
- National Institute of Mental Health, Section on Behavioral Endocrinology
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Hale GE, Zhao X, Hughes CL, Burger HG, Robertson DM, Fraser IS. Endocrine features of menstrual cycles in middle and late reproductive age and the menopausal transition classified according to the Staging of Reproductive Aging Workshop (STRAW) staging system. J Clin Endocrinol Metab 2007; 92:3060-7. [PMID: 17550960 DOI: 10.1210/jc.2007-0066] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Female reproductive aging based on changes in menstrual cycle length and frequency progresses through a number of stages as defined by the Stages of Reproductive Aging Workshop (STRAW) staging criteria. OBJECTIVE This paper provides a comprehensive description of the endocrine features associated with the STRAW stages. DESIGN Healthy women aged 21-35 and 45-55 yr submitted three blood samples a week over a single menstrual cycle. They were classified as mid-reproductive age (n = 21), late-reproductive age (n = 16), early menopause transition (n = 16), and late menopause transition (n = 23). RESULTS There were nine, one, zero, and two anovulatory cycles identified in the late menopause transition, early menopause transition, late-reproductive age, and mid-reproductive age groups, respectively. Ovulatory cycle FSH, LH, and estradiol levels increased with progression of STRAW stage (P = 0.001, P < 0.01, and P < 0.05, respectively), and mean luteal phase serum progesterone decreased (P < 0.01). Early cycle (ovulatory and anovulatory) inhibin B decreased steadily across the STRAW stages (P < 0.01) and was largely undetectable during elongated ovulatory and anovulatory cycles in the menopause transition. Anti-Mullerian hormone decreased markedly (10- to 15-fold) and progressively across the STRAW stages (P < 0.01 and P < 0.001, respectively). CONCLUSIONS Progression through the STRAW stages is associated with elevations in serum FSH, LH, and estradiol and decreases in luteal phase progesterone. The marked fall in inhibin B and particularly anti-Mullerian hormone indicate that they may be useful in predicting STRAW stage but future analyses of early cycle measurements on larger cohorts are needed to draw predictive conclusions.
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Affiliation(s)
- Georgina E Hale
- Department of Obstetrics and Gynecology, University of Sydney, New South Wales, Australia 2006.
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Burger HG, Hale GE, Robertson DM, Dennerstein L. A review of hormonal changes during the menopausal transition: focus on findings from the Melbourne Women's Midlife Health Project. Hum Reprod Update 2007; 13:559-65. [PMID: 17630397 DOI: 10.1093/humupd/dmm020] [Citation(s) in RCA: 234] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The menopause, defined as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity, marks the end of natural female reproductive life. It is preceded by a period of menstrual cycle irregularity, the menopausal transition, which usually begins in the mid-40s and is conventionally divided into early and late phases. The endocrine changes, which underlie the transition, are predominantly the consequence of a marked decline in ovarian follicle numbers. The most significant changes include a decrease in early cycle inhibin B and in anti-Mullerian hormone (AMH) levels. The decline in inhibin B results in an increase in FSH, which appears to be an important factor in the maintenance of estradiol (E2) concentrations until late in reproductive life. In the post-menopause, FSH levels are markedly raised, E2 levels are low, whereas inhibin B and AMH are undetectable. The menopausal transition is a time of marked hormonal instability. The Melbourne Women's Midlife Health Project has been an extremely productive study in which it has been possible to describe longitudinal changes in hormone levels throughout the menopause transition and to separate the effects of hormone change from the effects of ageing on a number of endpoints. This review provides the background for an accompanying manuscript in which a novel approach to modelling the hormonal changes during the transition is described.
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Affiliation(s)
- H G Burger
- Prince Henry's Institute of Medical Research, Monash Medical Centre, Clayton, Victoria, Australia.
