Modelling menstrual cycle length in athletes using state-space models.

The ability to predict an individual's menstrual cycle length to a high degree of precision could help female athletes to track their period and tailor their training and nutrition correspondingly. Such individualisation is possible and necessary, given the known inter-individual variation in cycle length. To achieve this, a hybrid predictive model was built using data on 16,524 cycles collected from a sample of 2125 women (mean age 34.38 years, range 18.00-47.10, number of menstrual cycles ranging from 4 to 53). A mixed-effect state-space model was fitted to capture the within-subject temporal correlation, incorporating a Bayesian approach for process forecasting to predict the duration (in days) of the next menstrual cycle. The modelling procedure was split into three steps (1) a time trend component using a random walk with an overdispersion parameter, (2) an autocorrelation component using an autoregressive moving-average model, and (3) a linear predictor to account for covariates (e.g. injury, stomach cramps, training intensity). The inclusion of an overdispersion parameter suggested that [Formula: see text] [Formula: see text] of cycles in the sample were overdispersed. The random walk standard deviation for a non-overdispersed cycle is [Formula: see text] [1.00, 1.09] days while under an overdispersed cycle, the menstrual cycle variance increase in 4.78 [4.57, 5.00] days. To assess the performance and prediction accuracy of the model, each woman's last observation was used as test data. The root mean square error (RMSE), concordance correlation coefficient and Pearson correlation coefficient (r) between the observed and predicted values were calculated. The model had an RMSE of 1.6412 days, a precision of 0.7361 and overall accuracy of 0.9871. In conclusion, the hybrid model presented here is a helpful approach for predicting menstrual cycle length, which in turn can be used to support female athlete wellness.

Experiências das mulheres quanto às suas trajetórias até o diagnóstico de endometriose / Experiencias de mujeres en cuanto a sus trayectorias hasta el diagnóstico de endometriosis / Experiences of women regarding their pathways to the diagnosis of endometriosis

Resumo Objetivo descrever as experiências das mulheres sobre as suas trajetórias desde o início dos sintomas até o diagnóstico da endometriose. Método pesquisa descritiva, qualitativa, realizada com dez mulheres com diagnóstico de endometriose no município do Rio de Janeiro (RJ), Brasil. Coletaram-se entrevistas semiestruturadas áudio gravadas e posteriormente submetidas à Análise de Conteúdo por meio do software Atlas.ti 8. Resultados sem o diagnóstico de endometriose, as mulheres vivenciam sintomas fortes desde a menarca. Essa situação repercute negativamente em diferentes esferas da vida, inclusive pela desvalorização de suas queixas em seus círculos de convivência. Assim, entende-se a importância da rede de apoio perante essa situação. Diante desse contexto, as mulheres peregrinam por diversos profissionais até o diagnóstico definitivo. Considerações finais e implicações para a prática as trajetórias dessas mulheres são marcadas pela desvalorização de suas queixas por profissionais de saúde e pessoas próximas, pela naturalização da dor feminina e pela dificuldade em estabelecer um diagnóstico diferencial. No entanto, a capacidade individual de reconhecer a presença de uma patologia, o conhecimento sobre a endometriose e a experiência do profissional facilitaram o diagnóstico. No contexto da assistência de enfermagem, entender essa trajetória pode promover a escuta ativa, melhor valorização das queixas, avaliação clínica e o encaminhamento para o diagnóstico precoce.

