Examination of changes caused by tubal sterilization in ovarian hormone secretion and uterine and ovarian artery blood flow rates

OBJECTIVES: To examine the changes caused by tubal sterilization (TS) in ovarian hormone secretion and uterine and ovarian circulation. DESIGN: Tubal sterilization was performed by minilaparotomy and laparoscopy methods in 36 women. Blood samples were taken for hormonal tests on Preoperative Day 3 (D3) of the menstrual cycle, on Postoperative Days 13-15 (periovulatory period) of the same cycle and on D3 in the 1st and 6th months post-TS. Uterine and ovarian artery blood flow rates of the women were measured on the same days as hormonal tests by transvaginal color Doppler ultrasonography (TVCDUSG). The control group was composed of 15 volunteers in the same age group who preferred the barrier method and who had the same TVCDUSG and hormonal analyses in the same periods. RESULTS: There was a decrease in the uterine and ovarian artery pulsatility index (PI) measurements and an increase in serum luteinizing hormone (LH) and estradiol (E2) values during the periovulatory period as compared with preoperative and postoperative menstrual measurements in all groups. There was no difference between baseline uterine and ovarian artery PI and serum follicle-stimulating hormone, LH and E2 values and those measured on D3 of the menstrual cycle in the 1st and 6th months post-TS. CONCLUSIONS: The 6-month postoperative follow-up of groups that had undergone different TS methods showed no difference in uterine or ovarian artery blood flow rates or ovarian hormone secretion in comparison with baseline values.     

Hormone levels before and after tubal sterilization

OBJECTIVE: The aim of this study was to determine whether women experience significant luteal phase hormonal changes following interval tubal sterilization. DESIGN: This is a partly randomized, prospective clinical study. SETTING: This study involved healthy volunteers in an academic research environment. PATIENTS: This study involved 118 fertile women seeking tubal sterilization and 57 fertile controls with at least three normal cyclic menstrual periods before entry into the study. INTERVENTIONS: The patients were randomized to bipolar cautery or Hulka clip as sterilization methods. Barrier contraception or abstinence was used by controls. MAIN OUTCOME MEASURES: The main outcome measures are serum estradiol and progesterone levels and urinary estradiol and pregnanediol levels obtained during the luteal phase before, 1 year and 2 years after sterilization. RESULTS: The women randomized to the bipolar cautery group had higher midluteal progesterone levels measured between Days 5 and 11 postovulation (15.5 ng/mL before sterilization, 14.5 ng/mL at 1 year and 14.5 ng/mL at 2 years) than did the other two groups. The clip group had progesterone levels of 14.1, 12.0 and 12.5 ng/mL at baseline, 1 year and 2 years, respectively, and the control group had levels of 12.0, 11.9 and 11.3 ng/mL for the same periods. Serum estradiol and progesterone and urinary pregnanediol and estradiol were not significantly changed over the 2-year period, nor were there significant differences between the two groups. CONCLUSIONS: There were no significant hormonal changes in sterilized women over a period of 2 years when compared with their baseline levels or when compared with unsterilized age-matched controls.     

Changes in menstrual pattern and ovarian function following bipolar electrocauterization of the fallopian tubes for voluntary surgical contraception

OBJECTIVE: Our aim was to investigate the changes in menstrual pattern, ovarian reserve and presence of dysmenorrhea and ovulation after tubal ligation via bipolar electrocautery. METHODS: Sixty patients requesting voluntary tubal ligation were recruited in the study. Laparoscopic tubal sterilization via bipolar electrocoagulation was performed in all patients in the early follicular phase. Blood samples were collected on day 3, one cycle before the procedure, in the same cycle when the procedure was carried out and on the third cycle following the procedure for determination of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E(2)), and on day 21 for progesterone (P) levels. All patients were followed for 3 months, and changes in menstrual pattern, presence or absence of dysmenorrhea and ovulation were noted. RESULTS: Menstrual changes occurred in six patients (10%), although only one patient had mild dysmenorrhea (1.6%) after the procedure. The incidence of ovulation was 33% preoperatively, rising to 40% in the cycle when surgery was performed and maintained a constant level at 40% 3 months after tubal ligation. There was no statistically significant difference in the serum FSH, LH and estradiol levels in preoperative and postoperative assessments (p > .05). CONCLUSION: Tubal ligation has been blamed for causing luteal phase defect as a result of an effect on ovarian circulation. In our study, the rate of ovulation was slightly improved after the procedure, and ovarian reserve was not negatively affected. Bipolar electrocoagulation of the fallopian tubes did not alter the ovarian reserve and function.     

