Amenorrheic Women Research Articles

The Effects of Previous Amenorrhea on Endothelial and Vascular Function

Introduction: Endogenous estrogen has a protective cardiovascular effect. Estrogen loss, such as during menopause and amenorrhea, results in stiffer vessels and endothelial dysfunction. It is unknown if reversing amenorrhea and regaining a regular menstrual cycle leads to the restoration of cardiovascular function.Methods: Sixteen women were divided into groups: eumenorrheic (n = 10; 23 ± 3 years) women who had a consistent menstrual cycle and amenorrheic (n = 6; 22 ± 1 year) women who previously were without their menstrual cycle for at least 6 consecutive months. Endothelial function, arterial stiffness, and brachial and aortic blood pressure were assessed.Results: There were no differences between groups in endothelial function or arterial stiffness measures. The previously amenorrheic group displayed lower brachial systolic and mean pressures and aortic systolic, diastolic, and mean pressures. When controlling for physical activity, only central pressure remained significantly lower in the amenorrheic group.Conclusions: Previous amenorrhea in young women does not result in long‐term cardiovascular consequences in arterial and endothelial function measures assuming regular menstruation resumes. Physical activity shows a blood pressure–lowering effect in the peripheral arteries, while the previously amenorrheic group demonstrated lower central pressures, independent of physical activity.

First successful ovarian cortex allotransplant to a Turner syndrome patient requiring immunosuppression: wide implications

ObjectiveTo determine whether we can safely and successfully transplant an ovary tissue allograft from a non-identical donor to her Turner syndrome sister. DesignTransplantation of cryopreserved ovary tissue, as well as fresh transplantation of ovarian tissue between identical twins, is now well established with numerous reported successful cases. However there have not yet been any ovary transplants between non-identical women requiring immunosuppression (ovary allotransplant). This could be a much more common indication for ovary tissue transplantation if safe and reliable immunosuppression were available. SubjectsA 20 year old amenorrheic woman with non-mosaic 45-XO Turner syndrome requested ovary tissue transplantation from her fertile 22 year old 46-XX sister. They were an HLA match but were ABO incompatible, a well known contra-indication to solid tissue or organ transplantation. The Turner syndrome sister strongly preferred to be able to become pregnant naturally without donor egg IVF, and to avoid HRT (hormone replacement therapy). In her religious group, that would also be important for finding a marital match. Despite the poor prognosis associated with ABO incompatibility, an ovary from her 22 year old non-identical fertile sister was transplanted to her employing the immunosuppression protocol now used for kidney transplant patients in our centers at Washington University and Johns Hopkins. Main Outcome MeasuresPost-operatively at 5 months she developed normal monthly menstrual ovarian function, and she became spontaneously pregnant with a normal baby girl. The relation between her post-op FSH and AMH levels continues to support the theory that tissue pressure controls primordial follicle recruitment. The fact that ABO incompatibility did not prevent success suggests that diffusion and not revascularization may be all that is required for successful long term ovarian cortex transplant survival with spontaneous pregnancy. ResultsOvary allotransplantation with safe immunosuppression allows natural conception, and also normal hormone function obviates the need for HRT. Orthotopic placement of the graft and surgical technique is critical for natural conception and a higher pregnancy rate. ConclusionAllotransplantation requiring safe immunosuppression, if successful, may be a much more commonly used indication for ovary transplantation in the future than frozen ovary grafts or grafts between identical twins.

Hypogonadism as a consequence of craniopharyngioma in female patients: comparison of childhood and adult onset and effects of estrogen replacement therapy.

(1) to compare clinical, biochemical features in female patients with hypoestrogenism due to childhood- and adult-onset CP; (2) to reveal effects of estrogen replacement therapy in female patients with childhood-onset CP. Thirty-seven women that received specific treatment for CP in the period from 1980 to 2019 were recruited: 21 with childhood-onset and 16 with adult-onset CP. Clinical and hormonal characteristics were evaluated. Seventeen-beta-estradiol 2 mg and dydrogesterone 10 mg in sequential regiment was used in 18 childhood-onset cases. Mean follow-up was 31 months. Amenorrheic women with childhood- and adult-onset CP presented with the same complaints except for lack of genital hair and breast hypoplasia, which were common in patients with childhood-onset CP. BMI was lower in childhood-onset CP group, as was the proportion of overweight patients. They had more favorable lipid profile. The levels of estradiol, testosterone and DHEA-S were low and did not differ. Uterine and ovary volumes were reduced in all patients, but the decline was noticeable in the childhood-onset group. Mineral bone density of lumbar vertebrae was diminished in childhood-onset group. Estrogen therapy in these patients led to clinical improvement: increase in BMD in lumbar spine without negative changes in BMI and/or lipid profile. Study showed that women with childhood-onset CP had less negative metabolic changes. However, they have more pronounced breast and uterus hypoplasia and lower BMD in lumbar spine. The estrogen replacement therapy led to clinical improvement and BMD increase in lumbar spine without increase of BMI and/or lipid profile changes.

