Search

This study was prompted by uncertainties engendered by several recent reports of the hepatotoxic effect of contraceptive drugs. The 12 patients studied were ages 29 to 42 years. All had been using oral contraceptives for 3-6 years continuously. A number of preparations had been used for varying periods of time. The liver-function tests have included cephalin cholesterol colloidal red thymol turbidity plasma bilirubin plasma glutamic oxalo-acetic transaminase (PGOT) bromsulphthalein retention and plasma alkaline phosphatase. The highest value of plasma bilirubin found was 1.7 mg/100 ml in 1 case (upper limit of normal .8 mg/100 ml). All other results were within normal limits. However there were a number of abnormal variations in the empirical tests but it is doubtful if importance need be attached to these. With the exception of these findings the results in all 12 cases have been normal. Since submitting this paper other relevant reports have appeared. A favorable report by Bakke from Seattle was at variance with a report by Cullberg from Sweden describing jaundice and hepatic damage. In 4 cancer-of-the-breast cases treated with 6 times the normal dose of Lyndiol jaundice and liver damage were produced by C ullberg.

A multicentre, placebo-controlled, double-blind, cross-over study conducted in general practice on 100 patients has shown clonidine to have a statistically highly significant effect in controlling the number and the severity and duration of menopausal flushes. The relatively mild side effects and the absence of potentially harmful oestrogenic effects suggest that clonidine in the dose range 25 to 75 mug twice daily is a useful addition or alternative to the existing therapy for this common symptom of the menopause.

The synthetic non-steroidal antioestrogen nafoxidine (U-11, 100A) was given by mouth to 52 women with locally advanced or metastatic breast cancer, in 85% of whom the disease had become resistant to, or relapsed after, previous endocrine treatment. The objective response rate (complete or partial regression of disease) among 48 cases treated for at least four weeks was 37%. Tumours in soft tissue seemed to respond better than skeletal metastases. The patients in all but one of the 52 cases were postmenopausal. Those who had had an objective response to previous hormone treatment had a greater chance of deriving benefit from nafoxidine than those who had been resistant to hormone treatment. Side effects of nafoxidine were dryness of skin, increased loss of scalp hair, and heightened sensitivity to sunlight. None were serious, and they could be lessened by protection from solar radiation or a decrease in dosage. No obvious depression of thyroid or adrenal function or obvious water retention or masculinization was seen. Cataract was a possible complication. This clinical trial was preceded by laboratory studies in which a transplantable oestrogen-dependent tumour in the Syrian hamster was notably inhibited by the administration of nafoxidine. This experimental model may prove useful in screening potentially useful antioestrogenic agents against breast cancer before a human trial.

Follicular contents were aspirated during laparoscopy just before ovulation from eight follicles from patients pretreated with human menopausal gonadotropin and human chorionic gonadotropin. The aspirates from each follicle were incubated for 1 h in a modified Tyrode B medium containing radioactive pregnenolone and progesterone in order to determine the relative efficiency of the 3β-hydroxysteroid dehydrogenase and 17α-hydroxylase systems. Labelled 17α-hydroxyprogesterone was not isolated but the conversion of pregnenolone to progesterone ranged from 9.9% to 45.4% of the recovered radioactivity.

The distribution of radioactivity in bile and urine after injection of progesterone-4-C14 was studied as a function of time in a normal postmenopausal woman with a biliary fistula. The amounts of methylene chloride-soluble (“free”) steroid and the material which became chloroform-soluble after hydrolysis with β-glucuronidase were measured and analyzed by paper chromatography. The major amount of radioactivity was excreted in the bile. Both bile and urine contained pregnanediol, pregnanolone and some unidentified polar material, all of which were released by β-glucuronidase hydrolysis. Characterization of pregnanediol and pregnanolone was based on chromatographic mobility and carrier experiments using authentic steroids.

