Dissociation between Cervical Mucus and Urinary Hormones during the Postpartum Return of Fertility in Breastfeeding Women

Identifying the return of fertility with cervical mucus observations is challenging during the postpartum period. Use of urinary measurements of estrogen and progesterone can assist in understanding the return to fertility during this period. The purposes of this study were to describe the postpartum return of fertility by an analysis of total estrogen (TE) and pregnanediol glucuronide (PDG) profiles and to correlate these profiles with cervical mucus observations. Twenty-six participants collected urine samples during the postpartum period and recorded mucus scores. TE and PDG hormones were analyzed and compared with mucus scores. During amenorrhea, mucus reflected TE changes in only 35 percent of women; after amenorrhea, typical mucus patterns were seen in 33 percent of cycles. We concluded that postpartum mucus and hormone profiles are significantly dissociated but that monitoring urinary hormones may assist in identifying the return of fertility. We also identified different hormonal patterns in the return to fertility. The postpartum period is a challenging time for identifying the return of fertility. The purposes of this study were to describe the hormonal patterns during the return of fertility and to correlate these patterns with cervical mucus observations. Twenty-six postpartum women collected urine samples and recorded mucus scores. Urinary estrogen and progesterone hormones were analyzed and compared with mucus scores. Before the return of menses, mucus reflected hormonal changes in only 35 percent women and after first menses in 33 percent of cycles. We found that hormone profiles do not correlate well with mucus observations during the postpartum return of fertility

Expressing the quantity of urinary analytes: a discussion of some issues arising from the monitoring of the menstrual cycle

Practical domestic monitoring of the menstrual cycle requires measurements of urinary metabolites of reproductive hormones: oestrone glucuronide (E1G) and pregnanediol glucuronide (PdG). Data reported in the literature are expressed as (i) concentration, without or with either creatinine- or specific gravity correction, or (ii) excretion rates. This variation in such a fundamental issue prompts consideration of the relationships between the four measures. Because the menstrual cycle kinetics of E1G and PdG are complex, we consider measurements of urinary creatinine, urea, galactose, xylose and inulin which tend to be more stable. We show that uncorrected concentration measurements of these urinary analytes can be positively correlated, negatively correlated or uncorrelated with the serum concentration. Based on measurements of urinary creatinine concentrations, urinary specific gravity and creatinine excretion rates, we conclude that urinary analyte concentration are likely to be more reliable when creatinine-corrected rather than corrected using specific gravity, but that both are less reliable than measurements of the excretion rate. This has implications for the quantitation of any urinary analyte, but especially for the monitoring of the menstrual cycle in which changes in E1G and PdG from one day to the next can be physiologically significant for a woman monitoring her fertility

On the distribution of urine output in normally cycling women

It has been suggested that it is possible to monitor the menstrual cycle by measuring the concentration of urinary reproductive steroids. This neglects the variation in void volume and in urine production rate. In neither case has any systematic analysis been reported previously. Overnight urine samples were collected each day for one complete cycle by 24 women and the void volumes and intervoid times were recorded. The void volume and urine production rate were approximately lognormally distributed and the intervoid time was approximately normally distributed. Using these distributions we consider the implications of the variation in void volume and urine production rate for the comparison of the concentrations of a urinary analyte in two samples

Does the use of ovulation monitors really increase pregnancy rates? Some things women should know

Ovulation monitors are widely used by women wishing to achieve pregnancy. However, there are few data substantiating claims that these devices enhance the probability of becoming pregnant. In one report it is concluded from the cumulative pregnancy rate that the use of the Clearblue Easy Fertility Monitor increased the pregnancy rate. In a second report, it is argued that the use of the Clearblue Digital Ovulation Test reduces the time taken to conceive. We reconsider these previously published data by analysing each cycle and show that use of such devices might have a small effect (ϕ ≈ 0.12, odds ratio = 2.1-2.2, relative risk = 1.9) in the first month of use, but has no significant effect (ϕ ≈ 0.01, odds ratio = 1.2, relative risk = 1.1-1.2) in the second month. However, the subjects recruited for these two trials had single cycle pregnancy rates (7-11%) that were more similar to those of women avoiding pregnancy (about 6%) than women trying to conceive (about 25%). Given this, there is a reason to suspect that the data that are available might not be representative of all women. Further work is required to test whether even this small transient effect can be replicated in women with higher pregnancy rates. Women should be aware of the limitations of these ovulation monitors

Autobiographical episodic memory-based training for the treatment of mood, anxiety and stress-related disorders: A systematic review and meta-analysis.