Man-like woman and the menstruating man

There are a number of oblique references in Sufi literature to pious women whose austerities resulted in the loss of their menstrual cycle, as well as pious men who ascribed to themselves a type of metaphorical menstruation as a method of self-disparagement. This article analyzes such references in relation to dominant medieval Sufi discourses of purity and piety, in order to investigate the gendered rhetoric and presuppositions that underlie explicit and implicit allusions to menstruation in Sufi texts. In isolating and analyzing allusions to menstruation, four categories of reference emerge: depersonalization of menstrual blood, metaphorical male menstruation, masculinization of pious women, and reification of amenorrheic women. These narrative strategies, although applied inconsistently, all contribute to an overall deliberate effort by male authors to justify the inclusion of female bodies in male-dominated discursive spaces, while ultimately perpetuating hegemonic theologies of sacred masculinity. Through examining these inconsistent applications of gender in male-authored Sufi writings, this analysis identifies new avenues for revisiting medieval Islamicate notions of gendered identity in society in ways that dismantle ahistorical binary models of gender that have often skewed readings of Sufi and medieval Muslim sources.

Pregnancy risks and contraceptive use among postpartum mothers in Cameroon: implications for improving the coverage of postpartum family planning services

BackgroundThe health hazards of short inter-birth intervals are severe in Cameroon. One-quarter of inter-birth intervals are less than 24 months and the probability of death before age 5 for children born after a short interval is double that associated with intervals of 36–47 months. We examine the risk of an unintended pregnancy in the 18 months following childbirth in Cameroon, taking into account the protective effects of lactational amenorrhea, delayed resumption of sex as well as contraceptive use.MethodsData from 3007 postpartum women in the nationally representative 2018 Cameroon Demographic and Health Survey were used. Risk of an unintended pregnancy was defined from current status information on resumption of sex and menses, contraceptive use, desire for another child within 12 months, and, for the minority of pregnant women, whether the conception was intended. Predictors of risk, and of modern method use, were assessed by bivariate and multivariate analysis.ResultsIn the first 6 postpartum months, only 8% of women were fully at risk (i.e., sex and menses resumed but no contraceptive use), rising to 24% at 6–11 postpartum months, and further to 30% at months 12–17. Though 89% wanted to delay the next birth by at least 1 year, only 17% were currently using a modern method. Menstruating women were much more likely to be users than amenorrheic women: 27% versus 15% at months 12–17 postpartum. Urban and better educated women recorded higher contraceptive use but lower protection from other factors than rural, less educated women, with the net result that risk differed little across these population strata. Uptake of maternal and child health (MCH) services was high but only one-third of women had discussed family planning at a facility visit during the preceding 12 months.ConclusionsThese results underscore the need for improved postpartum family planning services by means of closer integration with mainstream health services. In view of evidence from other sources of heavy workload and weak motivation of health staff, this will require strong leadership. A related priority is to increase the number of staff trained in provision of long-acting methods, such as implants.

Bone health in functional hypothalamic amenorrhea: What the endocrinologist needs to know.

In the original definition by Klinefelter, Albright and Griswold, the expression “hypothalamic hypoestrogenism” was used to describe functional hypothalamic amenorrhoea (FHA). Given the well-known effects of estrogens on bone, the physiopathology of skeletal fragility in this condition may appear self-explanatory. Actually, a growing body of evidence has clarified that estrogens are only part of the story. FHA occurs in eating disorders, overtraining, and during psychological or physical stress. Despite some specific characteristics which differentiate these conditions, relative energy deficiency is a common trigger that initiates the metabolic and endocrine derangements contributing to bone loss. Conversely, data on the impact of amenorrhoea on bone density or microarchitecture are controversial, and reduced bone mass is observed even in patients with preserved menstrual cycle. Consistently, oral estrogen-progestin combinations have not proven beneficial on bone density of amenorrheic women. Low bone density is a highly prevalent finding in these patients and entails an increased risk of stress or fragility fractures, and failure to achieve peak bone mass and target height in young girls. Pharmacological treatments have been studied, including androgens, insulin-like growth factor-1, bisphosphonates, denosumab, teriparatide, leptin, but none of them is currently approved for use in FHA. A timely screening for bone complications and a multidisciplinary, customized approach aiming to restore energy balance, ensure adequate protein, calcium and vitamin D intake, and reverse the detrimental metabolic-endocrine changes typical of this condition, should be the preferred approach until further studies are available.

