Does Molimina Indicate Ovulation? Prospective Data in a Hormonally Documented  Single-Cycle in Spontaneously Menstruating Women

Jerilynn C Prior; Chiaki Konishi; Christine L Hitchcock; Elaine Kingwell; Patti Janssen; Anthony P Cheung; Nichole Fairbrother; Azita Goshtasebi

doi:10.3390/ijerph15051016

Menstrual Cycle · Cycle Biomarkers

Does Molimina Indicate Ovulation? Prospective Data in a Hormonally Documented Single-Cycle in Spontaneously Menstruating Women

Prior JC, Konishi C, Hitchcock CL, Kingwell E, Janssen P, Cheung AP, Fairbrother N, Goshtasebi A

Published May 18, 2018 International Journal of Environmental Research and Public Health, 15(5), E1016

DOI 10.3390/ijerph15051016 PMID 29783630 PMC PMC5982055

RRM Academy Synopsis

Molimina did not indicate ovulation in a study of 432 women

Molimina did not tell ovulatory cycles from ovulation-disturbed cycles in a one-cycle study of 432 women with urine hormone tests. Molimina means mild changes women notice before a period. Most women in both groups said they could tell a period was coming.

Key Findings

Of 610 enrolled women, 476 completed the diary and 432 provided evaluable hormone data.
Urine hormone analysis found 398 women with a normally ovulatory cycle and 34 with an ovulation-disturbed cycle (anovulation, short luteal phase or luteal insufficiency), eight percent of the 432.
A positive answer to the Molimina Question came from 89% of women with an ovulatory cycle and 97% of women with an ovulation-disturbed cycle.
About half of both groups volunteered cramps and negative moods as important premenstrual experiences, with no significant differences between the groups by ovulatory status.
In testing before the authors recognized a statistical limit, axillary breast tenderness without front tenderness had 8.8% sensitivity (95% CI 6.3, 12.0%) and 100% specificity (95% CI 79, 100%) for ovulatory status.

Interpretation

The study followed women through one cycle and compared their answers with urine hormone results. Only 34 disturbed cycles left too few to calculate valid sensitivity and specificity for the Molimina Question. The authors ran the breast tenderness figures before they recognized that limit. The volunteers were a convenience sample from Metro Vancouver, fairly highly educated, aged 20 to 40. Answers shifted after women kept a daily diary. The authors suggest cultural expectations about premenstrual moods may have shaped responses.

RRM Context

Restorative reproductive medicine treats ovulation as the central event of the cycle and looks for it directly. The authors cite earlier work linking subclinical ovulatory disturbances to spinal bone loss. They call for an inexpensive, simple way to detect them. A regular cycle length leaves the question of ovulation open until someone evaluates it.

Our editorial summary of this paper, not the article's abstract.

Abstract

Approximately 33% of normal-length (21⁻35 days) cycles have subclinical ovulatory disturbances and lack sufficient progesterone, although their normal length ensures enough estrogen. Subclinical ovulatory disturbances are related to significant premenopausal spine bone loss (-0.86%/year). Molimina, non-distressing premenstrual experiences, may detect ovulation within normal-length cycles. This prospective study assessed the relationship between molimina and ovulation. After 1-cycle of daily diary and first morning urine collections, women answered the Molimina Question (MQ): "Can you tell by the way you feel that your period is coming?" and were invited to share (a) predictive premenstrual experience(s). A 3-fold increase in follicular-luteal pregnanediol levels confirmed ovulation. In 610 spontaneously menstruating women (not on hormonal contraception, mean age 31.5 ± 5.3, menarche age 12.7 ± 1.5, cycle length [CL] 29 days, MQ positive in 89%), reported premenstrual experiences which included negative moods (62%), cramps (48%), bloating (39%), and front (26%) or axillary (25%) breast tenderness. Of 432 women with pregnanediol-documented cycles, 398 (92%) were ovulatory (CL: 29 ± 5) and 34 (8%) had ovulatory disturbances (CL: 32 ± 14). Women with/without ovulatory cycles were similar in parity, body mass index, smoking, dietary restraint and the MQ; ovulatory-disturbed cycles were longer. Molimina did not confirm ovulation. A non-invasive, inexpensive ovulation indicator is needed to prevent osteoporosis.

Topics

Menstrual Cycle › Cycle Biomarkers › Hormonal Markers · Reproductive Endocrinology › Ovulation Physiology › Anovulation · Diagnostics › Cycle Biomarkers › Ovulation Detection

Jerilynn C Prior, Chiaki Konishi, Christine L Hitchcock, Elaine Kingwell, Patti Janssen, Anthony P Cheung, Nichole Fairbrother, Azita Goshtasebi

J Prior, C Konishi, Chris Hitchcock, C Hitchcock, E Kingwell, P Janssen, Tony Cheung, A Cheung, N Fairbrother, A Goshtasebi

PMID 29783630 29783630 DOI 10.3390/ijerph15051016 10.3390/ijerph15051016 Prior et al. 2018, Prior 2018