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Luteal Phase Deficiency in Recreational Runners: Evidence for a Hypometabolic State

Women’s Exercise and Bone Health Laboratory (M.J.D.S., J.V.H.), Faculty of Physical Education and Health, University of Toronto, Toronto, Ontario, Canada M5S 2W6; Department of Kinesiology (J.V.H.), University of Connecticut, Storrs, Connecticut 06269; Penn State University (L.M.D.), Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033; and Institute of Toxicology and Environmental Health (B.L.L.), University of California, Davis, California 95616

Address all correspondence and requests for reprints to: Mary Jane De Souza, Ph.D., FACSM, Faculty of Physical Education and Health, University of Toronto, 55 Harbord Street, Toronto, Ontario, Canada M5S 2W6. E-mail: maryjane.desouza{at}utoronto.ca.

Exercising women with amenorrhea exhibit a hypometabolic state. The purpose of this study was to evaluate the relationship of luteal phase deficient (LPD) menstrual cycles to metabolic hormones, including thyroid, insulin, human GH (hGH), leptin, and IGF-I and its binding protein levels in recreational runners. Menstrual cycle status was determined for three consecutive cycles in sedentary and moderately active women. Menstrual status was defined as ovulatory or LPD. Subjects were either sedentary (n = 10) or moderately active (n = 20) and were matched for age (27.7 ± 1.2 yr), body mass (60.2 ± 3.3 kg), menstrual cycle length (28.4 ± 0.9 d), and reproductive age (14.4 ± 1.2 yr). Daily urine samples for the determination of estrone conjugates, pregnanediol 3-glucuronide, and urinary levels of LH were collected. Blood was collected on a single day during the follicular phase (d 2–6) of each menstrual cycle for analysis of TSH, insulin, total T₃, total T₄, free T₄, leptin, hGH, IGF-I, and IGF binding protein (IGFBP)-1 and IGFBP-3. Among the 10 sedentary subjects, 28 of 31 menstrual cycles were categorized as ovulatory (SedOvul). Among the 20 exercising subjects, 24 menstrual cycles were included in the ovulatory category (ExOvul), and 21 menstrual cycles were included in the LPD category (ExLPD). TSH, total T₄, and free T₄ levels were not significantly different among the three categories of cycles. Total T₃ was suppressed (P = 0.035) in the ExLPD (1.63 ± 0.07 nmol/liter) and the ExOvul categories of cycles (1.75 ± 0.8 nmol/liter) compared with the SedOvul category of cycles (2.15 ± 0.1 nmol/liter). Leptin levels were lower (P < 0.001) in both the ExOvul (5.2 ± 0.4 µg/liter) and the ExLPD categories of cycles (5.1 ± 0.4 µg/liter) when compared with the SedOvul category of cycles (13.7 ± 1.7 µg/liter). Insulin was lower (P = 0.009) only in the ExLPD category of cycles (31.9 ± 2.8 pmol/liter) compared with the SedOvul (60.4 ± 8.3 pmol/liter) and ExOvul (61.8 ± 10.4 pmol/liter) categories of cycles. IGF-I, IGFBP-1, IGFBP-3, IGF-I/IGFBP-1, IGF-I/IGFBP-3, and hGH were comparable among the different categories of cycles. These data suggest that exercising women with LPD menstrual cycles exhibit hormonal alterations consistent with a hypometabolic state that is similar to that observed in amenorrheic athletes and other energy-deprived states, although not as comprehensive. These alterations may represent a metabolic adaptation to an intermittent short-term negative energy balance.

Abbreviations: BMI, Body mass index; Cr, creatinine; E1C, estrone conjugates; ExLPD, exercising subject in LPD cycle category; ExOvul, exercising subject in ovulating cycle category; FT₄, free T₄; hGH, human GH; IGFBP, IGF binding protein; LPD, luteal phase deficient or luteal phase deficiency; PdG, pregnanediol 3-glucuronide; SedOvul, sedentary subject in ovulatory cycle category; VO₂ peak, peak oxygen uptake.

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