A RECENT INVESTIGATION 7 of methods for determination of ovulation suggested

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1 The Relatin f Urine V lume t the Menstrual Cycle and Ovulatin WAYNE L. RYAN, PH.D., ROBERT J. LUBY, M.D., AND MICHAEL J. HALLER, A.B. A RECENT INVESTIGATION 7 f methds fr determinatin f vulatin suggested that significant changes in urine vlume ccurred during the menstrual cycle, and it appeared prbable that such changes might be related t vulatin. The purpse f the study described in this article as t determine if there is any general relatinship beteen urine vlume, vulatin, and the menstrual cycle. There is much indirect evidence indicating that changes in ater balance ccur during the menstrual cycle. A detailed study f such a relatinship as carried ut by Krhn and Zuckerman, h demnstrated that changes in eight and urine vlume ccur during the menstrual cycle f the babn. The eight f the female babn as fund t increase at midcycle, and increases in urine vlume ere bserved at the beginning and end f the menses and during midcycle. Thrn and Emersn studied eight changes in the human female during the menstrual cycle. A gain in eight ccurred at midcycle, after hich a eight lss as bserved. In additin, diuresis and eight lss ere fund t fll menstruatin. EXPERIMENTAL In rder t estimate the time f vulatin, mrning temperatures ere taken rally ith the use f basal-bdy-temperature thermmeters. Serial vaginal smears ere btained and prcessed as described by Riley et al. T determine mrning urine vlume, the subjects ere instructed t vid befre retiring and t cllect all f the first specimen vided upn aakening the next mrning. The duratin f sleep as recrded, and intake f cffee r alchl as nted n the chart kept by each subject. The urine vl- Frm the Creightn University Schl f Medicine, Omaha, Neb. 589

2 590 RYAN ET AL. FERTILITY & STERILITY ume as measured in a liter cntainer graduated in 60-ml. increments. The cmputatin f average daily urine vlume tk int accunt the vlume fr each day f the entire cycle, including the days f increased vlume. Sixty-nine cycles f 42 men ere studied in this manner. The subjects ere all nrmally menstruating men beteen the ages f 20 and 35. RESULTS Marked changes in urine vlume ere fund t ccur during the menstrual cycle. The first day f the cycle r last day f the previus cycle shed an increase f times the average vlume (the factr by hich the vlume as increased as, n the average, 1.5). There ere fur cycles in hich n increase ver the average vlume ccurred. The last day f the menses as characterized by an increase in mrning urine vlume frm 1.2 t 1.9 times the average vlume (the factr by hich the vlume as increased as, n the average, 1.5). There ere fur cycles in hich n increase ver the average vlume ccurred. The last day f the menses as characterized by an increase in mrning urine vlume frm 1.2 t 1.9 times the average vlume (the factr by hich the vlume as increased as, n the average, 1.4). T distinct increases in vlume ccurred after the cessatin f the menses. The first f these increases ccurred beteen the ninth and furteenth days f the cycle, and the secnd beteen the eleventh and seventeenth days f the cycle. Apart frm these fur peaks in urine vlume. n pattern f change in vlume culd be discerned (Table 1). TABLE 1. Relatin f Changes in Urine Vlume t Stage f Menstrual Cycle in 42 Nrmally Menstruating Wmen Perids f peak vlume Beginning f menses End f menses Days 9-14 Days Factr f increase ver average vlume Range Ovulatin as measured by BBT recrds and vaginal smears as clsely related t the increase in vlume seen beteen the ninth and furteenth days f the cycle (the third peak). This increase in urine vlume preceded the drp in BBT by 1 day in 63 per cent (43 cycles) f the men studied and cincided ith vulatin in the remainder f the subjects. The flling increase in vlume ccurred, n the average, 3 days later. The relatinship f 24-hur t mrning vlume (Fig. 1), the variatin

3 VOL. 12, N.6, 1961 URINE VOLUME AND MENSTRUAL CYCLE 591 in mrning vlume in the nrmal male (Fig. 2), and changes in mrning vlume flling pregnancy (Fig. 3) ere als studied, t prvide a better understanding f the data. Figure 4 shs the relatinship usually bserved beteen urine vlume, BBT, and vaginal smears, and Fig. 5, mrning vlume during an entire cycle. DISCUSSION The measurement f phenlic substances in the urine and the crrelatin f these cmpunds ith vulatin prduced strng evidence that a decrease in phenlic substances in the urine ccurred at vulatin.8 A later study established a relatinship beteen the phenlic substances and the crea- Fig. 1. Relatin f mrning &' b ~ ::;) ~ urine vlume t 24-hur vl- ~ ume, and changes in BBT in ~ ne patient.... Fig. 2. Mrning urine vlume in a nnnal male. ::;; ::...J 300 ICO DAY OF' CYCLE