To confirm that estrogens may be responsible for an increase in histidine transamination, 37 menopausal women being treated with oral estrogens (potassium salt of estrone sulfate or equilenin) underwent histidine loading tests before and after treatment. There was a highly significant (p.001) increase in total "transamination metabolites" after estrogen treatment; there was no significant effect on creatinine excretion or urocanic acid output. Unusual chromatographic patterns were observed in nearly all of the urine specimens studied. In 2-solution paper electrophoresis, histidine streaked badly. This might have been due to some unknown substance excreted by the menopausal women.

The uptake of oestradiol by human breast-tumour tissue estimated by in-vivo and in-vitro techniques has been examined in relation to patients' ages and menopausal status. Results from in-vivo studies showed no convincing correlations, while in-vitro results were significantly correlated with menopausal status. There was a significant correlation between results obtained by the two techniques.

Twenty-five patients with advanced metastatic breast cancer were treated with the combination of methotrexate 60 mg/M(2) and 5-fluorouracil 700 mg/M(2) intravenously on the first and eighth days, and cyclophosphamide 100 mg/M(2) and prednisone 40 mg/M(2) by mouth daily for the first 14 days of a 28-day cycle. The patients had had no previous chemotherapy or extensive radiotherapy and all but two had not responded to hormonal therapy or endocrine ablation. The major metastatic lesions were: lung (12 patients), liver (four patients), bone (four patients), soft tissue (three patients), nodes (two patients). Seventeen of the 25 patients (68%) responded to treatment with seven complete remissions; these included patients suffering metastatic lesions in the lung, nodes, and soft tissue. The overall median duration of response was nine months (range 6-26 months). Toxicity was primarily haematological, but the group received an average of at least 75% of their calculated dose for each monthly cycle. Haematological toxicity was most pronounced in patients with liver dysfunction and bone marrow involvement. Out of eight nonresponders seven died, with a median survival of six months. Only six of 17 responders died, and the median survival in this group will exceed thirteen months. There was no correlation between the length of the metastasis-free interval after previous treatment and subsequent response to chemotherapy.

The results are reported of a preliminary trial of P1496, a new non-steroidal oestrogen analogue, compared with a conjugated equine oestrogen and a placebo. The oestrogenicity of both substances was well substantiated by vaginal epithelial maturation indices. P1496 was superior to conjugated equine oestrogen in producing a significant reduction of plasma calcium levels and a possible reduction in serum cholesterol. Conjugated oestrogen caused slightly more nausea than P1496 but there were no notable side effects from either drug. P1496 is considered to be at least as effective an oestrogenic substance as conjugated oestrogen and worthy of further therapeutic evaluation.

Basal prolactin levels were measured before operation in 113 patients undergoing surgery for a lump in the breast. Prolactin concentrations were not significantly higher in those patients with breast cancer than in those with benign lumps. Prolactin concentrations were, however, found to be higher in premenopausal women than in postmenopausal ones, regardless of tumour histology.

In a previous study in postmenopausal women elevated serum levels of glutamic oxaloacetic transaminase and glutamic pyruvic transaminase were found in every case whereas other workers found no evidence of abnormal liver function in premenopausal women. A study is reported which was undertaken to explain this apparent discrepancy. The incidence of abnormal liver-function tests was studied in 109 premenopausal women (mean age 29.4) taking contraceptive tablets. Volidan was given to 45 women and Lyndiol to 39 women aged 17-41 for contraception; Orgametril was administered therapeutically to 25 women aged 23-52. Standard liver-function tests were performed at regular intervals in every case. The same low incidence of abnormal results was found in the Volidan and Orgametril groups; serum-transaminase levels were raised in 4% of women and the bromsulphthalein (BSP) retention was increased in 19%. In the Lyndiol group however the incidence was much higher with raised serum-transaminase levels in 18% of cases and increased BSP retention in 48%. In all cases the liver-function tests returned to normal within 4 weeks of withdrawal of the drug.

The overnight urinary calcium/creatinine ratio is higher in the early years after the menopause than before it. However, the increment of urinary calcium/creatinine after a late evening calcium supplement is less in early postmenopausal than in premenopausal women. It is suggested that calcium therapy in postmenopausal osteoporosis may be best administered as a single late evening dose rather than in divided doses throughout the day.

