Medroxyprogesterone increases basal temperature: a placebo-controlled crossover trial in postmenopausal women*
|
|
- Sydney Whitehead
- 6 years ago
- Views:
Transcription
1 FERTILITY AND STERILITY Copyright 1995 American Society for Reproductive Medicine Printed on acid-free paper in U. S. A. Medroxyprogesterone increases basal temperature: a placebo-controlled crossover trial in postmenopausal women* Jerilynn C. Prior, M.D.tt Donald W. McKay, Ph.D.tll Yvette M. Vigna, B.A.t Susan I. Barr, Ph.D. Division of Endocrinology, Department of Medicine, University of British Columbia and Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada Objective: To assess whether temperature is increased by medroxyprogesterone (MPA) and thus whether basal temperature records could be used to determine ovulation during cyclic MPA therapy. Design: A 2-month double-blind placebo-controlled crossover trial in which oral basal temperature was measured daily. Setting: Normal human volunteers in an academic medical environment. Subjects: Eleven postmenopausal women not taking gonadal hormones. Intervention: Medroxyprogesterone acetate (10 mg/d) or placebo, calendar days 16 to 25, with crossover. Main Outcome Measures: Comparison of mean temperature days 17 to 26 during MPA versus placebo; comparison of differences between temperatures days 7 to 16 and 17 to 26 in MP A versus placebo months; and analysis for a significant monthly thermal shift. Results: The mean temperatures during MPA treatment averaged 0.27 C higher than during the placebo phase and showed a significant change from pretreatment to "treatment" phases during MPA but not during placebo cycles. Eight of the MPA and one of the placebo cycles showed a shift from lower to higher temperatures days 16 to 25. Conclusion: Medroxyprogesterone acetate has a physiological progesterone-like thermal effect. Therefore basal temperature data cannot reliably indicate ovulation during cyclic MPA administration. Fertil Steril 1995;63: Key Words: Medroxyprogesterone acetate, progestin, basal temperature, progesterone For at least 100 years, the menstrual cycle has been known to affect core body temperature (1). Received June 17, 1994; revised and accepted December 20, * Supported by University of British Columbia, Vancouver, British Columbia, Canada, Medical Research Account , and Upjohn Company of Canada, Toronto, Ontario, Canada. t Correspondence: Jerilynn C. Prior, M.D., Department ofmedicine, University of British Columbia, Suite 3318, 910 West 10th Avenue, Vancouver, British Columbia, Canada, V5Z 1M9 (FAX: ). :j: Division of Endocrinology, Department of Medicine, University of British Columbia and Vancouver Hospital and Health Sciences Centre. Family and Nutritional Sciences, University of British Columbia. II Present address: Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada Prior et a!. Thermogenic effect of MPA Menstrual cycle records of BBT measurements have been used for scientific studies for 30 years (2-4) and have aided fertility planning for at least three generations. Progesterone's effect in raising core temperature is a reproducible phenomenon, an action not shared by other classes of steroids. Injected progesterone has been shown to raise temperature in humans (5, 6). Medroxyprogesterone acetate (MPA; Provera R; Upjohn Company, Kalamazoo, MI and Toronto, Ontario, Canada), a C-21-derived P derivative, was formulated for use in the diagnostic assessment of amenorrhea (7), in the assessment (8) and therapy of dysfunctional uterine bleeding (9), and in menopausal combined hormone treatment (10). More recent evidence indicates that cyclic MPA administration increases spinal bone density in women with abnormal menstrual cycles or subclini-
2 cal ovulatory disturbances (11, 12), thus increasing the potential indications for cyclic MPA therapy. We have used prospectively a quantitative analysis of list-recorded morning temperatures to assess ovulatory function in women in several studies (12-15). The least squares method of basal temperature analysis has been validated through a study in which the computer-generated day of significant temperature shift from a lower follicular to a higher luteal phase temperature was shown to highly correlate with the day on which the serum LH peak occurred (16). We needed to ascertain with more certainty whether MPA could increase the basal temperature to determine whether we would be justified in using quantitative temperature methods to assess cycle types during a randomized blinded study of cyclic MPA versus placebo in women with menstrual disturbances (12). In addition, should MPA be shown to not be thermogenic, BBT data could be used in clinical practice to assess endogenous hormonal changes in MPA-treated women. For practical as well as scientific and theoretical reasons, therefore, it has become useful to know whether the synthetic progestin MPA alters temperature regulation and thus would interfere with the simultaneous use of basal temperature records. Many resources, including clinical papers (17) and pharmacology texts (18), do not mention whether progestins of different chemical formulas, especially those derived from the nonthermogenic T molecule, have temperature effects. Finally, we have been unable to locate a source that has assessed systematically whether MPA has a thermogenic effect. This study was designed to determine whether MPA causes a significant thermogenic effect in the dose of 10 mg/d that is equivalent in its endometrial effect to the mean luteal phase P levels. The temperature investigation was part of a broader controlled MPA treatment study in which the enrolled postmenopausal women prospectively recorded feelings and experiences on a Daily Menopause Diary (19). Design MATERIALS AND METHODS This is a 2-month double-blind, random-ordered, placebo-controlled crossover trial in which women took 10 mg/d MPA or placebo during days 16 to 25 of the month with crossover during the next month. The order oftherapy was determined by the research pharmacist from a random numbers table. The active and