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High Frequency of Luteal Phase Deficiency and Anovulation in Recreational Women Runners: Blunted Elevation in Follicle-Stimulating Hormone Observed during Luteal-Follicular Transition1
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 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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Energy Metabolism and the Evolution of Reproductive Suppression in the Human Female
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Metadata
- 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)
- 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
- 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 › Reproductive Medicine › 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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