The diagnostic value of measurements of plasma and urinary luteinizing hormone (LH) has been studied in 209 patients with endocrine disease. In 44 patients puberty was either delayed or had failed to occur. In those with chromosomal abnormalities the LH levels were often within the normal range, whereas those with a pituitary cause usually had low levels. In boys with delayed puberty plasma LH levels rose before physical changes occurred and had prognostic value. In patients with later gonadal failure, men with impotence or infertility, and women with secondary amenorrhoea LH assays proved of little value, although in one case a premature menopause was suspected and six patients with anorexia nervosa had low LH levels.Sixty patients with disorders of the hypothalamicpituitary area were studied. Levels of LH were measured and considered in relation to the other anterior pituitary hormones. Impairment of LH secretion was one of the first effects on hormone production of disease affecting this area, and this was, of course, most readily detected in postmenopausal women.The normal ranges of both plasma and urine LH are wide and there seems to be considerable day-to-day variation, especially of urinary output. Several samples should, therefore, be measured if therapeutic decisions are involved.

The development of osteoporosis with advancing age in man is a widespread if not a universal phenomenon. The average loss between youth and old age amounts to about 15% of the skeleton but involves a much larger proportion of trabecular than of cortical bone. The principal clinical manifestation of osteoporosis is fracture, and three osteoporotic fracture syndromes can be defined: the lower forearm fracture, which predominantly affects women between the ages of 50 and 65; the fracture of the proximal femur, which affects both sexes over the age of 70; and the relatively rare vertebral crush fracture syndrome, which may present at any age but is most common in elderly women. The lower forearm fracture rate is inversely related to the mean normal lower forearm x -ray “density” of the wrist, which falls by about 30% in the 15 years following the menopause. This process, which is associated with corresponding trabecular bone loss elsewhere in the skeleton, is associated with a corresponding rise in the fasting urinary calcium excretion. Some degree of negative calcium balance, and consequent bone resorption, probably occurs in everyone during the later part of the night because calcium absorption is completed within about three to five hours of a meal. In postmenopausal women, however, the sensitivity of the bone to parathyroid hormone appears to be increased, and their nocturnal negative calcium balance therefore comes to exceed the positive balance which can be achieved during the waking hours. Femoral neck fractures in old people reflect the further progression of osteoporosis with advancing age since the fracture rate is inversely correlated with the mean thickness of the metacarpal cortex in the normal population. This progressive osteoporosis is associated with and could well result from a steady decline in calcium absorption which is at least partially attributable to vitamin-D deficiency and reversible on vitamin-D treatment. The vertebral crush fracture syndrome represents a severe degree of spinal osteoporosis which may be associated with relatively normal peripheral bones. It probably results from an accelerated negative calcium balance which mobilizes trabecular bone preferentially. Some of the factors which may contribute to this accelerated negative balance have been identified and include a reduced rate of bone turnover, impaired calcium absorption, and low oestrogen activity as judged by vaginal smears, but there may well be others as yet unidentified.

The role of oophorectomy in the development of osteoporosis was assessed retrospectively in 258 women who had been hysterectomized premenopausally for non-malignant disease. Bone density was assessed using the radiographic density of the third metacarpal. Oophorectomy before the age of 45 years was found to be associated with a significantly increased prevalence of osteoporosis within three to six years of operation. The bone density of women oophorectomized after the age of 45 years was indistinguishable three to six years after operation from that found in healthy women with intact ovaries. These findings confirm the major part played by loss of ovarian function in the development of postmenopausal osteoporosis.