Hormonal assessment of women submitted to tubal ligation

Sixteen fertile women aged 30-35 years with regular menstruations were studied before and 6 months after tubal ligation (TL). The diagnosis of ovulation was based on clinical ultrasonographic and hormonal parameters [follicle-stimulating hormone (FSH), luteinizing hormone (LH), E2 and P4]. The menstrual pattern did not vary before and after surgery. Follicular or luteal phase FSH and E2 levels did not differ between the pre- and post-TL period. Luteinizing hormone levels on days -2 and 0 of the follicular phase were significantly higher during the post-TL period, while no difference was observed for the luteal phase. P4 levels during the follicular phase did not differ between the two periods, except for day -4, while they were lower during the post-TL luteal phase. The results of the study suggest that in the present patient group, no modifications in the menstrual pattern could be observed 6 months after TL, and TL appears not to interfere with ovulation. Luteinizing hormone levels showed an increase during the ovulatory period after TL, and progesterone secretion decreased during the post-TL luteal phase.     

Menstrual function after tubal sterilization.

More than 10 million women in the United States have undergone tubal sterilization. There has been concern that this procedure may increase the risk of later menstrual dysfunction. The Collaborative Review of Sterilization (CREST) is a large, multicenter, prospective study of tubal sterilization in the United States. This report describes CREST participants who were interviewed immediately before sterilization and again in annual poststerilization interviews for up to 5 years between 1978 and 1988. The authors analyzed reported changes in six menstrual cycle characteristics for 5,070 women undergoing interval sterilizations. Longitudinal, multivariate regression was used to adjust for baseline menstrual function and other potential confounders. Five years after sterilization, 35% of the CREST participants reported high levels of menstrual pain, 49% reported heavy or very heavy menstrual flow, and 10% reported spotting between periods. In contrast to the fifth year, the first year of follow-up was similar to presterilization menstrual function; in the first year, 27% of participants reported high menstrual pain, 41% reported heavy menstrual flow, and 7% reported spotting. These findings may be affected by aging of the cohort and other study limitations, but they suggest that if tubal sterilization leads to changes in menstrual function, such changes may take some time to develop.     

Assessment of luteal function after surgical tubal sterilization

To evaluate ovarian luteal function after tubal occlusion, a group of women who underwent Pomeroy sterilization were studied. A prospective group I (n=16) were followed for one year and scheduled for blood sampling every other day during their luteal phase before surgical procedure and at 3 and 12 months thereafter. Group II (n=15) included women who were studied during their luteal phase at 1 or 5 years post-surgery. Mid-luteal progesterone and estradiol serum levels were calculated by estimating the average of at least 3 values of serum samples obtained in days 20–25 of a menstrual cycle. The data suggest that no major changes occur in ovarian function after surgical tubal occlusion, as assessed by the mid-luteal hormone serum levels, and underscore the safety of this procedure.     

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.     

Luteal function declines after laparoscopic sterilization by Hulka or Filshie clips

We evaluated the influence of laparoscopic sterilization by Hulka or Fishie clips on corpus luteum function. Changes in corpus luteum function were evaluated in 46 women, before and after sterilization by Hulka (n = 22) or Filshie clips (n = 24). The mean age of the participants was 37 years (range 31-43 years). All women were healthy with regular menstrual cycles. Serum progesterone (P) was measured in one cycle before, and 3 and 12 months after the sterilization on cycle day 20-24. Endometrial biopsies were performed in the luteal phase before and one year after the procedure. The women measured the basal body temperature daily and kept a menstrual diary. The luteal phase P concentrations declined after the sterilization and the values were at the lowest level 3 months after the procedure (27.9 +/- 14.3 nmol/L vs. 18.7 +/- 13.4 nmol/L, = 0.0016). The values seemed to have recovered by 12 months (23.0 +/- 14.0 nmol/L, = 0.114 vs. baseline). Endometrium tended to be out-of-phase more frequently 1 year after the sterilization than before the surgery (= 0.065). Laparoscopic tubal sterilization is associated with an increased risk of luteal phase deficiency. However, the change may be only temporary in nature.     

