The endocrinological profile of normal menstrual cycles in a population of Chinese women

Endocrinological profiles of normal menstrual cycles were studied in 41 Chinese women. Daily serum concentration of luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), estradiol (E2) and progesterone (P) were determined by RIA. Thirty-four cycles were of normal length (26-35 days) and 6 cycles were prolonged up to 40 days with a follicular phase of 22-26 days. One cycle was anovulatory. Cyclical changes of LH, FSH, E2 and P were typical of ovulatory cycles in other populations as reported in the literature. In the normal cycle group the geometric mean of the LH midcycle peak level was 46 IU/1, the FSH peak was 10 IU/1, the preovulatory estradiol peak was 1229 pmol/1 and the progesterone luteal maximum was 50 nmol/1. The pattern of cyclical changes in the prolonged ovulatory cycles was similar to the normal length cycles, except that there were significantly higher levels of LH in both follicular and luteal phases, lower FSH in luteal phase, and lower progesterone in luteal phase. A majority of cycles had a midcycle elevation of prolactin and mean PRL levels in the late luteal phase were higher than those in the follicular phase.     

促黄体生成激素水平诊断继发性闭经的意义

目的:观察继发性闭经患者、正常对照人群、孕期闭经人群和绝经期人群促卵泡成熟激素(FSH)、促黄体生成激素(LH)和催乳素(PRL)水平变化的差异,分析激素变化与继发性闭经之间的关系。方法:以正常对照人群、孕期闭经人群、继发性闭经人群和绝经期人群为研究对象,将继发性闭经组和绝经组的FSH和LH激素水平按FSH>40 mIU/ml、FSH<5 mIU/ml、LH>25 mIU/ml和LH<5 mIU/ml分为4个亚组,分析其FSH和LH激素水平差异。结果:继发性闭经组和绝经组的FSH和LH激素水平显著高于正常对照组和孕期闭经组,而PRL激素水平与正常对照组无显著性差异。继发性闭经人群LH>25 mIU/ml亚组的激素水平显著高于绝经期人群。结论 :LH异常升高是诊断、研究和治疗继发性闭经的切入点。     

The contraceptive benefit of breastfeeding

Breastfeeding has long been a means of fertility regulation in traditional communities but only recently have attempts been made to characterize and quantify this attribute. Breastfeeding encompasses behavioral, geographical, and cultural factors, which account for the differences in the prevalence and practice of breastfeeding in different communities. Ovarian activity is suppressed in the breastfeeding mother. Initially the suppression is complete and the woman is amenorrheic. This is followed by anovulatory menstrual cycles or ovulatory cycles that manifest luteal phase deficiency or normal ovulatory cycles. The duration of ovarian follicular suppression is variable and recent work suggests that lactation suppresses ovarian activity by disturbing the pulsatile pattern of luteinizing hormone (LH) secretion. During lactational amenorrhea, prolactin levels are high, LH levels are low to normal. Follicle stimulating hormone concentrations are normal by four weeks postpartum, and estrogen and progesterone levels are low. The degree of ovarian suppression is enhanced by increased frequency of suckling, longer duration of feeds, and more frequent night-time feeds. Introduction of supplementary feeds inhibits ovarian suppression. These and other factors account for variations in the length of lactational amenorrhea in an individual and between populations. The Bellagio Consensus Statement affirms that the risk of pregnancy in a fully breastfeeding, amenorrheic woman in the first six months of lactation is less than 2%. After the sixth month it is increasingly likely that ovulation will precede the first menstruation. The Bellagio Consensus has given scientific validity to birth-spacing in developing countries and the lactational amenorrhea method (LAM) as a means of contraception. If breastfeeding ceases to be full, menstruation resumes, or the baby is more than six months old, alternative methods of contraception should be used. Breastfeeding should feature more prominently in fertility regulation programs and counseling, especially in developing countries.     

