SUMMARYPlasma unconjugated oestriol (E3) and unconjugated oestradiol‐17β (E2) were determined by radioimmunoassay. In ten normal women in their last month of pregnancy the individual fluctuation of E3 concentrations (mean of the coefficients of variation, CV) from day to day (over 5 days) was 15.6% (range 6.4–26.2%). The individual fluctuation of E2 determined in eight of these women was 16.9 (10.4–25.5) %. In six of the same women who had blood samples collected every 10 min (for 3 h) the individual fluctuation of E3 concentrations was 13.8 (7.0–25.1) %, and of E2 was 16.1 (11.3–26.0) %. The degree of fluctuation of E3 in individuals was in proportion to the mean concentration, unlike E2, suggesting that in clinical practice individual changes in E3 values would be as easy to interpret at low levels as at high levels. The finding that concentrations of plasma unconjugated E3 fluctuate in individuals no more than for E2 or than reported for total E3, and less than reported for 24‐h urinary oestrogens, lends practical support to the theoretical preference for the assay of plasma unconjugated E3 to assess feto‐placental function.

SummaryIn 246 women with amenorrhoea we compared the result of the progestogen challenge test (menstrual response to oral medroxyprogesterone acetate 5 mg daily for 5 days) (225 patients) with the serum oestradiol‐17β (E2) concentration (154 patients) and with clinical assessment of the oestrogen state of the lower genital tract (183 patients) and related them to the response to clomiphene (188 patients). Ovulation in response to clomiphene was defined essentially by a mid‐luteal serum progesterone concentration of at least 25 nmol/l. E2 values were only useful when they fell below 150 pmol/l; they then indicated that ovulation was very unlikely to occur after clomiphene (2 per cent). Clinical assessment was also only useful in predicting failure to ovulate with clomiphene. However, the progestogen challenge test gave good prediction of ovulatory as well as anovulatory responses to clomiphene. After absent or scanty bleeding following progestogen, only 4 per cent of our patients ovulated, and repeated treatment with clomiphene did not increase the ovulatory rate. After a normal menstrual response to progestogen, 39 per cent ovulated in their first cycle with clomiphene using only 50 mg daily, this proportion rising to 55 per cent if 100 mg was used, and to 75 per cent after treatment for three cycles.

SummaryThe karyopyknotic index correlated significantly (p <0.001) with the plasma oestradiol but not plasma oestrone concentration in 38 postmenopausal women. This ties in with previous findings that postmenopausal women with superficial dyspareunia have a more severe degree of vaginal atrophy than asymptomatic women, and that oestradiol is probably more important biologically than oestrone.

Peripheral plasma levels of cortisol and androstenedione exhibit closely related patterns of change which reflect the episodic secretion of these steroids and their dependence upon corticotrophin. The diurnal pattern appears to be reproducible from day to day within an individual, implying the existence of some type of programmed C.N.S. activity. Although plasma aldosterone levels show changes which also relate closely to those described by cortisol, it appears that it is renin, not corticotrophin, which mediates these changes and thus ACTH and renin release appear to be linked in some way. Stimulation of adrenocortical activity with synthetic corticotrophin, or infusion of androstenedione, illustrates the rapid conversion of this steroid to oestrone. The pattern of peripheral steroid levels observed suggests that the clearance of androstenedione must alter rapidly, and confirms the importance of the adrenal cortex as an indirect source of oestrogen.

BJOG: An International Journal of Obstetrics & GynaecologyVolume 84, Issue 4 p. 314-314 PLASMA HORMONE PROFILES IN POST-MENOPAUSAL WOMEN BEFORE AND DURING OESTROGEN THERAPY H. S. Jacobs, H. S. Jacobs Department of Obstetrics and Gynaecology and Chemical Pathology St Mary's Hospital Medical School LondonSearch for more papers by this authorJ. D. Hutton, J. D. Hutton Department of Obstetrics and Gynaecology and Chemical Pathology St Mary's Hospital Medical School LondonSearch for more papers by this authorM. A. F. Murray, M. A. F. Murray Department of Obstetrics and Gynaecology and Chemical Pathology St Mary's Hospital Medical School LondonSearch for more papers by this authorV. H. T. James, V. H. T. James Department of Obstetrics and Gynaecology and Chemical Pathology St Mary's Hospital Medical School LondonSearch for more papers by this author H. S. Jacobs, H. S. Jacobs Department of Obstetrics and Gynaecology and Chemical Pathology St Mary's Hospital Medical School LondonSearch for more papers by this authorJ. D. Hutton, J. D. Hutton Department of Obstetrics and Gynaecology and Chemical Pathology St Mary's Hospital Medical School LondonSearch for more papers by this authorM. A. F. Murray, M. A. F. Murray Department of Obstetrics and Gynaecology and Chemical Pathology St Mary's Hospital Medical School LondonSearch for more papers by this authorV. H. T. James, V. H. T. James Department of Obstetrics and Gynaecology and Chemical Pathology St Mary's Hospital Medical School LondonSearch for more papers by this author First published: April 1977 https://doi.org/10.1111/j.1471-0528.1977.tb12585.xCitations: 7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume84, Issue4April 1977Pages 314-314 RelatedInformation