Hormonal effects of the 300 μg norethisterone (NET) minipill: 2. Daily gonadotrophin levels in 43 subjects during a pretreatment cycle and during the second month of NET administration

The peripheral plasma levels of immunoreactive follicle-stimulating hormone (hFSH) and luteinizing hormone (hLH) were measured daily in 43 normally menstruating women during a pretreatment (control) cycle and during the second month of daily administration of the 300 μg norethisterone (NET) minipill. In addition, the levels of biologically active LH were also determined in 29 of the 43 subjects.

As described in detail in the first paper of these series (1), the 43 women studied exhibited four distinctly different types of ovarian reaction to NET, as indicated by the daily estradiol and progesterone levels. Seven women (16 %) showed neither follicular, nor luteal activity (group A), 10 women (23 %) exhibited a cyclic follicular activity, but no luteal function (group B), 9 women (21 %) had normal follicular function, but insufficient luteal activity (group C), and 17 women (40 %) had estradiol and progesterone levels undistinguishable from those seen in a normal ovulatory cycle (group D).

Administration of the NET minipill did not influence the mean FSH lvel of cycle days 1–6, or those of 3 to 7 days before the LH peak; it slightly decreased the mean luteal phase FSH level in group C, but no in group D, and markedly suppressed the FSH peak value in all groups. There was no difference in this respect between women exhibiting different types of ovarian reaction. Similar to its effect on FSH, the administration of NET did not diminish the mean LH levels of days 1–6, those of 3 to 7 days before the LH peak, or of the luteal phase, but greatly suppressed the LH peak. Again, there was no difference in LH levels during NET administration among women showing different types of ovarian response to the drug. On the other hand, significant differences were found in the LH levels of the pretreatment (control) cycles of the various groups. The mean levels of LH both during days 1–6 and during the luteal phase of the pretreatment cycles were significantly lower in women in whom the minipill subsequently abolished all lutaeal activity (groups A+B) than in women exhibiting different degrees of luteal function (groups C+D). Hence the NET minipill will preferentially inhibit ovulation in women exhibiting relatively low tonic LH-levels in untreated cycles.

The results of the daily LH bioassays were in good agreement with those of the radioimmunoassays.

In the majority of women who exhibited normal (“ovulatory”) estradiol and progesterone profiles during NET administration, the preovulatory FSH, and especially LH peaks were below the lower limit of normal values, and in several instances, normal estradiol and progesterone profiles were found in the virtual absence of any FSH and LH surge.

It is concluded that ovarian suppression by the NET minipill is unrelated to the degree of inhibition of FSH and LH secretion as far as this is reflected by their peripheral levels measured daily.     

On the mechanisms of action of short-term levonorgestrel administration in emergency contraception.

The effects of short-term administration of levonorgestrel (LNG) at different stages of the ovarian cycle on the pituitary-ovarian axis, corpus luteum function, and endometrium were investigated. Forty-five surgically sterilized women were studied during two menstrual cycles. In the second cycle, each women received two doses of 0.75 mg LNG taken 12 h apart on day 10 of the cycle (Group A), at the time of serum luteinizing hormone (LH) surge (Group B), 48 h after positive detection of urinary LH (Group C), or late follicular phase (Group D). In both cycles, transvaginal ultrasound and serum LH were performed from the detection of urinary LH until ovulation. Serum estradiol (E2) and progesterone (P(4)) were measured during the complete luteal phase. In addition, an endometrial biopsy was taken at day LH + 9. Eighty percent of participants in Group A were anovulatory, the remaining (three participants) presented significant shortness of the luteal phase with notably lower luteal P4 serum concentrations. In Groups B and C, no significant differences on either cycle length or luteal P4 and E2 serum concentrations were observed between the untreated and treated cycles. Participants in Group D had normal cycle length but significantly lower luteal P4 serum concentrations. Endometrial histology was normal in all ovulatory-treated cycles. It is suggested that interference of LNG with the mechanisms initiating the LH preovulatory surge depends on the stage of follicle development. Thus, anovulation results from disrupting the normal development and/or the hormonal activity of the growing follicle only when LNG is given preovulatory. In addition, peri- and post-ovulatory administration of LNG did not impair corpus luteum function or endometrial morphology.     

