CeMCOR

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 vary throughout the lifespan. CeMCOR has a strong interest in the effects of a woman’s endogenous ovarian hormonal changes on her overall health.

• Menstruation and Ovulation Study (MOS)
• Community Pharmacists’ Knowledge about Progesterone: Knowledge Translation within the Vancouver Coastal Health Authority
• Validation of Perimenopause Experiences Project (PEP) Tools Using Interpersonal Comparisons (Round Robin study)
• Canadian Multicentre Osteoporosis Study (CaMOS)
• Premenopausal breast cancer, menstrual cycles and ovulation
• Young Osteoporosis Women (YOW)
• Perimenopause
• Upcoming literature review and synthesis
• Progesterone therapy for hot flushes/night sweats in menopausal women
• Positive Women’s Osteoporosis Study (PoWOS)
• Teen Bone Study
• Other Research

Menstruation and Ovulation Study (MOS)
CIHR grant funded

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 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.

Canadian Multicentre Osteoporosis Study (CaMOS)
www.camos.org

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 includes questionnaire data about women’s reproductive history and exposure to hormonal medications. These data provide a population-based normative sample whose characteristics can be compared with those of participants in other research studies. The data also provide unique insight into what is normal for Canadian women. CaMOS provides the only Canadian population-based information about bone mineral density and osteoporosis. Dr. Jerilynn C. Prior is Centre Director for the Vancouver CaMOS Centre and a member of the National Executive Committee. CeMCOR is home to the Vancouver Centre of CaMOS. See the CaMOS web page for information about the research team and funding sources.

Premenopausal breast cancer, menstrual cycles and ovulation

Chemotherapy treatment of breast cancer in premenopausal women often effects menstrual and ovulatory function as well as bone. These changes may be permanent or transitory. CeMCOR is assembling data from a two-year study of premenopausal women following treatment for breast cancer. These data comprise the most comprehensive longitudinal assessment of menstrual characteristics, and the only assessment of ovulatory characteristics following breast cancer treatment. Funding for this analysis comes from the Lohn Foundation of the BC Cancer Agency. These data were collected for a study on therapy for bone loss during chemotherapy, conducted with Cicely Bryce of BCCA, and funded by the Canadian Breast Cancer Foundation.

Young Osteoporosis Women (YOW)

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. YOW is a participatory research project with two principal investigators, Frances Kirson and Dr. Jerilynn C. Prior. The research is conducted by Frances Kirson with a core group of young women with osteoporosis acting as co-researchers. YOW has received funding from the Vancouver Foundation, the YWCA, and the BC Centre of Excellence in Women’s Health.

Perimenopause

Over the past decade, Dr. Jerilynn C. Prior has published a series of articles that challenge the prevailing view of the menopausal transition as a time of declining estrogen. In 1998 she published a scientific review and meta-analysis of published data demonstrating that estrogen levels are statistically higher during perimenopause, rather than lower, as was previously believed. In a recent paper, data on regularly cycling women who experience hot flushes and night sweats were presented, showing cyclicity of night sweats and breast tenderness within the menstrual cycle (see Hale GE, Hitchcock CL, Williams LA, Vigna YM, Prior JC: “Cyclicity of breast tenderness and night-time vasomotor symptoms in mid-life women”). This challenges the popular belief that hot flushes and night sweats are related to low levels of estrogen — adequate levels of estrogen are required to menstruate. Research about the years leading up to the last menstrual period is of ongoing interest.

Recently, CeMCOR has begun a pilot project, the Perimenopause Experiences Project (PEP), to develop a distance model for specialist consultation between women, their primary health care provider, and an endocrinology specialist. The goal is to develop techniques to build health care capacity and extend access to specialist care to very symptomatic women in poorly served communities. The study also incorporates data collection that will allow us to compare symptomatic women in perimenopause with the Canadian population (through CaMOS) and to follow women over the course of one year to show the patterns of change during the menopausal transition. PEP involves collaboration between CeMCOR and the James Bay Community Project in Victoria, BC. PEP is partially supported by the BC Endocrine Research Foundation.

Upcoming literature review and synthesis

Dr. Prior has undertaken a major review of the published epidemiological data on women’s reproduction, including menstrual cycles, ovulation, ages at menarche and menopause, infertility, anovulatory androgen excess and relationships of these variables with health outcomes such as osteoporosis, breast cancer and cardiovascular diseases. The review is a collaborative project with epidemiologist/gynecologist Dr. Siri Forsmo.

Progesterone therapy for hot flushes/night sweats in menopausal women

CeMCOR is has recruited over 100 healthy women past menopause for a clinical trial of oral micronized progesterone (Prometrium®) as compared with placebo. This five-month study examines the effects on hot flushes, and on risk factors for heart disease, particularly on endothelial function measured using standardized plethysmography. This research project was begun with support from an investigator-initiated grant-in-aid from Eli Lilly, Canada and is currently unfunded.

Positive Women’s Osteoporosis Study (PoWOS)

PoWOS is a collaborative project between two multi-centre studies: the Canadian Women’s HIV Study and the Canadian Multicentre Osteoporosis Study (CaMOS). Eight of the centres across Canada have been paired in a cohort-control study of the risk for osteoporosis and fracture for women who are HIV positive or have AIDS. One hundred and eighty women who are either using or have never used anti-retroviral drug therapies are currently being studied. These women’s histories, bone density and fracture experiences will be compared with a population-based sample of women in the corresponding local centre of CaMOS. This project involves many researchers from CaMOS and from the Canadian Women’s HIV Study. Funding comes from the Canadian Foundation of AIDS Research.

Teen Bone Study

Drs. Susan Barr and Jerilynn Prior studied 53 premenarcheal girls (ages 7-10) whose breasts were not more than at Tanner stage 2. These girls were observed over three years including calcium and general nutrition, exercise, eating attitudes, growth, maturation, menstrual cycles and changes in bone density in the spine and the whole body. Forty-five of these young teens completed two years and study reports showed that usual calcium intake positively and worry about eating negatively influenced changes in bone (see Barr SI, Petit MA, Vigna YM, Prior JC: Eating attitudes and habitual calcium intake in peripubertal girls are associated with initial bone mineral content and its change over 2 years). Information about maturation of breasts and pubic hair compared with first menstrual cycles and some data related to ovulation are awaiting analysis. This project involved collaboration among Susan Barr, professor of Nutrition at UBC, Moira Petit, then a UBC doctoral student, and Jerilynn Prior. The project was funded by the BC Research Foundation and the Vancouver Foundation.

Other Research

In the course of her research career, Dr. Prior has assembled a large collection of women’s self-reported experiences using various daily menstrual diary instruments. A focus of CeMCOR is to analyze these data and publish them as information about women’s experience. These data have been collected, for the most part, without external funding, in collaboration with the women who completed the diaries.

CeMCOR has also made these tools available on the web page for women to record their own experiences.