Mestranol, the three-methyl ether form of ethinyloestradiol and one of the two oestrogens used in oral contraceptive steroids, was administered in a dose of 0·02 mg daily for 120 days to 25 oophorectomized women. Urinary oestriol and pregnanediol excretions were unaffected by the mestranol treatment but there was a shift of the maturation index of the vaginal smear to the right, indicating a correction of the pretreatment oestrogen deficiency. No significant change in the blood pressure or electrocardiograph recordings occurred during this relatively short period of administration. A significant rise in the serum protein-bound iodine, which might be regarded as an undesirable effect of mestranol on a long-term basis, occurred. Hepatic function as measured by bromsulphthalein was not impaired by the treatment. Mestranol had no effect on the total body water or on the total exchangeable potassium of the women. Its two most serious adverse effects were impairment of glucose tolerance and a high incidence (16%) of venous thrombo-embolic disease. The gravity of the adverse effects far outweighs any beneficial ones and precludes the use of mestranol alone for long-term hormone replacement therapy in postmenopausal women.

Tamoxifen (ICI 46474) is the trans-isomer of 1(p-beta-dimethylaminoethoxy-phenyl)-1, 2-diphenylbut-1-ene. In several but not all mammal species it is a potent anti-estrogen. It is thought to act by blocking estrogen receptors. Patients were 68 women with advanced primary carcinoma of the breast, recurrences in the chest wall or soft tissue metastases. The oral dose of tamoxifen was either 10 mg or 20 mg twice daily. Patients were seen and laboratory tests done monthly for 6 months. Side effects were usually trivial and their incidence was the same at both dose levels. Of 26 patients who showed a reduction in tumor size to half or less, 5 had been in remission for over a year and another 10 for over 6 months. Some tumor responses were spectacular. The drug was less effective for bone deposits. In this study 12 of 33 patients (36%) receiving 10 mg of tamoxifen twice daily showed a definite response while a futher 8 (24%) showed a partial response. A definite response was seen in 14 out of 35 (40%) receiving 20 mg twice daily and a partial response in a further 13 (37%). The total response for low dosage was 60% and for high dosage 77%.

1. Examination of the cervical mucus for chlorides by the use of a “spot” test on a test paper parallels the fern test as a means of appraising ovarian hormone activity. 2. The test paper method is simpler, more accurate, easier to interpret, more economical, more rapid, and can be done readily by the doctor in his office. 3. The patient may take tests in sequence at home and bring the record to her physician for analysis. 4. The test paper technique has been found a valuable indicator for the determination of ovulation, ovarian hormone activity, the diagnosis of pregnancy, and observing the response to estrogen.

Since overproduction of estrogens could conceivably play a role in the pathologic physiology of Cushing’s syndrome, an attempt was made to isolate, identify, and quantitate the urinary estrogens excreted by a 58-year-old postmenopausal woman with metastatic adrenocortical carcinoma and Cushing’s syndrome. By means of countercurrent distribution and paper chromatography, estrone and estriol were identified and isolated in a fluorometrically homogeneous form. During the control period the patient excreted 5.7 micrograms of estrone and 34.2 micrograms of estriol daily as measured by photofluorometry. Upon the administration of ACTH, the excretion of estrone increased 12-fold and that of estriol 5-fold. The isolated estrogens were assayed for biologic activity and the positive results were in reasonable agreement quantitatively with the fluorometric measurements. The acetate derivatives of the isolated estrogens were prepared, and their behavior upon paper chromatography was found to be identical with that of...

The endocrine therapy of the agitated depressions occurring in association with the menopause has aroused interest in the past. Early experiments appeared to promise some success, but when these results could not be confirmed an attitude of pessimism developed. In recent years interest has been revived with the production of more potent extracts and the synthesis of estrogens. In the present paper the results obtained with these new products will be reviewed and 7 new cases, in which 4,4′-dihydroxy-α-β-diethylstilbene (hereafter referred to as diethylstilbestrol) was used in treatment, will be reported. An attempt has been made to include all the papers published in the more easily accessible English language journals during the seven years ending Dec. 31, 1940. REVIEW OF LITERATURE Casual reading of the literature suggests that no very consistent results have been obtained. Some writers have attributed their success to specific therapy; others who have been less fortunate