正常月经周期IVF-ET患者助孕情况与睾酮水平的关系

目的：探讨正常月经周期女性在进行体外受精（IVF）周期中其卵巢基础内分泌及助孕周期情况与血清睾酮水平的关系。方法：按一定标准收集2011年3月—2011年7月在中山大学附属第一医院生殖中心行IVF-胚胎移植（ET）治疗的、具有正常月经周期的495例妇女资料。比较患者不同年龄、基础促性腺激素、基础黄体生成激素（LH）、基础卵泡刺激素（FSH）/LH比值、基础雌二醇（E2）分组间的睾酮浓度差别;比较不同血清睾酮水平患者的IVF周期情况。结果：不同年龄、基础FSH/LH比值分组间睾酮差别有统计学意义（均P＜0.05）;而基础促性腺激素、基础LH、基础E2不同分组间睾酮差别无统计学意义（均P＞0.05）。不同睾酮水平组间IVF周期取卵数以及可移植胚胎数差别有统计学意义（均P＜0.05）。结论：血清睾酮水平与年龄、FSH/LH比值以及超促排卵取卵数等卵巢储备评估指标有关联。血清睾酮水平对有正常月经周期的女性IVF周期助孕结局也有影响。     

Alcoholic hypogonadism: Hormonal response to clomiphene

To investigate the androgen, weak androgen, estrogen, and gonadotrophin tesponse to clomiphene in alcoholics, we determined in 63 male patients (25 with and 38 without liver cirrhosis) serum testosterone, sexual hormone binding protein (SHBG), dehidroepiandrosterone, androstenedione, LH, FSH, prolactin, and estradiol levels, on the first and the sixth day after admission, and after a course of 8 days of clomiphene 200 mg/day. The same test was performed on 15 healthy volunteers. Cirrhotic patients showed decreased basal testosterone levels and a loss of the circadian rhythm with recovery after clomiphene. Although basal testosterone levels in noncirrhotic alcoholics did not differ from those of the controls, there was a significant improvement after withdrawal. SHBG levels were higher in both groups of alcoholics than in controls, pointing to a worse degree of hypogonadism, because only the free hormone is active. Before the clomiphene test, serum LH and FSH levels were nonsignificantly higher in both groups of alcoholics than in the control group. After clomiphene both LH and FSH increased. Androstenedione and estradiol showed a (parallelism) similar behavior in alcoholic and in cirrhotic groups, showing in both cases higher levels than in the control group, and an increase after clomiphene, perhaps reflecting peripheral conversion of androgens to estrogens. Because clomiphene has no effect on the adrenal cortex, the increase of androstenedione after clomiphene points to its testicular origin (directly or after testosterone conversion) and not to an adrenal one. The highest serum estradiol levels were observed in cirrhotics with ascites or gynecomastia. We have not found any relation between serum hormone levels and alcohol intake nor with nutritional status.     

Ovulation inhibition with nafarelin acetate nasal administration for six months

A group of 24 women with normal menstrual cycles were treated with nafarelin acetate administered in doses of either 125 ug or 250 ug daily intranasally for 6 months. Each subject was studied for one ovulatory control cycle, six treatment cycles, and post-treatment until the return of ovulation was documented. Once a week progesterone, estradiol, follicle stimulating hormone, and luteinizing hormone were measured in the serum. Acute hormone responses to nafarelin acetate were determined on-day 1, day 98 and day 186 of treatment.

Two subjects failed to complete the treatment phase. One subject using the 250 ug daily dose of nafarelin acetate discontinued treatment on the sixth day because of heavy uterine bleeding. One subject using the 125 ug daily dose of the study drug terminated treatment on day 126 because of a 21-pound weight gain.

There were significantly less presumed ovulatory cycles at the higher dose (2 out of 60 cycles) than at the lower dose (10 out of 54 cycles) (p<0.01). On the average menstrual cycles were reestablished 28.5 ± 8.3 (S.D.) days after discontinuing the 125 ug daily dose and 33.7 ± 17.9 (S.D.) days after terminating the 250 ug daily dose. With the higher dose of nafarelin acetate there were significantly fewer bleeding episodes, less number of days of bleeding, and longer cycles. During the treatment phase the area under the LH curve was significantly less and the acute response of LH in the last week of treatment was significantly less with the higher dose of drug. With both doses of nafarelin acotate the acute responses of LH, FSH and estradiol were significantly greater on day 1 than on either day 98 or day 186. Side effects observed during this study included galactorrhea (2 subjects) and vasomotor symptoms (7 subjects).     

