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Cited by 316Hypothalamic control of reproductive hormonesOvarian function and disordersReproductive Biology and Fertility

High Frequency of Luteal Phase Deficiency and Anovulation in Recreational Women Runners: Blunted Elevation in Follicle-Stimulating Hormone Observed during Luteal-Follicular Transition1

De Souza, Mary Jane, Miller, B. E., Loucks, A. B., Luciano, A. A., Pescatello, L. S., Campbell, C. G., Lasley, B. L.·1998·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jcem.83.12.5334
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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.

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  • In women using a monophasic COC, an acute bout of moderate-intensity aerobic exercise does not exert the same effects on ghrelin and insulin as in naturally menstruating women.

    “In a follow-up study, an acute bout of moderate intensity aerobic exercise did not exert the same effects on ghrelin and insulin for women using a monophasic COC and the participants maintained an energy deficit after exercise”

    From International society of sports nutrition position stand: nutritional concerns of the female athlete (2023) · cites this paper as [139]

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Authors
De Souza, M. J., Miller, B. E., Loucks, A. B., Luciano, A. A., Pescatello, L. S., Campbell, C. G., & Lasley, B. L.
Affiliations
  • Center for Fertility and Reproductive Endocrinology (M.J.D.S., B.E.M., A.A.L.), New Britain General Hospital, New Britain, Connecticut 06050
  • New Britain General Hospital (US)
  • Ohio University (US)
  • University of Hartford (US)
  • University of California, Davis (US)
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
1998-12-01
Volume
83
Issue
12
Pages
4220-4232
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jcem.83.12.5334
OpenAlex
W2135324780
Cited by
315
References
47
Citations by year
2026: 1 · 2025: 11 · 2024: 8 · 2023: 12 · 2022: 10 · 2021: 13 · 2020: 12 · 2019: 12 · 2018: 6 · 2017: 11 · 2016: 18 · 2015: 9 · 2014: 22 · 2013: 16 · 2012: 16
FWCI
3.25
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Environmental Health Sciences (ES 06198, P01ES006198)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
Keywords
luteal phase deficiency, anovulation, female runners, follicle-stimulating hormone, luteal phase, follicular phase, pregnanediol-3-glucuronide, estrone conjugates, ovulation, exercise-induced amenorrhea, urinary hormone excretion, sedentary women
MeSH terms
Adolescent, Adult, Anovulation, Energy Intake, Energy Metabolism, Estrogens, Female, Follicular Phase, Follicle Stimulating Hormone, Humans, Luteal Phase, Menstrual Cycle, Nutritional Physiological Phenomena, Physical Education and Training, Progesterone, Recreation, Running

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