title: High frequency of luteal phase deficiency and anovulation in recreational women runners: blunted elevation in follicle-stimulating hormone observed during luteal-follicular transition.
abstract: The purposes of this investigation were to evaluate the characteristics of three consecutive menstrual cycles and to determine the frequency ofluteal phase deficiency (LPD) and anovulation in a sample of sedentary and moderately exercising, regularly menstruating women. For three consecutive menstrual cycles, subjects collected daily urine samples for analysis of FSH, estrone conjugates (E1C), pregnanediol-3-glucuronide (PdG), and creatinine (Cr). Sedentary (n=11) and exercising (n=24) groups were similar in age (27.0+/-1.3 yr), weight (60.3+/-3.1 kg), gynecological age (13.8+/-1.2 yr), and menstrual cycle length (28.3+/-0.8 days). Menstrual cycles were classified by endocrine data as ovulatory, LPD, or anovulatory. No sedentary women (0%) had inconsistent menstrual cycle classifications from cycle to cycle, but 46% of the exercising women were inconsistent. The sample prevalence of LPD in the exercising women was 48%, and the 3-month sample incidence was 79%. In the sedentary women, 90% of all menstrual cycles were ovulatory (SedOvul; n=28), whereas in the exercising women only 45% were ovulatory (ExOvul; n=30); 43% were LPD (ExLPD; n=28), and 12% were anovulatory (ExAnov; n=8). In ExLPD cycles, the follicular phase was significantly longer (17.9+/-0.7 days), and the luteal phase was significantly shorter (8.2+/-0.5 days) compared to ExOvul (14.8+/-0.9 and 12.9+/-0.3 days) and SedOvul (15.9+/-0.6 and 12.9+/-0.4 days) cycles. Luteal phase PdG excretion was lower (P < 0.001) in ExLPD (2.9+/-0.3 microg/mg Cr) and ExAnov (0.8+/-0.1 microg/mg Cr) cycles compared to SedOvul cycles (5.0+/-0.4 microg/mg Cr). ExOvul cycles also had less (P < 0.01) PdG excretion during the luteal phase (3.7+/-0.3 microg/mg Cr) than the SedOvul cycles. E1C excretion during follicular phase days 2-5 was lower (P=0.05) in ExOvul, ExLPD, and ExAnov cycles compared to SedOvul cycles and remained lower (P < 0.02) in the ExLPD and ExAnov cycles during days 6-12. The elevation in FSH during the luteal-follicular transition was lower (P < 0.007) in ExLPD (0.7+/-0.1 ng/mg Cr) cycles compared to SedOvul and ExOvul cycles (1.0+/-0.1 and 1.1+/-0.1 ng/mg Cr, respectively). Energy balance and energy availability were lower (P < 0.05) in ExAnov cycles than in other menstrual cycle categories. The blunted elevation in FSH during the luteal-follicular transition in exercising women with LPD may explain their lower follicular estradiol levels. These alterations in FSH may act in concert with disrupted LH pulsatility as a primary and proximate factor in the high frequency of luteal phase and ovulatory disturbances in regularly menstruating, exercising women.
authors.affiliation: Center for Fertility and Reproductive Endocrinology, New Britain General Hospital, Connecticut 06050, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: De Souza
authors.forename: B E
authors.initials: BE
authors.lastname: Miller
authors.forename: A B
authors.initials: AB
authors.lastname: Loucks
authors.forename: A A
authors.initials: AA
authors.lastname: Luciano
authors.forename: L S
authors.initials: LS
authors.lastname: Pescatello
authors.forename: C G
authors.initials: CG
authors.lastname: Campbell
authors.forename: B L
authors.initials: BL
authors.lastname: Lasley
mesh_terms: D000293:Adolescent; D000328:Adult; D000858:Anovulation / Q000209:etiology*; D002149:Energy Intake; D004734:Energy Metabolism / Q000502:physiology; D004967:Estrogens / Q000652:urine; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D005498:Follicular Phase / Q000502:physiology*; D006801:Humans; D008183:Luteal Phase / Q000502:physiology*; D008597:Menstrual Cycle / Q000502:physiology; D009747:Nutritional Physiological Phenomena / Q000502:physiology; D010806:Physical Education and Training; D011374:Progesterone / Q000652:urine; D011998:Recreation / Q000502:physiology; D012420:Running / Q000502:physiology*
chemical_list: D004967:Estrogens; D011374:Progesterone; D005640:Follicle Stimulating Hormone