Carcinosarcoma is a Malignant mixed mullerian tumor (MMT) originating from the mesothelium and mesenchyme of embryonic mesoderm, now better established by electron microscopy and immuno-peroxidase techniques. The most interesting aspects in the histogenesis of this biphasic tumour mostly monoclonal in origin are briefly communicated in this paper. Unfortunately, no adjuvant chemo or radiotherapy for either persistent or recurrent malignant diseases has ever resulted in cure of this aggressive tumour, usually seen in menopausal women. Key words: Malignant mixed mullerian tumor (MMT), carcinosarcoma, menopause. doi:10.3126/njog.v2i1.1484 N. J. Obstet. Gynaecol Vol. 2, No. 1, p. 74 - 78 May -June 2007

A method is described for the incubation of small amounts of human ovarian tissue with isotopically labelled steroid substrates in the presence of ovine F. S. H. The products are analysed by paper chromatography after preliminary purification by silica gel chromatography and determined by liquid scintillation counting. The method has been applied to samples of ovarian tissue, using 14C-progesterone, 14C-androst-4-enedione and 14C-testosterone as substrates. The tissues were also examined histologically. The results reveal differences in steroid transformations between the various components of pre- and post-menopausal ovarian tissue.

IN a previous paper (1) del Castillo, Argonz and Galli Mainini in 1948 reported the results of an investigation on a special aspect of the cytologic content of the urinary sediment in women. From that study we showed that: 1. The cells present in the urinary sediment of women, when this sediment is smeared, fixed and stained with Shorr's technique, are very similar to, but not identical, with the vaginal cells. 2. These cells, contrary to what can be supposed, are not vaginal cells washed out by the urinary stream. In the previous report we showed that they come from somewhere in the epithelium of the urinary tract; and the present report, which confirms our previous findings, deals with the principal sources of the mentioned cells. 3. The cytologic content of the vaginal smear and of the urine sediment, taken simultaneously from the same patient, show a striking similarity: each one undergoes the same morphologic and staining changes in relation to the absence, normal presence, or therapeutic administrat...

THIS PAPER is concerned with a study bearing on the relationship between sex and immunity to syphilis. The origin of the problem lies primarily in a body of clinical observations which show that syphilis in many respects is a much milder disease in women than in men, and that pregnancy apparently plays an important role in activating, or in enhancing, the defensive reaction against this disease. Our immediate interest in the problem arose through contact with a case of severe secondary syphilis in a multiparous Chinese woman who had passed through the menopause before contracting the disease. The failure of sex and of many pregnancies to afford protection against an infection incurred at this late period of life attracted our attention. There was to be considered the probable importance of the waning sexual functions as a factor influencing the state of susceptibility.

In a monograph recently published by myself (1), dealing with the causation and treatment of “flushing” at the menopause, and in. a paper published in the British Medical Journal (2), I have drawn attention to certain phenomena associated with the administration of epinephrine to women at the menopause who complained of flushing. These were

TESTOSTERONE PROPIONATE has been added to the armamentarium of the obstetrician and gynecologist, since this hormone has been found a valuable aid J L in the treatment of dysmenorrhea (1, 2) metro-menorrhagia (3, 4, 5), the menopausal patient (6,7,8), and the after-pains and painful engorgement of the puerperium (9). These papers deal only with parenteral administration of this hormone. The purpose of this report is to present our experiences with the percutaneous use of testosterone propionate in the treatment of dysmenorrhea with or without premenstrual tension (10, 11). The therapeutic rationale for the use of testosterone propionate, in a disorder of the female may be briefly reviewed. All the sexual hormones possess bisexual properties, with wide individual variations (12). The female gonad, especially, possesses strong bisexual potentialities both on biological (13) and embryological (14) evidence.

SINCE the introduction into clinical medicine of the testicular biopsy by Hotchkiss (1) and by Charny (2) much progress has been made in elucidating the pathogenesis of various types of testicular deficiency. Some clinicians have been chiefly concerned with the problem of sterility (1, 2, 3, 4, 5, 6). Others have studied syndromes with endocrinologic manifestations, such as eunuchoidism (7, 8, 9), a testicular syndrome associated with gynecomastia (10, 11, 12), and the male “climacteric” (13, 14, 15). Nelson (16, 17) has made a general review of the subject of hypogonadism and more recently other general papers (18, 19, 20, 21, 22) have become available. The present study is an attempt to elucidate the various syndromes associated with testicular deficiency, from three angles: clinical status, testicular histology as determined by biopsy, and endocrinologic pattern as judged by hormonal assay. CLINICAL MATERIAL In the eight years up to 1947, at the Massachusetts General Hospital, each of 256 persons on on...