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17
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van der Steeg JW, Steures P, Eijkemans MJC, Habbema JDF, Hompes PGA, Broekmans FJ, Bouckaert PXJM, Bossuyt PMM, van der Veen F, Mol BWJ. Predictive value and clinical impact of Basal follicle-stimulating hormone in subfertile, ovulatory women. J Clin Endocrinol Metab 2007; 92:2163-8. [PMID: 17405849 DOI: 10.1210/jc.2006-2399] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Basal FSH is a marker for ovarian reserve. OBJECTIVES The objective of the study was to investigate the predictive value of basal FSH on spontaneous ongoing pregnancy in subfertile ovulatory women. DESIGN This was a prospective cohort study. SETTING The study was conducted in 19 fertility centers in The Netherlands. PARTICIPANTS Subfertile ovulatory women without two-sided tubal pathology and in whom the man had normal sperm parameters (total motile count > or = 3 x10(6)) participated in the study. INTERVENTIONS Interventions included a fertility work-up, including a basal FSH measurement on cycle d 3. MAIN OUTCOME MEASURES Spontaneous ongoing pregnancy was measured. RESULTS We included 3519 consecutive couples of which 562 (16%) had a spontaneous ongoing pregnancy within 1 yr. Basal FSH levels of 8 IU/liter or higher were associated with a decreased probability of spontaneous ongoing pregnancy [hazard ratio (HR) 0.93/IU.liter (95% confidence interval [CI] 0.87-0.98)]. In a multivariable analysis, female age (HR 0.97/yr, 95% CI 0.95-0.99), cycle length (HR 0.96/d, 95% CI 0.93-1.0), and FSH levels 8 IU/liter or greater (HR 0.93/IU.liter, 95% CI 0.87-0.99) were strong negative predictors for spontaneous ongoing pregnancy. Addition of FSH to a prediction model based on female age, duration of subfertility, previous pregnancy, referral status, and semen analysis changed the probability to conceive spontaneously from 30% or greater to less than 30% in 97 of 3219 couples (3.0%). CONCLUSIONS In ovulatory women, a basal FSH level of 8 IU/liter or higher is associated with decreasing fecundity, independent of female age and cycle length. Because the number of couples in whom the FSH level alters management decisions is low, we do not recommend routine testing of basal FSH in subfertile couples.
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Affiliation(s)
- Jan W van der Steeg
- Academic Medical Center, Center of Reproductive Medicine, Room H4-213, Department of Obstetrics/Gynecology, Meibergdreef 9, Amsterdam, The Netherlands.
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Ferrell RJ, O'Connor KA, Holman DJ, Brindle E, Miller RC, Rodriguez G, Simon JA, Mansfield PK, Wood JW, Weinstein M. Monitoring reproductive aging in a 5-year prospective study: aggregate and individual changes in luteinizing hormone and follicle-stimulating hormone with age. Menopause 2007; 14:29-37. [PMID: 17019379 DOI: 10.1097/01.gme.0000227859.50473.20] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study describes age-related changes in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in a 5-year prospective study of reproductive aging. DESIGN Participants (n = 156 college-educated, white, US women; 25 to 58 y) were recruited from the TREMIN Research Program on Women's Health. They collected daily urine specimens for 6 months in each of 5 consecutive years. Specimens were assayed for LH and FSH. Aggregate changes were calculated in LH and FSH with age, and multilevel models were used to estimate individual hormone trajectories and within-woman and between-woman variances by age. RESULTS Aggregate LH levels increased beginning after age 45; FSH increased at all ages, accelerating after age 45. Individual-level patterns with age included the following: reproductive-age LH and FSH levels, with increasing FSH and increasing or decreasing LH (ages 20 to 49); rapidly increasing LH and FSH (ages 40 to 59); and increasing or steady postmenopausal LH and FSH (ages 46 to 62). FSH levels were consistently high in the latter category, but LH levels overlapped with levels found in younger women (<45 y). Individual LH patterns showed more variability (5% to 35% of total variance) than FSH (3% to 22% of total variance). Both hormones had relatively low variation within individuals compared with between-woman differences (65% to 97% of total variance). CONCLUSIONS Aggregate-level data do not reflect differences across women and oversimplify the age-related increases and variability in LH and FSH. Individual FSH levels are not distinguishable from reproductive-age levels until after rapid perimenopausal increases in FSH occur; individuals vary in whether their postmenopausal LH levels are distinguishable from reproductive-age levels.
