High serum cortisol levels in exercise-associated amenorrhea
Abstract
OBJECTIVE: To determine whether basal cortisol levels are elevated in exercise-associated amenorrhea. DESIGN: Survey, with hormone levels measured weekly for 1 month and patients followed clinically for 6 months. SETTING: Volunteers were recruited through media advertisements and fliers. PARTICIPANTS: Ninety-two women were enrolled; 71 (77%) completed the study. Subjects were grouped by menstrual and activity histories reported by a self-administered questionnaire. After 6 months, final groups were assigned: amenorrheic athletes, 19; eumenorrheic athletes, 35; a transition group of amenorrheic athletes who had resumed menses after entering the study, 7; and normal cyclic nonathletes, 10. INTERVENTIONS: Four weekly resting blood samples (0800 to 1000 hours) were obtained and measured for cortisol, estradiol, progesterone, and prolactin levels. Lumbar bone mineral density was measured by dual-photon densitometry. MEASUREMENTS AND MAIN RESULTS: Mean (+/- SE) cortisol levels were higher in amenorrheic athletes (585 +/- 33 nmol/L) than in eumenorrheic athletes (411 +/- 14 nmol/L), transition athletes (378 +/- 33 nmol/L), or nonathletic women (397 +/- 30 nmol/L) (P less than 0.01). Of nine women with abnormally high cortisol levels (greater than 579 nmol/L), eight were amenorrheic athletes, and one was a eumenorrheic athlete. Bone mineral density was lower in amenorrheic athletes than in the other three groups (P less than 0.01). CONCLUSIONS: Increased glucocorticoid levels may be an etiologic factor in exercise-associated amenorrhea. High cortisol levels could also contribute to decreased bone density. The failure of amenorrheic athletes with hypercortisolemia to regain menses within 6 months suggests that they are at risk for a prolonged acyclic state.
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Human studies have highlighted the profound effect of glucocorticoid excess on the menstrual cycle.
“Human studies have also highlighted the profound effect of glucocorticoid excess on the menstrual cycle (Ding et al., 1988; Suh et al., 1988; Saketos et al., 1993; Crofford et al., 1999).”
From Dynamic Hormone Control of Stress and Fertility (2020) · cites this paper as Ding et al., 1988
The model provides insight into how a hyper-sensitized HPG axis may explain amenorrhea secondary to high serum cortisol levels.
“Thus, our model provides insight into how for example a hyper-sensitized HPG axis may explain amenorrhea secondary to high serum cortisol levels (Ding et al., 1988; Suh et al., 1988; Saketos et al., 1993).”
From Dynamic Hormone Control of Stress and Fertility (2020) · cites this paper as Ding et al., 1988
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References 31 · Cited by 131
- Authors
- DING, J.-H., SHECKTER, C. B., DRINKWATER, B. L., SOULES, M. R., & BREMNER, W. J.
- Affiliations
- University of Washington (US)
- Seattle, Washington
- Corresponding author
- DING, JU-HONG
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 1988-04-01
- Volume
- 108
- Issue
- 4
- Pages
- 530-534
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2060417855
- Cited by
- 131
- References
- 31
- Citations by year
- 2026: 2 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 4 · 2020: 5 · 2016: 2 · 2014: 1 · 2013: 4 · 2012: 2
- FWCI
- 5.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01hd018967-11)
- National Center for Research Resources (RR 37)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (P50HD012629, R01 HD 18967, P50-HD-12629)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Keywords
- serum cortisol, hypercortisolism, amenorrhea, athletes, bone mineral density, estradiol, progesterone, prolactin, menstrual cycle, glucocorticoids
- MeSH terms
- Adult, Amenorrhea, Bone and Bones, Estradiol, Physical Exertion, Female, Humans, Hydrocortisone, Minerals, Progesterone, Prolactin, Reference Values
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