title: Perceived stress, reproductive hormones, and ovulatory function: a prospective cohort study.
abstract: BACKGROUND
  Stress has been shown to suppress ovulation in experimental models, but its effect on human reproduction at the population level is unclear.
  
  
  METHODS
  Healthy women (n = 259), aged 18-44 years from Western New York, were followed for 2 menstrual cycles (2005-2007). Women completed daily perceived stress assessments, a 4-item Perceived Stress Scale (PSS-4) up to 4 times each cycle, and a 14-item PSS at baseline. Mixed model analyses were used to assess effects of stress on log reproductive hormone concentrations and sporadic anovulation.
  
  
  RESULTS
  High versus low daily stress was associated with lower estradiol (-9.5% [95% confidence interval (CI) = -15.6% to -3.0%]), free estradiol (-10.4% [-16.5% to -3.9%]), and luteinizing hormone (-14.8% [-21.3% to -7.7%]) and higher follicle-stimulating hormone (6.2% [95% CI = 2.0% to 10.5%]) after adjusting for age, race, percent body fat, depression score, and time-varying hormones and vigorous exercise. High versus low daily stress was also associated with lower luteal progesterone (-10.4% [95% CI = -19.7% to -0.10%]) and higher odds of anovulation (adjusted odds ratio = 2.2 [95% CI = 1.0 to 4.7]). For each unit increase in daily stress level, women had a 70% higher odds of an anovulatory episode (odds ratio = 1.7 [1.1 to 2.4]). Similar but attenuated results were found for the association between the PSS-4 and reproductive hormones, while null findings were found for the baseline PSS.
  
  
  CONCLUSIONS
  Daily perceived stress does appear to interfere with menstrual cycle function among women with no known reproductive disorders, warranting further research to explore potential population-level impacts and causal biologic mechanisms.
authors: From the aEpidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development, Rockville, MD; bDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; cProgram of Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; and dEpidemiology and Environmental Health, University at Buffalo, Buffalo, NY.
authors: Karen C
authors: KC
authors: Schliep
authors: Sunni L
authors: SL
authors: Mumford
authors: Catherine J
authors: CJ
authors: Vladutiu
authors: Katherine A
authors: KA
authors: Ahrens
authors: Neil J
authors: NJ
authors: Perkins
authors: Lindsey A
authors: LA
authors: Sjaarda
authors: Kerri A
authors: KA
authors: Kissell
authors: Ankita
authors: A
authors: Prasad
authors: Jean
authors: J
authors: Wactawski-Wende
authors: Enrique F
authors: EF
authors: Schisterman
mesh_terms: D000293:Adolescent; D000328:Adult; D000858:Anovulation / Q000097:blood / Q000523:psychology*; D015415:Biomarkers / Q000097:blood; D004958:Estradiol / Q000097:blood*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006065:Gonadotropins, Pituitary / Q000097:blood*; D006801:Humans; D016014:Linear Models; D007986:Luteinizing Hormone / Q000097:blood; D011374:Progesterone / Q000097:blood*; D011446:Prospective Studies; D013315:Stress, Psychological / Q000097:blood / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006065:Gonadotropins, Pituitary; D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone
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