placebo medications were identical capsules filled with white powder. Oral basal temperature was measured daily for 2 months. All women were given a digital Celsius thermometer (no. 4009; Bec- ton Dickinson Canada Inc., Mississauga, Ontario, Canada) and were instructed to take their morning oral temperatures at the usual time of rising. Temperatures were recorded in a list at the bottom of the Daily Menopause Diary form. Illness, disturbed sleep, or changed time of temperature recording also were noted and temperatures were omitted from analysis if a temperature exceeded the preceding one by >0.3 C and coincided with such a notation. Monthly temperature data (that were truncated at day 26 for consistency of analysis) were analyzed using quantitative least squares statistics to determine the occurrence of a significant temperature shift (16). Women were examined, had height and weight measurements taken that were used to derive the body mass index (BMI; weight in kg divided by height in meters squared), and had a blood sample for E2 (and FSH in one woman who had undergone hysterectomy) as reported previously (19). Subjects Fourteen menopausal women who were 2': 1 year beyond their last menstrual flow and who were not taking gonadal hormones were recruited by word of mouth or by advertisements posted in community centers, on hospital bulletin boards, and in clinical centers. Potential subjects were interviewed for hormone use, general health, possible allergy to progestin, and last menstrual period. Each volunteer signed informed consent to a protocol approved by the University of British Columbia Committee on Research Involving Human Subjects. Statistical Analysis Women began taking MPA or placebo on calendar day 16 and continued the intervention through day 25. However, because the BBT was taken in the morning, the day 16 temperature was recorded before starting the intervention. Thus, for the purposes of analysis, temperatures recorded on days 17 to 26 of the month were used as the time on MPA or placebo. Data were analyzed in three different ways: [1] the mean temperature during the 10-day block of time on MPA was compared with the temperature during the time on placebo; [2] the difference between mean temperature during the 10 days preceding MPA and placebo (days 7 to 16) and during taking of tablets (days 17 to 26) was obtained and these differences were compared within women; and [3] each month's temperature record was analyzed using the previously published least squares method (16). An intervention was considered to cause a significant temperature shift if the paired t-test of dif- Prior et al. Thermogenic effect of MPA 1223
3 Table 1 Mean Oral Morning Basal Temperatures During 10 Days Before Treatment and the 10 Days of Treatment With MPA or Placebo* Subject Before MPA MPA Difference Before placebo Placebo Difference Mean:!: SD 36.37:!: :!: :!: :!: :!: :!: 0.08 * Values are in degrees Celsius. ference between temperatures before and after shift resulted in a t value 2: 2.0, if the t value was a positive number (thus indicating a shift from lower to higher temperature), and ifthe temperature shift occurred during days 17 to 26 of the month. Nonparametric two-sided tests were used for all analyses. The significance level was set at RESULTS Of 14 women enrolled, 11 completed the 2-month study. The three women for whom data were incomplete (related to home and family responsibilities and travel) did not differ in demographic characteristics from those completing the study. None dropped out because of adverse symptoms. One of the 11 women experienced withdrawal flow-she was the youngest participant (43 years old) and was just 1 year beyond her last menstrual period (19). The 11 participants had a mean age of 53.5 years (range 43 to 63 years) and had been postmenopausal for a mean of 6.5 years (range 1 to 14 years). Their mean height was cm (range 153 to cm) and mean weight was 67.7 kg (range 47.4 to kg) with a BMI of 25.4 kg/m2 (range 19.2 to 37.5 kg/ m2). The mean serum E2 level was 27.8 pg/ml with a range of 2.7 to pg/ml (101.9 pmolll with a range of 10 to 482 pmolll). The highest E2 level (and the only one that was in the normal premenopausal range) was measured in a woman who was overweight (BMI 37.5 kg/m2), had undergone hysterectomy, had vasomotor symptoms, and also had a repeatedly elevated FSH level (19). The mean of daily temperatures for the 10 days before treatment and treatment phases in MPA and placebo treatment months are shown in Table 1. The mean of daily temperatures during the 10 days on active MPA was :±: 0.15 e (mean:±: SD) and during the 10 days on placebo was :±: 0.14 e (P = 0.001) Prior et al. Thermogenic effect of MPA The temperature change from the pre intervention to intervention phases is also shown in Table 1. The mean change during the month in which MPA was administered was :±: 0.16 versus 0.00 :±: 0.08 e during the month in which placebo was given (P = 0.002). Finally, we used a least squares analysis (Maximina computer program [16]) for assessing a temperature shift within an individual's treatment month. As shown in Table 2, a significant temperature increase occurred during days 17 to 26 of drug administration in 7 of 11 MPA treatment months and during 1 of 11 placebo months. The difference in the occurrence of increased temperature shifts is significant by X 2 (P = 0.008). There is no relationship between the random order of interventions (7 of 11 had the MPA in the 1st month) and whether a significant temperature increase occurred (X2 = 0.898). DISCUSSION During the normal ovulatory menstrual cycle, a :±: 0.09 e increase (95% confidence interval Table 2 Data for Subjects Showing a Significant Increase in Temperature by Maximina Program During MPA or Placebo Interventions Day of temperature Subject increase t value* Intervention MPA MPA MPA MPA MPA Placebo MPA MPA * Statistic derived from a paired t-test comparison of the mean temperature before with the mean temperature after the temperature shift. A t value"", +2.0 is significant at the P < 0.05 level.
