Monitoring the menstrual cycle: Comparison of urinary and serum reproductive hormones referenced to true ovulation. (2nd November 2015) - Roos, Judith
Abstract: Objective The aim of the study was to examine relationships and interindividual variations in urinary and serum reproductive hormone levels relative to ultrasound-observed ovulation in menstrual cycles of apparently normally menstruating women. Methods This was a prospective study of normally menstruating women (no known subfertility), aged 18–40 years ( n = 40), who collected daily urine samples and attended the study centre for blood samples and transvaginal ultrasound during one complete menstrual cycle. Serum luteinising hormone (LH), progesterone, estradiol, urinary LH, pregnanediol-3- glucuronide (P3G) and estrone-3-glucuronide were measured. Ultrasound was conducted by two physicians and interpreted by central expert review. Results Menstrual cycle length varied from 22 to 37 days (median 27 days). Ovulation by ultrasound ranged from day 8 to day 26 (median day 15). Serum and urinary hormone profiles showed excellent agreement. Estrogen and LH hormone peaks in urine and serum showed a range of signal characteristics across the study group before and after ovulation. The rise in estrogen and LH always occurred before ovulation; the progesterone rise from baseline always occurred after ovulation. Conclusions Urinary and serum reproductive hormones showed excellent agreement and may be used interchangeably. The beginning of the surge in serum and urinary LH was an excellent predictor of ovulation. The rise in progesterone and P3G above baseline was a consistent marker of luteinisation confirming ovulation. Both LH and progesterone surges delivered clear, sharp signals in all volunteers, allowing reliable detection and confirmation of ovulation. Chinese Abstract 摘要 目的 检验正常行经女性在月经周期中, 尿液与血清生殖激素水平与经阴道超声所观察到的排卵的关系及个体差异。 方法 这是一个对年龄为18-40岁( n = 40)的正常行经妇女(无已知生育能力低下) 进行的前瞻性研究，在一个完整的月经周期中，受试者采集自己的尿样并到研究中心采集血样和进行阴道超声测试。检测血清黄体生成素(LH), 孕酮, 雌二醇, 尿液LH, 雌酮3葡糖苷酸(P3G)及3-葡糖苷酸孕二酮水平。由两名医生进行超声检查, 中心专家评审判读结果. 结果 月经周期长度22至37天不等(中位时间为27天)。超声所监测到的排卵从第八天至第26天不等(中位时间为第15天)。血清和尿液的荷尔蒙的描绘显示了高度的契合。尿液和血清中雌激素和LH荷尔蒙的峰值在研究受试者群体中表现出排卵前后的一系列信号特征。雌激素和LH水平往往在排卵前升高；孕酮从基线值升高往往发生在排卵后。 结论 尿液和血清中的生殖激素表明了高度的一致性, 且可能可交换使用。血清和尿液中LH波峰的出现是对排卵期极佳的预测。 孕酮和P3G超出基线值的升高是黄素化的一致性标记，这证实了排卵。LH和孕酮的波峰在受试者中都表达了清晰尖锐的信号, 使得排卵期的可靠探测和确证成为可能。 关键词 雌二醇；雌酮-3-葡糖苷酸(E3G)；黄体生成素(LH)；排卵；3-葡糖苷酸孕二醇(P3G)；孕酮；生殖激素；经阴道超声