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Menstrual CycleBody Literacy

Monthly rhythm of libido in married women

Hart RD, 1960Br Med J

Since classical times there has been discussion on the existence or non-existence of variations in libido in women during the menstrual cycle.*This discussion reached its peak in the nineteenth and early part of the present century.The main difference of opinion lay between those who believed that there was increased libido in association with menstruation itself-that is, just before, just after, or during, or various combinations thereof (for example, Campbell, 1891 ; Kossmann, 1903; Havelock Ellis, 1910)-and those who denied the existence of any monthly enhancement of sexual desire in women (for example, Ftirbringer, 1918).The more recent literature continues to show marked differences of opinion.Thus Corner (1952) maintained that libido is maximal just before or just after menstruation, whereas Stopes (1937) considered the monthly rhythm to have two peaks, one just before menstruation and the other at mid-cycle.On the other hand, Eckstein and Zuckerman (1956) stated that " sexual behaviour in women very rarely manifests any rhythmic pattern."However, according to Swyer (1954), " Psychic changes occur throughout the menstrual cycle.So great are the variations in different individuals that generalizations are difficult to draw.Thus, whereas some women lose all or most of their libido during the menstrual period,

Reproductive EndocrinologyCardiovascular EffectsHormonal Treatment

Hypotensive action of progesterone in experimental and human hypertension

Armstrong JG, 1959Proc Soc Exp Biol Med

Summary(1) Progesterone administration to rats and dogs with experimental hypertension and to humans with primary arterial hypertension resulted in a decline in blood pressure levels. Blood pressures increased once more in all cases after progesterone was discontinued. (2) In humans, but not necessarily in rats and dogs, blood pressure reduction would appear to have resulted from natruresis.

Contraception/ComparisonClinical MeasurementContraceptive EfficacyComparative Studies

The clinical effectiveness of contraceptive methods

Tietze C, 1959Am J Obstet Gynecol

Physiologic effectiveness is the measure of protection against unwanted pregnancy afforded by a specific contraceptive method under ideal conditions ie, used consistently and according to instructions-without omissions, or errors of technique. Such ideal conditions are rarely present. Even when they are, it is not practicable to observe and verify them. Physiologic effectiveness, although not accessible to direct measurement, is by definition higher than the observed clinical effectiveness of the same method in the hands of the most …

PregnancyProgesterone LevelsMetabolism in Pregnancy

Progesterone in blood. III. Progesterone in the peripheral blood of pregnant women

Short RV et al., 1959J Endocrinol

The content of progesterone was determined in the peripheral venous blood of pregnant women from the 11th week after the last menstrual period up to the day of birth. There was a steady increase in the blood level from the 11th to the 35th week, but thereafter the level rose more rapidly, and remained high during labour itself. The significance of this rise after the 35th week is not fully understood. It may reflect a decrease in the rate of progesterone metabolism which occurs at this time. The blood level in three cases of twin pregnancy tended to be higher than the corresponding levels for single pregnancies. After removal of the placenta during elective caesarean sections, it was found that the blood progesterone level rapidly fell below the limits of sensitivity of the method. It has been estimated that the half-life of progesterone in the circulating blood must be 5 min or less.

Reproductive EndocrinologyUrinary MetabolitesPregnanediol ExcretionPregnanediol Assay

Some aspects of the urinary excretion of pregnanediol in pregnancy

Shearman RP, 1959J Obstet Gynaecol Br Emp

Normal Pregnancy. Eleven pregnant women were studied at weekly intervals for periods ranging from 24 to 32 weeks. Three hundred and ten estimations were done in this group. An additional 68 assays were made in 40 patients at various stages of pregnancy, a total of 378 estimations being done in 51 patients, 189 in primigravidae and an equal number in multigravidae. Two of the patients in the first group had been attending the sterility clinic before becoming pregnant. None of the patients were suffering from hypertension …

Reproductive EndocrinologyFSH TherapyGonadotropin TreatmentEstrogen and Pregnanediol Excretion

Clinical effect of human pituitary follicle-stimulating hormone (FSH)

