Normative study of age variation in salivary progesterone profiles

ELF5: A Molecular Clock for Breast Aging and Cancer Susceptibility

Breast cancer is predominantly an age-related disease, with aging serving as the most significant risk factor, compounded by germline mutations in high-risk genes like BRCA1/2. Aging induces architectural changes in breast tissue, particularly affecting luminal epithelial cells by diminishing lineage-specific molecular profiles and adopting myoepithelial-like characteristics. ELF5 is an important transcription factor for both normal breast and breast cancer development. This review focuses on the role of ELF5 in normal breast development, its altered expression throughout aging, and its implications in cancer. It discusses the lineage-specific expression of ELF5, its regulatory mechanisms, and its potential as a biomarker for breast-specific biological age and cancer risk.

Oogenesis in Women: From Molecular Regulatory Pathways and Maternal Age to Stem Cells

It is a well-known fact that the reproductive organs in women, especially oocytes, are exposed to numerous regulatory pathways and environmental stimuli. The maternal age is one cornerstone that influences the process of oocyte fertilization. More precisely, the longer a given oocyte is in the waiting-line to be ovulated from menarche to menopause, the longer the duration from oogenesis to fertilization, and therefore, the lower the chances of success to form a viable embryo. The age of menarche in girls ranges from 10 to 16 years, and the age of menopause in women ranges from approximately 45 to 55 years. Researchers are paying attention to the regulatory pathways that are impacting the oocyte at the very beginning during oogenesis in fetal life to discover genes and proteins that could be crucial for the oocyte’s lifespan. Due to the general trend in industrialized countries in the last three decades, women are giving birth to their first child in their thirties. Therefore, maternal age has become an important factor impacting oocytes developmental competence, since the higher a woman’s age, the higher the chances of miscarriage due to several causes, such as aneuploidy. Meiotic failures during oogenesis, such as, for instance, chromosome segregation failures or chromosomal non-disjunction, are influencing the latter-mentioned aging-related phenomenon too. These errors early in life of women can lead to sub- or infertility. It cannot be neglected that oogenesis is a precisely orchestrated process, during which the oogonia and primary oocytes are formed, and RNA synthesis takes place. These RNAs are crucial for oocyte growth and maturation. In this review, we intend to describe the relevance of regulatory pathways during the oogenesis in women. Furthermore, we focus on molecular pathways of oocyte developmental competence with regard to maternal effects during embryogenesis. On the background of transcriptional mechanisms that enable the transition from a silenced oocyte to a transcriptionally active embryo, we will briefly discuss the potential of induced pluripotent stem cells.

Minimally invasive biomarkers in human and non-human primate evolutionary biology: Tools for understanding variation and adaptation

BACKGROUND

The use of minimally invasive biomarkers (MIBs - physiological biomarkers obtained from minimally invasive sample types) has expanded rapidly in science and medicine over the past several decades. The MIB approach is a methodological strength in the field of human and non-human primate evolutionary biology (HEB). Among humans and our closest relatives, MIBs provide unique opportunities to document phenotypic variation and to operationalize evolutionary hypotheses.

AIMS

This paper overviews the use of MIBs in HEB. Our objectives are to (1) highlight key research topics which successfully implement MIBs, (2) identify promising yet under-investigated areas of MIB application, and (3) discuss current challenges in MIB research, with suggestions for advancing the field.

DISCUSSION AND CONCLUSIONS

A range of MIBs are used to investigate focal topics in HEB, including energetics and life history variation/evolution, developmental plasticity, and social status and dominance relationships. Nonetheless, we identify gaps in existing MIB research on traits such as physical growth and gut function that are central to the field. Several challenges remain for HEB research using MIBs, including the need for additional biomarkers and methods of assessment, robust validations, and approaches that are standardized across labs and research groups. Importantly, researchers must provide better support for adaptation and fitness effects in hypothesis testing (e.g., by obtaining complementary measures of energy expenditure, demonstrating redundancy of function, and performing lifetime/longitudinal analyses). We point to continued progress in the use of MIBs in HEB to better understand the past, present, and future of humans and our closest primate relatives.

Urinary Nickel and Progesterone in Workers Exposed to Urban Pollutants

OBJECTIVE

The aim of this study is to evaluate whether the exposure to a low dose of nickel could determinate a variation in levels of progesterone in outdoor workers.