4 0.301 to 0.334) in temperature occurs in the luteal phase under the influence of endogenous P (Prior JC, unpublished observations). This study indicates that the synthetic C-21 P derivative MPA has a significant and apparently physiological effect on the oral morning basal temperature. To our knowledge, this is the first clear documentation of the thermogenic effect ofmpa. It remains uncertain whether P exerts its temperature effects through mechanisms that are predominantly central (20) or peripheral (21). Recognition that MPA influences basal temperature becomes useful because women who are prescribed progestins for menometrorrhagia or oligomenorrhea also may want to use symptothermal methods to control fertility (22, 23). It also is useful for a woman who has been treated for some duration with cyclic MPA for ovulatory disturbances with or without osteopenia (12) to know whether she has become normally ovulatory. If MPA were to have no thermogenic effect on core temperature, diagnosis of the return of normally ovulatory cycles could be obtained by basal temperature records. For these reasons, it becomes important to know whether this commonly used exogenous progestin potentially can increase the basal temperature and thus obscure the thermogenic effect of endogenous P. The thermal effect of MPA appears to be neither totally consistent nor universally documented. We had shown previously that a woman with ovulation disturbances who took cyclic MPA on days 16 to 25 of her own cycle (doses and duration of treatment equal to those used in this study) had basal temperature changes that were sometimes indicative of ovulation and sometimes not (14). Similar variability is shown in this study. A few women had no temperature shift on MPA. Limits of the sample size preclude us from determining whether other factors (such as age or serum estrogen level) might influence the thermal response to MP A. We have applied the computerized least squares analysis to these data. We currently use this analysis in menstrual cycle temperature data sets as a way of documenting ovulation based on the thermogenic action ofp (16). By these criteria, 7 of 11 cycles had a significant temperature increase within the days of MPA administration. The one significant temperature increase during a placebo "cycle" would not be unexpected given that the acceptance level of a type 1 error was set at a = Vasomotor symptoms are known to be associated with a transient small decrease in core temperature (24). Medroxyprogesterone acetate treatment also is known to be effective for vasomotor symptom control (25). For both reasons, women volunteers for this study were selected to have few vasomotor symptoms (19). Although it is possible that some of the variability in temperature change during MPA administration related to the mild vasomotor symptoms that were recorded (19), it is unlikely that they would have altered the results of this study. Although progestin treatment commonly is given either cyclically or continuously as part of combined menopausal hormone treatment, cyclic progestins also are given to younger women with menstrual disturbances (12). This makes it important for all progestins being introduced to the market to be evaluated for their thermal effects. Further, studies investigating the presence or absence of effects on basal temperature ofthe currently available progestins, such as norethindrone and norgestrol, are needed. Acknowledgments. We thank the women volunteers, Nenita Alojado, R.N., for study coordination and data collection, and Luciana Frighetto, B.Sc. Pharm., and the pharmacy staff at Vancouver Hospital and Health Sciences Centre for randomizing the order of administration and holding the code and the medications. Medroxyprogesterone acetate and placebo were supplied by Upjohn Company of Canada (Toronto, Ontario, Canada). REFERENCES 1. Squire W. Puerperal temperatures. Lancet 1867;2: Marshall JR. Thermal changes in the normal menstrual cycle. Br Med J 1963;1: Vollman RF. The menstrual cycle. In: Friedman EA, editor. Major problems in obstetrics and gynecology. Vol. 7. Toronto: W.B. Saunders Company, 1977: Doring GK. The incidence of anovular cycles in women. J Reprod Fertil 1969;(Suppl 6): Rothchild I, Barnes AC. The effects of dosage and of estrogen, androgen or salicylate administration on the degree of body temperature elevation induced by progesterone. Endocrinology 1952;50: Israel SL, Schneller O. The thermogenic property of progesterone. Fertil Steril 1950;1: Ranick LD, Shangold MM, Ahmed SW. Cervical mucus and serum estradiol as predictors of response to progestin challenge. Fertil Steril 1990;54: Gambrell RD Jr, Massey FM, Castaneda TA, Ugenas AJ, Ricci CA, Wright JM. Use of the progestogen challenge test to reduce the risk of endometrial cancer. Obstet Gynecol 1980;55: Cowan BD, Morrison JC. Management of abnormal genital bleeding in girls and women. N Engl J Med 1991;324: Kirkham C, Hahn PM, Van Vugt DA, Carmichael JA, Reid RL. A randomized, double-blind, placebo-controlled, crossover trial to assess the side effects of medroxyprogesterone acetate in hormone replacement therapy. Obstet Gynecol 1991;78: Prior JC. Progesterone and its role in bone remodelling. In: Ziegler R, Pfeilschifter J, Brautigam M, editors. Sex steroids and bone. Berlin: Springer-Verlag, 1993: Prior JC, Vigna Y, Barr SI, Rexworthy C, Lentle BC. Cyclic medroxyprogesterone treatment increases bone density: a controlled trial in athletic women with menstrual cycle disturbances. Am J Med 1994;96: Prior JC, Vigna YM, Schechter MT, Burgess AE. Spinal bone Prior et al. Thermogenic effect of MPA 1225
5 loss and ovulatory disturbances. N Engl J Med 1990; 323: Prior JC, Vigna YM. Ovulation disturbances and exercise training. Clin Obstet Gynecol1991;34: Barr SI, Prior JC, Vigna Y. Restrained eating and ovulatory disturbances: possible implications for bone health. Am J Clin Nutr 1993;59: Prior JC, Vigna YM, Schulzer M, Hall JE, Bonen A. Determination of luteal phase length by quantitative basal temperature methods: validation against the midcycle LH peak. Clin Invest Med 1990;13: Cumming DD. Questions and answers: effects of exogenous steroids on basal body temperature. JAmMed Assoc 1990;264: Goodman AS, Gilman AG, Gilman A. The pharmacological basis of therapeutics. 6th ed. New York: Macmillan Publishing Company Inc, Prior JC, Alojado N, McKay DW, Vigna YM. No adverse ef- fects of medroxyprogesterone treatment without estrogen in postmenopausal women: double-blind, placebo-controlled, cross-over trial. Obstet Gynecol 1994;83: Nakayama T. Thermosensitive neurons in the brain. Jpn J Physiol 1985;35: Frascarolo P, Schutz Y, Jequier E. Decreased thermal conductance during the luteal phase of the menstrual cycle in women. J Appl Physiol 1990;69: Billings EL, Brown JB, Billings JJ, Burger HG. Symptoms and hormonal changes accompanying ovulation. Lancet 1972;1: Marshall JR. A field trial of the basal body temperature method of regulating births. Lancet 1968;2: Kronenberg F, Downey JA. Thermoregulatory physiology of menopause hot flashes: a review. Can J Physiol Pharmacol 1987;65: Schiff I, Tulchinsky D, Cramer D, Ryan KJ. Oral medroxyprogesterone in the treatment of postmenopausal symptoms. JAmMed Assoc 1980;244: Prior et al. Thermogenic effect of MPA
Centre for Menstrual Cycle and Ovulation Research at Eight: 2010 CeMCOR Anniversary Celebration
June 30, 2010 Centre for Menstrual Cycle and Ovulation Research at Eight: 2010 CeMCOR Anniversary Celebration by Dr. Jerilynn C. Prior, Scientific Director, Centre for Menstrual Cycle and Ovulation Research
More informationAppendix: Reference Table of HT Brand Names
Appendix: Reference Table of HT Brand Names This is a full reference table in alphabetical order, of Brand Name drugs used in HT. It is the basis for prescription advice throughout this handbook. Drug
More informationPERIMENOPAUSE. Objectives. Disclosure. The Perimenopause Perimenopause Menopause. Definitions of Menopausal Transition: STRAW.