Resumen Objetivo describir las vivencias de las mujeres en sus trayectorias desde el inicio de los síntomas hasta el diagnóstico de endometriosis. Método investigación descriptiva cualitativa realizada con diez mujeres diagnosticadas con endometriosis en la ciudad de Río de Janeiro (RJ), Brasil. Se recogieron entrevistas semiestructuradas grabadas en audio y posteriormente se sometieron a Análisis de Contenido utilizando el software Atlas.ti 8. Resultados sin el diagnóstico de endometriosis, las mujeres experimentan síntomas fuertes desde la menarquia. Esta situación tiene un impacto negativo en diferentes ámbitos de la vida, incluso por la devaluación de sus quejas en sus círculos de convivencia. Así, se comprende la importancia de la red de apoyo en esta situación. Ante este contexto, las mujeres deambulan por diferentes profesionales hasta el diagnóstico definitivo. Consideraciones finales e implicaciones para la práctica las trayectorias de estas mujeres están marcadas por la devaluación de sus quejas por parte de los profesionales de la salud y personas cercanas, por la naturalización del dolor femenino y por la dificultad para establecer un diagnóstico diferencial. Sin embargo, la capacidad del individuo para reconocer la presencia de una patología, el conocimiento sobre la endometriosis y la experiencia del profesional facilitaron el diagnóstico. En el contexto del cuidado de enfermería, comprender esta trayectoria puede promover la escucha activa, mejor valoración de las quejas, evaluación clínica y la derivación para diagnóstico precoz.

Abstract Objectives to describe the experiences of women on their trajectories from the beginning of symptoms to the diagnosis of endometriosis. Method descriptive, qualitative research, conducted with ten women diagnosed with endometriosis in the city of Rio de Janeiro (RJ), Brazil. Audio recorded semi-structured interviews were collected and later submitted to Content Analysis using Atlas.ti 8 software. Results without the diagnosis of endometriosis, women experience strong symptoms from the menarche. This situation has a negative impact on different spheres of life, including the devaluation of their complaints in their circles of coexistence. Thus, the importance of the support network in this situation is understood. Faced with this context, women wander through various professionals until the definitive diagnosis. Final considerations and implications for practice the trajectories of these women are marked by the devaluation of their complaints by health professionals and people close to them, by the naturalization of female pain and by the difficulty in establishing a differential diagnosis. However, the individual's ability to recognize the presence of a pathology, the knowledge about endometriosis and the professional's experience facilitated the diagnosis. In the context of nursing care, understanding this trajectory can promote active listening, better appreciation of complaints, clinical assessment and referral to early diagnosis.

Cervical-Vaginal Mucin in Fertility Assessment: CA125 as a Predictor of the Fertile Phase of the Normal Menstrual Cycle.

: To evaluate the cervical-vaginal mucin, CA125, as a measure of fertility and possible method for natural family planning (NFP). Cervical-vaginal fluid (CVF) swab samples have been previously used to measure CA125, 'Qvaginal CA125 levels', as a function of time of cycle relative to Day 0, the first day of positive urine LH (luteinizing hormone). Data from 15 women, 20 cycles were used with an algorithm to establish the Fertile Start Day (FSD) for the cycles. The FSD was determined as either the second consecutive day of ≥20% Qvaginal CA125 rise or the first day of ≥400% rise. The interval, (FSD to Day +3), was used as the theoretical window of fertility, and conception rates assuming abstinence during this predicted period of fertility were computed using published day-specific probabilities of conception (PoC). The mean FSD was Day -4.8 ± 0.5 (SE), 95% CI (-5.9, -3.7). The estimated pregnancy failure rate (PFR) with abstinence during [FSD, +3] was 10.7% ± 2.0% (SE), 95% CI (6.9%, 14.8%); with exclusion of one cycle with very low levels of Qvaginal CA125, the estimated PFR was 9.8% ± 1.9%, 95% CI (6.3%, 13.8%). Furthermore, the day-specific Qvaginal CA125 values were normalized to the respective peak Qvaginal CA125 for each cycle, and a mean normalized day-specific Qvaginal CA125 plot was generated. The first derivative of the mean normalized day-specific Qvaginal CA125 plot showed a significant increase between Day -4.5 and Day -3.5, which correlated with the mean FSD. A Qvaginal CA125-based method holds promise as a means to identify the start of the fertile window and may prove useful in NFP, especially when combined with available home hormonal fertility awareness kits.

