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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

Center for Fertility and Reproductive Endocrinology (M.J.D.S., B.E.M., A.A.L.), New Britain General Hospital, New Britain, Connecticut 06050; the Department of Biological Sciences, Ohio University (A.B.L., C.G.C.), Athens, Ohio 45701; the Institute for Toxicology and Environmental Health, University of California (B.L.S.), Davis, California 95616; and the Division of Health Professions, University of Hartford (L.S.P.), West Hartford, Connecticut 06117

Address all correspondence and requests for reprints to: Mary Jane De Souza, Ph.D., FACSM, Center for Fertility and Reproductive Endocrinology, New Britain General Hospital, New Britain, Connecticut 06050.

The purposes of this investigation were to evaluate the characteristics of three consecutive menstrual cycles and to determine the frequency of luteal 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 µg/mg Cr) and ExAnov (0.8 ± 0.1 µg/mg Cr) cycles compared to SedOvul cycles (5.0 ± 0.4 µg/mg Cr). ExOvul cycles also had less (P < 0.01) PdG excretion during the luteal phase (3.7 ± 0.3 µg/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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