Gemzell CA et al., 1958J Clin Endocrinol Metab

A partially purified follicle-stimulating hormone preparation (human pituitary FSH) has been obtained from human pituitaries. The ovarian response to this preparation was studied in 7 amenorrheic women. The effect of human chorionic gonadotropin (HCG) was studied in addition. In 4 patients exhibiting no endometrial activity or only slight proliferation, HCG alone did not induce ovulation and had no effect on the size of the uterus, on the endometrium, or on the urinary excretion of estrogen and pregnanediol. In 2 patients showing endometrial proliferation, the administration of HCG alone was followed by ovulation, a secretory transformation of the endometrium, and a marked increase in urinary pregnanediol excretion. The administration of human pituitary FSH alone to 2 patients resulted in an increase in the size of the uterine cavity, in polycystic enlargement of the ovaries, and in a pronounced increase in urinary estrogen output. Treatment with human pituitary FSH followed by HCG produced in all patients polycystic enlargement of the ovaries, ovulation in 4 out of 5, and a secretory transformation of the endometrium in 3 out of these 5 patients. Ovulation was accompanied by a marked increase in the urinary excretion of both estrogen and pregnanediol.

Reproductive EndocrinologyFetal SafetyProgestin Treatment ComplicationsProgestin-Induced Masculinization

Masculinization of the female fetus associated with administration of oral and intramuscular progestins during gestation: non-adrenal female pseudohermaphrodism

Wilkins L et al., 1958J Clin Endocrinol Metab

There are relatively few reports of female pseudohermaphrodism not associated with congenital adrenal hyperplasia. The writers report 21 cases of females born with partial masculinization of the external gcnitalia, consisting of an enlarged phallus, with or without varying degrees of fusion of the labioscrotal folds. The diagnosis was established by finding female chromatin patterns, low excretion of urinary 17-kctosteroids and absence of progressive virilization. Exploratory laparotomy revealed normal ovaries and a normal female genital tract, although in some cases the vagina and urethra opened into a common urogenital sinus. In 15 of the cases, the mother had been treated because of threatened or habitual abortion with an oral progestin, 17-cthinyltestosterone (anhydrohydroxyprogesterone or ethisterone), marketed undersuch trade names as Pranone, Progestoral and Lutocjlol. In 2 cases the mother had received intramuscular injections of progesterone. In 1 case both intramuscular progesterone and oral methyltcstosterone had been given. In 3 cases no steroids were administered during pregnancy. The progestinic medication was usually begun before the tenth week of gestation and in most instances between the fourth and sixth weeks. Reasons are discussed for believing that the oral and intramuscular administration of progestins induced the partial masculinization of the female fetus. It is believed that the female fetus is affected in only occasional mothers who receive these steroids, and that in such mothers there may be an abnormality of cither the metabolism of progestins or their transmission across the placenta. It is most important to diagnose the condition correctly at birth, and to rear the infant as a female. No treatment is required except surgical correction of the abnormalities of the external genitalia. Normal female development is certain.

Research MethodologySurvival AnalysisNonparametric Methods

Nonparametric Estimation from Incomplete Observations

Kaplan EL et al., 1958Journal of the American Statistical Association

Journal Article Pus collections in hernial sacs. An unusual complication of general peritonitis Get access K Cronin, K Cronin Department of Surgery, Radcliffe Infirmary, Oxford Search for Oxford Academic Google Scholar H Ellis H Ellis Department of Surgery, Radcliffe Infirmary, Oxford Search for Oxford Academic Google Scholar British Journal of Surgery, Volume 46, Issue 198, January 1959, Pages 364–367, //doi.org/10.1002/bjs.18004619810 06 December 2005

Reproductive EndocrinologyEmbryo Development EffectsIn Vitro Embryo CultureIn Vitro Studies

The effect of progesterone on the development of mouse eggs in vitro

Whitten WK, 1957J Endocrinol

SUMMARY 1. The action of progesterone on the development of the mouse ovum from the eight-celled stage to the blastula has been studied in vitro . 2. Concentrations of progesterone below 2 μg/ml. produced no observable effect, whereas some toxicity was observed at 4 μg/ml. and few ova survived higher concentrations. 3. Herniation of the zona pellucida by the developing blastula is described; this process was inhibited by 4 μg/ml., but not by 2 μg/ml. of progesterone. 4. Blastulae appear to be more sensitive to the action of progesterone than are earlier stages. 5. Oestrogens afforded no demonstrable protection against the toxic action of progesterone when added to the culture medium. 6. The possible physiological significance of these findings is discussed.

