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Notes: Urinary oestrogen and pregnanediol excretion was measured daily (“daily monitoring”) for a complete cycle in 20 normally menstruating women, in one patient with an anovulatory cycle and for 28 days in a patient with secondary amenorrhoea. The measurements were also performed on urine specimens collected at weekly intervals for 4 to 6 weeks (“weekly tracking”) from 506 patients with evidence of abnormal ovarian function. These included 9 patients with primary amenorrhoea, 132 patients with secondary amenorrhoea, 138 patients with oligomenorrhoea and 227 patients with evidence of ovarian dysfunction and cycle lengths of 25 to 42 days. The results were subjected to statistical analysis. In the normal cycles, ovulation could be identified on the criteria of a rising pregnanediol value reaching or exceeding 2.0 mg. per 24 hours for a period of 7 days or more. Valid conclusions on the overall mean oestrogen and pregnanediol values for a complete cycle could be made from the results of weekly tracking, irrespective of which day the tracking commenced. Correlations were obtained by comparing the mean and maximum urinary oestrogen values and the variability of the values with the evidence of ovarian function indicated by the clinical classifications of the patients, the duration of the disorders and the subsequent occurrence of uterine bleeding. Mean oestrogen values of 10μ g. per 24 hours or less were associated with lack of ovarian function. For values higher than this a discriminant function based on both the mean oestrogen value and the variability of the oestrogen values was useful in predicting onset of spontaneous menstruation. A single urine specimen collected 4 to 8 days before onset of menstruation showing a raised pregnanediol value of 2.0mg. per 24 hours or more provided a valid test for ovulation in women with regular cycles, and a single urine specimen giving an oestrogen value of 10 pg. per 24 hours or less gave a valid indication of absent ovarian function in women with amenorrhoea for two years or more. In all other circumstances serial sampling at weekly intervals provided a valid assessment of ovarian activity. Application of these principles allows the greatest amount of information on ovarian function to be obtained with the greatest economy of effort.

Notes: The results of 201 24-hour urinary oestriol estimations in 50 twin pregnancies are presented. The 10th, 50th and 90th centiles were approximately 1.7 times higher than those for singleton pregnancies, reflecting the combined weights of the two fetuses. In general, the oestriol values were not low before or after intrauterine death of one fetus or in pregnancies with intrauterine growth retardation. The trends in serial oestriol values were of more relevance in assessing fetal jeopardy than grading the values as normal or low.

Notes: Twelve anovulatory patients with normal serum prolactin values and six with elevated values were treated with bromocriptine and the effects on serum prolactin, FSH and LH levels were recorded. Ovulation resulted in one patient who had normal prolactin values and in all six who had raised values. No patient with normal basal prolactin values showed an increase in serum FSH during therapy with bromocriptine, whereas 5 of the 6 patients with elevated values showed significant increases. Similar results were obtained for LH. Although these differences were highly significant (P〈0·005) the majority of the serum FSH and LH values remained within the normal ranges. Five patients with normal basal prolactin values and one with elevated values were also treated with human pituitary gonadotrophin (HPG). An increase in ovarian responsiveness to HPG during therapy with bromocriptine was recorded in the one patient with initially elevated prolactin values. It was concluded that bromocriptine acts by allowing FSH to rise above threshold requirements for follicular stimulation.

Notes: Fifty-five patients admitted to hospital with the diagnosis of threatened abortion were assessed by means of urinary oestrogen, pregnanediol and chorionic gonadotrophin assays and by vaginal cytology. Oestrogen excretion was abnormally low (below the first percentile for the period of gestation) in 22 patients all of whom aborted, usually within a week of the measurement. Twenty-two of the 33 patients with oestrogen values in the normal pregnancy range had pregnancies which continued and resulted in surviving infants. Eleven patients with normal oestrogen values subsequently aborted. These abortions occurred more than one week after the original assessment and usually in the second trimester. Pregnanediol measure ments provided comparable information. In patients who aborted, vaginal cytology and initial chorionic gonadotrophin levels were less useful investigations.

