Comparison of the adrenocorticotropic hormone stimulation test in the follicular and luteal phases of the menstrual cycle.

A comparison was made of the ACTH stimulation test in the proliferative and luteal phases of the menstrual cycle in 13 subjects, each of whom served as her own control. The test yielded a 53.9% false-positive rate in the luteal phase. The study, therefore, clearly shows that from a practical, clinical point of view, the test is completely unreliable in the luteal phase, and is only valid when carried out in the follicular phase of the cycle.     

Pulsatile secretion of gonadotropins and prolactin during the follicular and luteal phases of the menstrual cycle: analysis of instantaneous secretion rate and secretory concomitance.

OBJECTIVE: To characterize the pulsatile secretions of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin (PRL) during the menstrual cycle and to statistically evaluate their secretory concomitance. DESIGN: Pulsatility study performed during the midfollicular and midluteal phases of a same menstrual cycle, blood samples being collected every 10 minutes for 6 hours. SETTING: Participants investigated in the Division of Endocrinology, University Hospital. PARTICIPANTS: Nine healthy women (22 to 38 years) with regular menstrual cycles. MAIN OUTCOME MEASURES: Plasma LH, FSH, and PRL values were analyzed as raw and deconvoluted data, and the specific (nonrandom) secretory concomitance was evaluated statistically. RESULTS: The pulsatile secretion of LH was confirmed, and that of FSH and PRL was clearly established during both phases of the cycle by characterization of peak frequency, period, and amplitude. A specific secretory concomitance was assessed between LH and FSH in the follicular but not the luteal phase, and a tight concomitance between LH and PRL was demonstrated during both phases. CONCLUSIONS: These results are supportive of significant pulsatile secretions of the three hormones during the menstrual cycle, and they are demonstrative of a definite copulsatility of these hormones, suggestive of common regulatory factors in the complex temporal patterns of gonadotropin and PRL secretions along the cycle.     

Growth hormone in serum of women during the menstrual cycle and during controlled ovarian hyperstimulation

STUDY OBJECTIVE: To investigate the interrelationships between circulating levels of endogenous human growth hormone (hGH), gonadotropins, estradiol (E2), and progesterone (P). DESIGN: Retrospective. SETTING: Assisted reproductive technology center. PATIENTS: Nine normally cycling women from whom blood samples were drawn daily; 18 patients undergoing controlled ovarian hyperstimulation. RESULTS: During the menstrual cycle, average (+/-SE) hGH levels in serum ranged between 7.97 +/- 2.71 microIU/mL on day 11 and 2.11 +/- 0.38 microIU/mL on day 22. Serum hGH levels did not correlate with peripheral levels of follicle-stimulating hormone (FSH), luteinizing hormone, P, or E2 and were related to the serum E2:FSH ratio (adhibited as an index of ovarian response to FSH) on cycle day 10 only. Levels of hGH in sera of patients undergoing controlled ovarian hyperstimulation were near 4 microIU/mL and were directly related to peripheral E2 levels at the time of induction of oocyte maturity. When corrected for differences in follicle number between stimulated patients, changes in serum E2 content were independent of respective hGH levels. CONCLUSION: The findings challenge speculation that endogenous peripheral hGH content might relate to ovarian responsiveness to FSH.     

Immunoradiometric assays of total renin and gonadotropins in serum during the menstrual cycle

The contribution of the ovary to the circulating total renin pool is linked to its secretory activity in relation with its reproductive function. In a longitudinal study of 13 normal women, total renin levels measured in serum by an immunoradiometric assay were lower in the midfollicular phase (180 +/- 59 pg/ml) than in the midluteal phase (291 +/- 100 pg/ml). Peak levels were encountered 1 day after the luteinizing hormone (LH) surge (375 +/- 97 pg/ml). Rapid circhoral fluctuations were observed in all periods of the cycle, unrelated to the LH pulses. In case of ovarian function inhibition (induced by gonadotropin-releasing hormone agonists), total renin levels were lower than in the midfollicular phase (126 +/- 56 pg/ml). Low levels also were encountered in the prepubertal period (153 +/- 89 pg/ml). Very high levels (17,600 +/- 11,400 pg/ml) were found in follicular fluids from stimulated cycles. These results show that circulating total renin levels follow a complex pattern in which LH, but possibly also follicle-stimulating hormone and gonadal steroid hormones (estradiol and progesterone), may play a role.     

The oxytocin secretory response to breast stimulation in women during the menstrual cycle

Plasma oxytocin concentrations were measured during 12 minutes of mechanical pump stimulation in nine healthy women during the follicular and luteal phases of the menstrual cycle. In the follicular phase (and in five healthy male subjects), plasma oxytocin values did not increase above baseline levels with breast pump stimulation. In contrast, pump stimulation evoked a significant increase in plasma oxytocin levels during the luteal phase of the menstrual cycle. These observations suggest that oxytocin secretion is modulated by hormones involved in the menstrual cycle in women.     

Circulating blood levels of gonadotropins and prolactin in the normal menstrual cycle

Circulating blood levels of luteinizing hormone, follicle-stimulating hormone and prolactin are reported in 17 normally menstruating Nigerian women. The profiles of the secretion of these pituitary hormones are similar to those reported in other ethnic groups. A significant midcycle peak of prolactin, coinciding with the peaks of luteinizing hormone and follicle stimulating hormone was also observed.     

Serum gonadotrophin and sex steroid hormone levels during mid-follicular and mid-luteal phases in hyperprolactinaemic women with regular menstrual cycles

Summary. Hyperprolactinaemia was found in 15 of 135 infertile patients with regular menstrual cycles, biphasic basal body temperature record and no galactorrhoea. In those 15 women, mean serum prolactin levels during the mid-follicular and mid-luteal phases of the menstrual cycle were 29.8 (SEM 1.8) ng/ml and 29–5 (SEM 1.3) ng/ml, respectively. Although serum FSH and LH levels were similar in normal and hyperprolactinaemic women, serum oestradiol level during the mid-follicular phase was subnormal in hyperprolactinaemic women ( P <0.05). In contrast, serum oestradiol and progesterone levels during the mid-luteal phase and luteal phase length were similar in nor-moprolactinaemic and hyperprolactinaemic groups. The results suggest that Hyperprolactinaemia is associated with defects of follicle development as measured by oestradiol production during the mid-follicular phase, but not with corpus luteum function as measured by progesterone production during the mid-luteal phase, and luteal phase length.     

Serum gonadotrophin and sex steroid hormone levels during mid-follicular and mid-luteal phases in hyperprolactinaemic women with regular menstrual cycles

Hyperprolactinaemia was found in 15 of 135 infertile patients with regular menstrual cycles, biphasic basal body temperature record and no galactorrhoea. In those 15 women, mean serum prolactin levels during the mid-follicular and mid-luteal phases of the menstrual cycle were 29.8 (SEM 1.8) ng/ml and 29.5 (SEM 1.3) ng/ml, respectively. Although serum FSH and LH levels were similar in normal and hyperprolactinaemic women, serum oestradiol level during the mid-follicular phase was subnormal in hyperprolactinaemic women (P less than 0.05). In contrast, serum oestradiol and progesterone levels during the mid-luteal phase and luteal phase length were similar in normoprolactinaemic and hyperprolactinaemic groups. The results suggest that hyperprolactinaemia is associated with defects of follicle development as measured by oestradiol production during the mid-follicular phase, but not with corpus luteum function as measured by progesterone production during the mid-luteal phase, and luteal phase length.     

Free testosterone levels during the menstrual cycle in obese versus normal women

In a group of seven normally ovulating moderately obese women, testosterone parameters were studied throughout the menstrual cycle and compared with values obtained in normal-weight control women. Plasma T, percent free T (unbound), and free T concentrations were higher and exhibited little variation during the phases of the cycle compared with the normal-weight controls. Testosterone production and its parameters thus are higher in even moderately obese women.     

The effect of follicle-stimulating hormone without additional luteinizing hormone on follicular stimulation and oocyte development in normal ovulatory women

Twelve normally menstruating women were stimulated with (1) human menopausal gonadotropins (hMG) containing follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and (2) FSH only to induce growth of multiple follicles for oocyte retrieval. Maturation of the follicles and presumptively the oocytes was assessed by daily serum estradiol (E2) values, the response of the vaginal epithelium, and cervical mucus. The growth and number of follicles were measured by ultrasound daily. Human chorionic gonadotropin was administered as a surrogate LH surge. The hMG cycles were compared with the FSH-only cycles in relation to serum E2 and oocyte maturation, fertilization, transfer, and pregnancy rates. Five of eight cycles adequately stimulated with FSH only resulted in successful pregnancies. FSH without additional LH can initiate and maintain E2 function and allow oocyte maturation to proceed up to the terminal maturation, which is associated with the LH surge. The effect of LH may be to hasten follicular atresia in the developing cohort of follicles.     

Effect of prednisone on plasma testosterone levels and on duration of phases of the menstrual cycle in hyperandrogenic women.

A group of 106 women of reproductive age with laboratory and clinical evidence of hyperandrogenism was treated with prednisone. The daily dosage varied between 7.5 and 10 mg. Ovulatory activity was assessed prior to and during therapy by basal body temperature and observation of changes in the cervical os and cervical mucus. Plasma testosterone levels were significantly suppressed by prednisone therapy. This was associated with initiation of ovulatory activity in 5 of 14 (35.7%) amenorrheic patients and 10 of 11 (90.9%) anovulatory patients. In 81 ovulatory patients, prednisone therapy resulted in statistically significant shortening of the follicular phase and lengthening of the luteal phase of the menstrual cycle. The mean length of the menstrual cycle was unchanged. Significant correlations between percentage suppression of plasma testosterone and shortening of the follicular phase or lengthening of the luteal phase were observed. Suppression of plasma testosterone by prednisone was maximal after 2 months of treatment, while the effect on the phases of the menstrual cycle was progressive with duration of treatment. The effects of prednisone at daily dosages of 7.5 or 10 mg were not significantly different. These results suggest that prednisone therapy in hyperandrogenic women exerts an effect on both phases of the menstrual cycle, possibly related to suppression of plasma testosterone levels.     

The effect of the menstrual cycle on serum CA 125 levels: a population study.

OBJECTIVE: Our objective was to assess the effect of the menstrual cycle on CA 125 levels in a population study. STUDY DESIGN: Serum CA 125 was measured in 1478 women, with day of menstrual cycle noted in 574 women. Repeat examination was performed in women with elevated results, and 40 of these women were tracked by weekly examination of CA 125 levels. RESULTS: A significant difference was demonstrated when midcycle samples were compared with day 1 and day 28 samples (p < 0.05). In spite of this significance the difference was not clinically useful. Elevated serum CA 125 (> 35 U/ml) levels were present in 77 (5.2%) of the premenopausal women. A significant variation was demonstrable with higher CA 125 levels about the time of menstruation in 29 of the 40 women tracked. CONCLUSION: This study suggests that in the population as a whole the effect of the menstrual cycle on serum CA 125 is not clinically significant, but single elevated levels in an individual may represent menstrual fluctuation.     

Ovarian stromal and luteal tissue prostaglandins, 17 beta-estradiol, and progesterone in relation to the phases of the menstrual cycle in women

The concentrations of prostaglandin F2 alpha, prostaglandin E2, the 15-keto-13, 14-dihydro-metabolite of prostaglandin F2 alpha, progesterone, and 17 beta-estradiol were measured in 31 ovarian stromal tissue and 18 luteal tissues. Tissue samples were obtained during abdominal hysterectomy. The ovarian stromal tissue prostaglandin F2 alpha content during the late secretory and early proliferative phases was significantly higher (p less than 0.001) than in tissues obtained during any other phases of the menstrual cycle. The ovarian stromal tissue prostaglandin E2 content was significantly elevated (p less than 0.01) during the late proliferative and early secretory phases. The content of the prostaglandin F2 alpha metabolite also was elevated (p less than 0.001) in ovarian stromal tissues obtained during the late proliferative and early secretory phases. Comparison of the concentrations of prostaglandins and sex steroids in ovarian stromal and luteal tissues indicate the latter to be far more active in terms of steroid and arachidonate metabolism. During the early luteal phase, when the luteal progesterone content was at its highest, both luteal and ovarian stromal tissue contents of prostaglandin E2 were also elevated. The late secretory phase of the menstrual cycle was characterized by lowered luteal progesterone content and a markedly elevated level of prostaglandin F2 alpha in luteal and ovarian stromal tissues. During cyclic ovarian activity in the woman, prostaglandin E2 predominated during the periovulatory phases while the period of luteal death was highlighted by the elevated prostaglandin F2 alpha content in ovarian stromal and luteal tissues.     

Renal sodium retention does not occur during the luteal phase of the menstrual cycle in normal women.

OBJECTIVE: To determine whether weight gain due to renal sodium and water retention occurs in the luteal phase of the normal menstrual cycle. DESIGN: Prospective observational study. SETTING: Research laboratory installed with modified spa bath. SUBJECTS: Ten normal healthy women. INTERVENTION: Each subject underwent two experiments, one in each phase of the menstrual cycle, involving 3 h head-out water immersion and a pre- and post immersion control hour. 25 ml blood samples were obtained every hour before, during and after water immersion. MAIN OUTCOME MEASURES: Renal and hormonal responses to water immersion during the luteal and proliferative phases of the cycle. RESULTS: There was no change in weight, creatinine clearance, basal sodium excretion or plasma atrial natriuretic peptide between the two phases of the cycle. There was a significant rise in basal progesterone, plasma aldosterone and plasma renin activity in the luteal phase of the ovulatory cycles. Renal and hormonal responses to immersion including sodium and calcium excretion, elevation of atrial natriuretic peptide (ANP) and suppression of plasma aldosterone and plasma renin activity were identical in the two phases of the menstrual cycle. CONCLUSION: We found no evidence to support the hypothesis that renal sodium and water retention occurs in the luteal phase of the normal menstrual cycle.     

Immediate effect of prostaglandin F2alpha during the luteal phase of the menstrual cycle.

Serum luteinizing hormone, estradiol, 17-hydroxyprogesterone, and progesterone determinations were performed in five normally ovulating women prior to, during, and after prostaglandin F2alpha (PGF2alpha was infusion. A total of 75 mg of PGF2alpha was infused over 48 hours, beginning on the 4th day of the luteal phase. Endometrial biopsies were obtained at the completion of the infusion. In all patients, transient decreases in serum progesterone and 17-hydroxyprogesterone levels were observed during PGF2alpha infusion. Subsequent rises in the serum progesterone and 17-hydroxyprogesterone levels were observed 24 hours after completion of the infusion. There was no significant change in serum luteinizing hormone levels. Premature menstrual bleeding occurred with 24 to 72 hours after the termination of the infusion, while progesterone and 17-hydroxyprogesterone levels were still elevated. Endometrial histology revealed focal stromal necrosis in the presence of the normal secretory endometrium. It is concluded that, in the human, PGF2alpha at this dose and time schedule is not luteolytic.