Changes in Insulin-Like Growth Factor 1 and Quadriceps Muscle Size in Follicular Stage Compared to Luteal Stage in Adaptation to Resistance Training in Young Women

Background and Objectives Menstrual cycle may affect the training of strength and muscle size. The aim of the present study was to determine the effect of exercise volume distribution in the 2 follicular and luteal phases of the menstrual cycle on serum Insulin-like Growth Factor 1 (IGF-1) and muscle mass in women. Methods in this semi experimental study’ 20 amenorrheic women with a mean age of 22±5 years, without contraceptive use and a history of eight weeks of resistance training were selected. Each subject had 8 training sessions on one leg in the first 14 days of menstruation and 2 training sessions on the second 14 days of menstruation (training in the follicular period) and the other leg had 2 training sessions on the first 14 days of menstruation and 8 training sessions on the second 14 days of menstruation (training in the luteal period). The training protocol was consist of unilateral leg extension. Results the quadriceps Muscle diameter (according to pretest size) in follicular training (FT) (0.67±0.34 (cm)) was higher than luteal training(LT) (0.46, 0.41 cm) (P=0.012). Also, insulin-like growth factor increased in both groups (13%) regardless of the type of exercise schedule (P> 0.001). Conclusion According to this study it is recommended that follicular based training may cause more muscle hypertrophy and maximum strength than luteal based training in young amenorrheic women who do not take birth control pills.

Oxytocin and Bone: Review and Perspectives.

Recent data demonstrate the anabolic effect of oxytocin on bone. Bone cells express oxytocin receptors. Oxytocin promotes osteoblasts differentiation and function, leading to an increased bone formation with no effect on bone resorption and an improvement of bone microarchitecture. Oxytocin is synthetized by osteoblasts, and this synthesis is stimulated by estrogen. Animal studies demonstrate a direct action of oxytocin on bone, as the systemic administration of oxytocin prevents and reverses the bone loss induced by estrogen deficiency. Although oxytocin is involved in bone formation in both sexes during development, oxytocin treatment has no effect on male osteoporosis, underlining the importance of estrogen that amplifies its local autocrine and paracrine secretion. There are few human data showing a decrease in the oxytocin serum level in anorexia nervosa independently of estrogen and in amenorrheic women associated with impaired bone microarchitecture; in post-menopausal women a higher oxytocin serum level is associated with higher bone density, but not in osteoporotic men. Oxytocin displays many effects that may be beneficial in the management of osteoporosis, cardiovascular diseases, cognitive disorders, breast cancer, diabetes and body fat gain, all age-related diseases affecting elderly women, opening exciting therapeutic perspectives, although the issue is to find a single route, dosage and schedule able to reach all these targets.

P–600 Ovarian function following intraovarian injection of autologous platelet rich plasma (APRP) in women with low functional ovarian reserve

