Baboon corpus luteum: size and sex steroid secretion throughout the luteal phase.

OBJECTIVE: To determine the size of the baboon corpus luteum (CL) and levels of plasma P, 17alpha-hydroxyprogesterone (17-OHP), and E2 in the ovarian vein draining it, the contralateral ovarian vein, and peripheral blood throughout the luteal phase of the menstrual cycle. DESIGN: Prospective study. SETTING: Academic department of obstetrics and gynecology in a US medical school. ANIMAL(S): Corpora lutea from a cohort of 27 adult cycling baboons (Papio anubis). INTERVENTION(S): Timed luteectomy. MAIN OUTCOME MEASURE(S): The authors weighed 166 CL and measured plasma P, 17-OHP, and E(2) in the blood samples obtained at luteectomy. RESULT(S): Early luteal phase corpora lutea weighed 189.1 +/- 12.3 mg (mean +/- SEM); their weight significantly increased to 239.4 +/- 8.4 mg at mid luteal phase and significantly declined to 188.3 +/- 14.0 mg in late luteal phase. Plasma P draining the CL (134.4 +/- 20.5 ng/mL in early, 167.4 +/- 18.7 ng/mL in mid, and 126.4 +/- 23.4 ng/mL in late luteal phase) was significantly higher than that in contralateral ovarian (11.0 +/- 1.4 ng/mL) and peripheral plasma (7.1 +/- 0.9 ng/mL). Similarly, levels of both plasma 17-OHP (10.9 +/- 1.5 to 15.9 +/- 2.4 ng/mL) and E2 (1.6 +/- 0.2 to 2.6 +/- 0.6 ng/mL) draining the CL were significantly higher than those from the contralateral ovary and peripheral blood (17-OHP, 1.1 +/- 0.2 ng/mL; E2, 0.2 +/- 0.05 ng/mL). CONCLUSION(S): Largest in mid luteal phase, the baboon CL secretes P, 17-OHP, and E2 throughout the luteal phase, with the highest levels seen in the ovarian vein draining the CL in the mid compared with the early and late luteal phases.

Effect of the oxytocin antagonist antocin and agonist decomoton on baboon luteal cell production and release of progesterone.

OBJECTIVE: To evaluate the effect of oxytocin, its antagonist antocin, and agonist decomoton on baboon luteal cell P secretion. DESIGN: Prospective study. SETTING: Academic department of obstetrics and gynecology in a US medical school. ANIMAL(S): Luteal-phased timed corpora lutea (CL) from a cohort of adult cycling baboons (Papio anubis). INTERVENTION(S): Dispersed luteal cells from luteal phase baboon CL were cultured and treated with nothing (control), oxytocin (4-400 mU), antocin (4-400 microg), oxytocin with antocin, decomoton (4-400 microg), or oxytocin with decomoton. MAIN OUTCOME MEASURE(S): Basal and hCG (10 U)-stimulated P were measured in the incubate. RESULT(S): Basal P secretion did not change significantly with all peptides studied. The hCG-stimulated P secretion was significantly inhibited by oxytocin (4-400 mU), antocin (4-400 microg), and antocin combined with oxytocin, and with oxytocin, decomoton, and decomoton combined with oxytocin. Antocin (-12%) was less inhibitory than oxytocin (-25% to -22%). Antocin combined with oxytocin enhanced the inhibition to -35% to -39%. Decomoton had stronger (not significant) inhibition than oxytocin. Mean inhibition was 28%-35% with all doses of oxytocin, decomoton, or combined together. CONCLUSION(S): Although decomoton, an oxytocin agonist inhibited hCG-stimulated luteal cell P secretion in vitro, antocin also acted like an agonist, rather than an antagonist, in inhibiting P secretion.

Clinical efficacy and differential inhibition of menstrual fluid prostaglandin F2alpha in a randomized, double-blind, crossover treatment with placebo, acetaminophen, and ibuprofen in primary dysmenorrhea.

