The Centre for Menstrual Cycle and Ovulation Research (CeMCOR) studies women’s self-reported experiences during the menstrual cycle. It also studies changes in these experiences as they relate to ovulation and throughout the lifespan. CeMCOR has a general interest in the effects of a woman’s own ovarian hormonal changes on women’s health.
CeMCOR has completed recruiting healthy women past menopause for a study of natural progesterone capsules (Prometrium®) compared with placebo capsules. This four-month study examines progesterone’s effects on hot flushes and on risks for heart disease especially how blood flow works (endothelial function).
Even if women's menstrual cycles are regular, they may not include release of an egg (ovulation) or result in the production of progesterone. Lack of ovulation (or anovulation) was found to occur about 10-18% of the time in two studies of women randomly sampled from the population. When ovulation doesn't occur, there is a hormone imbalance in which estrogen levels exceed progesterone levels. This imbalance has been correlated to infertility, bone loss, heavy flow, and anemia in premenopausal women. Lack of ovulation during women's younger years also increases menopausal women's risk of breast and endometrial cancers and heart disease.
The MOS investigation is a CIHR-funded study that aims to determine the validity of a questionnaire method for assessing whether a woman is ovulatory, anovulatory, or probably ovulatory. It will compare responses given by women to questions regarding their experiences with their menstrual cycles to their urinary progesterone levels. A minimum of 600 menstruating women, who are between the ages of 20 and 40 and not currently on any reproductive hormonal therapy (such as oral contraceptives) will be enrolled to participate in this research. If our findings validate the use of a questionnaire method to assess ovulation in women, it would be an invaluable tool in epidemiological studies in women's health.
Community Pharmacists’ Knowledge about Progesterone: Knowledge Translation within the Vancouver Coastal Health Authority
The main objective of this study was to assess community pharmacists’ knowledge about and attitudes toward treatment of menstruating women with oral micronized progesterone or medroxyprogesterone (a synthetic cousin of progesterone). Prior to the study we were aware that sometimes pharmacists questioned the use of cyclic progesterone and the dose. Our purpose was to gather information that would focus future education of pharmacists on their needs for further information. We also wanted to assess what characteristics were related to their knowledge and attitudes, including whether they were men or women, how long they had been working as a pharmacist and whether they worked in a pharmacy that created medicines from scratch (called compounding).
We gathered information about treatment of a variety of symptomatic menstruating women (a girl with heavy flow and low blood count, an older menstruating woman with night sweats, a younger woman with pimples and unwanted hair, for example). A volunteer community pharmacist, Monterrey Marks, asked the multiple-choice questions of the pharmacist within each of 100 randomly sampled pharmacies who was most knowledgeable about women’s health. She usually administered the questionnaire in person, traveled to several remote spots to do it, but ended up doing a few by telephone. This study is supported by a grant in the Interdisciplinary Research competition from the Vancouver Coastal Health Research Institute.
Over half of the 100 random pharmacies invited ended up providing a pharmacist for interview. We are currently doing a systematic review of the pharmacy literature from around the world relating to each clinical situation. In addition, we are providing the physiological reasons for and against use of oral contraceptives, progesterone, progesterone cream and other therapies that the pharmacist could choose in the multiple choice questions we asked.
When the analysis is completed, and a paper on the results is submitted, we will provide feedback on the results of the study directly to each participating pharmacist as well as give the evidence-based correct answers to the clinical questions to each pharmacist. We plan to create a discussion forum for pharmacists on the CeMCOR website starting with the responses to the questionnaire and including the optimal choices based on pathophysiology and evidence-based data. In addition, we will work with the BC College of Pharmacy to create educational sessions for pharmacists relating to the use of progesterone therapy in menstruating women.