二甲双胍联合克罗米芬治疗多囊卵巢综合征合并不孕的疗效分析

目的:探讨二甲双胍联合克罗米芬治疗多囊卵巢综合征合并不孕患者的疗效。方法:将收治的多囊卵巢综合征合并不孕患者96例随机分为观察组和对照组各48例,观察组接受二甲双胍联合克罗米芬治疗,对照组仅接受克罗米芬治疗。结果:观察组体质指数(BMI)、空腹胰岛素(FINS)、促黄体生成素(LH)、LH/促卵泡刺激素(LH/FSH)、睾酮(T)在治疗后显著降低,治疗前后比较差异有统计学意义(P<0.05);而FSH、雌二醇(E2)治疗前后相比差异无统计学意义(P>0.05)。对照组BMI、FINS、LH、LH/FSH、T、FSH、E2治疗前后相比差异无统计学意义(P>0.05)。治疗后观察组BMI、FINS、LH、LH/FSH、T显著低于对照组,差异有统计学意义(P<0.05);两组患者的FSH、E2相比差异无统计学意义(P>0.05)。治疗后观察组的排卵率、妊娠率显著高于对照组,差异有统计学意义(P<0.05)。结论:二甲双胍联合克罗米芬可提高多囊卵巢综合征患者对胰岛素的敏感性,并降低其LH、T等激素水平,提高患者的排卵率与妊娠率。     

小剂量米非司酮在子宫腺肌病治疗中的临床疗效分析

[目的]探讨米非司酮治疗子宫腺肌病的临床疗效。[方法]选择72例依临床症状、彩色超声或腔镜检查诊断为子宫腺肌病的患者予米非司酮口服10 mg,每天1次,连续服用6个月,治疗前后行妇科检查、子宫、附件阴式B超检查,同时观察治疗前与服药6个月后月经变化、激素水平变化、子宫大小变化、不良反应及复发情况。[结果]全部患者都发生闭经;治疗后痛经分级比治疗前明显降低(P﹤0.01);血清FSH、LH、E2水平较治疗前下降;B超测量子宫体积明显缩小。[结论]米非司酮治疗子宫腺肌病,能有效控制痛经,减少月经量,诱导闭经,近期疗效明显。     

米非司酮治疗子宫内膜异位症临床效果观察

目的：探讨米非司酮治疗子宫内膜异位症的临床疗效及其安全性。方法：选取子宫内膜异位症的患者60例,于月经来潮后5天内给予米非司酮10mg／d口服,共3个月,比较用药前后症状、体征改善情况,生殖激素的变化,不良反应的发生及停药后的妊娠情况等。结果：用药3个月后患者痛经等症状有所改善,有效率达96．67％;用药后后陷凹结节缩小,子宫活动度改善,卵巢囊肿缩小,差异有统计学意义（P〈0．05）;用药期间闭经40例（66．67％）,18例（30．00％）月经减少;用药前与月经恢复后血清雌二醇（E2）、孕激素（P）、卵泡刺激素（FSH）及黄体生成素（LH）水平无明显变化（P〉0．05）,9例（15．00％）出现转氨酶轻微升高,15例（25．00％）出现阴道不规则点滴出血;停药后1～7个月妊娠6例（10．00％）。结论：米非司酮治疗子宫内膜异位症,症状改善明显;对下丘脑一垂体一卵巢性腺轴无明显影响,不良反应少,对提高妊娠率有一定帮助。     

Studies on birth control

This general review covers IUDs, oral contraception (combined, sequential, low-dose progestins, postcoital), injectables, implanted progestins, immunization, and long-acting androgens for men, with most of the details taken from animal research. IUDs are thought to act via LH, tubal transport, uterine luteolysis, contractility, and inflammatory response. Oral contraceptives are theoretically almost 100% effective, but actually are less so because of user carelessness, particularly with sequential pills, which is due perhaps to side effects. Postcoital pills consist of 50 mg stilbestrol for 5 days. Monthly injections are likely to be unacceptable because of prolonged irregular bleeding, but 3- or 6-month injections may be accepted by women who desire no more children and who can tolerate amenorrhea and irregular bleeding. Still being developed are implanted progestagens, immunization against the husband's sperm or against FSH or LH, and androgens for men.     