We review evidence for training programmes that manipulate autobiographical processing in order to treat mood, anxiety, and stress-related disorders, using the GRADE criteria to judge evidence quality. We also position the current status of this research within the UK Medical Research Council's (2000, 2008) framework for the development of novel interventions. A literature search according to PRISMA guidelines identified 15 studies that compared an autobiographical episodic memory-based training (AET) programme to a control condition, in samples with a clinician-derived diagnosis. Identified AET programmes included Memory Specificity Training (Raes, Williams, & Hermans, 2009), concreteness training (Watkins, Baeyens, & Read, 2009), Competitive Memory Training (Korrelboom, van der Weele, Gjaltema, & Hoogstraten, 2009), imagery-based training of future autobiographical episodes (Blackwell & Holmes, 2010), and life review/reminiscence therapy (Arean et al., 1993). Cohen's d was calculated for between-group differences in symptom change from pre- to post-intervention and to follow-up. We also completed meta-analyses for programmes evaluated across multiple studies, and for the overall effect of AET as a treatment approach. Results demonstrated promising evidence for AET in the treatment of depression (d=0.32), however effect sizes varied substantially (from -0.18 to 1.91) across the different training protocols. Currently, research on AET for the treatment of anxiety and stress-related disorders is not yet at a stage to draw firm conclusions regarding efficacy as there were only a very small number of studies which met inclusion criteria. AET offers a potential avenue through which low-intensity treatment for affective disturbance might be offered

The spurious correlation between concentration and creatinine-corrected concentration in urine

The use of urinary analytes to monitor physiological processes relies on making the correct measurement. Three alternatives are commonly contemplated: concentration, creatinine-corrected concentration and excretion rate. Of these, the latter is the most reliable, but is perceived by some to be difficult to measure. This has led to the more frequent reliance on concentration and one of the justifications for this is the reported linear relationship between the concentration and the creatinine-corrected concentration. We show that this correlation is spurious in that the magnitude of the correlation coefficient depends on the ratio of the standard deviations of the creatinine and analyte concentrations. As an example urinary analyte we use pregnanediol (Pd) which is an important tool for women wishing to monitor their own fertility. Urinary Pd concentration is not a reliable substitute for creatinine-corrected Pd concentration or the Pd excretion rate

Does the Use of Ovulation Monitors Really Increase Pregnancy Rates? Some Things Women Should Know

Ovulation monitors are widely used by women wishing to achieve pregnancy. However, there are few data substantiating claims that these devices enhance the probability of becoming pregnant. In one report it is concluded from the cumulative pregnancy rate that the use of the Clearblue Easy Fertility Monitor increased the pregnancy rate. In a second report, it is argued that the use of the Clearblue Digital Ovulation Test reduces the time taken to conceive. We reconsider these previously published data by analysing each cycle and show that use of such devices might have a small effect (ϕ ≈ 0.12, odds ratio = 2.1-2.2, relative risk = 1.9) in the first month of use, but has no significant effect (ϕ ≈ 0.01, odds ratio = 1.2, relative risk = 1.1-1.2) in the second month. However, the subjects recruited for these two trials had single cycle pregnancy rates (7-11%) that were more similar to those of women avoiding pregnancy (about 6%) than women trying to conceive (about 25%). Given this, there is a reason to suspect that the data that are available might not be representative of all women. Further work is required to test whether even this small transient effect can be replicated in women with higher pregnancy rates. Women should be aware of the limitations of these ovulation monitors

Hidden intrabasin extension: Evidence for dike-fault interaction from magnetic, gravity, and seismic reflection data in Surprise Valley, northeastern California

The relative contributions of tectonic and magmatic processes to continental rifting are highly variable. Magnetic, gravity, and seismic reflection data from Surprise Valley, California, in the northwest Basin and Range, reveal an intrabasin, fault-controlled, ~10-m-thick dike at a depth of ~150 m, providing an excellent example of the interplay between faulting and dike intrusion. The dike, likely a composite structure representing multiple successive intrusions, is inferred from modeling a positive magnetic anomaly that extends ~35 km and parallels the basin-bounding Surprise Valley normal fault on the west side of the valley. A two-dimensional high-resolution seismic reflection profile acquired across the magnetic high images a normal fault dipping 56°E with ~275 m of throw buried ~60 m below the surface. Densely spaced gravity measurements reveal a \u3c1 mGal gravity low consistent with the fault offset inferred from the seismic data. Collinearity of the magnetic high and gravity low for ~6 km implies normal fault control of the dike along that length. The unusually shallow angle of the dike suggests that motion along the fault (perhaps aided by reduced friction along the dike) and associated block rotation resulted in post-intrusion tilting of the dike. The source of the dike is likely related to a shallow brittle-ductile transition zone that was elevated following rapid slip on the Surprise Valley fault after 3 Ma. Prior to our work, the Surprise Valley fault was assumed to accommodate the vast majority of extension across the region. Our results indicate that subsurface features, although no longer active, are significant contributors to the processes, timing, and total amount of extension observed in continental rift environments