BASAL METABOLISM AND THE MENSTRUAL CYCLE.

BY GLEN WAKEHAM.

(From the Department of Chemistry, University of Colorado, and the Colorado Sanitarium, Boulder.)

(Received for publication, March 24, 1923.)

The careful work of Blunt and Dye (1) would seem at first sight to have settled negatively the question of any relationship between basal metab- olism and the menstrual cycle. Their article mentions most of the liter- ature on the subject, and calls attention to the disagreement in the results of those who have investigated the question. Zunta (2), Gephart and Du Bois (3), and Wiltshire (4), in a more recent article, agree with Blunt and Dye that no variation of basal metabolism with the menstrual cycle can be established. Snell, Ford, and Rowntree (5) state definitely that menstruation “does Affect the basal metabolic rate of women at times in health and in disease,” and promise publication of details, which, as far as the present writer can ascertain, have not yet appeared.

The work of Zuntz was done on two subjects only. Ford studied ten cases, but his data are not available for critical examination. Gephart and Du Bois give the subject merely passing mention. Miss Wiltshire made a large number of determinations on five subjects, but publishes only her average results. The data of Blunt and Dye are given with admirable completeness with the single exception that in a number of cases the dates of the preceding or following menstrual periods are lacking, making it impossible to refer these determinations to the exact time of menstruation.

The last mentioned authors, together with Miss Wiltshire, divide the menstrual cycle into four phases, viz. premenstrual, menstrual, postmen- strual, and intermenstrual, and endeavor, by comparing the averages for these four periods, to ascertain whether menstruation affects basal metab- olism. Their conclusions, as stated above, are negative. Miss Wiltshire states : “The variations during the different phases of the sexual cycle are so small that they cannot be regarded as showing any marked effect due to menstruation;” and further, that “the fluctuations which normally occur are often greater than these variations,” leaving the subject at that point. It is the object of this paper to report and analyze data less extensive, indeed, than those of the above mentioned authors, but obtained under circumstances in some respects more favorable, and then, by sub- mitting the fundamental data of Blunt and Dye to the analytical methods used in this article, to show that certain quite definite positive inferences can be deduced from them. The fact that normal daily variations of basal metabolism exceed any which may be due to the menstrual cycle does not justify the assumption that the latter are unimportant or un- demonstrable.

555

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556 Basal Metabolism and Menstrual Cycle

Age.

TABLE I.

Fundamental Data.

Date of experiment.

Date of last menstrual

period. “2 lbje<

?fh ubjec

1

IRS.

22

2 24

3 20

Sept. 23 act. 1

‘I 8 “ 15 “ 28

Sept. 24 act. 10

“ 20 ” 27

Sept. 26 act. 10

“ 15 ” 25 “ 29

Nov. 8

lbs.

115 12( 121 124 12; 122 131 13E 13f 114 114 11: 118 114 11E

in.

59 59 59 59 59 69 69 69 69 65 65 65 65 65 65

cc.

191 190 202 184 192 230 252 236 224 188 200 215 210 203 180

cc.

17: 17E 18C 185 181 20E 20s 211 212 186 186 187 188 186 186

4 24

5 23

6 21

Sept. 26 Oct. 9

“ 15 “ 24

Sept. 28 Oct. 11

“ 29 Nov. 4

“ 8 Sept. 30 Oct. 15

Aug. 22 Sept. 24 Oct. 8

‘I 8 “ 8

Sept. 16 “ 16

Oct. I6 “ 16

Sept. 18 “ 18 “ 18

Oct. 16 “ 16 “ 16

Nov. 23 Sept. 18

“ 18 act. 10

“ 10 Sept. 8

“ 8 Oct. 16 Nov. 2

I‘ 2 Sept. 16

“ 16 Oct. 24 Sept. 2 act. 4

I( 4 “ 4

Sept. 24 “ 24

act. 22 “ 5 ‘I 4

Sept. 11 Oct. 8

134 131 133 134 145 145 132 133 135 139 140

61 61 61 61 69 69 69 69 69 63 63

225 251 252 250 220 210 254 230 201 208 202

192 190 191 192 217 217 212 212 213 203 204

7

8

9

10

20

26

Sept. 30 Oct. 9

“ 11 “ 24

Oct. 2 “ 16

115 64 224 112 64 201 116 64 198 115 64 202 121 64 2Y)4 124 64 219

188 186 189 188 187 189

28

22

Oct. 2 “ 12 ‘I 6 “ 12

112 65 224 115 65 199 156 65 252 160 65 232

185 188 213 217

-

:

-

Per- entage tbove

be% OlYG31.