PregnancyReproductive Endocrinology

Toxaemia of pregnancy treated with progesterone during the symptomatic stage

Dalton K, 1957Br Med J

While investigating the use of progesterone for the relief of premenstrual syndrome (Greene and Dalton, 1953) a high incidence of toxaemia of pregnancy (19.1 %) was recognized among sufferers from this syndrome. A further investigation, undertaken to ascertain the incidence of premenstrual syndrome in those who had previously suffered from toxemia of pregnancy, revealed that 86% of the 237 women thus affected at one time or another during the previous twelve years also suffered from premenstrual syndrome (Dalton, 1954). Furthermore, direct questioning and a scrutiny of records of these patients showed that before the full development of the signs of toxaemia–that is, oedema, hypertension, and albuminuria–most had earlier in the pregnancy experienced a symptomatic stage characterized by relatively minor afflictions–for example, lethargy 43 %, headache 48%, visual aura 37%, vertigo 29%, nausea and vomiting 16%, irritability 14%, depression 9%, and backache 6%. In fact, only 7% disclosed freedom from these symptoms during a toxaemic pregnancy. Of the 237 women, 92 (38.8%) had experienced both a normal and a toxaemic pregnancy, and 72 (78 %) contrasted the sense of well-being associated with a normal pregnancy with the malaise and minor symptoms characteristic of the toxaemic condition. The striking feature of these early minor symptoms of toxaemia was their close resemblance to those of premenstrual syndrome noted in an earlier investigation (Greene and Dalton, 1953), most patients confirming that the minor symptoms during their toxaemic pregnancy were similar, though of increased severity, to those experienced in the premenstruum, irrespective of whether the onset of premenstrual syndrome had preceded or followed the toxaemic pregnancy. Apart from the similarities of these minor symptoms in the two conditions, other points in common were noted. For example, day-to-day observations of sufferers of premenstrual syndrome had shown that, apart from minor symptoms, some developed oedema, hypertension, and albuminuria during the premenstruum, with spontaneous improvement during menstruation. This appeared to be analogous to the spontaneous resolution of oedema, hypertension, and albuminuria following delivery. Furthermore, if symptoms remain untreated either in premenstrual syndrome or in toxaemia both diseases may culminate in fits, epileptic in the one case, eclamptic in the other. In an earlier investigation one of the reasons for using progesterone in the treatment of premenstrual syndrome had been that some patients suffering from this condition were symptom-free during pregnancy. It was considered that the corpus luteum and placenta supplied enough progesterone during pregnancy to keep these patients symptom-free. Others were not only unrelieved of their premenstrual symptoms during pregnancy, but, as already indicated, developed symptoms closely resembling those of the premenstruum and culminating in toxaemia. It was therefore thought possible that the development of toxaemia might in such cases arise from failure of the corpus luteum and placenta to produce sufficient progesterone. In the light of similarities between premenstrual syndrome and toxaemia, and the fact that treatment of the former with progesterone not only relieved the symptoms (Greene and Dalton, 1953) but also prevented the development of edema, hypertension, and albuminuria in the premenstruum (Dalton, 1954, 1955), it was decided to carry out a trial, employing large doses of progesterone in patients disclosing early minor symptoms of toxaemia, in an attempt to arrest full development of that condition.

Reproductive EndocrinologyUterine QuiescenceProgesterone Block TheoryPregnancy Maintenance

Progesterone block

Csapo AI, 1956Am J Anat

In 1899 Gustav Born advanced the theory that the corpus luteum of the ovary is a gland of internal secretion, its activity being a prerequisite for the implantation and early development of the fertilized ovum. Conclusive proof of the theory was provided by Fraenkel ('10) in demonstrating that cauterization of the corpora lutea in pregnant rabbits leads to the resorption of the fertilized ova, provided that the operation took place during the first 7 days of gestation. He extended the period of the indispensable role of the corpora lutea in the …

Reproductive EndocrinologyOpioid Effects on OvulationGonadotropin ReleaseDrug-Induced Anovulation