Abstract Study question Does exposure of ovaries to autologous growth factors in platelet rich plasma (APRP) affect the pituitary ovarian axis? Summary answer Within 60 days after injection, growing follicle numbers and estrogen levels increased, though FSH did not change, with effects most pronounced in still menstruating women. What is known already APRP is extracted from a patient’s autologous blood and delivers growth factors. It is widely used in several medical specialties and has in infertility practice been reported to increase folicle/egg numbers if injected into ovaries and improve endometrial thickness/implantation if used for perfusion of the endometrium. Study design, size, duration Prospective observational cohort study of women with low functional ovarian reserve, followed for 60 days after subcortical injection of ovaries. Participants/materials, setting, methods 44 women with prior poor response to ovulation induction, FSH > 12 mIU/mL and AMH < 1.0 ng/mL. APRP was prepared using Regen Lab PRP Kit which is approved by the US-FDA. 1.0–1.5 ml of PRP was injected into the cortex of each ovary divided among 7 to 10 injection sites. Participants were followed every three days with monitoring for estradiol, FSH and follicle growth for the first two weeks after PRP and then weekly. Main results and the role of chance 21/43 patients still regularly menstruated (subgroup A, age 43.9 ± 5.1 years); 23/43 (subgroup B, age 42.6 ± 6.2 years) were amenorrheic for a median of 6 months. In A, AMH, FSH and estradiol were 0.18 ± 0.20 ng/mL, 37.5 ± 47.6 mIU/mL, and 100.2 ± 73.4 pg/mL, while in B they were 0.06 ± 0.11 ng/mL, 73.0 ± 44.8 mIU/mL and 66.7 ± 57.6 pg/mL. Following APRP, A-patients demonstrated increased estradiol to 211 ± 193.7 pg/mL (P = 0.029) while B-patients only demonstrated a trend to 98.1 ± 86.5 (P = 0.09). Among A patients, 14/21 (66.7%) entered IVF cycles and 5/21 (23.8%) reached retrieval. So-far 1 patients established an ongoing clinical pregnancy. Among B patients 8/23 (34.8%) entered IVF cycles and only 2/23 (8.7%) reached retrieval and none achieved pregnancy. Limitations, reasons for caution This observational study was only carried out to estimate possible effects of APRP treatments. Based on these observations, we are now conducting a randomized controlled trial, limited to cycling women under age 45 years [registration # NCT04278313]. Wider implications of the findings: PRP appears to have limited ability to affect ovarian reserve of older, and especially amenorrheic women. It may, however, exert more favorable effects on still menstruating women. Promotion of APRP treatment as “ovarian rejuvenation,” however, appears to be an inappropriate choice of words. Trial registration number N/A

Effect of Whey Protein Supplementation on Plasma Bone-Resorption Biomarker in Post-Menopausal Women Submitted to Physical Exercise Training

Abstract Objectives To evaluate the additional effect of whey protein supplementation (WPS) to the physical-exercise training on bone resorption in postmenopausal women. Methods In a prospective, controlled study, 38 postmenopausal women aged 50 to 70 years, were randomized into two groups: with WPS (n = 19) and without WPS (n = 19, control) intervention. The study included amenorrheic women (above 12 months) with normal bone mineral density (T-score ≥ −1.0 SD) not taken bone-related medicines, and practitioners of a physical exercise protocol involving combined walking/jogging and academy/resistance exercises performed under professional supervising, three times a week. Together, there was a weekly dietary counseling along with a daily supplementation of either 25 g of protein (WPS) or placebo. Food intake (24-hour recall), anthropometric, general biochemistry, plasma hormones and bone resorption marker: serum C-terminal cross-linked N-telopeptides of type-I collagen (s-CTX) assessments were undertaken at baseline and after 20-wk intervention. Statistical analysis of the data (P < 0.05) was performed by using a time-repeated measures (ANOVA) followed by the Tukey multiple comparison test adjusted for group x moment interaction, or by gamma distribution (asymmetric variables). Results The groups were anthropometric and biochemical homogeneous, at baseline and after the intervention. Both groups increased similarly the intake of energy and lipids. However, only WPS significantly increased the intake of protein, calcium, phosphates and magnesium, as well as leucine, isoleucine and valine. From a similar baseline plasma values of s-CTX, calcium, phosphorus, alkaline phosphatase and parathormone, only s-CTX responded significantly to the intervention, being reduced in both groups (-34% and −15.2%), statistically significant in the control(non-WPS) group (P = 0.016). Conclusions The reduced plasma marker of bone resorption marker was observed in post-menopause women submitted to a 20-wk lifestyle-modification protocol with physical exercises, independently to the whey protein supplementation. Clinical trial (REBEC): RBR-7KD97. Funding Sources Brazilian foundations CNPq and CAPES.

Indices of Resting Metabolic Rate Accurately Reflect Energy Deficiency in Exercising Women.