The effect of the menstrual cycle on running economy.

BACKGROUND: The aim of this study was to examine the effect of the menstrual cycle on running economy (RE). METHODS: Using a repeated-measures design, ten eumenorrheic, trained female runners (age: 32±6 yrs, V̇O2max: 59.7±4.7 mL·kg-1·min-1) completed four, weekly, identical sub-maximal and maximal incremental step tests on a treadmill to measure physiological responses across a full menstrual cycle. For phase comparison, the results from the trials that fell in the early follicular (low estrogen, low progesterone), late follicular (high estrogen, low progesterone) and mid-luteal (high estrogen, high progesterone) phases were used. RESULTS: There was a significant effect of menstrual cycle phase on RE (P=0.001), with RE in the mid-luteal (ML) phase being worse than that of the early follicular (EF) (+2.33 mL·kg-1·min-1; P=0.026) and late follicular (LF) (+2.17 mL·kg-1·min-1; P=0.011) phases. The ML phase also resulted in elevated core temperature versus the EF (+0.51 ºC; P=0.001) and LF (+0.66 ºC; P=0.037) phases, and elevated minute ventilation versus the EF phase (+3.83 L·min-1; P=0.003). No significant effects of menstrual cycle phase were found on body mass, heart rate, ratings of perceived exertion, time-to-exhaustion, maximal oxygen consumption, or blood lactate concentration. CONCLUSIONS: In the ML phase, which causes increased core temperature and minute ventilation, RE is impaired at exercise intensities that are applicable to training and performance. In physiologically stressful environments, this impairment in RE may have a significant impact on training and performance.

Identifying menstrual migraine- improving the diagnostic criteria using a statistical method.

OBJECTIVE: To develop a robust statistical tool for the diagnosis of menstrually related migraine. BACKGROUND: The International Classification of Headache Disorders (ICHD) has diagnostic criteria for menstrual migraine within the appendix. These include the requirement for menstrual attacks to occur within a 5-day window in at least [Formula: see text] menstrual cycles ([Formula: see text]-criterion). While this criterion has been shown to be sensitive, it is not specific. Yet in some circumstances, for example to establish the underlying pathophysiology of menstrual attacks, specificity is also important, to ensure that only women in whom the relationship between migraine and menstruation is more than a chance occurrence are recruited. METHODS: Using a simple mathematical model, a Markov chain, to model migraine attacks we developed a statistical criterion to diagnose menstrual migraine (sMM). We then analysed a data set of migraine diaries using both the [Formula: see text]-criterion and the sMM. RESULTS: sMM was superior to the [Formula: see text]-criterion for varying numbers of menstrual cycles and increased in accuracy with more cycle data. In contrast, the [Formula: see text]-criterion showed maximum sensitivity only for three cycles, although specificity increased with more cycle data. CONCLUSIONS: While the ICHD [Formula: see text]-criterion is a simple screening tool for menstrual migraine, the sMM provides a more specific diagnosis and can be applied irrespective of the number of menstrual cycles recorded. It is particularly useful for clinical trials of menstrual migraine where a chance association between migraine and menstruation must be excluded.

The role of cine MR imaging in the assessment of uterine function.

PURPOSE: To review the literature on uterine contraction and to highlight magnetic resonance imaging using the cine technique as a useful method to evaluate these movements. METHODS: The literature research on PubMed database was done up to February 2019 with restriction to English language about articles regarding uterine peristalsis and cine MR. RESULTS: Infertility is a common clinical problem and a source of frustration for those who want to have children. Uterine movements are crucial elements in respect of successful conception, implantation, and the development of a healthy pregnancy. It is known that the direction and frequency of uterine peristalsis are closely related to the different phases of the menstrual cycle, and that changes in its activity may interfere with reproduction. One condition that has been linked with infertility by several studies is dysfunctional uterine contractility. Magnetic resonance imaging, using the cine technique, has been shown to be a useful tool in the evaluation of these movements, allowing the identification of patients with some type of dysfunction and establish strategies to increase pregnancy rates. CONCLUSION: Cine MR is an excellent imaging method for the evaluation of uterine peristalsis and identification of dysfunctional contractions.

