"Ovulation during lactation" as determined by endometrial biopsy
Malkani, P.K.; Mirchandani, J.J.
Journal of Obstetrics and Gynaecology of India 11(2): 121-127
1960
ISSN/ISBN: 0971-9202 PMID: 12338435 Document Number: 519256
A study was conducted at the Lady Hardinge Medical College and Hospital in New Delhi, India with the objective of determining the frequency of ovulation during lactation. It is now accepted that the most satisfactory proof of ovulation is the presence of a secretory endometrium late in the menstrual cycle. The histology of endometrium was the only method of study for the presumptive evidence of ovulation employed in this investigation. Out of a total of 197 endometrial biopsies, 77 were obtained from menstruating women, and 120 were obtained from women who had amenorrhea. Of these 98 were taken during lactational amenorrhea in 89 cases. Out of 77 biopsies from the menstruating group, 30 were obtained from 26 lactating mothers. The biopsies during amenorrhea of lactation showed that the proportion of biopsies revealing inactive endometrium increases with the duration of amenorrhea. It was also observed that it is often impossible to obtain any endometrial tissue if the period of amenorrhea has been prolonged. In 31.6% of the specimens there was no sign of growth or activity of the endometrium. The endometrium corresponding to late and midproliferative phase was found only if the biopsy was taken within 3 months after delivery. 16% of the 1st cycles in lactating mothers were ovular (total 12 biopsies) and 57% of 1st cycles in nonlactating women were ovular. The finding suggests that lactation does inhibit ovulation in addition to postponement of menstruation. Few biopsies were available for the subsequent cycles. In lactating women, 50% of the 2nd cycles and 83% of the 3rd cycles were ovular. In a fully lactating mother the earliest ovular biopsy was detected at 9 weeks postpartum. In 1 partially lactating and 3 nonlactating cases, ovular biopsies were obtained at 41 days postpartum. The endometrium tends to be atrophic as amenorrhea is prolonged, but this atrophy is reversible.