Pamela Warner

Mood, Sexuality, Hormones and the Menstrual Cycle. I. Changes in Mood and Physical State: Description of Subjects and Method

&NA; Mood and physical symptoms through the menstrual cycle were investigated in 55 women with normal ovulatory cycles. One‐third had attended a clinic with severe premenstrual syndrome (clinic PMS group); the remainder were volunteers either with a history of PMS (non‐clinic PMS group) or without (no PMS group). Each cycle was divided into six hormonally distinct phases on the basis of repeated hormone measurement. Self‐ratings of “well‐being” reached their maximum in the late follicular phase, declining throughout the luteal half of the cycle. This pattern was pronounced and statistically significant in the “clinic” and “nonclinic PMS” groups. In all three groups, “physical distress” increased during the second half of the cycle to reach a maximum in the late luteal phase. A clear temporal relationship was therefore demonstrated between mood, physical state, and hormonal phases of the cycle. It remains uncertain whether changes in the “clinic” group were extreme forms of a normal pattern or were qualitatively different.

Mood, Sexuality, Hormones, and the Menstrual Cycle. III. Sexuality and the Role of Androgens

&NA; Sexual interest and activity at different stages of the menstrual cycle was recorded by 55 women with normal ovulatory cycles. In women with marked cyclical mood change, there was an associated cyclical pattern of sexual feelings. Subjective sexuality independent of mood change, was maximal in the mid‐follicular (i.e., postmenstrual) and late luteal (i.e., premenstrual) phases. Sexual activity was maximal in the mid‐follicular phase. There was no evidence of a periovulatory increase in sexual interest or activity. Mean testosterone levels were correlated with masturbation frequency but not with sexuality involving the partner. A weak association between testosterone and life style (i.e., in full‐time work or a housewife) was also evident.

Mood, sexuality, oral contraceptives and the menstrual cycle

4112 women completed a retrospective questionnaire indicating when during their last menstrual cycle they felt their well-being and sexual interest to be at their best and worst. The commonest pattern was for well-being to be lowest during the premenstrual and highest during the postmenstrual week. Sexual interest was strongly associated with well-being, suggesting that variations of well-being have a powerful effect on sexuality in the majority of women. Oral contraceptive users, though broadly similar in their reported pattern, were less likely to show peaks and troughs of well-being and highs and lows of sexual interest. This was most evident in the subgroup of monophasic pill users who showed the least tendency to variations in both well-being and sexual interest, and a greater tendency to show either peaks or troughs of well-being during menstruation. Triphasic pill users were intermediate between monophasic and non-pill users.

Referral for menstrual problems: cross sectional survey of symptoms, reasons for referral, and management

Abstract Objectives: To describe the menstrual experience of women referred for menstrual problems, in particular menorrhagia (excessive menstrual loss), and to assess associations with reasons for referral given by their general practitioners, the womens understanding of the reasons for their attendance at the hospital clinics, and clinic outcome. Design: Questionnaire survey, with partial review of case notes after 8 months. Setting: Three hospital gynaecology clinics in Glasgow and Edinburgh. Participants: 952 women completed the questionnaire, and the first 665 were reviewed. Outcome measures: Reason for referral, womens reported menstrual problems and reason for clinic attendance, diagnosis, and treatment. Results: Only 38% (95% confidence interval 34% to 41%) of women reported excessive menstrual loss as a severe problem. However 60% (57-63%) gave it as reason for attending a clinic, and 76% (73-79%) of general practitioners gave it as reason for referral. Reason for referral was significantly biased towards bleeding (McNemar odds ratio 4.01, 3.0 to 5.3, P<0.001) and against pain (0.54, 0.4 to 0.7, P<0.001). Dysfunctional uterine bleeding was diagnosed in 37% (31-42%) of the 259 women who gave as reason for attendance something other than bleeding. Women who were economically disadvantaged differed in prevalence of the main diagnoses and were more likely to fail to reattend. Hysterectomy was associated with referral for bleeding (relative risk 4.9, 1.6 to 15.6, P<0.001) but not with the patient stating bleeding as the reason for clinic attendance. Conclusions: Intolerance of the volume of their bleeding is not a key feature among women attending clinics for bleeding problems. Broad menstrual complaint tends to be reframed as excessive bleeding at referral and during management. This may result in women receiving inappropriate care. Conceptualisation and assessment of menorrhagia requires reconsideration. What is already known on this topic Excessive menstrual loss (menorrhagia) is one of the commonest reasons for secondary referral of women, but there is no formalised clinical assessment in routine use Management typically involves potent drugs or invasive surgery, with 60% of women having hysterectomy within 5 years Many women referred for menorrhagia have menstrual blood loss that is not excessive What this study adds Discordance exists between symptoms and both referral and diagnostic pathways, arising from a disproportionate focus on menstrual bleeding Among women referred for menorrhagia, volume of bleeding is not a key symptom This raises concerns about conceptualisation and assessment of menstrual complaint and the appropriateness of healthcare provision

Cardiovascular effects of physiological and standard sex steroid replacement regimens in premature ovarian failure