二甲双胍治疗肥胖型多囊卵巢综合征30例临床观察

目的:探讨二甲双胍治疗肥胖型多囊卵巢综合征(PCOS)的效果,方法:随机选择30例肥胖型PCOS患者,应用二甲双胍连续治疗3个月,比较治疗前后的临床症状,生殖激素和胰岛素水平、糖脂代谢改变情况和药物的副反应。结果:30例PCOS患者经二甲双胍治疗后,恢复规律月经13例,妊娠3例;治疗后体重指数(BMI)、腰臀比(WHR)、血清促黄体生成素(LH)、睾酮(T)、空腹胰岛素(FINS)、胰岛素曲线下面积(IAUC)、总胆固醇(TCH)、低密度脂蛋白(LDL-c)、载脂蛋白-B(ApoB)有明显下降,胰岛素敏感指数(ISI)有明显的提高,差异有显著性(P≤0·05~0·01)。促卵泡素(FSH)、雌二醇(E2)、空腹血糖(FSG)、高密度脂蛋白(HDL-c)、载脂蛋白-A(ApoA)治疗前后无明显差异(P>0·05)。结论:二甲双胍可使部分患者恢复月经和妊娠,降低T、LH水平,提高胰岛素的敏感性,改善血脂代谢,可作为治疗肥胖型PCOS患者的安全有效的新方法。     

Effect of d-norgestrel on LH levels and ovulation in the rhesus monkey.

The mode of action of a synthetic progestin on serum LH levels and ovulation was studied in female rhesus monkeys. Oral d-norgestrel was administered continuously for up to 10 cycles on a body weight basis designed to reflect clinical doses that have been used in the minipill and combination oral contraceptive. A dose of 3 μg d-norgestrel/day (minipill dose) did not alter the length of the menstrual cycle or midcycle LH surge. A dose of 30 μg d-norgestrel/day(combination dose) produced amenorrhea associated with elevated tonic levels of serum LH characterized by irregular, pulsatile surges. In monkeys treated with 3 μg d-norgestrel/day, ovulation occurred as judged by laparoscopy or histologic observation of a corpus luteum. At ten times this dose, ovaries were atrophic with a reduced number of developing follicles and no evidence of corpora lutea. Luteinized follicles were also present. When d-norgestrel (30 μg/day) was discontinued, ovulatory-like LH patterns and regular menses resumed in the first two consecutive post-treatment cycles. As in women, microdose d-norgestrel therapy does not block ovulation, but at higher doses produces a disturbance in LH secretion and ovulatory function which can be readily reversed when therapy is discontinued.     

二甲双胍、安体舒通联合复方醋酸环丙孕酮治疗PCOS疗效分析

目的:研究二甲双胍、安体舒通分别联合复方醋酸环丙孕酮(CPA)治疗PCOS的效果。方法:将86例多囊卵巢综合征(PCOS)患者随机分成两组,A组43例采用二甲双胍联合复方醋酸环丙孕酮治疗,B组43例采用安体舒通联合复方醋酸环丙孕酮治疗,3周期后观察患者血黄体生成素(LH)、卵泡刺激素(FSH)、睾酮(T)、LH/FSH、体重指数(BMI)、腰臀比(WHR)、血糖、胰岛素水平等变化情况。结果:A、B两组治疗后LH、LH/FSH、T、WHR、BMI均较治疗前明显下降差异无统计学意义,但A组胰岛素水平、血脂下降优于B组。结论:二甲双胍、安体舒通联合复方醋酸环丙孕酮治疗PCOS患者均能取得良好效果。     

Total urinary follicle stimulating hormone as a biomarker for detection of early pregnancy and periimplantation spontaneous abortion.

