Oestrogene im biphasischen und im gestörten menstruellen Cyclus

Summary

This review on estrogens in the ovulatory cycle and in anovulatory disorders is mainly based on long-term estrogen excretion studies as performed by the author in more than 45 cases during the last 12 years. This sort of investigations still today appears to be the only feasable approach for studying the dynamics of the endogenous estrogen production in this field. Its advantages and limitations are briefly referred to.

The well established urinary excretion pattern of estrogens in the course of the ovulatory cycle is discussed with regard to its physiological range of variation and to its correlation to other events and parameters of the cycle such as colpocytology, histology, urinary and plasma levels of gonadotropins and urinary pregnanediol. Special attention is paid to the time relationship between the first estrogen excretion peak, the ripening of the follicle and ovulation. The increase of the urinary estrogen output during the second half of the cycle is interpreted as being due to the activity of the corpus luteum.

On the basis of estrogen excretion curves, at least three types of anovulatory cycles may be distinguished. Most frequently pseudomenstruation are preceeded by remarkably elevated estrogen values in the urine. In rare cases a sharp midcycle peak occurs just as in ovulatory cycles, but no evidence of corpus luteum function is seen afterwards. In the third type, estrogen excretion is fairly constant at low or moderate levels throughout the whole anovulatory cycle.

Functional as well as dysfunctional uterine bleedings are generally thought to be triggered either by hormonal deprivation or — in the case of break-through bleedings — by a relative hormonal deficiency which is know to develope at constant estrogen levels in the course of time. This concept, however, does not appear to be attributable to all kinds of dysfunctional bleedings. Thus, recurrent dyshormonal uterine hemorrhages do not only start in the presence of decreasing or steady but also of sharply increasing urinary estrogen excretion values. Furthermore, endometria sometimes fail to respond with bleeding to adequate estrogen deprivation. Factors are quoted which may modify the responsiveness of the target organ in such instances.