Determination of menstrual prostaglandin levels in non-dysmenorrheic and dysmenorrheic subjects

doi:10.1016/0090-6980(78)90176-4

Prostaglandins

Volume 15, Issue 2, February 1978, Pages 365-375

Prostaglandins

https://doi.org/10.1016/0090-6980(78)90176-4 Get rights and content

Abstract

We have developed a method which can measure the menstrual prostaglandin (PG) activity in a single tampon specimen by bioassays. This method makes it possible to monitor the menstrual PG activity continuously during menstruation. Using this technique, we determined the menstrual PG patterns of two normal non-dysmenorrheic subjects, one subject on oral contraceptives (OC) and one subject with moderate to severe dysmenorrhea. Two to four cycles were studied per subject. We observed three menstrual patterns among the four subjects studied. Compared to the two normal controls, the subject on OC had a significantly lower menstrual fluid total and menstrual PG activity. The mean values ± S.E. per menstrual period were 33.4 g ± 1.5 vs 21.5 g ± 2.0 and 28.6 μg (PGF_2α equivalent) ± 1.5 vs 11.3 μg ± 4.2 respectively (control vs OC). The dysmenorrheic subject had a menstrual fluid total of 37.0 g ± 1.9 similar to the two normal controls. Her menstrual PG activity (49.8 μg ± 7.7), however, was nearly two times higher than the normal controls. In one cycle studied, the dysmenorrheic subject was treated with a PG synthetase inhibitor, ibuprofen (Motrin). Remarkable relief was achieved. The alleviation of symptoms was accompanied by a concomitant marked reduction in the menstrual PG activity.

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Cited by (109)