Total concentrations of follicle stimulating hormone (FSH) were evaluated in daily urine samples from conceptive and nonconceptive menstrual cycles by measurement of the FSH beta subunit following treatment of the samples to dissociate the FSH heterodimer. Samples were self-collected by normal subjects during cycles in which daily blood samples also were obtained. Daily blood and urine specimens were collected prospectively from 10 subject in conceptive cycles, which led to normal pregnancies, and from 10 subjects with bilateral tubal ligations to provide control samples form nonconceptive cycles. Mean serum and urinary FSH concentration profiles wer parallel in both groups following ovulation and during he first 9 days of the luteal phase. Mean values for both serum and urinary FSH rose significantly above the postovulatory baseline by 10-12 days following the midcycle luteinizing hormone (LH) peak in nonconceptive cycles, but did not rise at any time following ovulation during conceptive cycles. Following regression analysis of the changing FSH concentration between days 9-14 post-LH surge in conceptive cycles, a slope of </= 0.02 ng FHS/mg creatinine/day was selected as a cutoff point to identify conceptive cycles. There was a high concordance between the day of LH peak in serum and the day of FSH peak in urine. Therefore, in applying the algorithm, the day of FSH peak in urine was used to determine the days for which the FSH slope would be calculated, i.e., days 9-14 post-FSH peak in urine. The sensitivity and specificity of the change in urinary FSH concentrations to detect pregnancy in a different set of 55 cycles were found to 88.9% and 89.3%, respectively. All six cases of early fetal loss in the sample set were correctly identified. These results suggest that urinary FSH can be used as an additional biomarker for the verification of early pregnancy in prospective epidemiological studies in which early fetal loss is a suspected outcome.     

戊酸雌二醇对建立人工周期的作用

目的:通过观察戊酸雌二醇(商品名称为补佳乐)、安宫黄体酮序贯疗法对月经不调的疗效,探讨其对建立人工周期的作用。方法:将2003年3月~2005年2月来我院门诊的192例月经不调患者按病因不同分为青春期功血、卵巢早衰性闭经及围绝经期功血3组,采用戊酸雌二醇(补佳乐)、安宫黄体酮序贯治疗3~6个周期后,观察患者症状及用药前后血清激素水平。结果:所有病例停药后均发生少、中量撤退性出血,出血时间(5±2.5)天,青春期功血组停药后月经周期恢复正常者占56.9%;卵巢早衰组占9.3%;围绝经期功血组为20.2%,与用药前相比,各组血清激素水平有显著性变化(P<0.05),后两组更年期症状明显改善(P<0.05)。结论:戊酸雌二醇(补佳乐)人工周期治疗月经不调患者可使其恢复正常月经周期,调节H-P-O轴功能,同时对卵巢早衰和围绝经期的全身并发症亦有显著疗效。     

Effects of combined ethinylestradiol, and desogestrel on hormone profiles and sex hormone binding globulin in women with polycystic ovarian disease

A longitudinal study to determine the effects of combined ethinylestradiol (EE) and desogestrel (DG) on hormone profiles and levels of sex hormone binding globulin (SHBG) were carried out in 19 Thai women with polycystic ovarian disease (PCOD). Evaluations were performed before and after 3 and 6 cycles of treatment. Regularity of cycles was observed in all patients. Most of them had improvement of androgenic symptoms. Body weight decreased slightly after 6 cycles of treatment. During the treatment course, serum luteinizing hormone (LH), testosterone (T), free T and dehydroepiandrosterone sulfate decreased significantly. Serum follicle stimulating hormone (FSH) and prolactin levels did not change. LH-tc—FSH ratio markedly decreased. SHBG level increased to the control level. After discontinuation of the pill, menstrual disturbances recurred in all patients. It appears that low-dose combined OCs containing DGf is suitable for use in women with PCOD. However, long-term treatment may be needed since the abnormal menstrual pattern returned after stopping the pill.     