MT cent

+8 +6

+12 $1

$6 +11

+21 +12 +6 +1

+8

+x5 fll +9 -3

+17 +30 t30 i-29 +1 -3

t-20 +8

si -1

t19 +8 +6 t-7

Ai

i-20 t-6 l-18

+7 -

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11

*rs.

29

12 21

13 27

14 19

15 20

16 35

17

18

19

20

26

32

20

21

Age.

-

t Date of experiment.

Oct. 8 “ 13 LL 22 ‘I 5 “ 16 “ 20 “ 5 “ 17 ” 25 “ 28

Nov. 3 “ 10

Oct. 6 “ 18 “ 26

Nov. 6 Oct. 8

“ 19 “ 26

Nov. 19 <‘ 22 “ 29 “ 19 “ 30

Dec. 12 “ 18 “ 23

Nov. 20 “ 30 “ 21 “ 24

Dec. 1 “ 8 “ 13

Nov. 21 “ 24

Dec. 1 “ 8 “ 13

Glen Wakeham 557

TABLE I-Conlimed.

Date of last menstrual

period.

Sept. 16 “ 16

Oct. 14 “ 1 ‘I 1 “ 1 ‘I 1 “ 1 “ 1 ‘I 1 “ 30 “ 30 “ 2 “ 2 “ 2

Nov. 4 Sept. 29

“ 29 “ 29

Oct. 28 “ 25 “ 25

Nov. 23 “ 1 “ 1 I‘ 1

Dec. 18 “ 18

Nov. 10 “ 10

act. 28 “ 28 LL 28

Dec. 3 “ 3

Nov. 6 “ 6 “ 30 “ 30 “ 30

“%” ubjec

lbs. in. cc. cc.

142 64 241 204 145 64 257 202 146 64 220 2QE 111 64 188 183 114 64 182 184 115 64 187 185 118 66 184 189 121 66 178 191 119 66 200 190 120 66 204 191 118 66 195 189 120 66 190 191 141 61 203 195 144 61 195 198 145 61 220 199 143 61 212 197 126 66 215 200 124 66 223 196 121 66 227 196

Ml‘ cent +18 +26

+7 +3 -1

+1 -3 -6 +5 +7 +3 +0 +4 -2

+10 +7 +7

t13 tl6

145 63 185 199 -7 148 63 190 202 -6 146 63 180 200 -10 93 63 162 167 -3 92 63 160 165 -3

90 63 150 162 -7 92 63 158 166 -5 94 63 154 168 -9

188 66 236 230 +3 190 66 250 231 +8 114 64 191 185 $3 117 64 184 186 -1 117 64 203 186 +9 117 64 190 186 +2 118 64 177 186 -5 145 65 178 206 -14 142 65 193 205 -6 142 65 196 205 -4 143 65 187 206 -10 143 65 188 206 -9

3eigh of

ubjec

32 con F;ump mn pc min.

Per- entage tbove

t&v OiTl&l.

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558 Basal Metabolism and Menstrual Cycle

21

22

23

24

Age.

z/m.

22

19

18

20

Dste of experiment.

Nov. 22 “ 26

Dec. 3 “ 10 “ 18 “ 21

Nov. 22 “ 26

Dec. 3 “ 10 “ 17 “ 21

Nov. 23 “ 30

Dec. 7 “ 11 “ 19 l‘ 24

Nov. 23 “ 30

Dec. 7 “ 11 “ 19 “ 24

TABLE I-Concluded. -

Date of 1st menstrual

period.

Nov. 21 (‘ 21 “ 21 “ 21

Dec. 16 “ 16

Nov. 10 “ 10 “ 10

Dec. 4 “ 4 “ 4

Nov. 18 “ 1s “ 18 “ 18 “ 18 “ 18

Jan. 3 act. 30 Nov. 29

“ 29 “ 29 “ 29 “ 29

Dec. 27 -

“3” lbject

lbs. in. cc.

123 63 186 124 63 197 122 63 192 121 63 211 122 63 171 122 63 177 134 62 188 134 62 195 136 62 222 135 62 191 135 62 189 136 62 197 110 62 176 110 62 175 111 62 165 112 62 140 110 62 142 109 62 lG2

122 64 204 121 64 200 123 64 188 123 64 199 126 64 190 127 64 202

-

cc.

190 190 189 187 188 189 193 193 lQ4 193 193 194 179 179 179 180 179 178

191 189 192 192 194 195

Per- entage above

b%v ormal.