Section of the stria terminalis and fimbria led to a moderate degree of hyperactivity in the pituitary-testis system of the adult male rat. Similar changes were seen following destruction of the sexually differ­entiated portion of the medial preoptic area but not following destruction of the bed nuclei of the stria terminalis or the suprachiasmatic nuclei. In females, destruction of the sexually differentiated portion of the medial preoptic area caused an acute blockade of ovulation and resulted in a high incidence of both immediate and delayed pseudopregnancies. These effects were not seen following lesions of the bed nuclei of the stria terminalis, or the paraventricular nuclei. Neither these lesions nor lesions of the sexually differentiated portion of the medial preoptic area resulted in long-term failure of ovulation.

In each of six healthy, normally menstruating women, serum oestradiol, progesterone, basal and post luteinizing hormone releasing hormone (LHRH) gonadotrophin measurements were made during the luteal phase of a normal cycle and in a subsequent cycle in which 800 mg of danazol was given daily from the fifth day after the presumptive date of ovulation. No differences in the serum oestradiol, progesterone, or basal gonadotrophin levels were detected, but there was a selective impairment of the follicle stimulating hormone response to LHRH. The implications of these findings are discussed.

SummaryQuantitation of the endocrine effects of primary ovarian failure and of pure natural oestrogen therapy was studied by determining Cortisol, androstenedlone, testosterone, oestrone, oestradiol and gonadotropin concentrations on plasma samples obtained every 20 or 30 minutes for 24 hours. In post-menopausal women, only oestradiol levels were low when compared to mid-follicular phase levels in pre-menopausal women. Oestradiol, and particularly oestrone levels, showed marked independent fluctuations which were not temporally related to fluctuations in the androstenedlone levels, even after its acute suppression by dexamethasone, and then its stimulation by synthetic ACTH. After oral piperazine oestrone sulphate or oestradiol valerate, the oestrone concentrations rose to abnormally high levels, whereas oestradiol levels only showed a small rise which was insufficient to replace the circulating oestradiol deficiency which results from primary ovarian failure. Because of marked fluctuations in oestrone and oestradiol levels, quantitation of oestrogen status by a single blood measurement may be inaccurate.

The clinical, radiological and endocrine findings in thirty-five women with hyperprolactinaemia and amenorrhoea are described. Twelve patients had radiological evidence of a pituitary tumour and six were tested after pituitary ablation. Seventeen patients with hyperprolactinaemia and normal pituitary X-rays were also studied. None was on any drug known to increase prolactin secretion and all patients were euthyroid when tested. Basal serum prolactin concentrations were high in the group with untreated pituitary tumours and in those with normal X-rays. The levels were variable in the post-ablation cases. The increase of prolactin after TRH was subnormal in all of the groups. Serum oestradiol concentrations were low in most patients and nineteen of twenty-one patients tested had no withdrawal bleeding after treatment with a progestogen. Mean serum gonadotrophin concentrations (basal and after LHRH) were normal in twenty-nine patients but subnormal in four post-ablative cases. Anovulatory responses to clomiphene were obtained in nineteen of twenty patients tested. Fifteen patients were treated with bromocriptine; twelve ovulated and eight became pregnant; two not responding had impaired LH and FSH production. Hyperprolactinaemic amenorrhoea is a common disorder with characteristic endocrine features. Galactorrhoea is unusual (30%). Treatment with bromocriptine lowers prolactin concentrations and rapidly repairs the reproductive defect.

A programme for investigation of secondary amenorrhoea is described, which is based upon a functional classification of the endocrine causes of anovulation. All diagnostic enquiries not directly yielding a therapeutic dividend are excluded from this protocol. Three main categories of amenorrhoea are recognised: primary ovarian disease, hyperprolactinaemia and disorders of gonadotrophin secretion. There are subdivisions of each category, each with its own special diagnostic and therapeutic implications. Initial investigations take 6 weeks to complete and include measurements of follicle-stimulating hormone and prolactin, pituitary radiology and assessment of oestrogen production and of the response to clomiphene. The results of analysis of 75 consecutive cases of amenorrhoea and of 18 patients treated for infertility are presented and a cost benefit analysis applied.