PERIMENOPAUSE Patricia J. Sulak, MD Founder, Living WELL Aware LLC Author, Should I Fire My Doctor? Author, Living WELL Aware: Eleven Essential Elements to Health and Happiness Endowed Professor Texas
More informationPrediction of ovulation with the use of oral and vaginal electrical measurements during treatment with clomiphene citrate*
FERTILITY AND STERILITY Copyright 1987 The American Fertility Society Printed in U.8A. Prediction of ovulation with the use of oral and vaginal electrical measurements during treatment with clomiphene
More informationEffects of TX-001HR on Uterine Bleeding Rates in Menopausal Women with Vasomotor Symptoms
Effects of TX-001HR on Uterine Bleeding Rates in Menopausal Women with Vasomotor Symptoms Photo (compulsory) Steven R Goldstein, MD 1 ; Ginger D Constantine, MD 2 ; David F Archer, MD 3 ; James H Pickar,
More informationThe 6 th Scientific Meeting of the Asia Pacific Menopause Federation
Predicting the menopause The menopause marks the end of ovarian follicular activity and is said to have occurred after 12 months amenorrhoea. The average age of the menopause is between 45 and 60 years
More informationNANCY FUGATE WOODS a a University of Washington
This article was downloaded by: [ ] On: 30 June 2011, At: 09:44 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer
More informationOrals,Transdermals, and Other Estrogens in the Perimenopause
Orals,Transdermals, and Other Estrogens in the Perimenopause Cases Denise Black, MD, FRCSC Assistant Professor, Obstetrics, Gynecology and Reproductive Sciences University of Manitoba 6/4/18 197 Faculty/Presenter
More informationFrequency of menses. Duration of menses 3 days to 7 days. Flow/amount of menses Average blood loss with menstruation is 60-80cc.
Frequency of menses 24 days (0.5%) to 35 days (0.9%) Age 25, 40% are between 25 and 28 days Age 25-35, 60% are between 25 and 28 days Teens and women over 40 s cycles may be longer apart Duration of menses
More informationPicking the Perfect Pill How to Effectively Choose an Oral Contraceptive
Focus on CME at Queen s University Picking the Perfect Pill How to Effectively Choose an Oral Contraceptive By Susan Chamberlain, MD, FRCSC There are over 20 oral contraceptive (OC) preparations on the
More informationIs generic progesterone the same as prometrium
Is generic progesterone the same as prometrium The Borg System is 100 % Is generic progesterone the same as prometrium The progestins in hormonal birth control are not progesterone. They have different
More informationEstrogens and progestogens
Estrogens and progestogens Estradiol and Progesterone hormones produced by the gonads are necessary for: conception embryonic maturation development of primary and secondary sexual characteristics at puberty.
More informationInfertility for the Primary Care Provider
Infertility for the Primary Care Provider David A. Forstein, DO FACOOG Clinical Associate Professor Obstetrics and Gynecology University of South Carolina School of Medicine Greenville Disclosure I have
More information5. Summary of Data Reported and Evaluation
326 5. Summary of Data Reported and Evaluation 5.1 Exposure data Combined estrogen progestogen menopausal therapy involves the co-administration of an estrogen and a progestogen to peri- or postmenopausal
More informationA comparison of methods to interpret the basal body temperature graph*
FERTllJTY AND STERILITY Copyright c 1983 The American Fertility Society Vol. 39, No.5, May 1983 Printed in U.SA. A comparison of methods to interpret the basal body temperature graph* John J. McCarthy,
More informationReproductive System. Testes. Accessory reproductive organs. gametogenesis hormones. Reproductive tract & Glands
Reproductive System Testes gametogenesis hormones Accessory reproductive organs Reproductive tract & Glands transport gametes provide nourishment for gametes Hormonal regulation in men Hypothalamus - puberty
More informationManagement of Perimenopausal symptoms
Management of Perimenopausal symptoms Serge Rozenberg CHU St Pierre Université libre de Bruxelles Belgium serge_rozenberg@stpierre-bru.be serge.rozenberg@skynet.be Conflict of interest & Disclosure Conflicts
More informationLearning Objectives. Peri menopause. Menopause Overview. Recommendation grading categories
Learning Objectives Identify common symptoms of the menopause transition Understand the risks and benefits of hormone replacement therapy (HRT) Be able to choose an appropriate hormone replacement regimen
More informationEndocrinology of the Female Reproductive Axis
Endocrinology of the Female Reproductive Axis girlontheriver.com Geralyn Lambert-Messerlian, PhD, FACB Professor Women and Infants Hospital Alpert Medical School at Brown University Women & Infants BROWN
More informationSerum estrogen level after hormone replacement therapy and body mass index in postmenopausal and bilaterally ovariectomized women
Maturitas 50 (2005) 19 29 Serum estrogen level after hormone replacement therapy and body mass index in postmenopausal and bilaterally ovariectomized women Toshiyuki Yasui a,, Hirokazu Uemura a, Yuka Umino
More informationHormonal Changes Following Low-Dosage Irradiation of Pituitary and Ovaries in Anovulatory Women
Hormonal Changes Following Low-Dosage Irradiation of Pituitary and Ovaries in Anovulatory Women Further Studies A. E. Rakoff, M.D. Tms PRESENTATION is a second progress report in a long-term study of the
More informationManaging menopause in Primary Care and recent advances in HRT
Managing menopause in Primary Care and recent advances in HRT Raj Saha, MD, DMRT, FRCOG PG Cert. Advanced Gynaecology Endoscopy Consultant Gynaecologist Heart of England NHS Foundation Trust Spire Parkway