Notes: Forty-one patients with a diagnosis of possible hydatidiform mole were studied by HCG, oestrogen and pregnanediol determinations performed on 24-hour collections of urine. The results were compared with those obtained in a control series involving 5000 HCG analyses, 679 oestrogen analyses and 1080 pregnanediol analyses performed over the relevant period of gestation in single pregnancies which produced surviving infants. Of the 17 patients who were shown to have a hydatidiform mole, 8 (47 per cent) had high HCG levels, 5 (29 per cent) had oestrogen levels below the first percentile for the control series and 5 of 13 patients had low pregnanediol levels (38 per cent). Five of the nine patients with molar pregnancies associated with normal HCG excretion had oestrogen excretion below the first percentile and one of the remaining four with normal oestrogen values had non-pregnancy levels of pregnanediol. Thus the diagnosis of an abnormal pregnancy could be made in 14 of the 17 molar pregnancies studied (82 per cent). Two of the three exceptions had a fetus co-existent with the mole. There were no viable pregnancies when the oestrogen and pregnanediol values were below the first percentile. Oestrogen and/or pregnanediol values in the range consistent with multiple pregnancy were found in four patients with molar pregnancies. In the molar pregnancies there was a correlation between the levels of HCG and the levels of oestrogens and pregnanediol excreted. After evacuation of the mole, the levels of oestrogens and pregnanediol remained elevated for up to three weeks in approximately half of the patients, whereas the HCG levels fell immediately. These findings support the view that in molar pregnancies, levels of oestrogens above 300 μg. per 24 hours and of pregnanediol above 10 mg. per 24 hours are derived mainly from the stimulation of theca lutein cysts in the ovaries.

Notes: Summary. The psychosexual sequelae of diagnosis and treatment of pre-invasive cervical atypia were assessed in three groups of women. The first group included 30 women referred to a colposcopy clinic with an abnormal cervical smear indicating cervical intraepithelial neoplasia (CIN), the second comprised 50 women who were traced as sexual partners of men with penile human papillomavirus (HPV) infection; 26 of them had histologically proven cervical atypia and 24 had no such evidence. The third group included 25 women traced as partners of men with non-specific urethritis and who did not have cervical disease. Before and after questionnaires assessed six aspects of sexual behaviour and responses before diagnosis and 6 months after treatment in women with cervical atypia. These were compared with answers given by women investigated and treated, if necessary, as partners of men with sexually transmitted disease (control group). There were statistically significant adverse psychosexual sequelae associated with diagnosis and treatment of pre-invasive cervical epithelial disease.

Notes: Summary. A prospective study of the treatment of unconsummated marriage was carried out by 16 doctors trained by the Institute of Psycho-sexual Medicine. This training stresses the development of skills in using the doctor/patient interaction therapeutically, rather than in the acquisition of knowledge. The 159 couples admitted to the study had a mean duration of symptoms of 4.2 years; 60% of them had consummated by 6 months and 72% by 24 months. Other improvements in sexual function occurred even among those failing to consummate; 135 couples had previously consulted 253 other agents. The average cumulative length of treatment at the 6-month review was 3 h. Partners attending alone did as well as couples who attended together.

Notes: Forty nulliparous patients with a Bishop score of 3 or less were given 15 mg oestriol gel, 10 mg PGF2α gel or gel alone via the extra-amniotic route. Both the oestriol and prostaglandin treated patients had a significant increase in Bishop score and a significant reduction in induction-delivery interval compared to con-trols. Oestriol gel had significantly less stimulatory effect on uterine activity than prostaglandin gel, indicating a possible local action.

Notes: Basal serum levels of prolactin were measured in 37 infertile anovulatory patients who had failed to conceive on therapy with clomiphene citrate. Twenty of these patients, 16 of whom had galactorrhoea, had elevated basal serum prolactin values which were suppressed to normal or subnormal values during therapy with bromocriptine, the most commonly effective dose being 2·5 mg twice daily. Ovulation, as assessed by urinary oestrogen and pregnanediol measurements, was induced in 17 of these patients with pregnancy in 14. Ovarian responses short of defined criteria for ovulation were induced initially in eight patients, but these progressed to full ovulatory responses in five patients, either on the same or increased doses of bromocriptine. In all the patients who ovulated, the prolactin levels had been reduced below the mean value for normal women (10·6 ng-ml). The three patients who failed to ovulate all had values higher than this at a dose of bromocriptine reaching 5·0 mg thrice daily. There seemed to be no value in increasing the dose of bromocriptine once ovulation had been achieved. Of the 17 patients with normal basal prolactin values, only one had an unequivocal response to bromocriptine with ovulation and conception, even though the prolactin values in the majority were suppressed to below normal.