MATERIALS AND METHODS

Two hundred sixty one subjects were divided by sex, task, age, seniority, and cigarette smoking habit. For each workers was evaluated the dose of blood progesterone and urinary nickel.The statistical analysis was performed.

RESULTS

The Pearson correlation showed a statistically significant correlation between urinary nickel levels and progesterone. The multiple linear regression showed a significant correlation between progesterone and urinary nickel in the total sample and in the subgroups of smokers and workers with tasks of traffic direction.

CONCLUSIONS

The results of our study suggest that occupational exposure to low doses of nickel present in urban pollution may influence to progesterone levels in outdoor workers.

Socio-Ecological Challenges as Modulators of Women's Reproductive Trajectories

Amenorrhea, anovulatory cycles, miscarriages, and other reproductive outcomes are often seen as pathological. Life history theory, in contrast, treats those outcomes as adaptations that helped women optimize the timing of reproductive ventures across our evolutionary history. Women's bodies adjust their reproductive strategies in response to socio-ecological conditions, a process mediated by the hypothalamic-pituitary-adrenal axis (HPAA). Here, we review the links between socio-ecological conditions, HPAA activity, and the pace of women's reproductive transitions such as puberty, age at first birth, interbirth interval, and perimenopause. We also discuss the HPAA's role as a modulator of reproductive function: It not only suppresses it but may also prime women's bodies for future reproductive ventures. We conclude by reviewing challenges and opportunities within our subfield, including the need for transdisciplinary teams to develop longitudinal studies to improve our understanding of women's reproductive trajectories and outcomes from the moment they are conceived.

Rhythmic Fluctuations in Levels of Liver Enzymes During Menstrual Cycles of Healthy Women and Effects of Body Weight

BACKGROUND & AIMS

Female sex hormones affect several non-reproductive organs, but little is known about their effects on the liver during a normal menstrual cycle. We aimed to investigate the association between sex hormones and liver enzymes in healthy menstruating women.

METHODS

We performed a post-hoc analysis of data from the BioCycle study, a longitudinal cohort study designed to determine the association of sex hormones with markers of oxidative stress during the menstrual cycle. We analyzed data collected from 259 menstruating women, over 1-2 menstrual cycles, who had as many as 16 separate office visits, timed by fertility monitors. Levels of liver enzymes, including alanine aminotransferase (ALT), aspartate aminotransferase, and alkaline phosphatase (ALKP), bilirubin, and lipids were measured by laboratory assays.

RESULTS

We found a natural cyclic pattern for liver enzymes, with transaminases and ALKP peaking in the mid-follicular phase and reaching a trough in the late luteal phase; the peak to trough differences were 4.0 ± 4.9 U/L for ALT and 8.8 ± 4.0 U/L for ALKP. Levels of ALT were significantly and negatively associated with levels of progesterone on the preceding visit (P = 5x10^-4), whereas level of ALKP was negatively associated with level of estrogen (P = .007) and progesterone (P = 1x10^-11). Food and alcohol intake did not modify the association. The amplitude of ALT fluctuation was greater in African Americans and decreased with age. Fluctuations in levels of ALT were smaller in women with body mass indices >30 kg/m² (P = .03). During menstrual fluctuation, 49% of participants had ALT values both above and below the normal cut-off value (19 U/L).

CONCLUSIONS

Levels of liver enzymes fluctuate during the normal menstrual cycle, possibly mediated by progesterone, and the fluctuation varies with age and body mass index. These findings indicate the importance of accounting for phase of menstrual cycle when interpreting liver enzyme measurements in menstruating women.

A brief guide to the menstrual cycle and oral contraceptive use for researchers in behavioral endocrinology

There is increasing evidence that reproductive hormones exert regulatory effects in the central nervous system that can influence behavioral, cognitive, perceptual, affective, and motivational processes. These effects occur in adults and post-pubertal individuals, and can be demonstrated in humans as well as laboratory animals. Large changes in 17β-estradiol and progesterone occur over the ovarian cycle (i.e., the menstrual cycle) and afford a way for researchers to explore the central nervous system (CNS) effects of these hormones under natural physiological conditions. Increasingly, oral contraceptives are also being studied, both as another route to understanding the CNS effects of reproductive hormones and also as pharmacological agents in their own right. This mini-review will summarize the basic physiology of the menstrual cycle and essential facts about oral contraceptives to help novice researchers to use both paradigms effectively.

