The cytokine profile of menstrual blood.

INTRODUCTION: The menstrual cycle is regulated by a complex interplay between endometrial epithelial cells, endothelial cells, immune cells, and sex hormones. To communicate, cells secrete cytokines that have multiple and diverse effects on recipient cells. Knowledge of how these cells interact in the uterus is insufficient. Menstrual blood is easily accessible and provides a source to study menstrual cycle physiology. This study aimed to determine the cytokine profile in menstrual blood plasma and investigate the differences in cytokine profiles between menstrual and peripheral blood plasma. Several previous studies indicate an improved chance of embryo implantation after endometrial scratching. Consequently, our secondary aim was to compare the menstrual blood cytokine profile before and after luteal phase endometrial scratching. MATERIAL AND METHODS: Nineteen healthy donors collected menstrual blood for the first 24 hours of menstruation in two sequential cycles. Matched peripheral blood was taken at the same time. An endometrial biopsy was performed at cycle day 7-9 post ovulation in between the two collection times. A Luminex multiplex assay was performed in one batch analyzing a predetermined group of cytokines in plasma. RESULTS: Peripheral blood plasma and menstrual blood plasma showed substantial significant differences in cytokine profile. In menstrual blood plasma, C5/C5a, interleukin-6 (IL-6), IL-1ß, and CXCL8 were detected in high concentrations, whereas IL-2, IL-12p70, XCL1/Lymphotactin, and interferon-γ were low. The most pronounced median differences between menstrual and peripheral blood plasma were found for IL-6, IL-1ß, and CXCL8. The cytokine profiles of menstrual blood plasma were similar between the individual donors and did not differ over two subsequent cycles. None of the cytokines analyzed in menstrual blood plasma differed significantly before or after luteal phase endometrial scratching (P < .01). CONCLUSIONS: Our results demonstrate that the menstrual blood cytokine profile is distinctly different from peripheral blood plasma and that the inter-individual difference in menstrual blood cytokine profile in healthy donors is limited and stable over time. The small injury caused by an endometrial biopsy does not change the cytokine profile in the subsequent menstrual cycle. Our study provides new insights into menstrual cycle physiology.

[Endometriosis - new clinical guidelines for better and equal care in Sweden]. / Nationellt vårdprogram för bättre och jämlik vård vid endometrios.

Endometriosis is a chronic, inflammatory and estrogen-dependent disease affecting about 10 % of the female  population in fertile ages. There is no cure for endometriosis. The main symptoms include severe menstrual pain, ovulation pain, dyspareunia, dysuria and painful bowel movements. Endometriosis is associated with infertility. Endometriosis affects every day life with pain and fatigue and a negative impact on education, career, social life and quality of life.  Endometriosis can emerge at the first menstruations and also continue to give symptoms after menopause. The symptoms can vary greatly between individuals and also during life. The pathofysiology is unknown but the most accepted theory is retrograde menstruation where endometrial cells implant into the peritoneum affecting different abdominal organs. The immune system fails to clear the endometrial cells which results in endometriotic lesions that might cause inflammation, pain and adhesions. The treatment includes hormone treatment, surgical treatment, pain medication, physiotherapy, counseling and sometimes multi-disciplinary pain rehabilitation. It is important to increase the knowledge of this common disease both among the public and health professionals since early treatment is of great importance to reduce the risk for chronic pain and severe effects on quality of life. We hope that the recently published clinical guidelines will result in better and more equal care for patients with endometriosis in Sweden.

Hormonal and surgical treatments for endometriosis and risk of epithelial ovarian cancer.

OBJECTIVE: Whether hormonal or surgical treatment of endometriosis is associated with risk of epithelial ovarian cancer. DESIGN: Nested case-control study. SETTING: Sweden. POPULATION: All women with a first-time discharge diagnosis of endometriosis in 1969-2007 were identified using the National Swedish Patient Register and constituted our study base. METHODS: By linkage to the National Swedish Cancer Register we identified all women diagnosed with epithelial ovarian cancer at least one year after the endometriosis diagnosis (cases). Two controls per case with no ovarian cancer before the date of cancer diagnosis of the case were randomly selected from the study base and matched for year of birth. Two-hundred-and-twenty cases and 416 controls entered the study. Information on hormonal and surgical treatments and other reproductive factors was extracted from medical records according to pre-specified protocols. Conditional logistic regression was used for all calculations. MAIN OUTCOME MEASURES: Crude and adjusted odds ratios (OR) with 95% confidence intervals (CI) for all hormonal as well as surgical treatments. RESULTS: There was a significant association between one-sided oophorectomy, as well as for radical extirpation of all visible endometriosis, and ovarian cancer risk in both univariate analyses (crude OR 0.42, 95% CI 0.28-0.62 and OR 0.37, 95% CI 0.25-0.55, respectively) and multivariate analyses (adjusted OR 0.19, 95% CI 0.08-0.46 and OR 0.30, 95% CI 0.12-0.74, respectively). CONCLUSIONS: One-sided oophorectomy as well as radical extirpation of all visible endometriosis is protective against later development of ovarian cancer.

Painful pelvic joints induced by a levonorgestrel-releasing intrauterine system.

The normally occurring loosening of the pelvic joints with separation of the symphysis during pregnancy may give rise to pain over the symphysis pubis or/and over the sacroiliac joints. In contrast, increased mobility between the pubic bones and pelvic pain without any direct connection with pregnancy is rare and its etiology is unclear. The following is a report of a patient who experienced symphysiolysis-like pelvic pain following the use of a levonorgestrel-releasing intrauterine system.