,er cent

-2 +4 +2

+13 -9 -6 -3 i-1

+14 -1 -2 +2 -2 -2 -8

--22 -20

-8

f7 +G -2 +3 -2

f4

EXPERIMENTAL.

The fundamental data of Table I give the results of ninety- eight baeal metabolism determinations on twenty-four subjects, under conditions of uniformity not often obtainable in such work. Twenty of the subjects were nurses in training. Their mode of life and daily routine were subject to but little variation. Their meals were all taken at the same hours in the same vegetarian cafe, conducted by the institution in which they were employed, and the food at their disposal was almost monotonously uniform. All the determinations were made on the same apparatus (San-

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Glen Wakeham 559

born-Benedict) by the writer and an assistant technician, at the same hour of the day (between 6 and 7 a.m.). The subjects were taken in pairs for the most part, and slept the preceding night in the metabolism laboratory. A light vegetarian supper at 5 p.m. was in every case the last preceding meal, so their condition was postabsorptive. The determinations were made before the sub- ject moved in the morning, and the net weight, pulse, and tem- perature (if there was any indication of fever) were at once observed. Pulse and temperature are not recorded, as they were

First day of menstruation Days before menstruation Days after menstruation 15 10 5 1 5 10 15 20

t20

+15

Normal basal meiabolism I

-5

-10

&LkIlT 1.

within normal limits in all cases the data of which are subjected to analysis. Most of the subjects were in vigorous health, engaged in heavy manual labor from 7 to 12 hours daily, and sleeping soundly at night.

The oxygen consumption was estimated for two or three 10 minute periods, or until agreement within 3 per cent was reached. As convenient arbitrary “normal” basal metabolism values the tables given in Sanborn’s “Basal metabolism” (6) were used.

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560 Basal Metabolism and Menstrual Cycle

These are based on (a) the well known body surface formula of Du Bois, (b) the table of calories given by Aub and Du Bois (7) from which values (c), at the suggestion of Aub and Means (8), 1.8 calories are subtracted. The validity of this “normal” is not considered in the present paper. All individual results are given to the nearest whole numbers.

Chart 1 represents graphically the percentages in the last column of Table I. The data are plotted horizontally with regard to the 1st day of the nearest menstrual period, and verti-

+15

First day of menstruation Days before menstruation 15 10 5 i

Day;after menstruation 10 15

+ +10

I* -1 l I I I . I

t5

-5

- 10

-15

. . . . L..‘.’ . .,.. ,.

. . . . * l . ,

.

. . . . . , ‘. . .

I . . . l I .1 -

CHARTS.

tally with reference to the “normal” as defined above. A graph is drawn connecting the means of successive 5 day periods, the dotted line passing through the mean of the three determinations made on the 1st day of menstruation. The total number of observations is, indeed, small, representing about the minimum to which such a method could be applied. But the considerable daily fluctuations observed in basal metabolism, even when every possible precaution to secure uniformity of conditions is taken,

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Glen Wakeham 561

Days before menstruation

Days after menstruation

20 10 M 10 20

Subject 1

Subject 3

Subject 13

Subject 17

Subject 19

Subject 20

Subject 24 N

Subject 21 N

Subject 22 N

Subject 23

CHART 3.

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562 Basal Metabolism and Menstrual Cycle

easily masks, in any individual case, smaller variations due to some regular function like menstruation, and make it necessary to submit considerable data to some kind of statistical analysis if these smaller variations are to be detected.

Subject

Days before mergruatlon

Days after menstruation

5 M 5 10

Subject 5

N D

M M

Subject 6

N

Subject 7

SubjeCt 16 N

ls!iEl M

Subject 17

N

CHART 4. Compiled from data of Blunt and Dye.

Chart 2 subjects to the same method of analysis such of the data of Blunt and Dye as could be oriented with reference to the 1st day of the menstrual period. None of their determina- tions which could be thus placed is omitted from the chart. As quite a number of determinations fell on the 1st days of various menstrual periods{ the mean of the values for this day is taken as one point on the graph.

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Glen Wakeham

In Chart 3, graphs representing the basal metabolic fluctua- tions of a number of individual cases are given, the horizontal lines “IV’ being the “normals” as defined above, and the vertical lines “M” representing the 1st day of the menstrual period occur- ring during the course of the experiment. Chart 4 represents some of Blunt and Dye’s data in the same way.

Notes and Observations on the Table and Charts.