The level of luteinizing hormone (LH) excretion in patients with endometrial carcinoma assayed immunologically is about 7 times as high as the value given by Parlow's test. Treatment with 17α-hydroxyprogesterone caproate restores the immunologic index for LH excretion to normal. Such changes in LH excretion are not observed in cervical, ovarian, or mammary cancer. The paper deals with the importance of dissociation of immunologic and hormonal activity of LH in the light of data available on artificial and endogenous anahormones and the possibility of using this phenomenon for diagnostic purposes.

The cyclic activities of the female reproductive organs of mammals, constituting the œstrous cycle, fall naturally into two main series,i. e., the uterine cycle and the ovarian cycle, and the correlation between these two forms one of the most intricate problems of internal secretion. Two chief problems are presented—(a) what stimuli produce the uterine cycle in the first place, and (b) how is the uterine cycle so synchronised with the ovarian cycle as to result in the uterus being ready to receive the fertilised ovum just after the time of ovulation? Since ovariotomy results in cessation of the cycle, whereas excision of the other reproductive organs has not this effect, it is necessary to suppose that the controlling power resides in the ovary, and further, since transplantation of the ovary does not result in the cessation of the cycle, that the means of control is hormonic. The alternating maturation of follicles andcorpora luteain the ovaries is exactly synchronised with the changes which take place in the uterus, and it is therefore reasonable to look to the periodic growth of one or other of these ovarian structures for the origin of the periodic hypertrophy of the uterus. Owing to the fact, however, that in many mammals œstrus sets in when nocorpora luteaare present in the ovary, these structures can be eliminated as originators of the œstrous cycle. Similarly, the supposition that the corpusCorpus luteumhas an inhibitory effect, the removal of which allows œstrus to appear, can only be applied to certain special conditions. If, therefore, any cyclic structure of the ovary is responsible for the regulation of the œstrous cycle, it must be the maturing follicle. This conclusion is supported by the following facts:— (a) Œstrus first appears when ovulation starts at puberty, and the œstrous cycle stops when ovulation ceases at the menopause.

AEMLIORATION of the vaso‘motor symptoms of the menopause by the AMELIORATION use of testosterone.propionate has been reported by several investi ‘gators (1-4). Salmn (1) noted a change in the vaginal smear from the menc pausal to the cornified type, which was not found by Shorr et al. (2). Both, however, observed a decrease in the levels of FSH after treatment with testosterone became effective. It was concluded that testosterone had the same effect as the estrogens, that is, inhibition of the anterior pituitary gland. This study was undertaken to ascertain if there were changes from the pre’treatment levels of urinary FSH, androgens and estrogens, after ad‘ ministration of testosterone propionate1 to female castrates. Similar work on normal males, eunuchoids and female castrates, to be referred to later in this paper, has been reported by others during the course of these experiments. Subjects. Four women who had severe menopausal symptoms following surgical or radiation castration were selected for this...

The purpose of this paper is to test the hypothesis that hormones secreted by the ovaries are responsible for a “protective mechanism” of blood pressure regulation of the woman. Under physiologic conditions, there was a distinct correlation between the degree of estrogenic activity and the blood pressure response. This was true for normotensive women at rest and under stress. This protective mechanism was also demonstrated in pharmacologic experiments when estrogens were administered to ovariectomized women. An additional activity of progestins caused a slight alteration of the systolic blood pressure response to stress but did not abolish the effect of estrogens.

