title: A factor analysis approach to examining relationships among ovarian steroid concentrations, gonadotrophin concentrations and menstrual cycle length characteristics in healthy, cycling women.
abstract: OBJECTIVE
  How are ovarian steroid concentrations, gonadotrophins and menstrual cycle characteristics inter-related within normal menstrual cycles?
  
  
  CONCLUSIONS
  Within cycles, measures of estradiol production are highly related to one another, as are measures of progesterone production; however, the two hormones also show some independence from one another, and measures of cycle length and gonadotrophin concentrations show even greater independence, indicating minimal integration within cycles.
  
  
  BACKGROUND
  The menstrual cycle is typically conceptualized as a cohesive unit, with hormone levels, follicular development and ovulation all closely inter-related within a single cycle. Empirical support for this idea is limited, however, and to our knowledge, no analysis has examined the relationships among all of these components simultaneously.
  
  
  METHODS
  A total of 206 healthy, cycling Norwegian women participated in a prospective cohort study (EBBA-I) over the duration of a single menstrual cycle. Of these, 192 contributed hormonal and cycle data to the current analysis.
  
  
  METHODS
  Subjects provided daily saliva samples throughout the menstrual cycle from which estradiol and progesterone concentrations were measured. FSH and LH concentrations were measured in serum samples from three points in the same menstrual cycle and cycle length characteristics were calculated based on hormonal data and menstrual records. A factor analysis was conducted to examine the underlying relationships among 22 variables derived from the hormonal data and menstrual cycle characteristics.
  
  
  RESULTS
  Six rotated factors emerged, explaining 80% of the variance in the data. Of these, factors representing estradiol and progesterone concentrations accounted for 37 and 13% of the variance, respectively. There was some association between measures of estradiol and progesterone production within cycles; however, cycle length characteristics and gonadotrophin concentrations showed little association with any measure of ovarian hormone concentrations.
  
  
  CONCLUSIONS
  Our summary measures of ovarian hormones may be imprecise in women with extremely long or short cycles, which could affect the patterns emerging in the factor analysis. Given that we only had data from one cycle on each woman, we cannot address how cycle characteristics may covary within individual women across multiple cycles.
  
  
  CONCLUSIONS
  Our findings are generalizable to other healthy populations with typical cycles, however, may not be applicable to cycles that are anovulatory, extreme in length or otherwise atypical. The results support previous findings that measures of estradiol production are highly correlated across the cycle, as are measures of progesterone production. Estradiol and progesterone concentrations are associated with one another, furthermore. However factor analysis also revealed more complex underlying patterns in the menstrual cycle, highlighting the fact that gonadotrophin concentrations and cycle length characteristics are virtually independent of ovarian hormones. These results suggest that despite integration of follicular and luteal ovarian steroid production across the cycle, cycle quality is a multi-faceted construct, rather than a single dimension.
  
  
  BACKGROUND
  The EBBA-I study was supported by a grant from the Norwegian Cancer Society (49 258, 05087); Foundation for the Norwegian Health and Rehabilitation Organizations (59010-2000/2001/2002); Aakre Foundation (5695-2000, 5754-2002) and Health Region East. The current analyses were completed under funding from the National Institutes of Health (K12 ES019852). No competing interests declared.
authors.affiliation: Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14534, USA. emily_barrett@urmc.rochester.edu
authors.forename: E S
authors.initials: ES
authors.lastname: Barrett
authors.forename: I
authors.initials: I
authors.lastname: Thune
authors.forename: S F
authors.initials: SF
authors.lastname: Lipson
authors.forename: A-S
authors.initials: AS
authors.lastname: Furberg
authors.forename: P T
authors.initials: PT
authors.lastname: Ellison
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004958:Estradiol / Q000032:analysis* / Q000378:metabolism; D005163:Factor Analysis, Statistical; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood* / Q000378:metabolism; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood* / Q000378:metabolism; D008597:Menstrual Cycle / Q000097:blood / Q000502:physiology*; D009664:Norway; D010053:Ovary / Q000378:metabolism* / Q000502:physiology; D010902:Pituitary Gland / Q000378:metabolism* / Q000502:physiology; D011374:Progesterone / Q000032:analysis* / Q000378:metabolism; D011446:Prospective Studies; D012463:Saliva / Q000737:chemistry; D013997:Time Factors
chemical_list: D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone