Urine Volume and the Menstrual Cycle

Transcription

1 Urine Volume and the Menstrual Cycle WAYNE L. RYAN, PH.D. THE need for a simple test to detect ovulation has been discussed by Behrman. The test, in order to solve present needs, would have to be sufficiently simple to permit its use by the physician in the office without elaborate equipment. An even greater need exists for a means to detect ovulation in the home as an aid to solving the problems of fertility and sterility. The object of the present investigation was to attempt to correlate chemical changes in the urine with the menstrual cycle in order to obtain the basic information needed to detect ovulation. Only two reports could be found in the literature regarding variation in chemical constituents (other than the hormones) of the urine with the menstrual cycle. Shorr found a decrease in citric acid in the urine at midcycle but did not report any proof that this decrease was related to ovulation. U sing the phenol reagent of Folin and Ciocalteu, Sevag found that a characteristic variation of phenolic substances occurred at ovulation. Zondek and Cooper reported that the mechanism of fern test involved an increase in electrolyte concentration in cervical secretions. Arronet showed that crystal formation of the cervical mucus was due to the action of estrogen on sodium chloride balance. Landau found that progesterone caused an increase in urinary chloride and sodium excretion. The above facts suggested the possibility that the level of chloride in the urine might be significantly altered by the changes in estrogen and progesterone concentration that occur during the menstrual cycle. CHLORIDES, PHENOLIC SUBSTANCES AND BASAL BODY TEMPERATURE In view of the above, the initial investigations were directed to the study of chloride excretion in relation to ovulation. For this study, morning urine From the Creighton University School of Medicine, Omaha, Neb. This paper was prepared with the assistance of Michael Haller, John Slaughter, James Mills, M.D., and Thomas Little, M.D. 277

2 278 RYAN FERTILITY & STERILITY specimens were obtained from 35 unmarried, normally menstruating student nurses. Basal body temperatures (rectal) were also obtained from the subjects as a control method for ovulation time. Chloride concentration was determined using the method of Schales and Schales. Determination of phenolic substances in the specimens were carried out according to the method of Sevag. From the 35 complete cycles obtained, only seven showed the characteristic BBT curve. There was no discernible relationship between chloride excretion and presumed day of ovulation, although in some cases there was a gradual increase in the chloride excretion after ovulation, in agreement with the results of Landau. The phenolic substances did show the characteristic curve as described by Sevag. PHENOLIC SUBSTANCES, URINE VOLUME, CREATININE It could not be determined from the material presented by Sevag whether a correction had been made for urine volume. Since this appeared to be an important variable, studies of urine volume and creatinine were started. The relatively constant excretion of creatinine permits it to be used as a guide for urine volume. 9 Creatinine was determined by the alkaline picrate method. 5 Glass flasks graduated at 50-m!. intervals were used to measure urine volume. From the graph (Fig. 1) it is quite evident that creatinine shows the same general variability shown by phenolic substances. Table 1 shows optical density and volume for phenolic substances in the urine of 5 subjects. The data are arranged so that the volumes are shown in increasing value without regard to the day of the cycle. This was done to illustrate the inverse relation between volume and phenolic concentration as measured by the optical density. DISCUSSION If phenolic substances can be considered a valid measure of ovulation, as stated by Sevag and confirmed by Behrman, then urine volume can be used to detect ovulation, for phenolic substances are excreted at a reasonably constant rate,s as is creatinine, and the fluctuation in phenol concentration with the day of the menstrual cycle is caused by changes in urine volume. Smith suggested the possibility of such alterations in his studies of creatinine

3 VOL 12, No.3, 1961 URINE VOLUME AND THE MENSTRUAL CYCLE 279 metabolism. Further work is in progress to determine the relation of urine volume to ovulation and the sex steroids. '~D~ 'S~,... I;: ~/... >.. ~ S~ lodd /.~.. ~ s.. (/) W U> zf- ~Vi (/)Z mw ::>0 (/)--1 <{ u~ _fd~ ~ I 0... lodd PHENOLIC SUBSTANCES CREATI NINE D DAY OF MENSTRUAL CYCLE Figure 1.

4 280 RYAN FERTILITY & STERILITY TABLE l. Inverse Relation of Volume and Optical Density of Phenolic Substances in Urine of 5 Subjects mi. O.D. mz ml. O.D. mz. O.D. mz. O.D SOO SUMMARY l. In the subjects studied, basal body temperature was not an adequate method for detection of ovulation. 2. The concentration of chlorides in the urine did not show any discernible relationship to the presumed day of ovulation. 3. The concentration of phenolic substances in urine is constant or as constant as the creatinine level. 4. The change in phenolic substances observed at ovulation is the result of variation in urine volume. Dept. of Biochemistry The Creighton University School of Medicine 302 North 14 St., Omaha 2, Neb. REFERENCES 1. ARRONET, C. H. Studies on ovulation in the normal menstrual cycle. Fe/ til. & Steril. 8:301, BEHRMAN, S. J. Detection of ovulation. Postgrad. Med. 27:12,1960.

5 VOL. 12, No.3, 1961 URINE VOLUME AND THE MENSTRUAL CYCLE HAWK, P. B., OSER, B. L., and SUMMERSON, W. H. Practical Physiological Chemistry, ed. 13. Blakiston, New York, 1954, p LANDAu, R. L., BERGENSTAL, D. M., LUGffinn., K., and KAscHT, M. E. The metabolic effects of progesterone in man. J. Clin. Endocrinol. 15:1194, REINER, M. Standard Methods of Clinical Chemistry. 1 :55, SCHALES, 0., and SCHALES, S. S. A simple and accurate method in the determination of chloride in biological fluids. J. Biol. Chern. 140:879, SEVAG, M. G., and COLTON, S. W. Simple chemical method for determination of ovulation time in women. ].A.M.A.170(1):13, SHORR, K, BERNHEIM, A. R., TAUSSKY, H. The relation of urinary citric acid excretion to the menstrual cycle and the steroidal reproductive hormones. Science 95:606, SMITH, O. W. Creatinine excretion in women: Data collected in the course of urinalysis for female sex hormones. J. Clin. Endocrinol. 2: 1, ZONDECK, B., and COOPER, K. Inability of estrogen to produce arborization in pregnancy and its clinical significance. Obst. & Gynec. 4:484, 1954.