More informationORILISSA (elagolix) oral tablet
ORILISSA (elagolix) oral tablet Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy Coverage
More informationHormone Treatments and the Risk of Breast Cancer
Cornell University Program on Breast Cancer and Environmental Risk Factors in New York State (BCERF) Updated July 2002 Hormone Treatments and the Risk of Breast Cancer 1) Hormone Treatment After Menopause
More informationMedroxyprogesterone 10 mg and menopause
Medroxyprogesterone 10 mg and menopause Search Millions of women worldwide, many in their teenage years, have been using the longacting, injectable depot medroxyprogesterone. L acétate de médroxyprogestérone
More informationOBSTETRICS & GYNECOLOGY
AUGUST 2011 NORLAND AVENUE PHARMACY PRESCRIPTION COMPOUNDING N ORLANDA VENUEP HARMACY. COM We customize individual prescriptions for the specific needs of our patients. INSIDE THIS ISSUE: BHRT for Menopause
More informationLIE ASSAY OF GONADOTROPIN in human blood is one of the most important
Changes in Human Serum FSH Levels During the Normal Menstrual Cycle MASAO IGARASHI, M.D., JUNJI KAMIOKA, M.D., YOICHI EHARA, M.D., and SEIICHI MATSUMOTO, M.D. LIE ASSAY OF GONADOTROPIN in human blood is
More informationDeciding whether or not to use Hormone Therapy (HT) is a big decision and should be
Deciding whether or not to use Hormone Therapy (HT) is a big decision and should be made with input from your healthcare provider. After the decision has been made to take HT, many women don t realize
More informationMethods Used to Self-Predict Ovulation A Comparative Study
Marquette University e-publications@marquette Nursing Faculty Research and Publications Nursing, College of 5-1-1990 Methods Used to Self-Predict Ovulation A Comparative Study Richard Fehring Marquette
More informationTreatment of hirsutism with a gonadotropin-releasing hormone agonist and estrogen replacement therapy*
Gynecology-endocrinology FERTILITY AND STERILITY Copyright 1994 The American Fertility Society Printed on acid-free paper in U S. A. Treatment of hirsutism with a gonadotropin-releasing hormone agonist
More informationIndividual Study Table Referring to Part of the Dossier. Volume: Page:
1 SYNOPSIS (CR002878) Title of Study: The effect of on vasomotor symptoms in healthy postmenopausal women: a double-blind placebo controlled pilot study Investigators: Multiple, see Section 4, Investigators
More information3 SAMPL E REPORT S. This Assessment features three reporting options: Rhythm Adrenocortex Stress Profile Comprehensive Melatonin Profile GDX-4-225
3 SAMPL E REPORT S This Assessment features three reporting options: Rhythm Adrenocortex Stress Profile Comprehensive Melatonin Profile GDX-4-225 SAMPLE REPORT Rhythm Patient: SAMPLE PATIENT ID: Page 2
More informationReproductive Health and Pituitary Disease
Reproductive Health and Pituitary Disease Janet F. McLaren, MD Assistant Professor Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology jmclaren@uabmc.edu Objectives
More informationSexual behavior and steroid levels among gynecologically mature premenopausal women*
FERTILITY AND STERILITY Copyright 1986 The American Fertility Society VoL 45, No, 4, April 1986 PrinU!d in U.S A. Sexual behavior and steroid levels among gynecologically mature premenopausal women*
More informationUterine Fibroids: No financial disclosures. Current Challenges, Promising Future. Off-label uses of drugs. Alison Jacoby, MD.
Uterine Fibroids: Current Challenges, Promising Future Alison Jacoby, MD Professor, Dept of Obstetrics, Gynecology and Reproductive Sciences No financial disclosures Off-label uses of drugs The BIG Questions
More informationMenopausal Symptoms. Hormone Therapy Products Available in Canada for the Treatment of. Physician Desk Reference - 3rd Edition
Hormone Therapy Products Available in Canada for the Treatment of Menopausal Symptoms Physician Desk Reference - 3rd Edition A clinical resource provided to you by: The Society of Obstetricians and Gynaecologists
More informationPremature Menopause : Diagnosis and Management
Guideline Number 3 : August 2010 Premature Menopause : Diagnosis and Management Introduction : Premature menopause is a serious condition that affects young women and remains an enigma. The challenges
More informationEndometrial blood flow response to hormone replacement therapy in women with premature ovarian failure: a transvaginal Doppler study
. M.,nopause FERTILITY AND STERILITY Vol. 63, No.3, March 1995 Copyright 1995 American Society for Reproductive Medicine Printed on acid-free paper in U. s. A. Endometrial blood flow response to hormone
More informationJim Paoletti BS Pharmacy, FAARM, FIACP, Director of Education, P2P
presents Converting Patients from Conventional Pioneering Technologies For to Bioidentical Lifestyle Based Medicine Hormone Therapy with Jim Paoletti BS Pharmacy, FAARM, FIACP, Director of Education, P2P
More informationAbnormal Uterine Bleeding Case Studies
Case Study 1 Abnormal Uterine Bleeding Case Studies Abigail, a 24 year old female, presents to your office complaining that her menstrual cycles have become a problem. They are now lasting 6 7 days instead
More informationDisclosures. REPLENISH Trial: Objective and Design. Background Use of compounded bioidentical hormone therapy (CBHT) has become highly prevalent
17β Estradiol/Progesterone in a Single Oral Softgel Capsule (TX 001HR) Significantly Reduced Moderate to Severe Vasomotor Symptoms without Endometrial Hyperplasia Disclosures Research support: Actavis,
More informationUPDATE: Women s Health Issues