The role of mating context and fecundability in women's preferences for men's facial masculinity and beardedness

The ovulatory shift hypothesis proposes that women's preferences for masculine physical and behavioral traits are greater at the peri-ovulatory period than at other points of the menstrual cycle. However, many previous studies used self-reported menstrual cycle data to estimate fecundability rather than confirming the peri-ovulatory phase hormonally. Here we report two studies and three analyses revisiting the ovulatory shift hypothesis with respect to both facial masculinity and beardedness. In Study 1, a large sample of female participants (N = 2,161) self-reported their cycle phase and provided ratings for faces varying in beardedness (clean-shaven, light stubble, heavy stubble, full beards) and masculinity (-50%, -25%, natural, +25% and +50%) in a between-subjects design. In Study 2, 68 women provided the same ratings data, in a within-subjects design in which fertility was confirmed via luteinising hormone (LH) tests and analysed categorically. In Study 2, we also measured salivary estradiol (E) and progesterone (P) at the low and high fertility phases of the menstrual cycle among 36 of these women and tested whether shifts in E, P or E:P ratios predicted face preferences. Preferences for facial masculinity and beardedness did not vary as predicted with fecundability in Study 1, or with respect to fertility as confirmed via LH in Study 2. However, consistent with the ovulatory shift hypothesis, increasing E (associated with cyclical increases in fecundability) predicted increases in preferences for relatively more masculine faces; while high P (associated with cyclical decreases in fecundability) predicted increases in preferences for relatively more feminine faces. We also found an interaction between E and preferences for facial masculinity and beardedness, such that stubble was more attractive on un-manipulated than more masculine faces among women with high E. We consider discrepancies between our findings and those of other recent studies and suggest that closer scrutiny of the stimuli used to measure masculinity preferences across studies may help account for the many conflicting findings that have recently appeared regarding cycle phase preference shifts for facial masculinity.

Women's preferences for men's beards show no relation to their ovarian cycle phase and sex hormone levels

According to the ovulatory shift hypothesis, women's mate preferences for male morphology indicative of competitive ability, social dominance, and/or underlying health are strongest at the peri-ovulatory phase of the menstrual cycle. However, recent meta-analyses are divided on the robustness of such effects and the validity of the often-used indirect estimates of fertility and ovulation has been called into question in methodological studies. In the current study, we test whether women's preferences for men's beardedness, a cue of male sexual maturity, androgenic development and social dominance, are stronger at the peri-ovulatory phase of the menstrual cycle compared to during the early follicular or the luteal phase. We also tested whether levels of estradiol, progesterone, and the estradiol to progesterone ratio at each phase were associated with facial hair preferences. Fifty-two heterosexual women completed a two-alternative forced choice preference test for clean-shaven and bearded male faces during the follicular, peri-ovulatory (validated by the surge in luteinizing hormone or the drop in estradiol levels) and luteal phases. Participants also provided for one entire menstrual cycle daily saliva samples for subsequent assaying of estradiol and progesterone. Results showed an overall preference for bearded over clean-shaven faces at each phase of the menstrual cycle. However, preferences for facial hair were not significantly different over the phases of menstrual cycle and were not significantly associated with levels of reproductive hormones. We conclude that women's preferences for men's beardedness may not be related to changes in their likelihood of conception.

Human reproduction and health: an evolutionary perspective

According to life history theory, increased investment in reproductive function (physiology and behaviour) at different times throughout the life course affects the risk of many diseases and, ultimately, longevity. Although genetic factors contribute to interindividual and interpopulation variation in reproductive traits, the dominant source of variability is phenotypic plasticity during development and adult life. Reproductive traits in both sexes evolved sensitivity to ecological conditions, as reflected in contemporary associations of hormone concentrations with geographical setting, nutritional status, and physical activity level. Lifetime exposure to increased concentrations of sex hormones is associated with the risk of some cancers, hence decreasing fertility patterns contribute to secular increases in their incidence. Conversely, increased investment in reproductive function might compromise somatic investment in health, such that faster sexual maturation and higher parity increases risk of diabetes and cardiovascular disease. An evolutionary perspective on reproductive biology could improve the efficacy of public health efforts to reduce the risk of hormone-sensitive cancers and other non-communicable diseases.