Breast Density Assessment in Young Women with Ultrasound based on Speed of Sound: Influence of the Menstrual Cycle.

To investigate changes in breast density (BD) during the menstrual cycle in young women in comparison to inter-breast and -segment changes as well as reproducibility of a novel Speed-of-Sound (SoS) Ultrasound (US) method.SoS-US uses a conventional US system with a reflector and a software add-on to quantify SoS in the retro-mammillary, inner and outer segments of both breasts. Twenty healthy women (18-40 years) with regular menstrual cycles were scanned twice with two weeks in-between. Three of these were additionally measured twice per week for 25 days. Average SoS (m/s) and ΔSoS (segment-variation SoS; m/s) were measured. Variations between follicular and luteal phases and changes over the four-week period were assessed. Inter-examiner and inter-reader agreements were also evaluated. Variances between cycle phases, examiners and readers were compared.No significant SoS difference was observed between follicular and luteal phases for the twenty women (P = .126), and between all different days for the three more frequently measured women (P = .892). Inter-reader (ICC = 0.999) and inter-examiner (ICC = 0.990) agreements were high. The SoS variance due to menstrual variations was not significantly larger than the inter-examiner uncertainty (P = .461). Inter-reader variations were significantly smaller than menstrual and examiner variations (P < .001).SoS-US showed high inter-examiner and inter-reader reproducibility. The alterations during the menstrual cycles were not significantly larger than the confidence interval of measurements.

Effects of the Menstrual Cycle on Running Economy: Oxygen Cost Versus Caloric Cost.

Purpose: This study investigated the effects of the menstrual cycle on running economy (RE). Method: Eleven eumenorrheic female athletes (mean age: 21.18 ± 3.65 years, height: 170.2 ± 6.6 cm, VO2max: 49.25 ± 9.15 mL·kg-1·min-1, and menstrual cycle: 29.8 ± 0.98 days) were tested for anthropometric variables, physiological responses (oxygen consumption [VO2], blood lactate [LA], heart rate [HR], and respiratory exchange ratio [RER]) at rest and while running. The RE was measured at speeds of 75%, 85%, and 95% of the lactate threshold at 3.5 mmol·L-1 during the follicular (FP) and luteal phases (LP) of the menstrual cycle. The RE was evaluated as oxygen consumption (mL·kg·min-1 [O2C_min], mL·kg-1·km-1 [O2C_km]) and caloric unit cost (kcal·kg-1·km-1 [EC]) during both phases. Results: There were no significant differences in body composition or resting physiological measurements between the LP and FP (p > .05). Physiological responses measured during RE tests were similar in both phases (p > .05). The RE measured as O2C_min, O2C_km, and EC was significantly lower during the LP than during the FP (p < .05). The RE defined as O2C_ min significantly increased with speed (p < .05), but RE defined as O2C_km and EC was unaffected by speed increment (p > .05). Conclusions: The RE is better in the LP than the FP and is independent of running speed when RE is evaluated as O2C_km and EC. The menstrual cycle had no effect on body composition and physiological variables measured at rest.

Perimenstrual exacerbation of symptoms in borderline personality disorder: evidence from multilevel models and the Carolina Premenstrual Assessment Scoring System.