Inhibition of the release of pituitary ovulatory hormone in the rat by morphine

Barraclough CA et al., 1955Endocrinology

AMENORRHEA and sterility are frequent accompaniments of morphine addiction in the human female (Menninger-Lerchenthal, 1934; Pescor, 1938). The mechanisms by which these effects are induced, however, are not clearly understood. In experimental animals results are contradictory. Myers and Flynn (1928, 1931) failed to observe any disturbance of estrous cycles, ovulation or fertility despite 132 days of chronic morphine treatment in rats, and their results were confirmed by Forster (1928). In contrast, treatment of mice daily for a two-month period with morphine has been reported to suppress estrus and induce atrophy of the ovary and uterus (Ko, 1934). Similar observations were noted in the rabbit (Bun, 1937). The finding by Everett and Sawyer (1950) that “spontaneous” ovulation in the rat involves a neurogenic timing factor with a 24-hour rhythmicity offers a new approach to the study of the control of ovulation.

Reproductive EndocrinologyBlood MeasurementProgesterone DetectionSteroid Hormone Measurement

Progesterone in human blood and tissues

Zander J, 1954Nature

THE problem as to whether progesterone is present in human peripheral blood, and in what concentrations, has not yet been solved satisfactorily.

Fertility AwarenessCervical Mucus SpinnbarkeitCervical Mucus AssessmentCyclic Changes

Spinnbarkeit: a characteristic of cervical mucus; significance at ovulation time

Stein IF Sr et al., 1952Fertil Steril

Accurate timing of ovulation is especially necessary (1) in artificial insemination in order to avoid wastage of donor semen; (2) in cases where the husband is relatively infertile and it is necessary to conserve his semen. While many physicians rely upon the basal body temperature curve for timing ovulation, the interpretation of such curves is varied. Some physicians believe ovulation occurs prior to the lowest point in the temperature cycle, while others believe that ovulation occurs either at the low point or following the thermal shift. We have been disappointed in our ability to interpret the basal body temperature curve for accurate timing of ovulation, and have placed greater reliance upon concurrent phenomena, such as changes in the quantity and viscosity of cervical mucus and the cyclic changes observed in the vaginal smear. Although the relationship between the occurrence of a profuse, thin cervical mucus discharge and the optimal time of fertility in the human has been recognized for the past century, in our opinion this relationship requires further evaluation. In his excellent review, "Cervical Cyclic variations and their clinical significance," Shettles quotes Robin who, in 1848, noted the viscous nature of human cervical secretions; and Smith who, in 1865, concluded that conception is most likely when the mucus contents of the cervix are in the most fluid condition. J. Marion Sims, who invented a vaginal speculum and first described the postcoital examination in 1868, observed that the test is positive for motile spermatozoa when the cervical mucus becomes clear and translucent, and about the consistency of the white of egg. Although these observations on human cervical mucus have been well documented, they have been almost disregarded by gynecologists. The significance of the cyclical outpouring of cervical mucus has been rediscovered in the past few years and has aroused great interest in students of sterility. The optimal time of fertility in domestic animals is the period of heat or estrus. In 1925, Woodman and Hammond showed that during estrus, bovine cervical mucus is fluid and capable of being drawn out into threads, whereas in diestrus the mucus is thick. Seguy and Vimeux, and Seguy and Simonnet called attention to the optimal conditions of longevity of human spermatozoa in the fluid, glairy mucus of the cervix at midcycle. They postulated that these changes in cervical mucus were associated with ovulation and could be compared to the period of estrus in subprimate mammals. They correlated these changes with visual evidence of ovulation at laparotomy. ively, many women observe an increased sticky, mucoid discharge which is typical at midcycle and which is present over a period of days. On occasion this discharge is blood-tinged and may be compared to the distinct bloody mucoid discharge present in the domestic animal "in heat." This mucus can be seen exuding from the cervix at midcycle and it may be aspirated from the endocervix and actually weighed, as reported by Viergiver and Pommerenke. Clift demonstrated certain rheologic properties of cervical mucus, especially flow elasticity and Spinnbarkeit. Flow elasticity, or elastic recoil of mucus, is measured by an instrument described by Blair. The use of the Blair capillary viscometer is a cumbersome method which we discontinued. We have had no experience with the new modification of the viscometer described by Clift, Glover, and Blair. Spinnbarkeit is easily tested, and we have found it to be a very practical objective method for determining viscosity of cervical mucus. In performing this test (Fig. 1), a vaginal speculum is inserted, exposing the cervix. A glass cannula is inserted into the endocervix and by means of gentle suction, a quantity of endocervical mucus is obtained. This mucus is blown onto a glass slide and a cover slip is placed on it. The mucus adheres to both the slide and the cover slip, and by withdrawing the cover slip, a thread of mucus is formed which can be measured in centimeters (Fig. 2). Usually, the cover slip is withdrawn several times, and the average length of the thread is ascertained. It is our purpose to show the relationship of Spinnbarkeit to other cyclic phenomena occurring during the menstrual cycle, such as basal body temperatures, vaginal smears, quantity of cervical mucus, and longevity of spermatozoa (Fig. 3).

