Predicting menstrual migraine with a home-use fertility monitor

Self-identification of the clinical fertile window and the ovulation period

OBJECTIVE

To assess the sensitivity and specificity of the self-identified fertile window.

DESIGN

Observational study.

SETTING

Not applicable.

PATIENT(S)

A total of 107 women.

INTERVENTION(S)

Women recorded cervical mucus observation and basal body temperature daily while undergoing daily ovarian ultrasound.

MAIN OUTCOME MEASURE(S)

The biological fertile window, defined as the 6 days up to and including the day of ovulation; and the 2-day ovulation window, defined as the day before and the day of ovulation.

RESULT(S)

The self-identification of the biological fertile window by the observation of any type of cervical mucus provides 100% sensitivity but poor specificity, yielding a clinical fertile window of 11 days. However, the identification of the biological fertile window by peak mucus (defined as clear, slippery, or stretchy mucus related to estrogen) yielded 96% sensitivity and improved specificity. The appearance of the peak mucus preceded the biological fertile window in less than 10% of the cycles. Likewise, this type of mucus identified the ovulation window with 88% sensitivity.

CONCLUSION(S)

These results suggest that, when perceived accurately, more accurate clinical self-detection of the fertile window can be obtained by identification of peak mucus. This may improve efforts to focus intercourse in the fertile phase for couples with fertility concerns.

Assessment of anovulation in eumenorrheic women: comparison of ovulation detection algorithms

OBJECTIVE

To compare previously used algorithms to identify anovulatory menstrual cycles in women self-reporting regular menses.

DESIGN

Prospective cohort study.

SETTING

Western New York.

PATIENT(S)

Two hundred fifty-nine healthy, regularly menstruating women followed for one (n=9) or two (n=250) menstrual cycles (2005-2007).

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Prevalence of sporadic anovulatory cycles identified using 11 previously defined algorithms that use E2, P, and LH concentrations.

RESULT(S)

Algorithms based on serum LH, E2, and P levels detected a prevalence of anovulation across the study period of 5.5%-12.8% (concordant classification for 91.7%-97.4% of cycles). The prevalence of anovulatory cycles varied from 3.4% to 18.6% using algorithms based on urinary LH alone or with the primary E2 metabolite, estrone-3-glucuronide, levels.

CONCLUSION(S)

The prevalence of anovulatory cycles among healthy women varied by algorithm. Mid-cycle LH surge urine-based algorithms used in over-the-counter fertility monitors tended to classify a higher proportion of anovulatory cycles compared with luteal-phase P serum-based algorithms. Our study demonstrates that algorithms based on the LH surge, or in conjunction with estrone-3-glucuronide, potentially estimate a higher percentage of anovulatory episodes. Addition of measurements of postovulatory serum P or urine pregnanediol may aid in detecting ovulation.

Progress in the Pharmacotherapy of Menstrual Migraine

Menstrual migraine is a common neurological condition reported to affect up to 60% of women with migraine. Most women manage migraine adequately with symptomatic treatment alone. However, in women with menstrual migraine, menstrual attacks are recognised to be more severe, last longer, and are less responsive to treatment compared with attacks at other times of the menstrual cycle. In these situations, prophylactic treatment may be necessary. Short-term perimenstrual and continuous prophylactic treatments have shown efficacy in clinical trials but none are licensed for menstrual migraine. This article reviews the evidence for acute and prophylactic drugs in the management of this condition and considers future therapeutic options.

Prevention and treatment of menstrual migraine

Migraine is a prevalent headache disorder affecting three times more women than men during the reproductive years. Menstruation is a significant risk factor for migraine, with attacks most likely to occur on or between 2 days before the onset of menstruation and the first 3 days of bleeding. Although menstrual migraine has been recognized for many years, diagnostic criteria have only recently been published. These have enabled better comparison of the efficacy of drugs for this condition. Acute treatment, if effective, may be all that is necessary for control. Evidence of efficacy, with acceptable safety and tolerability, exists for sumatriptan 50 and 100 mg, mefenamic acid 500 mg, rizatriptan 10 mg and combination sumatriptan/naproxen 85 mg/500 mg. However, there is evidence that menstrual attacks are more severe, longer, less responsive to treatment, more likely to relapse and associated with greater disability than attacks at other times of the cycle. Prophylactic strategies can reduce the frequency and severity of attacks and acute treatment is more effective. Predictable menstrual attacks offer the opportunity for perimenstrual prophylaxis taken only during the time of increased migraine incidence. There is grade B evidence of efficacy for short-term prophylaxis with transcutaneous estradiol 1.5 mg, frovatriptan 2.5 mg twice daily and naratriptan 1 mg twice daily. Contraceptive strategies offer the opportunity for treating menstrual migraine in women who also require effective contraception.