克罗米芬诱导多囊卵巢综合征排卵失败的相关因素分析

目的 探讨克罗米芬（CC）诱导多囊卵巢综合征（PCOS）排卵失败的相关因素。方法 通过回顾分析178例569个周期的排卵率（OR）、排卵周期率（OCR）与临床特征及内分泌指标的关系。结果 显示本组OR73．0％,OCR45．3％,功血、无排卵月经型OCR明显高于继发性闭经型（P＜0．005,0．05）,功血型明显高于月经稀发型（P＜0．05）;无多毛、非肥胖者OR显著高于多毛和肥胖者9P＜0．01,0．005）。未婚妇女OCR高于不孕和已育者（P＜0．025,0．005）。LH／FSH≥3、T正常者OCR分别高于LH／FSH＜3和T升高者,PRL正常者OR高于PRL升高者9P＜0．05－0．025）。LH／FSH、T、BMT与OR、OCR及PRL与OR有明显相关性（P＜0．05－0．01）。提示CC诱导PCOS排卵疗效与月经类型、多毛、肥胖、婚育状态、LH／FSH、T、PRL有关。     

新兵训练对女兵性激素、月经功能的影响及其相关性研究

目的:探讨新兵训练对女兵生殖内分泌以及月经功能的影响,并进行相关性分析。方法:选取陆军某部女兵126名,采用酶免疫测定法(EIA)分别测定新训前、新训结束时血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(P)、睾酮(T)、泌乳素(PRL)水平,并对437名女兵新训前、新训期、新训结束半年后的月经状况、月经疾患进行调查、随访和分析。结果:激素测定结果显示,新训后FSH、LH、P水平明显降低,E2、T、PRL水平均为明显升高,与集训前比较,差异显著(P<0.05);月经期除E2、P于集训后升高外,FSH、LH、T及PRL集训后与集训前比较均无显著性差异(P>0.05)。新兵训练使女兵月经周期异常率、月经疾患发生率明显增高。结论:新兵训练对女兵性腺轴及月经功能有显著的影响,这种影响是功能性、可逆性的,对女性生殖健康并无永久性、器质性损害,但加强新训女兵生殖健康保健仍十分重要。     

The evaluation of guingestanol acetate as a low dose oral contraceptive

Four hundred patients completed 4,370 cycles of treatment using quingestanol acetate, 300 mcg daily. Twelve pregnancies occurred resulting in a failure rate of 3.3 per 100 woman years. Seven of these pregnancies were considered drug failures giving a rate of 1.9 per 100 woman years. Cycle length, amount and duration of flow were not significantly different from pretreatment. Intermenstrual bleeding occurred in 51% of the patients and in 12% of cycles; amenorrhea occurred in 20% of the patients and in 5% of cycles. Endometrial biopsies showed normal patterns in 92% of specimens taken during the follioular phase of the menstrual cycle and in 67% of those taken during the luteal phase. An anovulatory pattern was shown in 14% taken during the luteal phase. Numerous laboratory tests demonstrated no abnormalities which could be associated with therapy. The discontinuance rate of 15% for drug-related reasons during the three years of this program indicated favorable patient acceptance. This study indicated that quingestanol acetate used at a daily dose of 300 mcg is a safe and effective oral contraceptive.     

FSH/LH值与控制性超排卵中卵巢反应性关系的临床研究

目的:探讨FSH/LH值在控制性超排卵(COH)中与卵巢反应性的关系。方法:对336个周期分为超排卵治疗不反应组(34个周期)、低反应组(59个周期)、正常反应组(243个周期),比较3组FSH、LH,以及使用促性腺激素释放激素激动剂(GnRHa)后FSH、LH水平,促性腺激素(Gn)的用量等。激素测定采用酶联免疫分析法。结果:不反应组的FSH基础值为9.9±4.9U/L,分别与低反应组的8.1±5.1U/L及正常反应组的6.6±2.5U/L比较,差异均有统计学意义(P<0.05)。不反应组的FSH/LH基础值为2.8,分别与低反应组(2.1)及正常反应组(1.5)比较差异均有统计学意义(P<0.05)。使用GnRHa启动日不反应组FSH/LH比值为5.1,低反应组为4.1,两者与基础水平比较均有明显增高,而正常反应组增高不明显。结论:GnRHa降调节后,FSH/LH值可用于预测卵巢对Gn的反应性而作为判断COH结果的预测指标。