New York University School of Medicine, Department of Pediatrics, Division of Environmental Pediatrics, New York, New York.
Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia.
J Clin Endocrinol Metab. 2020 May 1;105(5):e2024-31. doi: 10.1210/clinem/dgaa099.
Menstrual cycle function is determined by a complex endocrine axis that controls the ovaries and endometrium. While the late luteal phase is characterized by declining progesterone and estrogen, how these hormonal profiles relate to menstrual bleeding patterns is not well understood.
Characterize associations between luteal phase hormonal profiles and subsequent menstrual bleeding patterns, specifically spotting before bleeding.
DESIGN, SETTING, AND PARTICIPANTS: We examined creatinine-adjusted urinary estrone 3-glucuronide (E13G) and pregnanediol 3-glucuronide (Pd3G) levels in relation to spotting in 116 premenopausal women (ages 20-47) who kept daily menstrual diaries and collected first morning urine samples for ≥ 2 consecutive cycles or 1 luteal-follicular transition (n = 283 transitions). We used linear mixed models to estimate associations between luteal phase hormone levels and spotting before bleeding.
MAIN OUTCOME MEASURE(S) AND RESULTS: Transitions with ≥ 1 days of spotting before menstrual bleeding (n = 118) had greater luteal phase Pd3G levels vs nonspotting transitions (n = 165). Differences in Pd3G between spotting and nonspotting transitions were largest at menses onset (34.8%, 95% confidence interval, 18.9%, 52.7%). Pd3G levels for spotting transitions dropped to similar levels as nonspotting transitions an average of 1 day later, which aligned with the first day of bleeding for transitions with contiguous spotting. Spotting transitions were preceded by slower rates of Pd3G decline than nonspotting transitions, whereas E13G declines were similar.
Self-reported bleeding patterns may provide insight into luteal phase Pd3G levels. First bleed appears to be the best choice for defining the end of the luteal phase and achieving hormonal consistency across transitions.
月经周期功能由控制卵巢和子宫内膜的复杂内分泌轴决定。虽然黄体晚期的特征是孕激素和雌激素水平下降，但这些激素谱与月经出血模式的关系尚不清楚。
描述黄体期激素谱与随后的月经出血模式之间的关系，特别是出血前的点滴出血。
设计、地点和参与者：我们检查了 116 名绝经前妇女（年龄 20-47 岁）的肌酐调整后的尿雌酮 3-葡糖苷酸（E13G）和孕烷二醇 3-葡糖苷酸（Pd3G）水平与点滴出血的关系，这些妇女记录了每日月经日记，并在至少 2 个连续周期或 1 个黄体-卵泡过渡期（n=283 个过渡期）中收集了第一个晨尿样本。我们使用线性混合模型来估计黄体期激素水平与出血前点滴出血之间的关系。
有≥1 天出血前点滴出血的过渡期（n=118）与无点滴出血的过渡期（n=165）相比，黄体期 Pd3G 水平更高。点滴出血与非点滴出血过渡期之间的 Pd3G 差异在月经来潮时最大（34.8%，95%置信区间，18.9%，52.7%）。点滴出血过渡期的 Pd3G 水平平均比非点滴出血过渡期晚 1 天降至类似水平，这与有连续点滴出血的过渡期的出血第一天相吻合。与非点滴出血过渡期相比，点滴出血过渡期的 Pd3G 下降速度较慢，而 E13G 的下降速度则相似。
自我报告的出血模式可能为黄体期 Pd3G 水平提供一些线索。首次出血似乎是定义黄体期结束和实现过渡期激素一致性的最佳选择。