Reproductive EndocrinologyPregnanediol MeasurementUrinary PregnanediolSteroid Metabolite Determination

Pregnanediol determinations in the clinic and in research

de Watteville H, 1951J Clin Endocrinol Metab

PREGNANEDIOL was first isolated by Marrian (1) in 1929, when he was engaged in thepurification of “oestrin” from pregnancy urine. He described the properties of this new “unidentified solid alcohol” very precisely, and his first analyses came surprisingly near to the right formula, C21H36O2,at a time when the greater part of steroid chemistry was still unknown. To-day, looking back on twenty years of chemical, biologic, and clinical research, it is comparatively easy to see the principal features of the interesting pattern which centers around the pregnanediol molecule. The first clue to the biologic significance of pregnanediol is given by its structural formula which shows a striking resemblance to that of the corpus luteum hormone, progesterone. Pregnanediol is nothing else but reduced progesterone, with all the double bonds of the latter saturated by hydrogen. Thus, the obvious inference would be that urinary pregnanediol is a metabolite of progesterone. This important fact is the reason why so many workers are interested in pregnanediol determinations.

SurgeryWedge ResectionSurgical InterventionOvarian Surgery

Ovarian resection for the relief of sterility

Meaker SR, 1950Fertil Steril

More than twenty-five years ago Edward Reynolds gave an excellent description of the polycystic ovary, and expressed the opinion that ovarian surgery was the most important single feature in the treatment of sterility of the female. This view was not accepted by later workers in the field. Indeed, the tendency has been to consider retention cysts as items of small importance, unlikely to cause symptoms and rarely calling for treatment on their own account. It remained for Stein15- 18 and his followers to define a type of case where the presence of multiple cysts evidently interferes both with ovulation and with endocrine activity, and to show that surgery frequently succeeds in restoring normal function. I propose to discuss certain aspects of this clinical problem, and to report my own series of 65 operated cases. The fundamental cause of retention cysts is probably, as Zondek believes, a phase of hypergonadotropism. Under normal conditions large numbers of primordial follicles start to mature but never complete the process. At some point along the way the ova die, whereupon the follicles regress and ultimately become insignificant corpora fibrosa. Under the influence of excessive pituitary stimulation, however, such follicles may continue to secrete liquor and to grow after the disappearance of their ova. Some of them eliminate themselves by delayed resorption and atrophy or, less often, by rupturing through the tunica albuginea. Others remain as permanent cystic structures. These retention cysts are pathologic, whereas atretic follicles in various stages of regression represent nothing more than phases of the normal ovulatory cycle.

InfertilityDefinition and CriteriaHistorical PerspectivesDelayed Childbearing

Some newer aspects of the management of infertility

Jones GE, 1949J Am Med Assoc

A discussion of infertility would be incomplete without a comment on the changing concepts of the definition. For statistical purposes it may be necessary to retain the criterion of a three year barren marriage. However, for the most satisfactory therapeutic results it appears that investigations for infertility must be instituted before these three, possibly most valuable, years have been wasted. The validity of shortening the period is substantiated by work of Diddle1 and Guttmacher,2 who independently obtained a figure of six months as the average time for a normal couple to achieve pregnancy. Relative infertility may be considered to exist any time after a six month interval. As late marriages and prolonged use of contraceptives are an integral part of our present society (especially in the private practice group) the foregoing fact is extremely important. Patients who marry after the age of 28 are contending, after a three

Fertility AwarenessCervical MucusCervical Mucus ChangesMucus Composition

Cyclic changes in the physical and chemical properties of cervical mucus

Pommerenke WT, 1946Am J Obstet Gynecol

Cervical mucus at midcycle is increased in amount, acellularity, water content, and fluidity. Furthermore, cervical mucus at this time is well supplied with carbohydrate and presumably amino acids. From a teleologic standpoint, we may conclude that because of these characteristics the sperm, on deposition in the vagina, find an environment propitious for their nutrition and migration through the cervical canal.