Validation of Perimenopause Experiences Project (PEP) Tools Using Interpersonal Comparisons (Round Robin study)
The purposes of this study are to better understand what perimenopausal women experience that is difficult for them to deal with, and to discover how small a change in experiences can be detected using the Perimenopause Interference Instrument (PII). The PII is a short questionnaire that simply asks: How much do the bodily changes of perimenopause interfere with your daily activities? A second question asks about mood changes. Women are to mark on a line from 0 to 10, with 10 being major interference. They answer this question twice about a month or two apart. We devised this tool for the Perimenopause Experiences Project (PEP). During this study women also keep the Daily Perimenopause Diaryã between the two meetings. At the second meeting they talk with about six other women for 10 minutes each. At the end of each of these (amazingly animated) discussions, they rate their experiences compared with the woman with whom they have just spoken. This study is supported by a research grant from The Office of Research Services, University of British Columbia.
We did this study in Vancouver and in Abbotsford. Approximately 50 women completed this study and about 20 more participated in the initial meeting and provided some Diary and questionnaire data. We are working on data entry and analysis and hope to have the results available within the next few months.
CaMOS is a population-based longitudinal study of 9423 women and men in nine centres across Canada. In addition to regular bone mineral density measurements, CaMOS collects information about women’s reproductive history and use of hormone treatments. These data contribute to an understanding of what is normal in Canadian women. CaMOS provides the only Canadian population-based information about bone mineral density and osteoporosis. CeMCOR is home to the Vancouver Centre of CaMOS.
Chemotherapy treatment of breast cancer in premenopausal women is often associated with changes in menstrual cycles. Ovulation hasn’t been studied. These changes appear to last or may be short lived. CeMCOR is studying women’s daily experience data from a two-year study of premenopausal treatment for breast cancer.
Some women are diagnosed with osteoporosis before menopause. The experiences and feelings of women with early osteoporosis have not been well described. YOW is a project to bring these women together to share their experiences, provide each other support and to learn more through collection of information using a questionnaire. YOW will show whether these women differ from average women enrolled in the BC Centre of CaMOS.
Over the past decade, Dr. Jerilynn C. Prior has written a number of scientific and lay articles about perimenopause. In 1998 she published a major scientific review showing that estrogen levels are higher during perimenopause, rather than lower, as was previously believed. CeMCOR recently published a paper on regularly cycling women who experience hot flushes and night sweats. Results showed that night sweats and breast tenderness were greater around flow. These results challenge the popular belief that night sweats are related to low levels of estrogen — adequate levels of estrogen are required to menstruate.
Recently, CeMCOR has begun a pilot project, the Perimenopause Experiences Project (PEP), to explore a long distance kind of consultation by an endocrinology specialist with a perimenopausal woman and her family doctor. The goals are to train family doctors and provide specialist care to women in poorly served communities. The study will also allow us to compare symptomatic women in perimenopause with the Canadian population (through CaMOS) and to follow perimenopausal changes women over one year.
Women’s reproduction in population studies
During her recent sabbatical, Dr. Prior gathered hundreds of papers about menstruation and reproduction published in studies of whole populations (epidemiology). She is currently revising the major report she is writing with Dr. Siri Forsmo, a CeMCOR scientist from Norway.
Positive Women’s Osteoporosis Study (PoWOS)
The Canadian Women’s HIV Study and the Canadian Multicentre Osteoporosis Study (CaMOS) have teamed up in eight centres across Canada to study bone density and fractures in women who are HIV positive or have AIDS. PoWOS is studying over 180 women who are either using or have never used HIV drug therapies. These women’s histories, bone density and fracture experiences will be compared with women in the corresponding local centres of CaMOS.
Teen Bone Study
Drs. Susan Barr and Jerilynn Prior studied 53 girls before their first period (ages 7-9) whose breasts were not more than at the first bud (Tanner 2) stage. These girls were observed over three years including calcium and general nutrition, exercise, eating attitudes, growth, maturation, menstrual cycles and changes in bone density. Results from 45 of these young teens who completed two study years showed that usual calcium intake was positively related to changes in bone and worry about eating was negatively related to changes in bone.
Changes within a woman over years
In the course of her research career, Dr. Prior has assembled a large collection of women’s completed daily diaries. A focus of CeMCOR is to use these data to better understand women’s menstrual cycle related experiences. CeMCOR has made these same tools available on the web page for women who wish to record their own experiences.