UPDATE: Women s Health Issues Renee B. Alexis, MD, MBA, MPH, FACOG Associate Professor Department of OBGYN Kiran C. Patel College of Osteopathic Medicine Disclosure of Conflicts of Interest I have no financial
More informationOVERVIEW OF MENOPAUSE
OVERVIEW OF MENOPAUSE Nicole Budrys, MD, MPH Reproductive Endocrinology Michigan Center for Fertility and Women s Health Presented at SEMCME March 13,2019 Objectives Define menopause Etiology of menopause
More informationClinical Study Synopsis
Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace
More informationColumbia University Medical Center, New York, NY 2. Clinical Research Center, Eastern Virginia Medical School, Norfolk, VA 3
17β-Estradiol/Progesterone in a Single Oral Softgel Capsule (TX-001HR) Significantly Reduced Moderate-to-Severe Vasomotor Symptoms without Endometrial Hyperplasia Rogerio A Lobo, MD 1 ; David F Archer,
More informationDaily blood hormone levels related to the luteinizing hormone surge in anovulatory cycles
FRTILITY AND STRILITY Copyright 1983 The American Fertility Society Printed in U.8A. Daily blood hormone levels related to the luteinizing hormone surge in anovulatory cycles Chung H. Wu, M.D. * F. Susan
More informationUpdate on Medical and Surgical Therapy Sara Jane Pieper, MD Chair, Gynecology Development Team
ABNORMAL UTERINE BLEEDING Update on Medical and Surgical Therapy Sara Jane Pieper, MD Chair, Gynecology Development Team Goals Review appropriate medical therapies for abnormal uterine bleeding Review
More informationWHI Estrogen--Progestin vs. Placebo (Women with intact uterus)
HORMONE REPLACEMENT THERAPY In the historical period it was commonly held that estrogen had two principal benefits to postmenopausal women: 1) To alleviate the constitutional symptoms related to the climacteric
More informationReproductive outcome in women with body weight disturbances
Reproductive outcome in women with body weight disturbances Zeev Shoham M.D. Dep. Of OB/GYN Kaplan Hospital, Rehovot, Israel Weight Status BMI (kg/m 2 ) Underweight
More informationTop 5 Fertility Secrets Revealed
Top 5 Fertility Secrets Revealed by Melinda Stevens Brought to you by http://www.pregnancy-online.info All rights reserved, 2007. Copyright 2007, Pregnancy-Online.info 2 Hi, thanks for downloading my free
More informationFactors associated with withdrawal bleeding after administration of oral micronized progesterone in women with secondary amenorrhea *t
FERTILITY AND STERILITY Copyright e 1991 The American Fertility Society Printed on acid-free paper in U.S.A. Factors associated with withdrawal bleeding after administration of oral micronized progesterone
More informationConditioning exercise decreases premenstrual symptoms: a prospective, controlled 6-month trial*
FERTILITY AND STERILITY Copyright 1987 The American Fertility Society Printed in UBA. Conditioning exercise decreases premenstrual symptoms: a prospective, controlled 6-month trial* Jerilynn C. Prior,
More informationManaging menopause in Primary Care and recent advances in HRT
Managing menopause in Primary Care and recent advances in HRT Raj Saha, MD, DMRT, FRCOG Consultant Gynaecologist Heart of England NHS Foundation Trust rajsaha1@yahoo.co.uk Content of today s talk Aims
More informationBASAL BODY TEMPERATURE: UNRELIABLE METHOD OF OVULATION DETECTION
FERTILITY AND STERILITY Copyright c 1981 The American Fertility Society Vol. 36, No. 6, December 1981 Printed in U.SA. BASAL BODY TEMPERATURE: UNRELIABLE METHOD OF OVULATION DETECTION JOAN E. BAUMAN, PH.D.
More informationCASE 41. What is the pathophysiologic cause of her amenorrhea? Which cells in the ovary secrete estrogen?
CASE 41 A 19-year-old woman presents to her gynecologist with complaints of not having had a period for 6 months. She reports having normal periods since menarche at age 12. She denies sexual activity,
More informationVirtual Mentor Ethics Journal of the American Medical Association November 2005, Volume 7, Number 11
Virtual Mentor Ethics Journal of the American Medical Association November 2005, Volume 7, Number 11 Clinical Pearl Post Women's Health Initiative Menopausal Women and Hormone Therapy by JoAnn V. Pinkerton,
More informationMenopausal hormone therapy currently has no evidence-based role for
IN PERSPECTIVE HT and CVD Prevention: From Myth to Reality Nanette K. Wenger, M.D. What the studies show, in a nutshell The impact on coronary prevention Alternative solutions Professor of Medicine (Cardiology),
More informationInfertility: A Generalist s Perspective
Infertility: A Generalist s Perspective Learning Objectives Fertility and Lifestyle: Patient education Describe the basic infertility workup Basic treatment strategies unexplained Heather Huddleston, MD
More informationThe study of correlation between BMI and infertility. Dr. seyed mohammadreza fouladi
The study of correlation between BMI and infertility Dr. seyed mohammadreza fouladi Female Infertility Infertility is a generally defined as one year unprotected intercourse without contraception. Approximately
More informationof Chlormadinone on Amount of Human Cervical Mucus and Its Glycogen Content
" Effect, of Chlormadinone on Amount of Human Cervical Mucus and Its Glycogen Content A. T. GREGOIRE, PHD, and K. USTAY, MD* THE MODE OF ACTION of orally administered steroids in contraceptive therapy
More informationPCOS and Obesity DUB is better treated by OCPs
PCOS and Obesity DUB is better treated by OCPs Dr. Ritu Joshi Senior consultant Fortis escorts Hospital, Jaipur Chairperson Family welfare com. FOGSI (20092012) Vice President FOGSI 2014 Introduction One
More informationHormone replacement therapy: Will it affect seizure control and AED levels?