4 592 RYAN ET AL. FERTILITY & STERILITY tinine cncentratin f the urine. 7 These t facts suggested the investigatin f mrning urine vlume. Our results uld appear t supprt thse f the previus investigatins. The changes in cncentratin f phenlic substances and creatinine during the menstrual cycle are due t changes in the mrning urine vlume. The cause f these marked changes in vlume is an interesting subject fr investigatin. Frm hat is knn regarding the actin f estrgen and prgesterne and their cncentratins during the menstrual cycle/ the flling interpretatin f the fur peaks described abve has been made. The increase in vlume n the first day f menstruatin is mst prbably due t estrgen ithdraal. Estrgens are knn t cause ater retentin, and the decrease in estrgen that ccurs at the beginning f the menses. ~ ::...J 3 Fig. 3. Mrning urine vlume befre and after pregnancy DAY OF CYCLE VAG. SMEAR Fig. 4. Relatin f mrning urine vlume t BBT and vaginal smears.. ::Ii ::...J DAY OF CYCLE

5 VOL. 12, N.6, 1961 URINE VOLUME AND MENSTRUAL CYCLE 593 culd cause this ater lss. Thrn et al. gave estradil t dgs and bserved a decrease in urine vlume; the vlume increased hen the estradil as ithdran. The change in vlume that ccurs at the cessatin f the menses ( the secnd peak in vlume) is difficult t interpret, fr there is n knn 98,6 Fig. 5. Mrning urine vlume during cmplete cycle, and changes in BBT during middle prtin f cycle. 60 ~ J DAY OF CYCLE hrmnal change at this pint in the cycle, except fr a slight increase in estrgen level. The third increase in urine vlume (Days 9-14) may be a result f the decrease in estrgen level that ccurs near midcycle. As mentined, estrgen ithdraal can cause an increase in vlume. The furth increase in urine vlume flls r cincides ith the rise in BBT and uld therefre seem t have a causal relatinship t the increase in prgesterne that ccurs during this pint in the cycle. The actin f prgesterne n ater balance is nt entirely clear at present, althugh the effect f prgesterne n electrlyte balance has been ell established. 4 A number f studies-e.g., that f Gillman and Gilbert, h described the prductin f turgescence in the sex skin f the babn by estradil and deturgescence by prgesterne-indirectly indicate that prgesterne has a diuretic actin. Similarly, the diuresis prduced by prgesterne in patients ith cngestive heart failure may be due t the actin f prgesterne n an estrgen-primed patient. 5 Studies being cnducted by the authrs n cirrhtic patients have yielded further evidence f a diuretic actin f prgesterne in the estrgen-primed subject. Althugh there is a definite relatinship beteen the changes in urine vlume and vulatin as measured by BBT and vaginal smears, it seems unlikely that measurement f urine vlume ill be useful as a guide t

6 594 RYAN ET AL. FERTILITY & STERILITY vulatin. Its disadvantages are the necessity f recrding and measuring daily urine vlumes, the careful bservance f cnsumptin f diuretics such as cffee, tea, and alchl, and, finally, the difficulties f interpretatin f the data btained. SUMMARY The changes in mrning urine vlume have been studied, ith recrding f BBT and taking f serial vaginal smears, in 69 cycles f 42 nrmal menstruating men. Increases in vlume ere fund t ccur n the first day f the menses, the last day f the menses, beteen Days 9 and 14 f the cycle, and beteen Days 11 and 17. The peaks in vlume ere related t vulatin, as determined frm BBT recrds and serial vaginal smears, and are believed t be evidence f hrmnal activity. 802 N.14th St. Omaha 2, Neb. REFERENCES 1. BROWN, J. B., KLOPPER, A., and LORAINE, J. A. The urinary excretin f estrgens, pregnandil and gnadtrphins during the menstrual cycle. J. Endcrinl. 17: 401, GILLMAN, J., and GILBERT, C. The reprductive cycle f the chacma babn (Papi ursinus) ith special reference t the prblems f menstrual irregularities as assessed by the behavir f the sex skin. S. African]. M. Sc. 11: 1, KROHN, P. L., and ZUCKERMAN, S. Water metablism in relatin t the menstrual cycle. ]. Physil. 88:369, LANDAU, R. L., et al. The metablic effects f prgesterne in man. J. Clin. Endcrinl. 15: 1194, PAULA, P. DE, et al. Prgesterne in cngestive heart failure and hepatic cirrhsis. Am.]. Cardil. 6:886, RILEY, G. M., DONTAS, E., and GILL, B. Use f serial vaginal smears in detecting time f vulatin. Fertil. & SteNl. 6:86, RYAN, W. L. Urine vlume and the menstrual cycle. Fertil. & Steril. 12:277, SEVAG, M. G., and COLTON, S. W. Simple chemical methd fr determinatin f vulatin time in men. J.A.M.A. 170:13, THORN, G. W., and EMERSON, K. The rle f gnadal and adrenal crtical hrmnes in the prductin f edema. Ann. Int. Med. 14:757, THORN, G. W., NELSON, K. R., and THORN, D. W. A study f the mechanism f edema assciated ith menstruatin. Endcrinlgy 22: 155, 1938.