Current hormone replacement therapy may not optimize cardiovascular health in women with premature ovarian failure. We compared the effects of physiological and standard sex steroid replacement regimens on cardiovascular health in these women. In an open-label, randomized, controlled crossover trial, 34 women with premature ovarian failure were randomly assigned to 4-week cycles of physiological (transdermal estradiol and vaginal progesterone) and standard (oral ethinylestradiol and norethisterone) therapy for 12 months. Cardiovascular health was assessed by 24-hour ambulatory blood pressure, arterial stiffness, and renal and humoral factors. Eighteen women (19 to 39 years of age) completed the 28-month protocol. Both regimens caused similar suppression of luteinizing hormone and follicle-stimulating hormone and provided symptom relief. In comparison with the standard regimen, physiological sex steroid replacement caused lower mean 24-hour systolic and diastolic blood pressures throughout the 12-month treatment period (ANOVA; P≤0.0001 for both): systolic blood pressure was 7.3 mm Hg (95% CI: 2.5 to 12.0 mm Hg) and diastolic was 7.4 mm Hg (95% CI: 3.9 to 11.0 mm Hg) lower at 12 months. Although there were no differences in arterial stiffness, physiological sex steroid replacement reduced plasma angiotensin II (ANOVA; P=0.007) and serum creatinine (ANOVA; P=0.015) concentrations without altering plasma aldosterone concentrations. In comparison with a standard regimen, physiological sex steroid replacement in women with premature ovarian failure results in lower blood pressure, better renal function, and less activation of the renin-angiotensin system. These findings have major implications for the future cardiovascular health of young women who require long-term sex steroid replacement therapy.

ANDROGENS AND SEXUAL BEHAVIOUR IN WOMEN USING ORAL CONTRACEPTIVES

Twenty women using oral contraceptives and complaining of impaired sexual function were compared with twenty women without sexual problems, matched for age and oral contraceptive. Whilst the sexual behaviour differed in the two groups, the plasma testosterone, androstenedione, oestradiol and SHBG concentrations were very similar. The total androgen levels were low in both groups. Plasma testosterone and oestradiol concentrations were correlated with measures of sexual interest in the no‐problem group, but not in the problem group. Administration of exogenous androstenedione to women in the problem group, using a double blind cross‐over comparison with a placebo, failed to improve their sexual function except in one case. The majority of women showed a rise in androgen and oestradiol between day 24 of one pill cycle and day 4 of the next. The possible behavioural indications of this pattern are discussed.

Physiological versus standard sex steroid replacement in young women with premature ovarian failure: effects on bone mass acquisition and turnover

Background  The aim of this exploratory study was to establish whether we could improve skeletal health with a physiological regimen of SSR in young women with premature ovarian failure (POF).

The relationship between perimenstrual depressive mood and depressive illness.

In a study of 144 women, mainly self-designated PMS sufferers, the premenstrual depression experienced was, apart from its shorter duration, quantitatively and qualitatively similar to major depressive disorder for a substantial proportion of subjects. The associations with previous history of depression were complex: the severity of premenstrual depression was related to previous history of postnatal depression, whereas its duration (i.e., whether it persisted through longer) was related to a history of treatment with antidepressants. Two independent dimensions are proposed. (i) A menstrual cycle-related factor which in vulnerable women can results in severe and disabling premenstrual dysphoria, and which may be aetiologically related to a subgroup of postnatal depression. (ii) In a minority of women a more general propensity for depressive illness evidence as a tendency for any premenstrual depression to be prolonged.

Contraceptive practices, sexual and reproductive health needs of HIV-positive and negative female sex workers in Goa, India

Objectives In India, female sex workers (FSWs), suffer from high HIV prevalence and abortions. Contraceptive use among general population women is well understood. However, FSWs contraceptives practices and reproductive health needs are under-researched. We investigated contraceptive practices among HIV-positive and negative FSWs in Goa, India and explored its association with socio-demographic and sex work related factors. Methods Cross-sectional study using respondent driven sampling recruited 326 FSWs. They completed an interviewer-administered questionnaire and were screened for STI/HIV. Multivariable logistic regression was used to explore factors associated with sterilisation relative to no contraception. Results HIV prevalence was high (26%). Of the 59 FSWs planning pregnancy, 33% were HIV-positive and 5–7% had Gonorrhoea, Chlamydia and Trichomonas. 25% and 65% of FSWs screened-positive for Syphilis and Herpes simplex virus type 2 antibodies respectively. Among the 260 FSWs analysed for contraceptive use, 39% did not use contraceptives, and 26% had experienced abortion. Half the FSWs had undergone sterilisation, and only 5% used condoms for contraception. Among HIV-positive FSWs, 45% did not use contraceptives. Sterilisation was independently associated with older age, illiteracy, having an intimate non-paying male partner, having children and financial autonomy. Exposure to National AIDS Control Organisations HIV-prevention interventions was reported by 34% FSWs and was not significantly associated with contraceptive use (adjusted odds ratio 1.4, 95% CI 0.7 to 2.9). Conclusion HIV-prevention interventions should promote contraception, especially among young and HIV-positive FSWs. Integrating HIV treatment and care services with HIV-prevention interventions is vital to avert HIV-positive births.

Factors affecting adequacy of Pipelle and Tao Brush endometrial sampling

Objective  To compare factors influencing adequacy of endometrial samples obtained using two outpatient sampling devices – Pipelle and Tao Brush.