Endocrinology, energetics, and human life history: A synthetic model

Human life histories are shaped by the allocation of metabolic energy to competing physiological domains. A model framework of the pathways of energy allocation is described and hormonal regulators of allocation along the pathways of the framework are discussed in the light of evidence from field studies of the endocrinology of human energetics. The framework is then used to generate simple models of two important life history transitions in humans, puberty and the postpartum return to full fecundity in females. The results of the models correspond very closely to observations made in the field.

Endocrine disrupting chemicals and ovulation: Is there a relationship?

Although the potential for endocrine disrupting chemicals (EDCs) to disrupt female fecundity is great, few studies have assessed the threat to human reproduction. This study investigates levels of organochlorines in relation to their impact on women's menstrual cycles and ovulatory status. To address concerns of the Akwesasne Mohawk community in upstate New York regarding well-established exposure to EDCs, women's fertility and reproductive health endpoints, we recruited 215 women between the ages of 21 and 38 years to measure menstrual cycle characteristics and levels of local pollutants. Of these, 155 women collected saliva over the course of their menstrual cycle allowing for analysis of estradiol and progesterone levels and the determination of ovulatory status in relationship to their serum pollutant levels. A subset of participants (15) who did not commence cycling within a month of their enrollment were not included in the analysis, hence reducing the sample size to 140 participants. Additionally, a lipid panel, estradiol and progesterone were assessed in serum on Day 3 of the menstrual cycle. Median cycle length for women in the sample was 29 days. After aligning the cycles, 110 women were considered ovulatory and 45 (29%) anovulatory. Concentrations of groups of more persistent PCBs congeners, HCB, and p,p'-DDE did not differ significantly with ovulatory status. However, a sub-group of low-chlorinated PCB congeners, considered to be estrogenic were significantly higher among anovulatory women. These findings suggest that certain EDC's, ubiquitous in our environment, may adversely affect menstrual cycles and thus have the capacity to impair reproductive function, including likelihood of conception.

Endocrine assessment of ovarian cycle activity in wild female mountain gorillas (Gorilla beringei beringei)

Variability of fertility (i.e. number of births per female per year) has been reported in females of many primate species but only a few studies have explored the associated physiological and behavioral patterns. To investigate the proximate mechanisms of variability in fertility of wild female mountain gorillas (Gorilla beringei beringei), we quantified the occurrence of ovulation, matings, and successful pregnancies among females. We examined the profiles of immunoreactive pregnanediol-3-glucuronide (iPdG) for sixteen females (seven nulliparous and nine parous females, including one geriatric female; average sampling period for fecal sample collection and behavioral observations per female=175 days; SD=94 days, range=66-358 days) monitored by the staff of the Dian Fossey Gorilla Fund's Karisoke Research Center in Parc National des Volcans, Rwanda. We quantified ovarian cycles from iPdG profiles using an algorithm that we developed by adjusting the method of Kassam et al. (1996) to the characteristics of ovarian cycle profiles based on fecal hormone measurements. The mean length of ovarian cycles was 29±4 days (median: 28 days, N=13 cycles), similar to ovarian cycle lengths of other great apes and humans. As expected, we found that female mountain gorillas exhibit longer follicular phases (mean±SD: 21±3 days, N=13 cycles) than luteal phases (mean±SD: 8±3 days, N=13 cycles). We also found that the frequency of ovarian cycles was greater in parous females (i.e. 20 ovarian cycles across 44 periods of 28 days; 45.5%) than in nulliparous females (i.e. two ovarian cycles across 34 periods of 28 days; 6%). However, the frequency of days on which matings were observed did not differ significantly between parous and nulliparous females, nor between pregnant and non-pregnant females. Five pregnancies were detected with iPdG levels, but only three resulted in live births, indicating miscarriages of the other two. In sum, this study provides information on the underlying endocrine patterns of variation in fertility depending on parity, mating behavior, and pregnancy success in a critically endangered great ape.

