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Physiological intermenstrual bleeding—Gross or microscopic—as a possible diagnostic aid in abdominal pain studies
ARSTR 1\(“I?> , Rutherford, Robert N. : scopic-as a Possible 52: 62, 1944.
Physiological
Diagnostic
Intermenstrual
Aid in Abdominal
439 Bleeding-Gross
Pain Studies, West.
or MicroJ. Surg:.
Intermittent menstrual pain or I\ilittelschtrrerz was first cleacaribed in 1847. ln 1928, it was first observed that microscopic uterine bleeding may occur periodically between the fifteenth and nineteenth days of the menstrual cycle. This has been found to occur in 73 per cent of Rhesus monkeys at the time of ovulation. Gross bleeding is also occasionally seen in women. Periodic intermenstrual pain associated \I-ith ovulation may be due to rupture of the follicle, chemical irritation of the adjacent tissues by the follicular fluid or related to vascular or nerve response. The author carefully follows 20 normal patients without intermenstrual pain for a period of 1 year. The patients were instructed to inject 1 ounce of saline in the vagina each morning during theil estimated ovulation period and collect the mashings in a bottle. ‘These daily washings were examined microscopically for blood. When blood was found, a pelvic examination was done and an endometrial biopsy taken. In 237 cycles, microscopic blood was found in 67.9 per cent. It appeared at an average 11.7 days before the onset of the next period. The bloodSwas usually present :: days. Of the 20 patients studied, 17 showed microscopic bleeding in one or more cycles. On pelvic examination, 79 per cent had a sense of fullness and tenderness, and 18 per cent had definite abdominal tenderness associated with bleeding. Endometrial biopsies taken at the t,ime of bleeding usually showed early secretory phase. There was no definite relaConship with libido. In an another series of patients with periodic pain similar findings were noted as in the above group, iXany of the patients in this group presented a problem in the differential diagnosis of appendicitis and ovulation pain. It is the author?s opinion that the simple technique of vaginal washings wit!) a search for microscopic bleeding will further aid in the differential diagnosis. It may also help in dating ovulation for sterility, or contraceptive study. WILLIAM
Loeser, Alfred A.: Effect of Emotional Shock Endometrial Development, Lancet 244: 318, 1943.
on Hormone
BICKERS.
Release
and
The author reports four cases of suppressed menstruation due to shock. In three instances the shock or psychic trauma was due to bomb explosions, and in the other to the omission of the use of contraception. ‘Q’he specimens obtained by curettage were examined by Professor Emil Novak. it is conrluded in summary that ‘ i four women who had always menstruatetl regularly missed a period after an emotional shock. Iliet.ological examination of the biopsy specimens showed an cndometrium at the stage of development it would normally have reached at the time of the shock, suggesting that the shock caused an immediate arrest of development by interruption of the release of the proper hormones. ’’ FRED I,. ADAIR.
Morton, S., Gerson, R., and Biskind, Leonard H.: Nutritional Etiology of Menorrhagia, Metrorrhagia, Cystic Mastitis, Tension, Surg., Gynee. & Obst. 78: 49, 1944.
Deficiency iu the and Premenstrual
Based on two earlier observations, namely, that estrogen is inactivated in the liver, and that this inactivation cannot be accomplished in vitamin B deficient animals, the authors have made observations on 104 patients with menorrhagia, metrorrhagia, cystic mastitis, premenstrual tension, and uterine myomata. Thirty-
Physiological
Diagnostic
Intermenstrual
Aid in Abdominal
439 Bleeding-Gross
Pain Studies, West.
or MicroJ. Surg:.
Intermittent menstrual pain or I\ilittelschtrrerz was first cleacaribed in 1847. ln 1928, it was first observed that microscopic uterine bleeding may occur periodically between the fifteenth and nineteenth days of the menstrual cycle. This has been found to occur in 73 per cent of Rhesus monkeys at the time of ovulation. Gross bleeding is also occasionally seen in women. Periodic intermenstrual pain associated \I-ith ovulation may be due to rupture of the follicle, chemical irritation of the adjacent tissues by the follicular fluid or related to vascular or nerve response. The author carefully follows 20 normal patients without intermenstrual pain for a period of 1 year. The patients were instructed to inject 1 ounce of saline in the vagina each morning during theil estimated ovulation period and collect the mashings in a bottle. ‘These daily washings were examined microscopically for blood. When blood was found, a pelvic examination was done and an endometrial biopsy taken. In 237 cycles, microscopic blood was found in 67.9 per cent. It appeared at an average 11.7 days before the onset of the next period. The bloodSwas usually present :: days. Of the 20 patients studied, 17 showed microscopic bleeding in one or more cycles. On pelvic examination, 79 per cent had a sense of fullness and tenderness, and 18 per cent had definite abdominal tenderness associated with bleeding. Endometrial biopsies taken at the t,ime of bleeding usually showed early secretory phase. There was no definite relaConship with libido. In an another series of patients with periodic pain similar findings were noted as in the above group, iXany of the patients in this group presented a problem in the differential diagnosis of appendicitis and ovulation pain. It is the author?s opinion that the simple technique of vaginal washings wit!) a search for microscopic bleeding will further aid in the differential diagnosis. It may also help in dating ovulation for sterility, or contraceptive study. WILLIAM
Loeser, Alfred A.: Effect of Emotional Shock Endometrial Development, Lancet 244: 318, 1943.
on Hormone
BICKERS.
Release
and
The author reports four cases of suppressed menstruation due to shock. In three instances the shock or psychic trauma was due to bomb explosions, and in the other to the omission of the use of contraception. ‘Q’he specimens obtained by curettage were examined by Professor Emil Novak. it is conrluded in summary that ‘ i four women who had always menstruatetl regularly missed a period after an emotional shock. Iliet.ological examination of the biopsy specimens showed an cndometrium at the stage of development it would normally have reached at the time of the shock, suggesting that the shock caused an immediate arrest of development by interruption of the release of the proper hormones. ’’ FRED I,. ADAIR.
Morton, S., Gerson, R., and Biskind, Leonard H.: Nutritional Etiology of Menorrhagia, Metrorrhagia, Cystic Mastitis, Tension, Surg., Gynee. & Obst. 78: 49, 1944.
Deficiency iu the and Premenstrual
Based on two earlier observations, namely, that estrogen is inactivated in the liver, and that this inactivation cannot be accomplished in vitamin B deficient animals, the authors have made observations on 104 patients with menorrhagia, metrorrhagia, cystic mastitis, premenstrual tension, and uterine myomata. Thirty-