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Types of ovarian activity in women and their significance: the continuum (a reinterpretation of early findings).

Brown JB - Hum. Reprod. Update (2010)

Bottom Line: Unpredictable movement from fertile to infertile types and back can occur at any time during reproductive life.Stress is a major causative factor.The findings explain the erratic fertility of women and why ovulation is not always associated with fertility.

View Article: PubMed Central - PubMed

Affiliation: University of Melbourne, Melbourne, Victoria 3010, Australia.

ABSTRACT

Background: There are many types of ovarian activity that occur in women. This review provides information on the relationship between the hormone values and the degree of biological response to the hormones including the frequency and degree of uterine bleeding. The continuous process is termed the 'Continuum' and is thus similar to other processes in the body.

Methods: This review draws on information already published from monitoring ovarian activity by urinary oestrogen and pregnanediol measurements using timed 24-h specimens of urine. Much of the rationalization was derived from 5 to 6 year studies of girls progressing from childhood to adulthood, women progressing through menopause, and the return of fertility post-partum. During these times, all the reported types of ovarian activity were encountered.

Results: All cycle types can be understood in terms of steps in the normal maturation of fertility at the beginning of reproductive life, its return post-partum and its demise at menopause. Each step merges into the next and therefore the sequence is termed the 'Continuum'. Unpredictable movement from fertile to infertile types and back can occur at any time during reproductive life. Stress is a major causative factor. Hormonal definitions for each step, the relevance of the various cycle types in determining fertility and in the initiation of uterine bleeding and the roles of the pituitary hormones in causing them, are presented.

Conclusions: The findings explain the erratic fertility of women and why ovulation is not always associated with fertility. They provide an understanding of the various types of ovarian activity and their relation to pituitary function, fertility and uterine bleeding.

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Weekly TE and pregnanediol values in a girl measured over 4 years from age 12 to 16 years. Menarche and first ovulation were documented. Arrow denotes birthdays; filled boxes denote vaginal bleeding, vertical dotted lines show day of bleeding, horizontal dotted lines denote production of fertile type cervical mucus. [Reprinted with permission from Brown et al. (1978). Copyright Cambridge University Press].
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DMQ040F2: Weekly TE and pregnanediol values in a girl measured over 4 years from age 12 to 16 years. Menarche and first ovulation were documented. Arrow denotes birthdays; filled boxes denote vaginal bleeding, vertical dotted lines show day of bleeding, horizontal dotted lines denote production of fertile type cervical mucus. [Reprinted with permission from Brown et al. (1978). Copyright Cambridge University Press].

Mentions: Figure 2 (from Brown et al., 1978), shows the TE and pregnanediol values, and times of uterine bleeding recorded in a girl who provided weekly samples of urine at intervals between ages 12 and 16 years. At age 12.5 years, her TE excretion was fluctuating between 1.2 and 2.6 µg/24 h and the pregnanediol values were between none detected and 0.4 mg/24 h (not shown). During the age of 13 years the oestrogen values increased gradually with rhythmical fluctuations. At the age of 14 years the TE value peaked to 44µg/24 h and she experienced her first bleed (menarche) 3 days later. The pregnanediol values during this time remained at <0.4 mg/24 h. The TE values continued to fluctuate between 10 and 80 µg/24 h and initially, bleeding occurred immediately after the peaks. The second bleed occurred 8 weeks after the first bleed but bleeding occurred at decreasing intervals until eventually it settled to an approximately monthly rhythm. As the interval between the oestrogen peaks and bleeding increased, so did the pregnanediol values before the bleeds. The first pregnanediol value that exceeded 2 mg/24 h (the criterion for ovulation) was observed in May 1975 at age 15 years. The study ceased at age 16 years before the pregnanediol values reached 3 mg/24 h, the criterion for a fully fertile ovulation. This is therefore a pattern of follicular activity increasing until the oestrogen values reached were sufficient to initiate bleeding followed by the gradual maturation of the ovulatory mechanism as shown by the increasing pregnanediol values and the increasing interval between the oestrogen peak and bleeding. This was a continuous process which included lengthening of initially short and deficient luteal phases and increasing progesterone production. All the types of ovarian activity referred to in the introduction could be conceptualized in the process.Figure 2


Types of ovarian activity in women and their significance: the continuum (a reinterpretation of early findings).

