Gynaecology Malignancies and other Chronic Conditions

Review of Literature

In 1981, T Hilgers et al published a study where the observation of the "Peak" mid-cycle mucus was correlated with the estimated time of ovulation, as evaluated by hormone levels. In 65 of the 73 cycles studied in 24 patients, there was hormonal confirmation of ovulation; in eight cycles, anovulation or luteal dysfunction was suspected. Ovulation was estimated to occur from 3 days before to 3 days after the Peak symptom with a mean of 0.31 days before the Peak symptom. In 95.4% of these cycles, ovulation was estimated to occur from 2 days before to 2 days after the Peak symptom. The variation between cycles of the same patient ranged from 0 to 4 days with a mean of 1.8 days. The beginning of the mucus cycle preceded the estimated time of ovulation by an average of 5.9 days 2, 3. Oestrogen is the dominant preovulatory hormone, while progesterone and oestrogen are both produced during the post-ovulatory (post-peak) phase of the cycle. Traditionally, gynaecologists estimate day 21 progesterone level to ascertain ovulation assuming that all women have a standard 14-day luteal phase. The CrMS has confirmed that in reality the luteal phase is variable between 9 and 17 days. Thus we propose to use the CrMS to estimate the peak progesterone level and oestradiol in the luteal phase more precisely.

Breast cancer: The Treloar data set on menstruation and reproductive history, which began in 1934 and had over 50 years of recorded menstrual events, has been evaluated for variations in menstrual cycle patterns and the risk of breast cancer. This study showed that women who had cycles of extreme length at ages 25 to 29 years had a nearly twofold increased incidence of breast cancer. This was the one of the few prospective studies on breast cancer. Most of the other epidemiological studies recorded retrospective data which are not very reliable 4. Progesterone deficiency diagnosed on endometrial biopsies at the time of curettage as an investigation for infertility, cervical mucus tests and basal body temperature (used more widely at that time), Cowan et al reported a 141.6 number of breast cancer cases per 100,000 women years as compared to 27.1 cases in women with non-hormonal infertility. This is a 5.4 times increased incidence of premenstrual breast cancer 5.

Hilgers et al also reported a decreased progesterone level and decreased mucus score in their preliminary data published in their naprotechnology textbook.

Ovarian cancer : is responsible for 5% of all female cancer deaths. It is often diagnosed at a late stage (70-75%) with a 5-year survival of 25 to 30%. Nulliparous and infertile women have a 3 times increased risk of ovarian cancer. Women with endometriosis also have a higher risk 6, 7, 8.

It has been suggested that the risk of ovarian cancer is directly related to a woman’s lifetime number of ovulations or menstrual cycles. Yet women who for some reason had a unilateral oophorectomy, do not have an increased incidence of cancer in the remaining ovary which thus takes over with monthly ovulation. More research is required in this field.

Osteoporosis

Women with premature menopause are at increased risk of osteoporosis and standard treatment now includes female hormonal replacement therapy. There is evidence to suggest that progesterone is a bone-building hormone but more research is required to investigate women with intrinsically low progesterone levels and possible supplements to prevent the development of osteoporosis 9.

Polycystic ovarian syndrome: which clinically often manifests itself with excessive facial and body hair growth, loss of scalp hair and increased body mass index is a metabolic disorder affecting many Mediterranean women. It affects multiple organs. Such women often have irregular cycles due to the absence of ovulation and the chronic stimulation of the endometrium with unopposed oestrogen which irregularly sheds itself erratically.Affected women have an increased risk of developing Type II diabetes mellitus, hypertension, hyperlipidaemia as well as ischaemic heart disease . They have also an increased incidence of chronic fatigue syndrome10.