OBJECTIVE: The purpose of this study was to compare acetaminophen with ibuprofen for pain relief and menstrual fluid prostaglandin F2alpha (PGF2alpha) suppression in primary dysmenorrhea. STUDY DESIGN: Twelve subjects were randomized to placebo, acetaminophen (1000 mg orally, 4 x daily for 3 days) or ibuprofen (400 mg orally, 4 x daily for 3 days), once during each cycle in a prospective, double-blinded, crossover study. Using preweighed super absorbent tampons, menstrual fluid was collected, extracted, and PGF2alpha radioimmunoassayed. RESULTS: Ten patients completed the study. Ibuprofen (P = .002) and acetaminophen (P = .022) were rated significantly better than placebo. Total menstrual fluid PGF2alpha with placebo was 36.2 + 6.1 microg but were 14.8 + 3.0 microg with ibuprofen (P = .001) and 21.4 + 3.4 microg with acetaminophen (P = .008). PGF2alpha concentrations with placebo were 0.34 + 0.054 microg/mL, with ibuprofen 0.16 + 0.026 microg/mL (P = .001), and with acetaminophen 0.23 + 0.029 microg/mL (P = .016). CONCLUSION: Both ibuprofen and acetaminophen were superior to placebo for pain relief and menstrual fluid PGF2alpha suppression, with ibuprofen being more potent.

Differential suppression of menstrual fluid prostaglandin F2a, prostaglandin E2, 6-keto prostaglandin F1a and thromboxane B2 by suprofen in women with primary dysmenorrhea.

Eleven women with primary dysmenorrhea completed a randomized, double-blind, placebo-controlled, three-way cross-over study comparing 200 and 400mg suprofen. Menstrual fluid volume did not change. Mean+/-S.E.M. menstrual fluid PGF2a was significantly suppressed from 18.9+/-1.9 microg (placebo) to 10.9+/-1.7 and 9.3+/-2.1 microg with 200 and 400 mg suprofen, respectively (p=<0.005). PGE2 dropped from 7.8+/-0.9 to 4.6+/-0.8 and 4.6+/-1.1 microg (p=<0.05) and TxB2 from 17.5+/-4.3 to 7.5+/-2.9 and 3.6+/-1.3 microg (p=<0.01), respectively. 6-Keto PGF1a was significantly suppressed (2.7+/-0.4 to 1.9+/-0.5 microg, p=<0.025) with only 400 mg suprofen. Six subjects rated placebo poor and five fair to very good. In contrast, nine rated suprofen excellent to fair while two rated poor. Thus, suprofen was clinically effective but the differential suppression of prostanoids favors 200mg which spares 6-keto PGF1a.

Primary dysmenorrhea: advances in pathogenesis and management.

Primary dysmenorrhea is painful menstrual cramps without any evident pathology to account for them, and it occurs in up to 50% of menstruating females and causes significant disruption in quality of life and absenteeism. Current understanding implicates an excessive or imbalanced amount of prostanoids and possibly eicosanoids released from the endometrium during menstruation. The uterus is induced to contract frequently and dysrhythmically, with increased basal tone and increased active pressure. Uterine hypercontractility, reduced uterine blood flow, and increased peripheral nerve hypersensitivity induce pain. Diagnosis rests on a good history with negative pelvic evaluation findings. Evidence-based data support the efficacy of cyclooxygenase inhibitors, such as ibuprofen, naproxen sodium, and ketoprofen, and estrogen-progestin oral contraceptive pills (OCPs). Cyclooxygenase inhibitors reduce the amount of menstrual prostanoids released, with concomitant reduction in uterine hypercontractility, while OCPs inhibit endometrial development and decrease menstrual prostanoids. An algorithm is provided for a simple approach to the management of primary dysmenorrhea.

Detecting the signal of the menstrual cycle in fluorescence spectroscopy of the cervix.

Fluorescence spectroscopy of the cervix has been shown to be an effective noninvasive diagnostic tool for cervical intraepithelial neoplasia (precancer). To assess the effect of the menstrual cycle on fluorescence spectroscopy, daily measurements were made on ten subjects for the length of their cycle. These measurements were analyzed to determine if there was a statistically significant signal associated with the menstrual cycle. A signal was found for emission wavelengths between 425 and 445 nm inclusive--near the main hemoglobin absorption band, the Soret band, at 420 nm. We suspect that the slight displacement of the Soret band is due to the nearby dominant NAD(P)H peak, which increases the signal-to-noise ratio and affects statistical significance. The signal consists of a reduction in fluorescence intensity for the first few days of the cycle. This analysis indicates that hemoglobin absorption is the main menstrual-cycle effect on the use of fluorescence spectroscopy on the cervix. The effect is confined to a small set of excitation/emission wavelengths and to approximately the first 8 days of the cycle. This suggests that any problems from the menstrual cycle can be avoided with a simple requirement that the device not be used during the period of menstrual bleeding.

Cyclic perimenstrual pain and discomfort: the scientific basis for practice.

