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Contribution to the pathogenesis of dysmenorrhea

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Summary

Menstrual blood was collected from five eumenorrheic and seven dysmenorrheic women aged between 20 and 35 years for a period of three cycles each.

The levels of prostaglandin F2α (PGF2α), prostaglandin E2 (PGE2), 6-keto-prostaglandin F1α (6-k-PGF1α) — the stable metabolite of prostacyclin (PGI2) —, oestradiol, oestrone, and progesterone were determined radioimmunologically.

Both eumenorrheic and dysmenorrheic women showed identical blood losses. The levels of oestradiol excreted by the dysmenorrheic women were markedly elevated as compared to the non-dysmenorrheic subjects (2 p < 0.05).

Oestrone excretion was in the same order of magnitude in all subjects examined. The concentration of progesterone per menstruation was significantly higher in the eumenorrheic women (2p < 0.02) than in the dysmenorrheic patients. Menstrual excretion of PGF2a was 2.5 times higher in the dysmenorrheic women compared to the normal subjects (2p < 0.05). The levels of PGE2 was identical in both groups. Excretion of 6-k-PGF1α was significantly lower in the dysmenorrheic women than in the eumenorrheic subjects (2p š 0.02).

The oestradiol/progesterone ratio showed a distinct predominance of oestradiol in the dysmenorrheic patients. PGF2α dominance in the dysmenorrheic patients is expressed by the PGFα/6-k-PGF1α and the PGF2α/PGE2 ratios.

A shift in the oestradiol/progesterone ratio in favour of oestradiol seems to be the underlying pathogenic principle of dysmenorrhea. The oestradiol dominance is associated with a shift in the PGF2α/PGI2 and the PGF2α/ PGE2 proportions. Thus, the PGF2α predominance and a simultaneous reduction of PGI2 in uterine tissue seem to be responsible for dysmenorrheic bleeding.

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  1. Abteilung für Geburtshilfe und Gynäkologie, Universität Freiburg, Hugstetterstrasse 55, D-7800, Freiburg i.Br., Federal Republic of Germany

    H. P. Zahradnik & M. Breckwoldt

  2. Abteilung für Klinische Endokrinologie, Universität Freiburg, Hugstetterstrasse 55, D-7800, Freiburg i.Br., Federal Republic of Germany

    H. P. Zahradnik & M. Breckwoldt

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Zahradnik, H.P., Breckwoldt, M. Contribution to the pathogenesis of dysmenorrhea. Arch. Gynecol. 236, 99–108 (1984). https://doi.org/10.1007/BF02134006

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