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Objective: To estimate whether serum etonogestrel concentrations influence bleeding patterns and related side effects in contraceptive implant users., Methods: We conducted a prospective cross-sectional study with healthy, reproductive-aged women using etonogestrel implants for 12-36 months. Participants completed a brief questionnaire to assess their current bleeding pattern and any experience of abnormal bleeding with the implant. We then measured serum etonogestrel concentrations. We also reviewed the charts of participants to determine whether a prescription for oral contraceptive pills was ever given for treatment of implant-related bothersome bleeding. We performed multivariable logistic regression to test for associations between serum etonogestrel concentrations and both bleeding patterns and related side effects., Results: We enrolled 350 women, and 59.4% reported having experienced abnormal bleeding with the contraceptive implant. Only 14.9% of participants reported amenorrhea and 37.7% reported monthly periods. Among participants with reviewable medical records (n=253), roughly 20% had received a prescription for oral contraceptive pills during implant use. Increasing serum etonogestrel concentrations were significantly associated with increasing odds of reporting abnormal bleeding (adjusted odds ratio [aOR] 1.005, P=.015) and increasing odds of having received an oral contraceptive pill prescription (aOR 1.008, P=.002). For every 100 pg/mL increase in serum etonogestrel concentration, contraceptive implant users in this study had 1.6 times the odds of reporting abnormal bleeding and 2.3 times the odds of having received a prescription as treatment for bothersome bleeding., Conclusion: We found both objective and subjective evidence that higher levels of progestin from the contraceptive implant were associated with bleeding side effects experienced by women in this study. Pharmacologic variation may influence the side effects women experience with a variety of hormonal contraceptive methods, in turn affecting patient satisfaction and discontinuation rates.

The aim of this study was to assess the effects of intensive training on menstrual function and related serum hormones and peptides.Forty female participants who attended a training course for an officer at the Korea Third Military Academy, and had regular menstrual periods were enrolled. Menstrual questionnaires and fasting blood samples were collected before entry and at 4-week intervals for 8 weeks. The levels of corticotropin-releasing hormone (CRH), cortisol, prolactin, endorphin-β, neuropeptide Y (NPY), leptin, orexin-A, ghrelin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), thyrotropin (TSH), and thyroxine (T4) were determined.Body mass index and waist circumference decreased during the training course. Intensive training of military cadets resulted in changes of menstruation and related biomarkers. The levels of CRH, endorphin-β, NPY, orexin-A, ghrelin, E2, and T4 decreased substantially, and cortisol, prolactin, and TSH increased. Seventy percent of participants with regular menstrual periods before developed irregular during the training course. Participants were then categorized into 2 groups: those with regular menstruation (n = 12) and those with irregular menstruation (n = 28). The levels of hormones and peptides were not different between the 2 groups.In conclusion, cortisol, prolactin, and TSH level increased but levels of CRH, endorphin-β, NPY, orexin-A, ghrelin, E2, and T4 decreased throughout the training. Moreover, the levels were not different between participants with normal menstruation and those with irregular menstruation. Further research should extend these findings by investigating the exact mechanism by which high exercise levels, including intensive training, interfere with regular menstruation.

This study was conducted to evaluate the prevalence of transient hyperprolactinemia in infertile women with luteal phase deficiency. One hundred fifty-one luteal phase deficiency patients and 11 controls had serum prolactin (PRL) measured daily for 3-4 days near ovulation. Thirty-three subjects (21.9%) had transient hyperprolactinemia, with PRL above 20 ng/mL for 1 or 2 days, and were studied further. The blood samples of these 33 subjects and of the controls were also analyzed for LH and FSH. Plasma progesterone was measured on the fourth, seventh, and tenth days after ovulation in both groups. The mean (+/- SD) of the mid-cycle integrated LH surge (125.0 +/- 23.0 mIU/mL; N = 26) and the sum of three plasma progesterone levels (23.8 +/- 4.5 ng/mL; N = 21) in the luteal phase deficiency women were significantly (P less than .001) lower than those of the controls (LH 158.7 +/- 13.8 mIU/mL; progesterone 33.8 +/- 6.5 ng/mL). All 33 luteal phase deficiency subjects with transient hyperprolactinemia were treated with bromocriptine at a dose ranging from 1.25-5 mg/day to maintain mid-cycle PRL levels between 5-15 ng/mL. Both the integrated LH surge and the sum of three progesterone levels increased significantly (P less than .05) during bromocriptine treatment, to 142.6 +/- 22.4 mIU/mL (N = 20) and 28.2 +/- 6.2 ng/mL (N = 18), respectively. Fourteen of the 33 patients conceived. The cumulative probability of conception was 31% for six cycles and 45% for 12 cycles of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Currently available measurements of beta-endorphin and beta-lipotropin in exercising women are in excellent agreement and indicate a 2-3 fold increase over basal levels. Possible effects of exercise upon the transfer of endorphins from the peripheral circulation to the brain are examined, and evidence is presented that suggests the occurrence of a concomitant exercise-related increase of endorphins in both humoral and central nervous system compartments. Steady-state measurements of circulating luteinizing hormone and follicle-stimulating hormone levels in oligo-amenorrheic athletes, on the other hand, do not agree. It is felt that the lack of consensus may be attributable partly to technical inadequacies and partly to lack of awareness of the need for frequent sampling. The bulk of the findings suggest a tendency for luteinizing hormone levels to be low and follicle-stimulating hormone levels to be normal or low, a pattern compatible with repeated activation of the CRH-ACTH-POMC system as a result of exercise.