Energy deficiency in exercising women can lead to physiological consequences. No gold standard exists to accurately estimate energy deficiency, but measured-to-predicted resting metabolic rate (RMR) ratio has been used to categorize women as energy deficient. The purpose of the study was to (a)evaluate the accuracy of RMR prediction methods, (b)determine the relationships with physiological consequences of energy deficiency, and (c)evaluate ratio thresholds in a cross-sectional comparison of ovulatory, amenorrheic, or subclinical menstrual disturbances in exercising women (n = 217). Dual-energy X-ray absorptiometry (DXA) and indirect calorimetry provided data on anthropometrics and energy expenditure. Harris-Benedict, DXA, and Cunningham (1980 and 1991) equations were used to estimate RMR and RMR ratio. Group differences were assessed (analysis of variance and Kruskal-Wallis tests); logistic regression and Spearman correlations related ratios with consequences of energy deficiency (i.e.,low total triiodothyronine; TT3). Sensitivity and specificity calculations evaluated ratio thresholds. Amenorrheic women had lower RMR (p < .05), DXA ratio (p < .01), Cunningham1980 (p < .05) and Cunningham1991 (p < .05) ratio, and TT3 (p < .01) compared with the ovulatory group. Each prediction equation overestimated measured RMR (p < .001), but predicted (p < .001) and positively correlated with TT3 (r = .329-.453). A 0.90 ratio threshold yielded highest sensitivity for Cunningham1980 (0.90) and Harris-Benedict (0.87) methods, but a higher ratio threshold was best for DXA (0.94) and Cunningham1991 (0.92) methods to yield a sensitivity of 0.80. In conclusion, each ratio predicted and correlated with TT3, supporting the use of RMR ratio as an alternative assessment of energetic status in exercising women. However, a 0.90 ratio cutoff is not universal across RMR estimation methods.

MON-111 Amenorrhea In Exercising Women Is Associated With A Greater Reduction In Post-prandial Ghrelin

Ghrelin and peptide YY (PYY) are appetite related hormones which may influence energy balance. In anorexia nervosa, a model of severe energy deficiency, ghrelin and PYY remain elevated after consuming a standardized meal and may be related to the etiology of the disorder. Amenorrhea in exercising women is associated with significant but less severe energy deficiency. Whether alterations in gut hormone responses to a single meal contribute to energy deficiency in this population is unclear. The purpose of this investigation was to compare the postprandial response of PYY and ghrelin to a mixed meal in amenorrheic (AMEN n=7) and eumenorrheic (EUMEN n=9) exercising women. Menstrual status was assessed by self report history of menses and confirmed by daily urinary measures of estrogen and progesterone metabolites. Serial blood draws and subjective appetite measures were obtained before consuming a 700kcal standardized mixed composition meal (14% PRO, 64% CHO, 22% FAT) and at regular intervals until 180 minutes post. PYY (3-36) and total ghrelin were assayed in serum by RIA. Baseline Total T3 was assessed by Immulite. Statistical analyses included independent t-tests, two-way repeated measures ANOVA (LSD post-hoc), and correlations. Subjects were similar in age (23±1 yrs), height (168±2 cm), and weight (61.0±1.6 kg). AMEN had lower Total T3 at baseline compared to EUMEN (55.3±3.7, 76.1±4.8, p=0.01). PYY increased from pre (29.8±3.9 pmol/L) to 15min post (34.1±4.1 pmol/L) (time; p<0.001) and remained elevated through 180 minutes. Change in ghrelin depended on group (time*group; p=0.02), such that ghrelin was significantly greater in AMEN than EUMEN (2810.1±456.4 pg/mL, 1511.2±138.9 pg/mL; p=0.03) prior to the meal and both absolute (1709.7±352.2 pg/mL, 593.8±125.3 pg/mL, p=0.02) and percent decrease (55.8 ±5.9%, 36.6±4.7%, p=0.02) in ghrelin from PRE to nadir were significantly greater in AMEN than EUMEN. AUC for change from baseline through 180 min was significantly greater in AMEN than EUMEN (14941.8±2455.4, 4675.2±1089.1, p=0.001) for ghrelin but did not differ for PYY (130.7±29.7, 108.4±36.3, p=0.67). There were no differences in subjective appetite scores of hunger and satiety between groups and change in appetite score was not correlated with baseline ghrelin or PYY. Baseline ghrelin was highly correlated with nadir (r=0.81, p<0.001) and AUC (r=.86, p<0.001). These results suggest ghrelin, an orexigenic hormone, is elevated in conditions of energy deficiency which may be an adaptive response to increase energy intake and reverse the underlying energy deficit. The greater magnitude of ghrelin suppression following meal consumption in amenorrheic women may be related to the elevated baseline concentration. Future studies should explore if the greater meal related decline in ghrelin is related to reduced food intake or increased satiety. Childhood Obesity Prevention Training grant.