BACKGROUND: Individuals with a borderline personality disorder (BPD) suffer from a constellation of rapidly shifting emotional, interpersonal, and behavioral symptoms. The menstrual cycle may contribute to symptom instability among females with this disorder. METHODS: Fifteen healthy, unmedicated females with BPD and without dysmenorrhea reported daily symptoms across 35 days. Urine luteinizing hormone and salivary progesterone (P4) were used to confirm ovulation and cycle phase. Cyclical worsening of symptoms was evaluated using (1) phase contrasts in multilevel models and (2) the Carolina Premenstrual Assessment Scoring System (C-PASS), a protocol for evaluating clinically significant cycle effects on symptoms. RESULTS: Most symptoms demonstrated midluteal worsening, a perimenstrual peak, and resolution of symptoms in the follicular or ovulatory phase. Post-hoc correlations with person-centered progesterone revealed negative correlations with most symptoms. Depressive symptoms showed an unexpected delayed pattern in which baseline levels of symptoms were observed in the ovulatory and midluteal phases, and exacerbations were observed during both the perimenstrual and follicular phases. The majority of participants met C-PASS criteria for clinically significant (⩾30%) symptom exacerbation. All participants met the emotional instability criterion of BPD, and no participant met DSM-5 criteria for premenstrual dysphoric disorder (PMDD). CONCLUSIONS: Females with BPD may be at elevated risk for perimenstrual worsening of emotional symptoms. Longitudinal studies with fine-grained hormonal measurement as well as hormonal experiments are needed to determine the pathophysiology of perimenstrual exacerbation in BPD.

Predictors of premenstrual impairment among women undergoing prospective assessment for premenstrual dysphoric disorder: a cycle-level analysis.

BACKGROUND: Women who experience significant premenstrual symptoms differ in the extent to which these symptoms cause cyclical impairment. This study clarifies the type and number of symptoms that best predict premenstrual impairment in a sample of women undergoing prospective assessment for premenstrual dysphoric disorder (PMDD) in a research setting. Central research goals were to determine (1) which emotional, psychological, and physical symptoms of PMDD are uniquely associated with premenstrual impairment, and (2) how many cyclical symptoms optimally predict the presence of a clinically significant premenstrual elevation of impairment. METHOD: A total of 267 naturally cycling women recruited for retrospective report of premenstrual emotional symptoms completed daily symptom reports using the Daily Record of Severity of Problems (DRSP) and occupational, recreational, and relational impairment for 1-4 menstrual cycles (N = 563 cycles). RESULTS: Multilevel regression revealed that emotional, psychological, and physical symptoms differ in their associations with impairment. The core emotional symptoms of PMDD were predictors of impairment, but not after accounting for secondary psychological symptoms, which were the most robust predictors. The optimal number of premenstrual symptoms for predicting clinically significant premenstrual impairment was four. CONCLUSION: Results enhance our understanding of the type and number of premenstrual symptoms associated with premenstrual impairment among women being evaluated for PMDD in research contexts. Additional work is needed to determine whether cognitive symptoms should receive greater attention in the study of PMDD, and to revisit the usefulness of the five-symptom diagnostic threshold.

Assessment of the menstrual cycle, eating disorders and self-esteem of Polish adolescents.

INTRODUCTION: Eating disorders are an important factor in menstrual cycle disorders in girls. Moreover, low self-esteem among adolescent girls may be a risk factor for eating disorders. The aim of the study was to assess the menstrual cycle, eating habits and self-esteem of Polish adolescents. METHODS: The study was conducted from January 2014 to March 2015 and included 623 girls, aged 15-19, from randomly selected junior high schools in Silesia, Poland, in which their menstrual cycle, risk of eating disorders and self-esteem were evaluated. A five-part questionnaire was used to assess basic demographic data, lifestyle and physical activity, gynecological history, as well as Rosenberg Self-Esteem Scale (SES) and Eating Attitude Test (EAT-26). RESULTS: Irregular menstrual cycles were observed in 236 (37.88%) girls; 5.20% presented secondary amenorrhea. Based on the EAT-26 test, 101 (16.21%) girls were indicated being at risk for an eating disorder. Low self-esteem was observed in 340 (54.57%) study girls on the base of SES. DISCUSSION: Girls with irregular menses had higher scores on the EAT-26 test in subscales: EAT-overall score, EAT-diet and EAT-bulimia, while lower scores on the SES. In our study, we did not observe a significant relationship between exercise intensity, body mass, BMI and menstrual cycle regularity. Low self-esteem among adolescent girls may be a risk factor for eating disorders which could interrupt the menstrual cycle.