Seizure (2008) 17, 176 180 www.elsevier.com/locate/yseiz Hormone replacement therapy: Will it affect seizure control and AED levels? Cynthia L. Harden * Comprehensive Epilepsy Center, Department of Neurology,
More informationPrevention of endometrial hyperplasia by progesterone during long-term estradiol replacement: influence of bleeding pattern and secretory changes*
FERTILITY AND STERILITY Vol. 59, No.5, May 1993 Copyright e 1993 The American Fertility Society Printed on acid-free paper in U.S.A. Prevention of endometrial hyperplasia by progesterone during long-term
More informationCurrent Topics in Hormone Replacement Therapy
Current Topics in Hormone Replacement Therapy Corey R. Babb, D.O., FACOOG, IF, NCMP Clinical Assistant Professor of Obstetrics and Gynecology Director of the Oklahoma State University Center for Women
More informationWhat s New in Menopause Management. Objectives
What s New in Menopause Management Leslee L. Subak, MD Professor of Obstetrics, Gynecology & Reproductive Science University of California, San Francisco Objectives Define the menopause transition Review
More informationInvestigation: The Human Menstrual Cycle Research Question: How do hormones control the menstrual cycle?
Investigation: The Human Menstrual Cycle Research Question: How do hormones control the menstrual cycle? Introduction: The menstrual cycle (changes within the uterus) is an approximately 28-day cycle that
More information5/5/2010. Infertility FINANCIAL DISCLOSURE. Infertility Definition. Objectives. Normal Human Fertility. Normal Menstrual Cycle
Infertility FINANCIAL DISCLOSURE I HAVE NO FINANCIAL INTEREST IN ANY OF THE PRODUCTS MENTIONED IN MY PRESENTATION Bryan K. Rone, M.D. University of Kentucky Obstetrics and Gynecology I AM RECEIVING COMPENSATION
More informationCASE 4- Toy et al. CASE FILES: Obstetrics & Gynecology
CASE 4- Toy et al. CASE FILES: Obstetrics & Gynecology A 49-year-old woman complains of irregular menses over the past 6 months, feelings of inadequacy, vaginal dryness, difficulty sleeping, and episodes
More informationDysfunctional Uterine Bleeding (DUB) OB/GYN Hospital of Fudan University Weiwei Feng, MD,Ph D Tel:
Dysfunctional Uterine Bleeding (DUB) OB/GYN Hospital of Fudan University Weiwei Feng, MD,Ph D Email: wfeng7347@aliyun.com Tel: 13918551061 2014-8-20 Contents DUB: definition, mechanism of normal menses,
More informationGonadotrophin treatment in patients with Polycystic Ovary Syndrome
Int. J. Adv. Res. Biol. Sci. (218). 5(4): 95-99 International Journal of Advanced Research in Biological Sciences ISSN: 2348-869 www.ijarbs.com DOI: 1.22192/ijarbs Coden: IJARQG(USA) Volume 5, Issue 4-218
More informationHormonal Control of Human Reproduction
Hormonal Control of Human Reproduction Bởi: OpenStaxCollege The human male and female reproductive cycles are controlled by the interaction of hormones from the hypothalamus and anterior pituitary with
More informationHormones friend or foe? Undertreatment and quality of life. No conflicts of interest to declare
Hormones friend or foe? Undertreatment and quality of life Anette Tønnes Pedersen MD, Ph.D. Consultant, Associate professor Dept. Of Gynecology / Fertility Clinic Rigshospitalet No conflicts of interest
More informationReproductive FSH. Analyte Information
Reproductive FSH Analyte Information 1 Follicle-stimulating hormone Introduction Follicle-stimulating hormone (FSH, also known as follitropin) is a glycoprotein hormone secreted by the anterior pituitary
More informationThe Study of Tamoxifen and Raloxifene (STAR): Questions and Answers. Key Points
CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s The Study of Tamoxifen
More informationSexual dysfunction of chronic kidney disease. Razieh salehian.md psychiatrist
Sexual dysfunction of chronic kidney disease Razieh salehian.md psychiatrist Disturbances in sexual function are a common feature of chronic renal failure. Sexual dysfunction is inversely associated with
More informationDoes Hysterectomy Lead to Weight Gain or Does Overweight Lead to Hysterectomy?
Dr Janneke BERECKI D Fitzgerald, J Berecki, R Hockey and A Dobson 1 1 School of Population Health, Faculty of Health Sciences, University of Queensland, Herston, QLD, Australia Does Hysterectomy Lead to
More informationThe biology of menstrually related. Ovulation Suppression of Premenstrual Symptoms Using Oral Contraceptives REPORTS. Patricia J.