Serum Brain-derived Neurotrophic Factor Levels Mirror Bone Mineral Density in Amenorrheic and Eumenorrheic Athletes.

Amenorrhea and osteoporosis are strongly associated in female athletes. Amenorrheic women show lower serum levels of brain-derived neurotrophic factor (BDNF) than eumenorrheic women. BDNF is known to regulate bone tissue development and remodeling; thus, athletes with low serum BDNF levels may show low bone mass. This study investigated the associations between serum BDNF, estradiol, and bone mineral density (BMD) in female athletes. This study included 160 elite female athletes (21.7±4.3 years). Serum levels of BDNF and estradiol were in 195 blood samples obtained from 132 eumenorrheic athletes (EA) and 63 amenorrheic athletes (AA). BMD was measured in the radius, lumbar spine, pelvis, and legs using dual-energy X-ray absorptiometry. AA showed significantly lower serum BDNF levels than EA (p=0.017). Serum BDNF levels were positively and significantly associated with both serum estradiol levels (p=0.0004) and the BMD measured at all sites (all p<0.05). 10 AA received transdermal estrogen therapy, and serum BDNF levels were measured at baseline and 6 months after therapy. Hormone-treated AA demonstrated a significant increase in serum BDNF levels after 6 months (p=0.022). Thus, serum BDNF levels may be associated with decreased BMD and serve as an indicator of the therapeutic effect of estradiol supplementation in female athletes with osteoporosis.

Iron status at opposite ends of the menstrual function spectrum

ObjectivesAlthough exercising women are at high risk of poor iron status, it is unknown how non-pathological, physiological menstrual function affects iron status. As such, this study investigates the association between menstrual function and iron status in exercising women with amenorrhea and exercising women with ovulatory, eumenorrheic menstrual cycles. DesignCross-sectional analysis of iron depletion prevalence, iron status indices, exercise parameters, and diet composition. MethodsWomen aged 18–35 years performing at least 2 h per week of aerobic exercise were recruited. Women with amenorrhea (AMEN) were defined by the absence of menses for at least 90 days or less than 6 menses in the past 12 months (n = 82). Women with ovulatory, eumenorrheic menstrual cycles (OvEU) were defined by the presence of ovulatory cycles of 26-35 days in length for the past 6 months (n = 109). Group differences in serum ferritin (Ft), soluble transferrin receptor (sTfR), total body iron (TBI), hemoglobin (Hb), hematocrit (Hct), iron depletion prevalence (Ft <15 μg/L), peak oxygen consumption (VO2peak), exercise minutes per week, and diet logs were assessed. ResultsThe prevalence of iron depletion was greater in OvEU when compared to AMEN (26% vs. 15%, p = 0.04). No significant differences were observed between AMEN and OvEU in Ft (30.2 ± 2.2 vs. 24.9 ± 2.6 μg/L; p = 0.62), sTfR (5.2 ± 1.4 vs. 4.9 ± 1.5 mg/L; p = 0.95), TBI (5.3 ± 2.7 vs. 4.8 ± 3.7 mg/kg; p = 0.42), Hb (13.2 ± 0.4 vs. 13.4 ± 0.6 g/dL; p = 0.80), Hct (39.5 ± 0.8% vs. 39.8 ± 4.1%; p = 0.93), or exercise parameters. AMEN consumed more vitamin C than OvEU (269 ± 180 vs. 129 ± 141 mg/day, p < 0.001), but all other dietary factors were similar between AMEN and OvEU. ConclusionExercising women with ovulatory, eumenorrheic cycles are at a greater risk of iron depletion than exercising, amenorrheic women. Thus, menstrual function must be considered when screening for poor iron status in exercising women.

Impact of Energy Availability, Health, and Sex on Hemoglobin-Mass Responses Following Live-High-Train-High Altitude Training in Elite Female and Male Distance Athletes.