Serum dehydroepiandrosterone sulfate (DHEAS) was measured in 32 infertility patients who were found to be ovulatory, in 37 women with oligomenorrhea, and in 52 hirsute patients under basal conditions. It was also measured in conjunction with adrenocorticotropic hormone (ACTH) stimulation and dexamethasone suppression in 10 of the hirsute women. Serum DHEAS levels were elevated in only 19% of the infertile women with regular ovulation, in 34% of the oligomenorrheic patients, and in 60% of the hirsute women. Of the C-19 steroids (androgens) measured in the 52 hirsute women, ie, total and unbound serum testosterone (T), androstenedione (A), and DHEAS, unbound serum T was most frequently elevated. Eighty-two percent of the hirsute women had either an elevated serum DHEAS level or an increased unbound T level, suggesting 1) that elevations in unbound serum T may be associated with or result from increased serum DHEAS levels and 2) that only a minority of women with so-called idiopathic hirsutism do not have demonstrable androgen excess. Three of 10 hirsute women with elevated serum DHEAS levels had an increased ACTH-induced rise in DHEAS. Dexamethasone given as a single daily dose of 0.5 mg at bedtime resulted in a marked decrease in serum DHEAS in all of the 10 hirsute patients tested within 2 weeks of therapy. Thus, serum DHEAS is a clinically useful indication of adrenal C-19 steroid secretion. When combined with clinical and other hormonal evaluations, its measurement adds an important dimension to the study of gynecologic endocrinology and infertility.

The problem of menstrual dysfunction in women who engage in endurance training for participation in distance running events has been studied. Through survey, selected aspects of the personal, training, menstrual, and contraceptive histories of 168 women who were defined as runners, joggers, or controls were evaluated. In addition, defined subsets of the study subjects were evaluated for serum levels of pituitary and ovarian hormones and determination of percentage body fat. The data show significant differences among the 3 groups. It is concluded that menstrual dysfunction in distance runners is a real phenomenon. Presumably this is related to decreased percentage of body fat and/or minimal ovarian function secondary to diminished hypothalamic or pituitary hormone secretion.

This study group consisted of 10 female patients undergoing chronic hemodialysis. The duration of their illness was from 10 months to 8 years. Nine of the 10 had been undergoing hemodialysis for more than 1 year. Their menstrual patterns have been investigated, specifically with regard to menstrual history, gonadotropin and progesterone levels, and basal body temperature. Nine of the 10 patients had had regular menses prior to their renal illnesses. All patients became amenorrheic during and after hemodialysis with the exception of one patient who became hypermenorrheic. The gonadotropin levels were as follows: the luteinizing hormones were high-normal and the follicle stimulating hormones were low, almost to a hypogonadotropic range; progesterone level coupled with the basal body temperature showed no evidence of ovulatory cycles, except in one case.

Standard gonadotropin stimulation tests of ovarian function and basal plasma prolactin measurements have been carried out in 151 patients with amenorrhea or severe oligomenorrhea. In 90 of these a standardized multiple pituitary stimulation test, including the prolactin response to thyrotropin releasing hormone, was also performed. There was a tendency for the basal estrogen excretion and the ovarian response to gonadotropin to be lower in patients with hyperprolactinemia. These correlations were weak and did not reach the levels of statistical significance except when compareing the ovariance response in patients with mild hyperprolactinemia to those with moderate or severe hyperprolactinemia. It is concluded that, in women, elevated plasma prolactin levels have little, if any, direct inhibitory influence on the ovariance response to gonadotropins in vivo.

Blood samples were obtained from 5 women during the menstrual cycle in which they had conceived. Although neither the women nor their physicians were clinically aware that conception had occurred, one or more of the blood specimens from each woman contained human chorionic gonadotropin (hCG), as measured by a specific radioimmunoassay. Each patient underwent a spontaneous abortion with 4 of the 5 women describing a delayed, but otherwise normal, menses. The fifth noted an unusually abundant amount of vaginal bleeding. Immunologic urinary pregnancy slide tests were negative in the 4 women on whom the tests were performed. The levels of hCG in the serum of these women were abnormally low for the estimated length of gestation, suggesting that defective trophoblastic function may be important in the pathogenesis of this phenomenon. These examples illustrate that some women may conceive and abort so early that the pregnancy and the abortion may remain subclinical. Therefore, it is likely that the true incidence of spontaneous abortions during the first trimester is greater than the presently accepted incidence of 15%.