Influence of Knowledge of Spousal Fertility Cycles on Male Reproductive Health Participation in Ibadan Metropolis, Nigeria.

In spite of the established roles and influence of men on women's uptake and utilization of reproductive health care interventions, the degree of involvement with intimate issues within the household which could help to understand male involvement and support remains an under-researched topic. The aim of this study was to investigate the degree of involvement at the family level of men within sub-urban communities of Ibadan in South-West Nigeria. A cross sectional survey design was conducted among 380 men selected from sub-urban communities in Ibadan, Oyo State using multi-stage sampling. Data was obtained using pre-tested, semi-structured, interviewer administered questionnaires. Data were analysed using descriptive statistics, bivariate analysis and logistic regression with level of significance set at 5%. Mean age of respondents was 41.1 ± 7.6 years. Men who were knowledgeable of spouse's menstrual cycles and ovulation dates were significantly more likely to have supported some form of public health intervention before (p <0.001). Age over 30, above secondary education, and men aware of menstrual dates of spouse were significant predictors of reproductive health interventions. Men who were aware of menstrual cycles of spouse were 96.6% more likely to be supportive or involved in reproductive health matters compared to those who were not (OR =0.034; 95% CI = 0.02 - 0.07; p <0.001). Involvement of men at family level as demonstrated in this study serves to influence and explain the level of involvement with reproductive health. Further research investigating other proximal factors that influence male participation is recommended.

There is a Positive Correlation Between Socioeconomic Status and Ovarian Reserve in Women of Reproductive Age.

BACKGROUND The purpose of this study was to investigate the potential association between socioeconomic status and ovarian reserve, anti-Mullerian hormone level, antral follicle count, and follicle stimulating hormone level in women of reproductive age. MATERIAL AND METHODS A total of 101 married women between 20-35 years of age who presented to the Department of Obstetrics and Gynecology, Health Research System In Vitro Fertilization (HRS IVF) Center between October 2014 and November 2015 and met the inclusion criteria were included in this study. The participants were divided into three socioeconomic groups using Kuppuswamy's socioeconomic status scale. Thirty-one participants were assigned to the low socioeconomic status group, 37 to the middle socioeconomic status group, and 33 to the high socioeconomic status group. On days 3-6 of the menstrual cycle, 10 mL of blood was collected from the participants for follicle stimulating hormone and anti-Mullerian hormone measurements. Transvaginal ultrasonography was performed for both ovaries for the purpose of counting antral follicles measuring 2-10 mm in diameter. RESULTS Both ovarian reserve parameters, namely anti-Mullerian hormone level and antral follicle count, exhibited a significant association with socioeconomic status (p=0.000 and p=0.000, respectively). The association between follicle stimulating hormone level and socioeconomic status was also significant (p=0.000). CONCLUSIONS A low socioeconomic status aggravated by sources of stress such as undernutrition and financial hardships affects ovarian reserve, which should be remembered in approaching infertile patients.

[Endometriosis : An often unrecognized pain disorder]. / Endometriose : Eine oft verkannte Schmerzerkrankung.

Endometriosis is a chronic disease of women during their reproductive age. The most typical symptoms are dysmenorrhoea, dyspareunia, dysuria, cyclical and acyclical pelvic pain, bleeding disorders and infertility. These symptoms lead to significant impairment of the quality of life and economic burden. The prevalence is estimated to be 2-20 % of all women in this age and due to this fact, it is one of the most frequently benign gynecological diseases. Not all women suffer from severe symptoms, but more than 50 % require ongoing treatment. Beside the severe physical impairment due to the pain, the high recurrence rate of 50-80 % also after surgical and/or hormonal treatment is problematic. The interval between onset of symptoms and diagnosis is approximately 6-8 years. These problems are a consequence of lack of knowledge about the pathogenesis of the disease and the pain mechanisms as well as the lack of awareness of physicians in this field.