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Affiliation(s)
- Rebecca J Ferrell
- Center for Population and Health, Georgetown University, Washington, DC, USA.
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Urinary beta-luteinizing hormone and beta-follicle stimulating hormone immunoenzymometric assays for population research. Clin Biochem 2006; 39:1071-9. [PMID: 17010960 DOI: 10.1016/j.clinbiochem.2006.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Revised: 05/12/2006] [Accepted: 08/18/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We developed assays for measurement of urinary betaLH and betaFSH under collection and storage conditions typical of non-clinical research settings. DESIGN AND METHODS IEMAs for free betaLH and total betaFSH were validated by standard methods. Stability of urinary betaLH and betaFSH was tested across freeze-thaws and stored long term at 4 degrees C or -20 degrees C, or short term at room temperature, and with heating to dissociate the subunits. RESULTS The IEMAs exhibited acceptable parallelism, specificity, recovery (averaging 100% for betaLH, 97% for betaFSH), imprecision (maximum within-run and between run CVs, respectively, 4.8% and 25.7% for betaLH, 5.6% and 17.0% for betaFSH), and minimum detectable dose (2.5 pmol/L for betaLH, 6.8 pmol/L for betaFSH). Urine and serum measures were highly correlated (r=0.95 for LH, 0.86 for FSH). There was no consistent decline with any storage type. Dissociation of subunits by heating was needed for betaLH, but not betaFSH. CONCLUSION These IEMAs measure free betaLH and total betaFSH, overcoming inter-individual variability in, and collection and storage effects on, subunit dissociation, without the need for urine preservatives.
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Affiliation(s)
- Georgina E Hale
- Department of Obstetrics and Gynaecology, University of Sydney, Queen Elizabeth II Building (DO2), 2006 Sydney, NSW, Australia.
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Miro F, Parker SW, Aspinall LJ, Coley J, Perry PW, Ellis JE. Sequential classification of endocrine stages during reproductive aging in women: the FREEDOM study*. Menopause 2005; 12:281-90. [PMID: 15879917 DOI: 10.1097/01.gme.0000147018.30796.25] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Reproductive aging involves complex endocrine changes affecting women's fertility, health, and well-being; however, understanding of the specific changes involved is limited by the lack of detailed quantitative studies. We undertook a thorough study with the aim of characterizing the different endocrine stages involved in female reproductive aging. DESIGN FREEDOM is a cohort study designed to determine the endocrine changes during reproductive aging in women. Here, we ascertained the different endocrine patterns in a representative population and developed a staging system. In this study, 112 women aged 30 to 58 years collected daily urine samples over a 6- to 18-month period and recorded their menstrual periods. A total of 36,786 samples were analyzed for follicle-stimulating hormone (FSH), luteinizing hormone, estrone 3-glucuronide, and pregnanediol 3-glucuronide. RESULTS A classification of five sequential endocrine stages of reproductive aging was developed: stage 1, regular menstrual cycles with mean initial (day 1-5) FSH less than 5 IU/L; stage 2, regular cycles with FSH greater than 5 IU/L; stage 3, menstrual irregularity (with the appearance of "delayed-response cycles"); stage 4, acyclical ovarian activity with no evidence of ovulation and luteinization; and stage 5, ovarian quiescence and persistently raised gonadotropins. Distinct hormonal characteristics during the follicular and luteal phase were noted at each stage. CONCLUSION This classification provides a detailed insight into the endocrinology of reproductive aging in women that could be useful for both clinical guidance and personal health care.
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Affiliation(s)
- Fernando Miro
- Unipath Limited, Priory Business Park, Bedford, United Kingdom.