OBJECTIVE: To review and organize the science related to cyclic perimenstrual pain and discomfort for the fifth research-based practice project of the Association of Women's Health, Obstetric and Neonatal Nurses. DATA SOURCES: Computerized searches in CINAHL, MEDLINE, and the Cochrane Library, as well as hand searches of cited references. Keywords included cyclic pelvic pain, comfort, pain guidelines, and dysmenorrhea. DATA EXTRACTION: All relevant articles prior to 1999 were considered. Thirty-three research-based articles (1992-1999) were reviewed for relevance by the science team as part of the fifth research-based practice project of the Association of Women's Health, Obstetric and Neonatal Nurses. DATA SYNTHESIS: The literature review and synthesis resulted in a cogent description of cyclic perimenstrual pain and discomfort and the development of three nursing diagnoses: perimenstrual cyclic pelvic pain, perimenstrual discomfort, and perimenstrual negative affect. Cyclic pelvic pain is a new concept, developed by the science team during the project. Perimenstrual cyclic pelvic pain is an acute, subjective experience defined by pelvic pain that presents in a repeating time frame associated with the menstrual cycle. It is usually clustered with other discomforts and appreciably affects a woman's quality of life. Because the science about interventions is complex and extensive, data synthesis led to organization of the interventions within seven categories. CONCLUSIONS: Translation of research into practice is essential. Cyclic perimenstrual pain and discomfort is an important clinical issue, yet the science had not previously been comprehensively reviewed with the mission to translate it for nursing practice. Translation of this complex literature was accomplished though an innovative clinical practice guideline and subsequently evaluated in nursing practice through the research-based practice project.

Fluorescence spectroscopy for cervical precancer detection: Is there variance across the menstrual cycle?

This study assesses one possible cause of inter-patient variation in fluorescence spectroscopy of the cervix: the menstrual cycle. Ten patients with no history of an abnormal Pap smear were seen daily throughout 30 consecutive days of their cycle. Fluorescence excitation-emission matrices were measured from three cervical sites on each patient. Principal component analysis was used to determine which spectral regions varied with the day of the cycle. Classification was performed to assess the influence of menstrual cycle on precancer diagnosis. Variations in the principal component scores and the redox ratio values show that the fluorescence emission spectra at 340-380 nm excitation appear to correlate with the cell metabolism of the cervical epithelium throughout the menstrual cycle; these changes do not affect diagnostic classification. The menstrual cycle affects intra-patient variation but does not appear to cause a significant level of inter-patient variation. It does not need to be controlled for in optical detection strategies based on fluorescence spectroscopy.

Comparison of the efficacy and safety of nonprescription doses of naproxen and naproxen sodium with ibuprofen, acetaminophen, and placebo in the treatment of primary dysmenorrhea: a pooled analysis of five studies.

BACKGROUND: Dysmenorrhea is the most common menstrual complaint in young women, with a prevalence as high as 90%. It is responsible for substantial repeated short-term absenteeism from school and work in young women. Effective treatments are available, including nonsteroidal anti-inflammatory drugs (NSAIDs). In many countries, a variety of NSAIDs have become available as over-the-counter (OTC) drugs. OBJECTIVE: The goal of this study was to compare the efficacy and safety of OTC doses of naproxen (400 mg) and naproxen/naproxen sodium (200/220 mg) with acetaminophen (1000 mg), ibuprofen (200 mg), and placebo in the treatment of primary dysmenorrhea. METHODS: A pooled analysis of 5 trials was performed. Efficacy was assessed by pain relief, relief of other dysmenorrheic symptoms, time to backup medication or remedication, and treatment preference. Tolerability was assessed by recording adverse events (AEs). RESULTS: A total of 443 women were enrolled in the combined studies. Naproxen 400 mg provided greater pain relief than acetaminophen and placebo within 30 minutes of administration (P < 0.01 and P < 0.05, respectively). Furthermore, naproxen 400 mg and 200 mg provided greater pain relief than both acetaminophen (P < 0.01 and P < 0.05, respectively) and ibuprofen (P < 0.001 and P < 0.01, respectively) at 6 hours after administration. Both doses of naproxen had higher scores than placebo for symptom relief and drug preference (all P < 0.001). The AEs and their frequency were similar among the treatment groups. No serious AEs were reported. CONCLUSION: When administered at OTC doses, naproxen was effective in the relief of pain and other symptoms of primary dysmenorrhea and had a good safety profile in the population studied.