The authors investigated the effects of sex, energy availability (EA), and health status on the change in hemoglobin mass (ΔHbmass) in elite endurance athletes over ∼3-4 wk of live-high-train-high altitude training in Flagstaff, AZ (2135m; n = 27 women; n = 21 men; 27% 2016 Olympians). Precamp and postcamp Hbmass (optimized carbon monoxide rebreathing method) and iron status were measured, EA was estimated via food and training logs, and a Low Energy Availability in Females Questionnaire (LEAFQ) and a general injury/illness questionnaire were completed. Hypoxic exposure (h) was calculated with low (<500h), moderate (500-600h), and high (>600h) groupings. Absolute and relative percentage ΔHbmass was significantly greater in women (6.2% [4.0%], P < .001) than men (3.2% [3.3%], P = .008). %ΔHbmass showed a dose-response with hypoxic exposure (3.1% [3.8%] vs 4.9% [3.8%] vs 6.8% [3.7%], P = .013). Hbmasspre was significantly higher in eumenorrheic vs amenorrheic women (12.2 [1.0] vs 11.3 [0.5]g/kg, P = .004). Although statistically underpowered, %ΔHbmass was significantly less in sick (n = 4, -0.5% [0.4%]) vs healthy (n = 44, 5.4% [3.8%], P < .001) athletes. There were no significant correlations between self-reported iron intake, sex hormones, or EA on Hbmass outcomes. However, there was a trend for a negative correlation between LEAFQ score and %ΔHbmass (r = -.353, P = .07). The findings confirm the importance of baseline Hbmass and exposure to hypoxia on increases in Hbmass during altitude training, while emphasizing the importance of athlete health and indices of EA on an optimal baseline Hbmass and hematological response to hypoxia.

Unmet need for family planning in Turkey.

Data from the 1988 Turkish Fertility and Health Survey covering 5257 ever-married women were employed to compute the unmet need for family planning for both modern methods and all methods. The method of Westoff (1988) which includes those desiring family limitation or spacing was applied although amenorrheic women were omitted because of insufficient data. The total ummet need was 25.2%; 13% if users of traditional methods are excluded. The need in rural areas was 29% compared to 23% in urban areas. The more industrialized western region of Turkey had the lowest need 20.6% while the eastern region had the highest 26.4%. Younger women had a higher demand for contraception while those under 20 desiring spacing had a need 5 times higher than woman desiring family limitation. Unmet need is inversely related to education. Need for specific methods in Turkey really means need for IUDs since pill failure rates in this population often surpass those of traditional methods. Unmet need for contraception in Turkey is about 25% a fairly high estimate similar to that of Korea and the Philippines.

Similarity of female central (hypogonadotropic) hypogonadism and postmenopause

Objectives: Central (hypogonadotropic) hypogonadism in women could be a cause of persistent amenorrhea and hypoestrogenemia as observed in postmenopause. This study aimed to compare the clinical, hormonal and biochemical features in women with non-physiological (central hypogonadism) and physiological (postmenopause) hypoestrogenemia.Methods: A total of 161 young women, median age 24.9 years (interquartile range (IQR) 21.2; 30.5) with central hypogonadism (with isolated hypogonadotropic hypogonadism, n = 76, and with hypopituitarism, n = 85), 53 healthy young women, median age 23.9 years (IQR 23.1; 28.0) and 50 healthy postmenopausal women, median age 56.0 years (IQR 53.1; 58.5), were examined. Psychoemotional, neurovegetative and urogenital symptoms, sex steroid levels, parameters of lipid and mineral metabolism were evaluated.Results: In young women with central hypogonadism, the frequencies of psychoemotional, neurovegetative and urogenital complaints differed significantly from those in healthy young women and were similar to those in postmenopausal women. Concentrations of estradiol, testosterone, dehydroepiandrosterone sulfate, parameters of lipid and mineral metabolism as well as quality of life in women with central hypogonadism were not typical of healthy young women but were similar to those of postmenopausal women of middle/old age.Conclusions: Despite the young age of women with central hypogonadism, clinical, hormonal and biochemical abnormalities were similar in many aspects to those in postmenopausal women at middle/old age. These revealed features could be considered as signs of premature aging in young amenorrheic women with low gonadotropin levels.

Unique effects of energy versus estrogen deficiency on multiple components of bone strength in exercising women.