All the determinations of basal metabolism on all the subjects chosen for this investigation are recorded in Table I, including some which are obviously abnormal.

Subject I presents a menstrual cycle of 20 days, which her history showed to have persisted since puberty.

Subject 4, a young married woman, without children, of sedentary occupation, apparently in good health, gave abnormally high results for no reason which could be assigned. The data in this case are not used in Chart 1.

Subject 5 was severely burned on Oct. 28, and the data of determinations made after the accident are not used in Chart 1, as there was some fever.

Subjects 13 and 17 were engaged in sedentary work (typists). Subjects 1 to 12 were all nurses approaching the completion of a 3 year

training period. They were girls of exceptional strength, survivors of a class originally three times as large, and were working at high pressure, preparing for their graduation exercises as well as performing their regular duties. Their average basal metabolism was 10.1 per cent above the arbitrary “normal” used in these experiments.

Subjects 19 to 24, on the other hand, were younger girls, just beginning their course of training. The determinations were made after the rush season of the institution was over, while the girls were attending two or three classes daily, and not doing, on the average, more than 7 hours of daily manual labor. Their average basal metabolism was 2.1 per cent below the arbitrary normal, which agrees very well with the results ob- tained by Blunt and Dye for women engaged in sedentary occupations.

In the construction of Chart 1, the following data from Table I were omitted: (a) Data of a clearly abnormal character as noted above; (b) all determinations which were more than 20 per cent above, or 10 per cent below, the arbitrary “normal.” These limits were chosen (a) because nearly all of the data lay between them and (b) because the average of all the determinations made was nearly 5 per cent above the arbitrary “normal.”

The rise in the graph representing the average basal metabolism in all these cases preceding menstruation, followed by a fall equally pronounced, is so striking that the writer was inclined to look for some factor of error, and did not feel like trusting his own results until a similar analysis of the data of Blunt and Dye confirmed, in part at least, these observations.

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564 Basal Metabolism and Menstrual Cycle

All the data of Blunt and Dye which could be placed with reference to the 1st day of menstruation are used in Chart 2. The graph of average basal metabolism determinations shows a small but distinct rise during the period between 7 and 15 days before menstruation. More significant is the sharp fall immediately after the 1st day of menstruation. The large number of determinations made just before and during the 1st week of menstruation gives this result great weight as evidence of the generality of this phenomenon.

Charts 3 and 4 give graphs of individual fluctuations in basal metabolism of some of the subjects of the above experiments. The graphs of Chart 3,

from the writer’s subjects, are not of great significance, taken individually, because of the small number of determinations made in each case. And even the graphs of Chart 4, taken from Blunt and Dye’s data, while much more complete, serve chiefly to demonstrate that individual daily fluctua- tions are so much greater than the periodic monthly variation that the latter can be demonstrated only by statistical methods.

DISCUSSION.

Some of the above observations would be valueless standing by themselves, but the fact that they all point in the same direc- tion can hardly be without significance. In spite of the great irregularity and apparent confusion of the data, one feature stands out clearly, and that is the distinct fall in basal metab- olism about the beginning of the menstrual period. This is confirmed by every method of analysis used for both sets of data, and further emphasized by the following:

Comparison of Data of Blunt and Dye, and Wakeham.

2%’ Dye.

Per cent

Average of all premenstrual determinations (within 15 days of 1st day of menstruation). . . . . . . . . . . . . . +O.t

Average of all postmenstrual determinations (within 15 days after menstruation, omitting 1st day). . . . . . . . . -1.1

Difference between premenstrual and postmenstrual phases (being in each case a decrease). . . . . . . 2.c

Number of premenstrual determinations above normal.. . . . 37 “ “ “ “ below “ . . . . 29 “ “ postmenstrual “ above “ . . . 28 “ ‘I “ I‘ below “ . . . . . . 46

Percentage of total premenstrual “ above “ . . . . . . 56 “ “ “ postmenstrual “ “ “ . . . . . 37

Drop in thesk percentages due (presumably) to menstruation. 19

Per cent

f5.7

t1.7

4.0 30 13 31 23 70 57.4 12.6

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Glen Wakeham

The writer’s data indicate a distinct rise in basal metabolism within the week or 10 days prior to menstruation. This is not so clearly shown by Blunt and Dye’s results. But if there is a fall after menstruation, there must be a rise at some phase of the menstrual cycle. Blunt and Dye made very few determinations during the 2nd and 3rd weeks after menstruation, and the effect of other factors disturbing basal metabolism seems to have masked the influence of the menstrual cycle. The writer’s data, obtained from subjects whose mode of life and general habits were presumably much more uniform than those of Blunt and Dye’s subjects, indicate a premenstrual rise beginning a week or 10 days before menstruation, a sudden drop at the beginning of the menstrual period (this is confirmed by Blunt and Dye’s data) followed by a gradual return to normality within from 7 to 10 days.