High-tech family planning: reproductive regulation through computerized fertility monitoring

Issues related to family planning have profound public health significance as they directly impact individuals, couples, and families throughout the world. A new method of family planning is now available using a computerized fertility monitor that accurately measures urinary surges in estrone-3-glucuronide (E3G) and luteinizing hormone (LH) prior to ovulation, thus identifying the short-lived fertile phase of the cycle and providing women with the choice to achieve or avoid conception. As well as ease of use and instruction, hand-held computerized fertility monitors are accurate and effective and can be used indefinitely. An algorithm for computerized monitoring is presented for use in situations of infrequent or irregular ovulation such as with polycystic ovarian syndrome and the post-partum period. Hormone-based fertility monitoring is compared to other computerized fertility monitoring techniques. A case series of seven reports reflecting varied clinical backgrounds and medical histories demonstrates broad-based success and high satisfaction with computerized monitoring for regulation of reproductive potential. Limitations of fertility monitoring are also discussed.

Menstrual migraine

PURPOSE OF REVIEW

Menstrual migraine is prevalent but it is only recently that research has specifically addressed the pathophysiology and management of this disabling condition.

RECENT FINDINGS

For many years, menstrual migraine was a loose term used to describe an undefined association between migraine and menstruation. The introduction of recognized criteria has improved the diagnosis and enabled the study of a more homogenous population of women with this condition. As a consequence, studies have addressed putative mechanisms, particularly the association between oestrogen 'withdrawal' and migraine. It is recognised that other mechanisms have yet to be identified. Studies have confirmed the efficacy of perimenstrual prophylaxis with triptans and physiological doses of oestrogen. Despite robust data from randomized placebo-controlled studies, no treatments are licensed specifically for this indication at the time of writing.

SUMMARY

Recognition of menstrual migraine as a specific entity has resulted in improved diagnosis and increased research into the condition. However, our understanding of the pathophysiology and the consequent development of effective management strategies remain limited.

Increased pregnancy rate with use of the Clearblue Easy Fertility Monitor⁎⁎Unipath Ltd., Bedford, United Kingdom

OBJECTIVE

To determine the effect on pregnancy rates through use of the Clearblue Easy Fertility Monitor (CEFM) in women trying to conceive.

DESIGN

Prospective study, in which volunteers were randomly assigned either to use or not to use the CEFM. All participants could also use other aids to conception. Data were self-reported by volunteers using daily diaries, supplied and collected by mail.

SETTING

Home use, under conditions normally experienced by over-the-counter purchasers of the marketed device.

PATIENT(S)

Women who were trying to conceive; 653 (CEFM 305, control 348) provided evaluable information.

INTERVENTION(S)

CEFM was used for two cycles.

MAIN OUTCOME MEASURE(S)

Cumulative pregnancy rates over two cycles of use.

RESULT(S)

The cumulative pregnancy rate for 2 cycles was significantly higher in the CEFM group (22.7%) compared with the control group (14.4%). More women who had been trying to conceive for <6 months became pregnant than women who had been trying to conceive for >6 months (odds ratio: 2.67). Previous pregnancy and younger age of partners were also significant prognostic factors, but use of other aids to conception was not. After adjustment for other factors, CEFM use remained a significant factor affecting the chance of conceiving within two cycles (odds ratio: 1.89). CEFM users found the device to be easy/very easy to use (90%) and convenient/very convenient (80%).

CONCLUSION(S)

Use of the CEFM increases the likelihood of getting pregnant during the first two cycles of use compared with its nonuse, in women who had been trying to conceive for up to 2 years.

Variability in the Phases of the Menstrual Cycle

OBJECTIVE

To determine variability in the phases of the menstrual cycle among healthy, regularly cycling women.

DESIGN

A prospective descriptive study of a new data set with biological markers to estimate parameters of the menstrual cycles.

PARTICIPANTS

One hundred forty one healthy women (mean age 29 years) who monitored 3 to 13 menstrual cycles with an electronic fertility monitor and produced 1,060 usable cycles of data. MEASURES AND OUTCOMES: Variability in the length of the menstrual cycle and of the follicular, fertile, and luteal phases, and menses. The estimated day of ovulation and end of the fertile phase was the peak fertility reading on the monitor (i.e., the urinary luteinizing hormone surge).

RESULTS

Mean total length was 28.9 days (SD = 3.4) with 95% of the cycles between 22 and 36 days. Intracycle variability of greater than 7 days was observed in 42.5% of the women. Ninety-five percent of the cycles had all 6 days of fertile phase between days 4 and 23, but only 25% of participants had all days of the fertile phase between days 10 and 17.

CONCLUSIONS

Among regularly cycling women, there is considerable normal variability in the phases of the menstrual cycle. The follicular phase contributes most to this variability.

Chronic disorders with episodic manifestations: focus on epilepsy and migraine

Epilepsy and migraine are chronic neurological disorders with episodic manifestations that are commonly treated in neurological practice and frequently occur together. In this review we examine similarities and contrasts between these disorders, with focus on epidemiology and classification, temporal coincidence, triggers, and mechanistically based therapeutic overlap. This investigation draws attention to unique aspects of both epilepsy and migraine, while identifying areas of crossover in which each specialty could benefit from the experience of the other.

Female sex hormones and migraine

During the reproductive years migraine is three times more common in women than in men. Although it is often assumed that this female preponderance is associated with the additional trigger of fluctuating sex hormones of the menstrual cycle, few studies have been undertaken to confirm or refute this. There is increasing evidence confirming an association between estrogen 'withdrawal' and attacks of migraine without aura, as well as evidence for an association between high estrogen states and attacks of migraine with aura.