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The Menstrual Cycle - Getting the "Vital" Respect it Deserves

A Compilation of Abstracts Presented By:

Lawrence M. Nelson, M.D., M.B.A., National Institute of Child Health and Human Development, NIH, Bethesda, MD
Paula Hillard, M.D., University of Cincinnati College of Medicine, Department of Obstetrics and Gynecology and Department of Pediatrics, Cincinnati, OH
Justina Trott, M.D., F.A.C.P., American College of Women's Physicians, Santa Fe, NM
Sundeep Khosla, M.D., Endocrine Research Unit, Mayo Clinic and Foundation, Rochester, MN
Michelle P. Warren, M.D., Columbia College of Physicians and Surgeons, New York, NY
Edited by: Cydney Halpin

At a recent meeting held at the National Institute of Health (NIH) in Bethesda Maryland, it was the consensus among leading endocrinologists, obstetricians, gynecologists, epidemiologists, pediatricians, researchers, nurses and mid-wives, that the menstrual cycle is as much a "vital sign" as blood pressure, pulse rate, or temperature as an indicator when assessing a woman's overall health.

 

According to Dr. Lawrence M. Nelson, National Institute of Child Health and Human Development, NIH, the presence of normal regular menstrual cycles provides evidence that the hypothalamus and the pituitary are providing proper coordinated stimulation to support normal ovarian function, and the ovary is responding to this stimulation appropriately. Many young women do not appreciate that regular menstruation is a sign that the ovary is functioning normally in its endocrine role, and that absence of menstruation could be a sign of an endocrine deficiency.

Every woman - age appropriate, not pregnant and under otherwise healthy conditions - should menstruate regularly. Oligomenorrhea (sparse or infrequent menstruation) or amenorrhea (the absence or stopping of the menstrual period) are very significant indicators of an endocrine problem and measures should be taken to find out why a woman has ceased menses and provide appropriate treatment as indicated. Taking a "wait and see" attitude or worse yet, masking conditions with inappropriately prescribed birth control pills without a complete and accurate diagnosis could have potentially debilitating and life-threatening effects.

Causes of oligomenorrhea and amenorrhea include the relatively common conditions of hyperandrogenism, eating disorders and exercise-induced amenorrhea, as well as conditions such as pituitary tumor, gonadal dysgenesis and premature ovarian failure. Recognition and accurate diagnosis are undermined when clinicians and patients (women and teens alike) themselves believe that "anything goes" with regard to menstrual cyclicity and that's it's OK (or even cool) to not have menstrual periods. Furthermore, even subtle abnormalities in the menstrual cycle may, over the long term, have significant adverse consequences.

In addition to a role in reproduction, the ovary functions as an important endocrine gland that is responsible for producing steroid and glycoprotein hormones that have important systemic effects. Sex steroids (androgens and estrogens) play an important role in accruing and maintaining bone mass, and cessation of ovarian function results in significant bone loss (osteoporosis).

The menstrual cycle is a window into the unique biology of a woman. Attention to menstrual irregularity and the earlier diagnosis of conditions causing it may lead to interventions that are "vital" to a woman's overall sustained good health. Women must know their own vital signs and partner with well-trained doctors to maintain age-appropriate health and fitness.