Dysmenorrhea in the adolescent
2023, Encyclopedia of Child and Adolescent Health, First Edition
Dysmenorrhea in the adolescent is extremely common and often not adequately treated. Studies of the epidemiology show both that it is a worldwide phenomenon, but also varies significantly by the group studied. Theories of etiology initially leaned toward the psychogenic, while still recognizing the role of pelvic pathology in the most severe cases. Ultimately, primary dysmenorrhea was recognized to be related to increased intrauterine production of prostaglandins. Secondary causes were identified as obstructive anomalies of the reproductive tract or increasingly as endometriosis. The mainstays of treatment should be non-steroidal anti-inflammatory drugs or oral contraceptives. Failure of these two treatments to improve symptoms should result in investigation for causes of secondary dysmenorrhea, starting with pelvic ultrasound, and progressing to possible laparoscopy. Complementary therapies may be used as an adjunct to evidence-based medical treatment, but these do not yet have scientifically sound evidence of efficacy nor data on adverse side effects.
Effect of traditional Chinese medicine formula GeGen decoction on primary dysmenorrhea: A randomized controlled trial study
2020, Journal of Ethnopharmacology
GeGen Decoction, a well-known Chinese herbal formula, is widely used in China and other Asian countries to treat gynecological diseases, including primary dysmenorrhea. Pharmacological studies have confirmed that GeGen Decoction is able to inhibit spasmodic contractions of the uterus in vivo and in vitro.
The objective of this study is to examine the efficacy and safety of GeGen Decoction on primary dysmenorrheic patients.
This was a randomized, double-blinded, placebo-controlled trial. GeGen Decoction or placebo was administered a week before the expected start of each cycle for three consecutive menstrual periods. Between-group differences in pain intensity were detected by visual analogue scale (VAS). In addition, serum levels of arginine vasopressin (AVP) and estrogen (E) were examined by enzyme-linked immunosorbent assay. Metabolomic analysis was further used to evaluate the influence of GeGen Decoction on the metabolomics of primary dysmenorrheic patients.
A total of 71 primary dysmenorrheic women were recruited and 30 participants met the criteria were randomized into GeGen Decoction or placebo group. After three consecutive menstrual cycles’ treatments, the VAS score of the GeGen Decoction group was significantly lower than that of the placebo group. Both serum levels of AVP and E decreased after GeGen Decoction administration, while the placebo seemed to have little effect on either of the index. Moreover, after GeGen Decoction treatment, seven important metabolites were identified by metabolomic analysis compared to the placebo group. No abnormalities in blood biochemical and routine physical examination pre and post GeGen Decoction intervention were observed.
GeGen Decoction can remarkably relieve the severity of menstrual pain without obvious adverse effects. Its therapeutic effect on primary dysmenorrhea might be related to the regulation of pituitary hypothalamic ovarian hormones, and interfering with the metabolic change.
Rates of Anovulation in Adolescents and Young Adults with Moderate to Severe Primary Dysmenorrhea and Those without Primary Dysmenorrhea
2018, Journal of Pediatric and Adolescent Gynecology
Citation Excerpt :
Specifically, growing effort has been put forth to further understand the factors contributing to its etiology. PD is believed to be caused in large part by the overproduction of uterine prostaglandins.1,13–15 The decline in progesterone during the late luteal phase of ovulatory (OV) cycles creates an environment more favorable for prostaglandin production,16 which has led to the belief that ovulation is necessary for the development of PD.14,17
To evaluate rates of presumptive anovulation in eumenorrheic adolescents and young adults with moderate to severe primary dysmenorrhea and those without primary dysmenorrhea.
Participants completed luteinizing hormone surge ovulation predictor test kits. Anovulatory cycles were defined by never receiving a positive result before the next menstrual period; participants were grouped as anovulatory if they experienced at least 1 anovulatory cycle during study participation. Participants rated daily level of menstrual pain on a 0-10 numeric rating scale.
A university-based clinical research laboratory.
Thirty-nine adolescents and young adults (ages 16-24) with primary dysmenorrhea and 52 age-matched control girls.
Rates of presumptive anovulation.
One hundred sixty-eight cycles were monitored, 29.8% (N = 50) of which were anovulatory (37.1% [39/105] vs 17.5% [11/63] of cycles in control and dysmenorrhea groups, respectively). During study participation, control girls were significantly more likely to have had at least 1 anovulatory cycle than were girls with primary dysmenorrhea (44.2% [23/52] vs 17.9% [7/39] of participants, respectively; P < .01). Cycle length and number of bleeding days between ovulatory and anovulatory cycles were similar. The primary dysmenorrhea group's maximum menstrual pain ratings did not differ between ovulatory and anovulatory cycles (4.77 and 4.36, respectively; P > .05).
Our data support previous findings of increased rates of ovulation in primary dysmenorrhea. However, menstruation after anovulatory cycles can be as painful as menstruation after ovulatory cycles. These data support the idea that regular menses do not necessarily indicate that a normal ovulatory cycle has occurred. Previous implications that ovulation is necessary for the development of substantial menstrual pain are incomplete.