REPORTS Ovulation Suppression of Premenstrual Symptoms Using Oral Contraceptives Patricia J. Sulak, MD Abstract Managing premenstrual symptoms at the most fundamental level necessitates careful consideration
More informationWomen s Health: Managing Menopause. Jane S. Sillman, MD Assistant Professor of Medicine Harvard Medical School
Women s Health: Managing Menopause Jane S. Sillman, MD Assistant Professor of Medicine Harvard Medical School Disclosures I have no conflicts of interest. Learning Objectives 1. Apply strategies to help
More informationOutline. Estrogens and SERMS The forgotten few! How Does Estrogen Work in Bone? Its Complex!!! 6/14/2013
Outline Estrogens and SERMS The forgotten few! Clifford J Rosen MD rosenc@mmc.org Physiology of Estrogen and estrogen receptors Actions of estrogen on bone BMD, fracture, other off target effects Cohort
More informationEstrogens & Antiestrogens
Estrogens & Antiestrogens Menstrual cycle... Changes and hormonal events Natural estrogens: Estadiol >> Estrone > Estriol Ineffective orally Synthesis: From cholesterol ; role of aromatase enzyme in converting
More informationThe Effect of an Oral Contraceptive on Tests of Thyroid Function
The Effect of an Oral Contraceptive on Tests of Thyroid Function DANIEL R. MISHELL, JR., M.D., STEPHEN Z. COLODNY, M.D., and LEONARD A. SWANSON, M.D. SEVERAL OF the oral ovulation-inhibiting progestational
More informationBreast Cancer Risk in Patients Using Hormonal Contraception
Breast Cancer Risk in Patients Using Hormonal Contraception Bradley L. Smith, Pharm.D. Smith.bradley1@mayo.edu Pharmacy Ground Rounds Mayo Clinic Rochester April 3 rd, 2018 2017 MFMER slide-1 Presentation
More informationEVALUATION OF WOMEN FOLLOWING HYSTERECTOMY WITH AND WITHOUT CONSERVATION OF OVARIES
Int. J. Chem. Sci.: 6(3), 2008, 1228-1235 EVALUATION OF WOMEN FOLLOWING HYSTERECTOMY WITH AND WITHOUT CONSERVATION OF OVARIES RAMPRASAD DEY, SUBHASH CHANDRA BISWAS, RANU ROY BISWAS a and ARUNIMA MUKHOPADHYAY
More informationme LUTEINIZED UNRUPTURED FOLLICLE SYNDROME AND ENDOMETRIOSIS
FERTILITY AND STERILITY Copyright c 980 The American Fertility Society Vol. 33,, JanuaEY 980 Printed in U.S.A. me LUTEINIZED UNRUPTURED FOLLICLE SYNDROME AND ENDOMETRIOSIS W. PAULDMOWSKI, M.D.,.PH.D.*
More informationREVIEW POSSIBLE DELETION OF MEDROXYPROGESTERONE FROM THE 14 TH WHO MODEL LIST OF ESSENTIAL MEDICINES
REVIEW POSSIBLE DELETION OF MEDROXYPROGESTERONE FROM THE 14 TH WHO MODEL LIST OF ESSENTIAL MEDICINES Author: Lenita Wannmacher Application: To perform a quick review of medroxyprogesterone acetate tablet
More informationFERTILITY & TCM. On line course provided by. Taught by Clara Cohen
FERTILITY & TCM On line course provided by Taught by Clara Cohen FERTILITY & TCM FERTILITY AND TCM THE PRACTITIONER S ROLE CAUSES OF INFERTILITY RISK FACTORS OBJECTIVES UNDERSTANDING TESTS Conception in
More informationEfficacy and safety of drospirenone 2 mg/17β-estradiol 1 mg hormone therapy in Korean postmenopausal women
Short Communication Obstet Gynecol Sci 2017;60(2):213-217 https://doi.org/10.5468/ogs.2017.60.2.213 pissn 2287-8572 eissn 2287-8580 Efficacy and safety of drospirenone 2 mg/17β-estradiol 1 mg hormone therapy
More informationReproductive. Estradiol Analyte Information
Reproductive Estradiol Analyte Information - 1 - Estradiol Introduction Estradiol (E2 or 17β-estradiol) is the major estrogen in humans. Although it is often called the "female" hormone, it is also present
More informationThe Science Behind Natural Family Planning
The Science Behind Natural Family Planning Presented by Scott & Laura Schulze Pro-Life Symposium & Technology Symposium Saturday, September 20, 2008 Dayton Engineers Club Dayton, OH Definition of NFP Crash
More informationCriteria for considering studies for this review
Página 1 de 6 Ovulation induction in women with spontaneous premature ovarian failure [protocol] Kalantaridou SN, Calis KA, Nelson LM This protocol should be cited as: Kalantaridou SN, Calis KA, Nelson
More informationHow Neurosteroids Modulate Seizures in Children and Adults November 30, 2012
How Neurosteroids Modulate Seizures in Children and Adults November 30, 2012 Page B. Pennell, MD Brigham and Women s Hospital Harvard Medical School Boston, MA American Epilepsy Society Annual Meeting
More information1. Ng M et a l. Global, regional, and national prevalence of overweight and obesity in children and adults during : A systematic analysis
1 2 3 1. Ng M et a l. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980 2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet
More informationPalm Beach Obstetrics & Gynecology, PA
Palm Beach Obstetrics & Gynecology, PA 4671 S Congress Avenue 4631 N Congress Avenue Lake Worth, FL 33461 West Palm Beach, FL 33407 INSTRUCTIONS FOR INFERTILITY WORKUP Please read these handouts carefully.
More informationWARNING LETTER DEPARTMENT OF HEALTH & HUMAN SERVICES TRANSMITTED BY FACSIMILE
DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service Food and Drug Administration Rockville, MD 20857 TRANSMITTED BY FACSIMILE Carole S. Ben-Maimon, M.D. President and Chief Operating Officer One
More informationMANAGEMENT OF REFRACTORY ENDOMETRIOSIS
(339) MANAGEMENT OF REFRACTORY ENDOMETRIOSIS Serdar Bulun, MD JJ Sciarra Professor and Chair Department of Ob/Gyn Northwestern University ENDOMETRIOSIS OCs Teenager: severe dysmenorrhea often starting
More informationMenopause management NICE Implementation
Menopause management NICE Implementation Dr Paula Briggs Consultant in Sexual & Reproductive Health Southport and Ormskirk NHS Hospital Trust Why a NICE guideline (NG 23) Media reports about HRT have not
More informationBiology of Reproduction- Zool 346 Exam 2
Biology of Reproduction- Zool 346 Exam 2 ANSWER ALL THE QUESTIONS ON THE ANSWER SHEET. THE ANSWER ON THE ANSWER SHEET IS YOUR OFFICIAL ANSWER. Some critical words are boldfaced. This exam is 7 pages long.
More informationHRT in Perimenopausal Women. Dr. Rubina Yasmin Asst. Prof. Medicine Dhaka Dental College
HRT in Perimenopausal Women Dr. Rubina Yasmin Asst. Prof. Medicine Dhaka Dental College 1 This is the Change But the CHANGE is not a disease 2 Introduction With a marked increase in longevity, women now
More information9.4 Regulating the Reproductive System
9.4 Regulating the Reproductive System The Reproductive System to unite a single reproductive cell from a female with a single reproductive cell from a male Both male and female reproductive systems include
More informationAltered reflex control of cutaneous circulation by female sex steroids is independent of prostaglandins
Altered reflex control of cutaneous circulation by female sex steroids is independent of prostaglandins NISHA CHARKOUDIAN AND JOHN M. JOHNSON Department of Physiology, University of Texas Health Science
More information