Menstrual CycleEndometrial ChangesBiopsy Dating CriteriaAmenorrhea and Menorrhagia

Biopsy studies of human endometrium: criteria of dating and information about amenorrhea, menorrhagia, and time of ovulation

Bartlett MK et al., 1937J Am Med Assoc

Of 900 biopsies made with a small suction curet 457 from 329 women were analyzed to show the progression of the endometrium from the high-estrogen early-proliferative phase, immediately following menstruation, through the late proliferation occurring about Day 12 foll owing menstruation. Classifications from Days 14 to 27 are much easier to make because the 1st sign of progestin effect causes significant change. On Day 15 vacuolization of the cytoplasm and beginning migration of the nuclei toward the surface of the cells is seen, leaving a lucid zone underlying the nuclei. On Day 17 this zone is well-marked and the nuclei above it are lining up to lie later each beside the other near the middle of the cell. On Day 19 the row of nuclei has sunk distally near to the base of all the cells. On Day 18 a beginning edema of the stroma is seen, first in patches; by Day 21 it is generalized and the last vestige of the zona pellucida has disappeared. On Day 21 the process of secretion, which began about Day 17, is well advanced. From Day 21 on the signs of hormonal action are seen not primarily in the gla nds but in the stroma and vascular system. Edema has become generalized by Day 21; on Day 23 the stroma cells are larger, more thick-walled, and more numerous; by Day 25 the edema is replaced by masses of contiguous large cells with large pale nuclei and much cytoplasm; and on Day 26 size of the stroma cells has extended so that almost all the interglandu lar cells are contiguous. On Day 27 this solidification of the most sup erficial stroma becomes complete, the glands are widely dilated, the epithelium approaches the cuboidal, the vascular system is highly developed, and the arterioles and venules are engorged with blood. Late on Day 27, just before menstruation, lymphocytes and polymorphonuclear leukocytes appear in great numbers and erythrocytes appear in clumps. T he whole predeciduum is infiltrated, the stroma nuclei become pale, neutrophils appear in large numbers, the tissue disintegrates, and menstruation occurs. Understanding of this normal process can aid in clinical diagnosis of menstrual disorders. A series of biopsies taken with a small surgical curet does little tissue damage and can reveal hormonal imbalance, thin stroma associated with menopause or hypoplastic endometrium, and such pathological conditions as tuberculous endometritis and cancer of the endometrium. In the 3 cases in which a woman with unsuspected early pregnancy was biopsied, no harm was done. This study showed amenorrhea is usually due to deficient follicular development but may be present even if a proliferative endometrium shows a high degree of follicle activity; in the absence of pregnancy there is never a persistent corpus aluteum.

PCOSHistorical DefinitionPolycystic Ovarian MorphologyAnovulatory Amenorrhea

Amenorrhea Associated with Bilateral Polycystic Ovaries

Stein IF et al., 1935American Journal of Obstetrics and Gynecology

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Menstrual CyclePremenstrual SyndromeLuteal Phase SymptomsPremenstrual Hormonal Changes

THE HORMONAL CAUSES OF PREMENSTRUAL TENSION

Frank RT, 1931Arch NeurPsych

My attention has been increasingly directed to a large group of women who are handicapped by premenstrual disturbances of manifold nature. It is well known that normal women suffer varying degrees of discomfort preceding the onset of menstruation. Employers of labor take cognizance of this fact and make provision for the temporary care of their employees. These minor disturbances include increased fatigability, irritability, lack of concentration and attacks of pain. In another group of patients, the symptoms complained of are of sufficient gravity to require rest in bed for one or two days. In this group, particularly, pain plays the predominant rôle. There is still another class of patients in whom grave systemic disorders manifest themselves predominantly during the premenstrual period. REPORT OF CASESCase 1. —A young, unmarried woman suffered from frequent convulsive attacks, which later occurred exclusively within ten days preceding menstruation. Neurologic investigation resulted in a diagnosis

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