Continuous Norethisterone Acetate versus Cyclical Drospirenone 3 mg/Ethinyl Estradiol 20 μg for the Management of Primary Dysmenorrhea in Young Adult Women
2016, Journal of Pediatric and Adolescent Gynecology
Citation Excerpt :
Menstrual fluid PGs, serum PGs, serum arginine vasopressin, and intrauterine pressure all change with COC use. Chan and Hill15 reported that prostaglandin F2α levels in menstrual fluid were lower in 2 women with dysmenorrhea effectively treated with COC than in 6 women with untreated dysmenorrhea or normal control participants. Moreover, ovulation inhibition is known to relieve dysmenorrhea, and OCs that contain synthetic estrogen and progestin may be used for this purpose.16
To evaluate the efficacy of continuous norethisterone acetate (NET-A), 5 mg (group N) vs cyclical combined oral contraceptive pill (COC) consisting of drospirenone 3 mg/ethinyl estradiol 20 μg pills (group P) in treating dysmenorrhea in young adult women.
This prospective, open-label, nonrandomized study included 38 Jordanian patients: 20 patients in group N and 18 patients in group P.
Continuous NET-A 5 mg daily or cyclical COC.
Pain scores, adverse effects, analgesic use, school absence, and cost.
Thirty-eight patients used NET-A or COC for 6 months. All participants had almost the same starting levels of visual analogue scale (VAS) scores. Both drugs were similar in suppressing dysmenorrhea at the 3-month follow-up visit; VAS score mean (±SD) in group N and P were 1.30 ± 1.22 and 1.28 ± 0.83 (P = .22), respectively, and after 6 months, with mean VAS scores (±SD) of 1.30 ± 1.22 and 1.28 ± 0.83, respectively (P = .95). The cost of the treatment in the N group was much less than in the P group. Participants in the N group were less likely to use pain killers: 20% and 44% in the N and P groups, respectively (P = .006) in the first month and only 5% and 17% (P = .019) in the N and P groups, respectively, at the 3-month follow-up, and none of them used any analgesics at the 6-month follow-up.
A continuous NET-A regimen is a well tolerated, effective, and inexpensive option for dysmenorrhea treatment and was as good as COC.
Ge-Gen Decoction attenuates oxytocin-induced uterine contraction and writhing response: Potential application in primary dysmenorrhea therapy
2016, Chinese Journal of Natural Medicines
The uterine tetanic contraction and uterine artery blood flow reduction are possible reasons for primary dysmenorrhea (PD). In the present study, we aimed to evaluate the uterine relaxant effect and the influence on uterine artery blood velocity of Ge-Gen Decoction (GGD), a well-known Chinese herbal formula. In female ICR mice, uterine contraction was induced by oxytocin exposure following estradiol benzoate pretreatment, and the uterine artery blood velocity was detected by Doppler ultrasound. Histopathological examination of the uterine tissue samples were performed by H&E staining. Ex vivo studies demonstrated that oxytocin, posterior pituitary, or acetylcholine induced contractions in isolated mouse uterus. GGD inhibited both spontaneous and stimulated contractions. In vivo study demonstrated that GGD significantly reduced oxytocin-induced writhing responses with a maximal inhibition of 87%. Further study demonstrated that GGD normalized oxytocin-induced abnormalities of prostaglandins F₂ alpha (PGF_2α) and Ca²⁺ in mice. In addition, injection of oxytocin induced a decrease in uterine artery blood flow velocity. Pretreatment with GGD reversed the oxytocin response on blood flow velocity. Histopathological examination showed pretreatment with GGD alleviated inflammation and edema in the uterus when compared with the model group. Both ex vivo and in vivo results indicated that GGD possessed a significant spasmolytic effect on uterine tetanic contraction as well as improvement on uterine artery blood velocity which may involve PGF_2α and Ca²⁺ signaling, suggesting that GGD may have a clinic potential in PD therapy.
Spontaneous Membranous Dysmenorrhea in an Adolescent Girl: A Case Report and Literature Review
2015, Journal of Pediatric and Adolescent Gynecology
Membranous dysmenorrhea is a rare entity. It involves the sloughing of the endometrium in 1 cylindrical or membranous piece, retaining the shape of the uterine cavity. Herein, we report the first case of spontaneous membranous dysmenorrhea in an adolescent girl.
A 17-year-old girl was admitted to the emergency clinic with severe painful menstrual bleeding and passage of tissue via the vagina. Bloody endometrial tissue resembling the endometrial cavity expulsed from the vagina was seen on inspection. The pathologic diagnosis of the mass was membranous dysmenorrhea.
To our knowledge, this is the first case of the spontaneous occurrence of membranous dysmenorrhea. The relationship between membranous dysmenorrhea and endogenous or exogenous progesterone should be investigated further. A review of the literature on membranous dysmenorrhea is presented.

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Determination of menstrual prostaglandin levels in non-dysmenorrheic and dysmenorrheic subjects

Abstract

Prostaglandins

J Endocrin

Gynecology, Principles and Practices

Dysmenorrhoea

Med J Aust

Novak's Textbook of Gynecology

The separation of the smooth-muscle stimulants in menstrual fluid

J Physiol

The isolation and identification of two smooth muscle stimulants from menstrual fluid

Nature (London)

The isolation and identification of two smooth muscle stimulants from menstrual fluid

Nature (London)

Prostaglandins in endometrium and menstrual fluid from normal and dysmenorrhoeic subjects

J Obstet Gynecol Br Commonw

Primary dysmenorrhea alleviation by an inhibitor of prostaglandin synthesis and action

Obstet Gynecol