The purpose of this study was to describe volumetric bone mineral density (vBMD), bone geometry, and estimated bone strength in exercising women (n=60) grouped according to energy status (energy replete (EnR: n=30) vs. energy deficient (EnD: n=30)) and estrogen status (estrogen replete (E2R: n=33) vs. estrogen deficient (E2D: n=27)), resulting in four distinct groups: EnR + E2R (n=17), EnR + E2D (n=13), EnD + E2R (n=16), EnD + E2D (n=14). Energy status was determined using the ratio of measured to predicted resting energy expenditure (mREE/pREE). Estrogen status was based on self-reported menstrual status confirmed by daily evaluation of urinary estrone-1-glucoronide (E1G), pregnanediol glucuronide (PdG), and luteinizing hormone (LH). Eumenorrheic women were considered E2R, amenorrheic women were E2D, and oligomenorrheic women were categorized based on history of menses in the past year. Bone was assessed using peripheral quantitative computed tomography (pQCT). EnD women exhibited lower total vBMD, trabecular vBMD, cortical area, and BSI at the distal tibia and lower total vBMD, smaller cortical area and cortical thickness, and larger endosteal circumference at the proximal tibia compared to EnR women (p<0.042). E2D women had lower total and cortical vBMD, larger total and trabecular area, and lower BSI at the distal radius and lower cortical vBMD at the proximal radius compared to E2R women (p<0.023). Energy and estrogen interacted to affect total and trabecular area at the distal tibia (p<0.021). Efforts to correct energy deficiency, which in turn may promote reproductive health, are warranted in order to address the unique contributions of energy status versus estrogen status to bone health.

A Phase 2 Study of Continuous Subcutaneous Hydrocortisone Infusion in Adults With Congenital Adrenal Hyperplasia

Classic congenital adrenal hyperplasia (CAH) management remains challenging, given that supraphysiologic glucocorticoid doses are often needed to optimally suppress the ACTH-driven adrenal androgen overproduction. This study sought to approximate physiologic cortisol secretion via continuous subcutaneous hydrocortisone infusion (CSHI) and evaluate the safety and efficacy of CSHI in patients with difficult-to-treat CAH. Eight adult patients with classic CAH participated in a single-center open-label phase I-II study comparing CSHI to conventional oral glucocorticoid treatment. All patients had elevated adrenal steroids and one or more comorbidities at study entry. Assessment while receiving conventional therapy at baseline and 6 months following CSHI included: 24-hour hormonal sampling, metabolic and radiologic evaluation, health-related quality-of-life (HRQoL), and fatigue questionnaires. The ability of CSHI to approximate physiologic cortisol secretion and the percent of patients with 0700-hour 17-hydroxyprogesterone (17-OHP) ≤1200 ng/dL was measured. CSHI approximated physiologic cortisol secretion. Compared with baseline, 6 months of CSHI resulted in decreased 0700-hour and 24-hour area under the curve 17-OHP, androstenedione, ACTH, and progesterone, increased osteocalcin, c-telopeptide and lean mass, and improved HRQoL (and SF-36 Vitality Score), and fatigue. One of three amenorrheic women resumed menses. One man had reduction of testicular adrenal rest tissue. CSHI is a safe and well-tolerated modality of cortisol replacement that effectively approximates physiologic cortisol secretion in patients with classic CAH poorly controlled on conventional therapy. Improved adrenal steroid control and positive effects on HRQoL suggest that CSHI should be considered a treatment option for classic CAH. The long-term effect on established comorbidities requires further study.

Usefulness of the Ultrasensitive Anti-Müllerian Hormone Assay for Predicting True Ovarian Reserve.

Serum concentration of anti-Müllerian hormone (AMH) is a useful marker for ovarian reserve. Measurement of AMH in clinical practice has gained widespread use to predict parameters such as the ovarian response, menopause, and recovery after chemotherapy. However, undetectable AMH levels assayed by conventional enzyme-linked immunosorbent assay (ELISA) kits fail to predict depletion of follicles because of low sensitivity of the kits. We investigated whether a recently developed ultrasensitive ELISA kit, picoAMH, would be more effective at detecting very low AMH levels in association with menstrual status. We analyzed 68 women with undetectable serum AMH levels using an ELISA kit, AMH Gen II. The AMH concentration of the same samples was detected in 36 samples using picoAMH; 32 samples were within the standard range, and 4 samples were out of the standard range but still detectable. Thirty-two women whose AMH levels were undetectable using the picoAMH all showed amenorrhea. We also found a significant correlation between the classes of serum AMH levels (undetectable, detectable under the limit of quantification, and measurable within the assay range) and menstrual status. Five of the 6 amenorrheic women with detectable AMH eventually achieved follicle growth. The present study demonstrated that very low AMH levels detectable using picoAMH correspond well to current and future ovulation status. This suggests that serum AMH levels can be useful for the assessment of ovarian reserve and follow-up of women with a declined ovarian reserve.