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Prior JC. Ovarian aging and the perimenopausal transition: the paradox of endogenous ovarian hyperstimulation. Endocrine 2005; 26:297-300. [PMID: 16034185 DOI: 10.1385/endo:26:3:297] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Accepted: 04/27/2005] [Indexed: 11/11/2022]
Abstract
The purpose of this review is to put into a useful clinical context the changing over time of basic ovarian-pituitary-hypothalamic relationships during perimenopause. "Perimenopause" means changes in ovarian hormones, feedback relationships, and clinical experiences beginning in women ages 35-50 with regular flow and ending 1 yr after the final menstrual flow. A key observation must be explained--estradiol levels are increased in perimenopause. Inhibin B levels are lower and activin may be higher in midlife, menstruating women. These changes probably cause higher follicular phase FSH levels--"endogenous ovarian hyperstimulation" results. The positive estradiol feedback on LH is also disturbed--midcycle LH peaks and mid-luteal slow-frequency, high-amplitude LH pulses are less frequent. In addition to higher levels, estradiol receptors may increase in tissues of symptomatic women. Despite hyperstimulation of follicles, progesterone levels and luteal phase lengths are paradoxically decreased--reasons probably include LH peak disruptions and estrogen-stimulated greater corticotrophin-mediated reproductive suppression. In summary, disturbed feedback relationships causing higher and unpredictable estrogen and lower progesterone levels occur throughout perimenopause, especially during regular cycles. Prospective, population-based research is needed to systematically relate these feedback hormonal changes to clinical characteristics and to allow a diagnosis of perimenopause in regularly cycling midlife women.
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Affiliation(s)
- Jerilynn C Prior
- Division of Endocrinology and Metabolism, Vancouver Coastal Health Research Institute, Centre for Menstrual Cycle and Ovulation Research, University of British Columbia, Canada.
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Miro F, Aspinall LJ. The onset of the initial rise in follicle-stimulating hormone during the human menstrual cycle. Hum Reprod 2005; 20:96-100. [PMID: 15471927 DOI: 10.1093/humrep/deh551] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The rise in FSH (FSHr) that leads to the recruitment of a cohort of follicles during the menstrual cycle occurs during the luteal-follicular transition, however, it is unclear whether it consistently occurs on one particular day, or is subjected to reproductive ageing. METHODS We determined the FSHr in 836 complete menstrual cycles from 102 women with regular menses using an algorithm, and additionally compared the relative variation in FSH during the last 14 days of the cycle. Possible effects of reproductive ageing on the onset of FSHr were also investigated. RESULTS The day of FSHr follows a normal distribution with a median value of -4 (relative to first day of menses), mean -4.1 and SD 2.1. Analysis of the relative changes in FSH during the last 14 days of the cycle revealed the first significant rise on day -4 (P=0.0033), coinciding with the first significant drop in estrogens (P=0.0002). No effect of chronological age, or initial FSH levels, on FSHr was found, however, there was an inverse relationship between total follicular phase length (from day of FSHr to LH peak) and initial FSH levels (P<0.0001). CONCLUSIONS The initial FSH rise in the cycle occurs consistently 4 days before menses, is related to a drop in estrogen levels, and is not affected by reproductive ageing.
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Affiliation(s)
- F Miro
- Unipath Limited, Priory Business Park (FM), Bedford, MK44 3UP, UK.
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Abstract
Ovarian stimulation is an integral part of assisted reproduction treatments. Ovarian response to gonadotrophin treatment, besides other factors, determines the outcome of treatment, as the number and quality of oocytes retrieved are related to the chance of achieving a pregnancy. A number of factors have been identified that might predict ovarian response, such as age of the patient and antral follicle count. In addition, it has been shown that genetic factors such as the patient's FSH-receptor genotype also determine individual response to FSH treatment. Besides patient-related factors, the choice of drugs for ovarian stimulation plays a significant role. Until recently, biopotency of gonadotrophin preparations was tested by an in-vivo bioassay with an intrinsic variability up to 20%. Due to a superior manufacturing technique, follitropin alpha can now be filled by mass. This allows assessment of FSH with a precise SE-HPLC assay and variability of the FSH content between production lots has now been estimated at 1.6%. Results of recent studies indicate that treatment with follitropin alpha filled by mass results in consistent ovarian response, fewer treatment days and fewer cancelled cycles. This is an important step towards further minimizing drug-related variability of ovarian response to FSH treatment.
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