A number of investigators have reported on the urinary excretion of gonadotropins following treatment of women with the steroid sex hormones. With the use of either estrogens (1–4) or androgens (3, 5, 6, 7) the increased gonadotropic output of ovariectomized or menopausal women can be abolished, although with small doses of estrogens there may be no material reduction in the titers (8). Few studies relate to gonadotropin excretion in castrate males treated with the male sex hormones. Frank and Salmon (9) using rather limited doses of androsterone, dihydroandrosterone benzoate, and testosterone reported only slight amelioration of castration symptoms, and no influence on the excretion of gonadotropins. In a preliminary note (10) the present authors reported a definite decrease in the elimination of gonadotropins following administration of testosterone propionate to castrate males. These results are amplified in this paper. Urine specimens for 24 consecutive hours were collected, preserved under refrigerat...

We have reported in previous papers (1, 2) that women who have had both ovaries removed show a reduction in blood volume of 20 to 25 per cent. A normal blood volume is found in women after the menopause even though the ovaries presumably cease their function at this time. In menopause artificially produced by radiotherapy the blood volume also remains normal. These facts appear to indicate that some substance is produced in the ovary, even when the menstrual cycle is in abeyance, which influences the amount of circulating blood. It has been reported that there is an absence of female sex hormone in the blood and urine of castrated women (3). The low blood volume and the absence of female sex hormone in these cases suggested the possibility of a relationship worthy of further investigation. Since it is easy to supply biologically standardized estrogenic hormone by subcutaneous injections, the effect of this substance on the blood volume could be studied.

Science rightly concluded many years ago that the phenomenon called the menopause is associated with a cessation of ovarian function. The structure of the ovary after the menopause, the atrophy of the uterus and vagina during the menopause, the close analogy between physiological menopause and artificial menopause were all evidence of this. But ovarian function, it is now known, may cease because the ovary per se ceases to function or because the stimulating hormone or hormones from the anterior pituitary cease to be furnished. With which of these possibilities is one confronted at the menopause? Evidence that ovary is primarily and not secondarily hypofunctioning at the menopause. In the previous paper of this series (1) it was pointed out how the determination of certain hormones in the urine could be used in differentiating between a hypogonadism of primary ovarian cause and one secondary to a hypofunction of the gonad-stimulating hormone or hormones of the anterior pituitary. Obviously in both instanc...

IN A PAPER read before the American Gynecological Society, May 1932, Rubin (1) reported his experience with insufflation in 7 women of the menopause age. There were no tubal contractions in 3 instances, while in 4 of the 7 cases the contractions were infrequent and barely reached an amplitude over 5 mm. Hg. He also considered the possible influence of ovarian hormonal function on the fallopian tubes in relation to the different phases of the ovarian cycle. From comparative observations of many graphs obtained during clinical tubal insufflation, a definite impression was gained that there was a possible relationship between tubal contractions and the ovulation menstruation cycle. This impression gained from clinical experience with the test for tubal patency led Rubin (2, 3) to suggest in 1927 and in 1928 that parallel investigations be “carried out in estimating the quantity of female sex hormone.” Along the same line of investigation, Morse and Rubin (4) applied the method of uterotubal insufflation in t...

This paper attempts to show the correlations between the subjective symptoms of the menopausal woman and of the condition of the vaginal and oral mucosa. Thirty female subjects were evaluated through psychiatric interviews (including brief psychiatric rating and anxiety scales), gynecological and oral physiological examinations. According to our findings, personality and psychosocial factors seem to play a major role in the development of ‘dry mouth syndrome’ during the menopausal stage.

This paper consists of an investigation of various pathological conditions that have been reported to occur in women who have received oral steroid preparations for the purpose of contraception. The article reviews amenorrhea during and following oral contraceptive therapy, as well as effects upon adrenal, thyroid and liver function and carbohydrate metabolism. In addition, there is a discussion of thromboembolic phenomena, possible carcinogenicity, potential genetic effects, neuroophthalmologic disturbances and other long-term effects. Reports concerning reversibility of this method of contraception as well as potential harmful effects to the lactating woman are also reviewed. Concluding this article is an outline of recommendations for physicians to employ prior to the initiation of hormonal contraceptives and a list of contraindications and special observations for patients receiving this type of contraception.