Assessment of the endothelial function with changed volume of brachial artery by menstrual cycle.

BACKGROUND: The endothelial function has been proven to be an important factor in the pathogenesis of atherosclerosis, hypertension and heart failure. The flow-mediated vasodilation (FMD) of the peripheral artery is an endothelium-dependent function. Brachial-artery ultrasound scanning is the popular method for evaluating FMD. However, good technical training on ultrasonography is required for the user to obtain high-quality data. Therefore, the goal of this study was to propose a new method which only used a sphygmomanometer cuff to occlude the blood flow and record the vascular volume waveform (Vwave). RESULTS: We used this method to assess the FMD in the menstrual cycle for 26 volunteer females. All female subjects were evaluated two times (M: menstrual phase; F: luteal phase) in one menstrual cycle and for two cycles. In the first cycle, the FMD volume ratio in M was 101.9 ± 45.5 % and was higher in L, at 137.5 ± 62.1 % (p = 0.0032 versus M). In the second cycle, the FMD volume ratios in M and L were 91.4 ± 37.0 % and 124.0 ± 56.4 %, respectively (p < 0.001 vs. M). CONCLUSIONS: Our results have confirmed those results in the study of Hametner et al. Blood pressure measurement and FMD assessment all used the same mechanic of digital blood pressure monitor, which makes our method suitable using at home.

Women's Knowledge of Ovulation, the Menstrual Cycle, and Its Associated Reproductive Changes.

BACKGROUND: The purpose of this study was to examine women's knowledge of female reproduction-anatomy, hormones and their functions, ovulation, the menstrual cycle and its associated reproductive changes, conception, and signs of pregnancy. METHODS: A survey was completed by 125 women of childbearing age as part of a larger "Women's Health Promotion Program." Descriptive statistics, mainly univariate and bivariate analyses were conducted using STATA 13. RESULTS: The women in the study were ages 18-51 years, 52.0 percent were Hispanic, 36.0 percent African American, and 12.0 percent White. The majority, 70.4 percent, had a household income of less than $20,000, 58.4 percent were not married, 83.2 percent were not trying to get pregnant at the time, and 37.6 percent had sexual intercourse that may have put them at risk for pregnancy in the past month. Less than one-third knew about the reproductive hormones. Over 80.0 percent knew their reproductive anatomy, 68.8 percent were not keeping any log to track their menstrual flow, 53.6 percent did not know when their next menstruation would be, and 49.6 percent did not know the average number of days for a regular menstrual cycle. Many did not know what ovulation is (47.2%), the ovulation timing (67.2%), the number of eggs released from an ovary each month (79.2%), and how long an egg or sperm could live in a woman's body (62.4%). CONCLUSIONS: Reproductive knowledge should be assessed during preconception visits and women should be taught comprehensive reproductive education-not just selected topics-to be adequately equipped to make informed reproductive decisions.

Assessment of brain temperatures during different phases of the menstrual cycle using diffusion-weighted imaging thermometry.