利津县部分育龄妇女实施输卵管结扎术避孕10年综合效果评价

[目的]了评价实施输卵管结扎手术对妇女身体健康的影响，为今后开展工作提供可行的科学依据。[方法]2005年，对利津县1995年实施输卵管结扎手术避孕的200名育龄妇女（实验组）进行调查，并与未实施输卵管结扎手术避孕的200名育龄妇女（对照组）比较。[结果]性欲增强、性欲降低、月经期延长、月经期缩短者所占比例，实验组分别为6．5％、4．0％、8．0％、10．0％，对照组分别为5．5％、4．0％、12．0％、7．0％（P〉0．05）；白带增多、白带减少、附件炎患病率，实验组分别为5．0％、3．5％、5．0％，对照组分别为8．0％、2．5％、9．0％（P〉0．05）；子宫颈炎患病率，实验组为5．0％，对照组为11．0％（P〈0．05）；雌激素水平低于正常水平者所占比例，实验组为2．0％，对照组为2．5％（P〉0．05）；1995-2005年中，实验组无1人怀孕，对照组有38人怀孕46人次。[结论]实施输卵管结扎手术避孕的效果很好，对妇女的身体健康无不良影响。     

Laparoscopic tubal sterilization: long-term postoperative follow-up.

93 women who underwent laparoscopic tubal coagulation during 1972-1973 were followed up for periods of 18 months to 3 years. Ages ranged from 17 to 47 years (mean 30.7) and 71% had 2-4 children. 8 requested sterilization prior to conception and 5 had pregnancy previously terminated by abortion. Most common postoperative complaints were tenderness at the incision site and shoulder or neck pain. In the 64 cases in which sterilization alone was performed average blood loss was less than 50 cc. In 8 cases it was associated with diagnositc dilatation and curettage, in 20 with therapeutic abortion, and in 1 with laparotomy. Complications included 1 case each of bleeding mesosalpinx controlled by cautery, wound hematoma, hematoma epiploic appendix, and peritoneal burn. A detailed menstrual history 18-36 months after operation found 73 of the 93 had regular periods with amount of bleeding and length of cycle generally unchanged. Of the 20 with menstrual changes, 2 developed amenorrhea within 1 year and 8 with preoperative menstrual irregularities were unchagned. 10 developed longer periods and/or shorter intervals. 5 related these changes to discontination of oral contraceptives. Of the remaining 1 had an abnormal Pap smear, 2 were 40-45 years of age (1 of whom refused vaginal hysterectomy for stress incontinence), and 2 were 35-40 with no previous history of cesarean sections or pelvic complaints. The majority (77%) of the women were satisfied with the procedure, 16% uncertain, and 5 patients expressed regret. 4 of the 5 who regretted the operation reported gynecological complaints. 5 required subsequent surgery. In 3 of the 5 the indication preexisted the sterilization and a more thorough screening might have prevented 2 surgical procedures. In this series the incidence of postoperative gynecological disease 18-36 months after laparoscopic tubal ligation is significantly lower than that reported in the literature for conventional tubal ligation.     

Abnormal endocrine profile among women with confirmed or presumed ovulation during long-term Norplant use

FSH, LH, estradiol and progesterone were serially assayed during 8 cycles of six subjects using six subdermal implants releasing levonorgestrel (NORPLANT) for a period of 2 to 6 years. All 8 cycles studied had a very low LH peak and a low or nonexistent FSH peak as compared to 8 control cycles. The mean LH peak for NORPLANT users was 33.9 mIU/ml as compared to 142 mIU/ml in the control group; and FSH was 13.0 mIU/ml as compared to 31.3 mIU/ml in controls. A subsequent rise in progesterone was observed in the 8 cycles studied, but the mean mid-luteal levels were significantly lower than in controls (9.0 ng/ml vs. 15.6 ng/ml). No differences were observed in the estradiol curve. Two of the subjects using NORPLANT had a laparotomy performed on days 17 and 20 of the cycle, for surgical sterilization purposes. A distinctive corpus luteum with a stigma was observed. Our results indicate that women under prolonged use of NORPLANT do not have normal endocrine cycles, even though they may ovulate. It is doubtful however, that these ovulatory cycles can be fertile under the abnormal endocrine conditions found in our subjects. In addition to the possible effect of luteal insufficiency, the normal maturation of the oocyte may be impaired.     

