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Diurnal Profiles of Testosterone and Pituitary Hormones Suggest Different Mechanisms for Menstrual Disturbances in Endurance Athletes

Departments of Obstetrics and Gynecology (A.R., B.v.S., A.L.H.) and Endocrinology and Diabetology (M.T.), Karolinska Hospital; and Department of Obstetrics and Gynecology (K.C.), Huddinge University Hospital, SE-17176 Stockholm, Sweden

Address all correspondence and requests for reprints to: Anette Rickenlund, M.D., Research Laboratory for Reproductive Health, Department of Obstetrics and Gynecology, C4-U1, Karolinska Hospital, SE-17176 Stockholm, Sweden. E-mail: anette.rickenlund{at}ks.se.

The aim of this study was to evaluate the diurnal pattern of testosterone and pituitary hormones in endurance female athletes with different types of menstrual disorder. Age- and body mass index-matched groups of endurance athletes with amenorrhea (n = 10) and oligomenorrhea (n = 6), regularly cycling athletes (n = 8), and sedentary controls (n = 8) were compared with respect to 24-h hormonal profiles of testosterone, LH, prolactin (PRL), GH, insulin, IGF binding protein 1 (IGFBP-1), and cortisol. The 24-h hormone profiles in amenorrheic athletes were characterized by decreased LH pulsatility and peak amplitude of PRL and increased baseline levels of GH and cortisol. However, oligomenorrheic athletes displayed a significantly different pattern with higher diurnal testosterone secretion than all other groups. Furthermore, LH, PRL, GH, and cortisol secretions were comparable with regularly menstruating subjects. In the combined group of athletes with menstrual disturbances, diurnal secretions of testosterone, LH, and PRL were positively, whereas cortisol was negatively correlated with the number of menstruations the last year. Although this could be explained by a gradual inhibition of the hypothalamic-pituitary-gonadal axis, our results indicate that the symptoms of amenorrhea and oligomenorrhea may reflect two hormonally distinct conditions. Thus, amenorrheic athletes displayed a hormonal pattern in agreement with hypothalamic inhibition due to energy deficiency, whereas oligomenorrheic athletes demonstrated increased diurnal secretion of testosterone, suggesting a different mechanism, e.g. essential hyperandrogenism.

This work was supported by the Swedish Medical Research Council (05982, 13142), Center for Sports Research, and Karolinska Institutet.

Abbreviations: AM, Athlete with amenorrhea; AUC, area under curve; BMD, bone mineral areal density; BMI, body mass index; CTR, sedentary regularly menstruating control; HPG, hypothalamic-pituitary-gonadal; IGFBP, IGF binding protein; LBM, lean body mass; OM, athlete with oligomenorrhea; PCO, polycystic ovary; PRL, prolactin; RM, regularly menstruating athlete; VO₂ max, maximal oxygen uptake.

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