The analysis shows that whatever variation there is due to the menstrual cycle must be much smaller than the daily fluctuations caused by other factors. It is therefore to the point to emphasize the necessity of obtaining, for investigation of this question, not only as large a number of data as possible, but also the greatest possible uniformity of conditions. For analytical purposes it would also be desirable to have determinations evenly distrib- uted throughout the menstrual cycle.

Further possible inferences from comparison of the two sets of data used in this article are that the average basal metabolism of women engaged in strenuous physical labor is higher, perhaps by 10 per cent, than of those in sedentary occupations, that basal metabolism fluctuations due to the menstrual cycle are at least twice as great in the former as in the latter class, and that, in normal subjects, uniform habits of life are accompanied by a smaller range of individual daily fluctuation than occurs in individuals who lead a more varied existence. This last point is made clear in the following tabulation, in which only presum- ably normal subjects are considered:

Blunt and Dye. Wakeham.

per cent per cent

Maximum daily variation.. . . . . . . . . . . . . . . 28.8 20 Minimum “ “ . . . . . . . . . . . . . 7.4 6 Average “ “ . . . . . . . . 13.2 12.4

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566 Basal Metabolism and Menstrual Cycle

Results.

It is shown by the analysis of data given by the writer, and others by Blunt and Dye (who did not think that their data revealed any connection between basal metabolism and the menstrual cycle) that there is a distinct fall in basal metabolism during or immediately after menstruation.

The writer’s data indicate a premenstrual rise in basal metabo- lism, but this conclusion is not deducible from the data of Blunt and Dye.

Further suggestions, which must be regarded as merely ten- tative are :

1. That basal metabolism is considerably higher, on the average, in those engaged in strenuous labor than in those of sedentary occupations.

2. That basal metabolism fluctuations in those living under uniform conditions are less than in those whose mode of life is more varied.

3. That the basal metabolism variation due to the menstrual cycle, while in every case less than the average daily fluctuations, is greater in active individuals than in sedentary individuals.

4. That causes which produce too frequent menstruation are likely to be accompanied by high basal metabolism.

5. That causes which delay or suppress menstruation are likely to be accompanied by low basal metabolism.

The writer begs leave, in conclusion, to emphasize the impos- sibility of considering any of these results final except, perhaps, the first one, and to hope that this article will lead to the publi- cation of further data which may enable these questions to be satisfactorily settled.

My best thanks are due to the nurses who, at considerable personal inconvenience, cooperated in this investigation; to the assistants who carried out much of the work here recorded; and, most of all, to Dr. Robert C. Lewis, Director of the Denison Re- search Laboratory and Professor of Riochemistry, University of Colorado, for his helpful suggestions and criticism in preparing this paper for publication.

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Glen Wakeham 567

BIBLIOGRAPHY.

1. Blunt, K., and Dye, M., Basal metabolism of normal women, J. Biol. Chem., 1921, xlvii, 69.

2. Zunta, L., Untersuchungen tiber den Einfluss der Ovarien auf den Stoffwechsel, Arch. Gyniik., 1906, lxxviii, 106.

3. Gephart, F. C., and Du Bois, E. F., Clinical calorimetry. XIII. The basal metabolism of normal adults with special reference to surface area, Arch. Int. Med., 1916, xvii, 902.

4. Wiltshire, M. 0. P., Some observations on basal metabolism in men- struation, Lancet, 1921, ii, 388.

5. Snell, A. M., Ford, F., and Rowntree, L. G., Studies in basal metab- olism, J. Am. Med. Assn., 1920, lxxv, 515.

6. Sanborn, F. B., Basal metabolism; its determination and application, Boston, 1922, pp. 241-243.

7. Aub, J. C., and Du Bois, E. F., Clinical calorimetry. XIX. The basal metabolism of old men, Arch. Int. Med., 1917, xix, 823.

8. Aub, J. C., and Means, J. H., The basal metabolism and the specific dynamic action of protein in liver disease, Arch. Int. Med., 1921, xxviii, 173.

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Glen WakehamMENSTRUAL CYCLE

BASAL METABOLISM AND THE

1923, 56:555-567.J. Biol. Chem. 

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