Clitoral artery blood flow in healthy young women: preliminary report on menstrual cycle and hormonal contraception

The aim of the present study was to measure clitoral artery blood flow throughout the menstrual cycle and in oral contraceptive users. We recruited healthy young women (n = 19, age range: 21-28 years; body-mass index: 18-23 kg/m2) without sexual dysfunction (Female Sexual Functioning Index criteria; Rosen et al., 2000). Clitoral arterial peak systolic velocity (PSV) in at least two phases of the same ovulatory cycle or during the second week of the pill was measured by doppler ultrasonography. Clitoral arterial PSV measures (cm/s) were superimposable during the follicular and the luteal phase of the menstrual cycle (10.4 +/- 1.2 versus 10.2 +/- 1.6), whereas a slight but significant increase (12.2 +/- 1.2, f = 3.99; p < 0.04) was evident at the time of ovulation. In addition, PSV measures were significantly higher in women taking hormonal contraception compared to women studied throughout the menstrual cycle (14.2 +/- 2.7 versus 10.8 +/- 1.5; p < .001). Whether or not these preliminary data may be of any significance to female sexual arousal throughout the menstrual cycle remains to be established.     

Serum leptin concentrations during the menstrual cycle in Iranian healthy women

Leptin, a circulating 16-kd polypeptide consisting of 167 amino acids, appears to be involved in the body weight homeostasis. Moreover leptin plays an important role for the reproductive system, early embryogenesis, and fat metabolism during pregnancy and puberty. Significant correlations have been found between leptin and sexual hormones, which is a cytokine and has hormonal properties. The aim of this study was to determine serum leptin levels during the menstrual cycle, and the association between serum leptin and reproductive hormones in young, healthy Iranian women. 42 healthy women volunteered for the study. They all had regular menstrual cycles, with cycle length varying between 26 and 32 days. None of them used oral contraceptives. All were of normal weight, with body mass index ( BMI) < 25 Kg/m2. Fasting blood samples were collected during the follicular phase, mid cycle and luteal phase of the menstrual cycle. FSH and LH were measured with coated tube immunoradiometric assay. Estrogen and progesterone were measured using antibody -coated tubes. Serum Leptin concentration were measured by Leptin (sandwich) ELISA. In menstruating women, serum leptin increased from 13.15+/-1.60 ng/ml in the early follicular phase to 16.57+/-1.68 ng/ml (P<0.01) at the luteal phase. Serum leptin concentration negatively correlated with LH and progesterone (P<0.05). Mean serum leptin levels correlated with body mass index (BMI) (r =0.78, P<0.001).     

101例使用5年以上短效口服避孕药的安全性调查

目的:评价长期使用短效口服避孕药对身体健康的影响。方法:对连续服用国产短效口服避孕药5年以上101例(服药组)采用问卷调查和体格检查,并与5年前使用输卵管结扎103例妇女(结扎组)进行对照。两组妇女使用措施时间、平均体重均无统计学差异,但结扎组平均年龄高于服药组(P<0.05),妊娠次数与孩子数明显高于服药组(P<0.001)。结果:服药组组内前后月经情况比较,服药后月经周期缩短、经量减少(P<0.01),经期≥8天者比率显著减少,无痛经主诉的比率明显增加(P<0.05);服药组和结扎组组间比较,经期≥8天者的比率明显低于结扎组,经量显著低于结扎组(P<0.01),轻度痛经者的比率明显高于结扎组(P<0.05);两组生殖系统疾病比较,乳腺小叶增生的发生率服药组明显低于结扎组(P<0.001);高血压及其它疾病比较无统计学差异。结论:长期使用短效口服避孕药总体是安全的,并对月经情况有益。     

控制性超促排卵对正常妇女心脏物理学的影响

目的:通过对正常妇女自然周期和控制性超促排卵过程中监测心脏彩超,探讨控制性超促排卵对心脏物理学的影响。方法:选择2005年2月～2008年10月,在青岛市妇女儿童医疗保健中心接受IVF-ET治疗单纯输卵管因素或男方因素的患者48例,采用每例患者促排卵周期和自然周期自身对照,分别于自然周期月经第3天、LH日、降调后月经第3天及HCG日进行内分泌激素和心脏彩超检测。结果:自然周期月经第3天与降调后月经第3天及自然周期LH日与促排周期HCG日的心脏结构各腔室、心室壁厚度、心脏血流动力学、心室顺应性相比较无统计学差异(P0.05)。结论:控制性超促排卵对女性心血管系统从心脏物理学角度没有明显影响,是比较安全的。     