Brown JB - Hum. Reprod. Update (2010)

Weekly TE and pregnanediol values in a girl measured over 4 years from age 12 to 16 years. Menarche and first ovulation were documented. Arrow denotes birthdays; filled boxes denote vaginal bleeding, vertical dotted lines show day of bleeding, horizontal dotted lines denote production of fertile type cervical mucus. [Reprinted with permission from Brown et al. (1978). Copyright Cambridge University Press].
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3039221&req=5

DMQ040F2: Weekly TE and pregnanediol values in a girl measured over 4 years from age 12 to 16 years. Menarche and first ovulation were documented. Arrow denotes birthdays; filled boxes denote vaginal bleeding, vertical dotted lines show day of bleeding, horizontal dotted lines denote production of fertile type cervical mucus. [Reprinted with permission from Brown et al. (1978). Copyright Cambridge University Press].
Mentions: Figure 2 (from Brown et al., 1978), shows the TE and pregnanediol values, and times of uterine bleeding recorded in a girl who provided weekly samples of urine at intervals between ages 12 and 16 years. At age 12.5 years, her TE excretion was fluctuating between 1.2 and 2.6 µg/24 h and the pregnanediol values were between none detected and 0.4 mg/24 h (not shown). During the age of 13 years the oestrogen values increased gradually with rhythmical fluctuations. At the age of 14 years the TE value peaked to 44µg/24 h and she experienced her first bleed (menarche) 3 days later. The pregnanediol values during this time remained at <0.4 mg/24 h. The TE values continued to fluctuate between 10 and 80 µg/24 h and initially, bleeding occurred immediately after the peaks. The second bleed occurred 8 weeks after the first bleed but bleeding occurred at decreasing intervals until eventually it settled to an approximately monthly rhythm. As the interval between the oestrogen peaks and bleeding increased, so did the pregnanediol values before the bleeds. The first pregnanediol value that exceeded 2 mg/24 h (the criterion for ovulation) was observed in May 1975 at age 15 years. The study ceased at age 16 years before the pregnanediol values reached 3 mg/24 h, the criterion for a fully fertile ovulation. This is therefore a pattern of follicular activity increasing until the oestrogen values reached were sufficient to initiate bleeding followed by the gradual maturation of the ovulatory mechanism as shown by the increasing pregnanediol values and the increasing interval between the oestrogen peak and bleeding. This was a continuous process which included lengthening of initially short and deficient luteal phases and increasing progesterone production. All the types of ovarian activity referred to in the introduction could be conceptualized in the process.Figure 2

Bottom Line: Unpredictable movement from fertile to infertile types and back can occur at any time during reproductive life.Stress is a major causative factor.The findings explain the erratic fertility of women and why ovulation is not always associated with fertility.

View Article: PubMed Central - PubMed

Affiliation: University of Melbourne, Melbourne, Victoria 3010, Australia.

ABSTRACT

Background: There are many types of ovarian activity that occur in women. This review provides information on the relationship between the hormone values and the degree of biological response to the hormones including the frequency and degree of uterine bleeding. The continuous process is termed the 'Continuum' and is thus similar to other processes in the body.

Methods: This review draws on information already published from monitoring ovarian activity by urinary oestrogen and pregnanediol measurements using timed 24-h specimens of urine. Much of the rationalization was derived from 5 to 6 year studies of girls progressing from childhood to adulthood, women progressing through menopause, and the return of fertility post-partum. During these times, all the reported types of ovarian activity were encountered.

Results: All cycle types can be understood in terms of steps in the normal maturation of fertility at the beginning of reproductive life, its return post-partum and its demise at menopause. Each step merges into the next and therefore the sequence is termed the 'Continuum'. Unpredictable movement from fertile to infertile types and back can occur at any time during reproductive life. Stress is a major causative factor. Hormonal definitions for each step, the relevance of the various cycle types in determining fertility and in the initiation of uterine bleeding and the roles of the pituitary hormones in causing them, are presented.

Conclusions: The findings explain the erratic fertility of women and why ovulation is not always associated with fertility. They provide an understanding of the various types of ovarian activity and their relation to pituitary function, fertility and uterine bleeding.

Show MeSH
Related in: MedlinePlus