PURPOSE: To investigate changes in brain temperature according to the menstrual cycle in women using diffusion-weighted imaging (DWI) thermometry and to clarify relationships between brain and body temperatures. MATERIALS AND METHODS: In 20 healthy female volunteers (21.3-38.8 years), DWI of the brain was performed during the follicular and luteal phases to calculate the brain temperature. During DWI, body temperatures were also measured. Group comparisons of each temperature between the two phases were performed using the paired t test. Correlations between brain and body temperatures were analyzed using Pearson's correlation coefficient test. RESULTS: Mean diffusion-based brain temperature was 36.24 °C (follicular) and 36.96 °C (luteal), showing a significant difference (P < 0.0001). Significant differences were also seen for each body temperature between the two phases. Correlation coefficients between diffusion-based brain and each body temperature were r = 0.2441 (P = 0.1291), -0.0332 (0.8387), and -0.0462 (0.7769), respectively. CONCLUSIONS: In women of childbearing age, brain and body temperatures appear significantly higher in the luteal than in the follicular phase. However, brain and body temperatures show no significant correlations.

Menstrual cycle corrupts reliable and valid assessment of language dominance: Consequences for presurgical evaluation of patients with epilepsy.

PURPOSE: Functional transcranial Doppler sonography (fTCD) is a valid and non-invasive tool for determining language dominance, e.g. in the context of presurgical evaluations. Beyond this, fTCD might be an ideal tool to study dynamics in language dominance over time. However, an essential prerequisite would be a high test-retest reliability. This was addressed in the present study. METHODS: Test-retest reliability of hemispheric hemodynamics during open speech was determined in 11 male and 11 female healthy volunteers using the Animation Description Paradigm. Expressive language dominance was assessed weekly over an interval of 4-5 weeks. RESULTS: Internal consistency of the four measurements was excellent (split-half reliability 0.85-0.95), but test-retest reliability of the lateralization index was poor to moderate (rtt=0.37-0.74). Controlling for gender, test-retest reliabilities were better in men (rtt=0.67-0.78) as compared to women (rtt=0.04-0.70). When arranging the assessments in women around day one of menstruation - all were on contraceptives - a significant shift from left hemisphere dominance toward bilaterality (t=2.2 p=0.04) was evident around menstruation with significant reversal afterwards (t=-3.4 p=0.005). CONCLUSION: A high intraindividual variability of language dominance patterns is indicated in women when assessed repeatedly by fTCD. Menstrual cycle appeared to be the source of inconsistency. The finding challenges the use of non-deactivating methods for language dominance assessment in epilepsy. Support for this is demonstrated with a female patient with epilepsy in whom language dominance assessed by repeated fMRI and fTCD varied concordantly with cycle but not so the repeated intracarotidal amobarbital test.

Work schedule and physically demanding work in relation to menstrual function: the Nurses' Health Study 3.

OBJECTIVES: This study aimed to evaluate occupational exposures and menstrual cycle characteristics among nurses. METHODS: Using cross-sectional data collected in 2010-2012 from 6309 nurses aged 21-45 years, we investigated nurses' menstrual function in the Nurses' Health Study 3. We used multivariable regression modeling to analyze the associations between occupational exposures and prevalence of irregular cycles and long and short cycle lengths. RESULTS: The cohort reported cycle length as <21 (1.5%), 21-25 (15.6%), 26-31 (69.7%), and 32-50 (13.2%) days. In addition, 19% of participants reported irregular cycles. Working ≥41 hours/week was associated with a 16% [95% confidence interval (95% CI): 4-29%] higher prevalence of irregular cycles and a higher prevalence of very short (<21-day) cycles [prevalence odds ratio (OR) 1.93, 95% CI 1.24-3.01] in adjusted models. Irregular menstrual cycles were more prevalent among women working nights only (32% higher; 95% CI 15-51%) or rotating nights (27% higher, 95% CI 10-47%), and was associated with the number of night shifts per month (P for trend <0.0001). Rotating night schedule was associated with long (32-50 day) cycles (OR 1.28, 95% CI 1.03-1.61). Heavy lifting was associated with a higher prevalence of irregular cycles (34% higher), and the prevalence of cycles <21 days and 21-25 day cycles increased with increasing heavy lifting at work (P for trend <0.02 for each endpoint). CONCLUSION: Night work, long hours, and physically demanding work might relate to menstrual disturbances.