Menstrual cycle in women addicted to alcohol during the first week following drinking cessation--changes of sex hormones levels in relation to selected clinical features

AIMS: To assess the prevalence of hormonal dysfunction in women addicted to alcohol during first week following drinking cessation; to determine whether fluctuations of hormone levels in follicular, ovulation and luteal phases in addicted women are equal to those normally found in healthy women; to determine the association between hormonal imbalances with selected clinical features. METHODS: Biochemical parameters of liver function and hormone levels were assessed in 30 women treated for 30 days in a Short Term Therapy and Detoxification Ward. The following hormones were measured: prolactin (PROL), folliculotropin (FSH), luteotropin (LH), estradiol (ES) and testosterone (TEST)--(i) after menstruation, at follicular phase, between 5th and 7th day of the cycle; (ii) around ovulation, 11-14th day of the cycle; and (iii) before menstruation, at luteal phase, between 19th and 22th day of the cycle. RESULTS: Mean PROL levels in all three cycle phases and progesterone level in follicular phase were above, while mean TEST level was below, the reference values. Over 50% of women had abnormally increased PROL values in all phases of the cycle while decreased values of PROG or LH were found in approximately 50% and >30% of study women. CONCLUSIONS: The menstrual cycle disturbances in alcoholic women are most prominent around the middle part of the cycle and age influences the pattern of hormonal changes.     

Tubal ligation, menstrual changes, and menopausal symptoms

One of the problematic effects of tubal sterilization is menstrual changes or disorders, although the results of studies in this area have been inconsistent and inconclusive. Recently, there has been growing evidence that tubal sterilization protects against ovarian cancer, possibly through physiological transformations that result in ovarian dysfunction and decline. This report explores the possibility that the biological mechanism of ovarian dysfunction and decline may affect the menstrual and menopausal changes that result from hormonal imbalances. Using data from a homogeneous population of college alumnae assessed for health status, athletic history, and lifestyle characteristics, we focused on a premenopausal subgroup of women in the age range of 40-44 years and with at least one pregnancy. Multivariate analyses were performed to compare sterilized women (n = 56/516, 11%) in this subgroup with nonsterilized women (89%). The two groups were alike in mean age, mean parity, body mass index, smoking history, physical activity levels, and athletic status. Factors that significantly distinguished sterilized women from nonsterilized women were perimenopausal symptoms, such as flushing, sweating, breast pain, vaginal dryness, and pain associated with menstrual cycles.     

A nonhormonal model for emergency contraception: prostaglandin synthesis inhibitor effects on luteal function and lifespan,a pilot study

ObjectivesThe purpose of this study is to determine if the use of a specific prostaglandin endoperoxide-2 inhibitor will prevent luteal development in women.Study DesignOvulatory reproductive-aged women not using or needing hormonal contraception were prospectively followed for three menstrual cycles. Women were randomized into two groups using a crossover design [Group 1: control cycle, placebo cycle, active drug (celecoxib 400 mg orally) cycle; Group 2: control cycle, celecoxib cycle, placebo cycle]. Study drug was dosed daily until the onset of the next menses. Demographics, menstrual cycle length and twice-weekly progesterone (P) levels during the placebo and active drug cycles were recorded. End points included the change in luteal phase P levels and menstrual cycle length (days) during active drug exposure.ResultsA total of 11 women completed the study (Group 1, n=7; Group 2, n=4). No demographic differences were found between groups [age, race, body mass index (BMI), control cycle length]. A comparison of the control and active drug cycles for all participants demonstrated a trend toward a longer menstrual cycle with active drug exposure [control, 27.2 days (SD, 2.4); study drug, 28.5 days (SD, 2.5), p=.09]. Five women had a delay in the rise of their luteal phase P levels, two women had lower peak P levels and two women had no elevation of luteal phase P levels during active drug cycle as compared to placebo cycle.ConclusionDaily administration of a prostaglandin synthesis inhibitor may delay the timing of luteal events and, therefore, fertility in women. PTGS2 inhibitors may hold potential as an emergency contraceptive.