How maya women respond to changing technology : The effect of helping behavior on initiating reproduction

In the mid 1970s labor-saving technology was introduced into a Maya subsistence agricultural community that markedly increased the efficiency with which maize could be ground and water collected. This increased efficiency introduces a possible savings in the time that women allocate to work, which can be reapportioned to child care, food production, domestic work, or leisure. An earlier study suggested that this labor-saving technology had a positive effect in decreasing the age at which these Maya women begin their reproductive careers. Although there is a statistical association between the age at which women bear their first child and the introduction of modern technology, this association does not demonstrate that the decline in age at first birth is causally related to the presence of technology. This paper pursues two objectives to evaluate this potential causal relationship in greater detail. First, a theory relating technological change to the initiation of a reproductive career is briefly developed in order to make qualitative predictions about behavioral changes as a response to changing technology. Second, these predictions are then tested against time allocation data recently collected in this same Maya community.We suggest that both of the conditions necessary to initiate reproduction-fecundity and access to mates-fundamentally depend on the amount of help that a girl provides to her family. Further, the help that a girl provides can be affected by technological changes. Analyses show that when modern technology is available, unmarried young women do not change the time allocated to domestic tasks and child care, and allocate more time to low-energy leisure activities. This lack of perceived benefit to working more and a potential concomitant shift towards a positive energy balance may in part explain why Maya women leave home and initiate reproduction at a younger age after labor-saving technology is introduced.

Differences in ovarian hormones in relation to parity and time since last birth

OBJECTIVE

To examine ovarian function in relation to parity and time since last birth.

DESIGN

Cross-sectional study.

SETTING

Health-care program in California.

PATIENT(S)

346 naturally cycling women, aged 18 to 39 years.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Mean follicular urinary estradiol metabolite concentration (E1C) (cycle days -8 to -1), mean luteal progesterone metabolite concentration (PdG) (days 0 to +10), and cycle phase lengths in ovulatory cycles.

RESULT(S)

After the women had collected daily urine samples for up to eight menstrual cycles, we measured the E1C and PdG using enzyme-linked immunoassay. The cycle phase lengths were calculated from the hormone profiles and daily diaries. Women who had given birth within the previous 3 years had lower E1C than the nulliparous women and women who last given birth >3 years earlier. Among the parous women, E1C was positively associated with the time since last birth. Women who last gave birth >3 years earlier had longer follicular phases than the nulliparous women. There were no associations between parity and PdG or luteal phase length.

CONCLUSION(S)

Our cross-sectional data suggest that ovarian function differs in nulliparous and parous women and is positively associated with the time since last birth. Longitudinal research is needed to explore within-woman changes in ovarian function prepartum and postpartum.

Estradiol and mental rotation: relation to dimensionality, difficulty, or angular disparity?

Several studies have reported that performance on spatial rotation tests is better at menses than at high estradiol phases of the menstrual cycle in women. These effects are debated because nearly all reports of menstrual cycle variability have relied on a single test, the Mental Rotations Test (MRT, Vandenberg and Kuse, 1978). In the present study, we investigated key features of the MRT that might be responsible for its association with estradiol levels. We hypothesized that associations could be demonstrated for other tasks that share the same characteristics. Forty-four women ages 20-38 years, matched on education and general ability, were assessed at low (n=24) or high (n=20) estradiol stages of the menstrual cycle on a set of spatial tests that varied in dimensionality, plane of rotation, angular disparity, and effortfulness. Saliva was used to quantify estradiol and progesterone. Low estradiol was found to be associated with significantly better accuracy on the MRT and also on a mental rotation task that required large angles of rotation but employed only two-dimensional object representations and rotations limited to the picture plane. In contrast, a task using identical stimuli that required only small angles of rotation did not show an estradiol effect. A group difference also was seen on a test of perceptual closure. The results confirm that the estradiol effect is not limited to the MRT, and identify the rotational element, but also aspects of figural perception, as possible processes that may be responsive to estrogens. These findings advance our understanding by showing an association between estradiol and discrete spatial processes. Implications for understanding the origins of the robust sex difference commonly observed on the MRT are discussed.

The effect of socio-economic status and food availability on first birth interval in a pre-industrial human population

Individual variation in nutritional status has direct implications for fitness and thus is crucial in shaping patterns of life-history variation. Nevertheless, it is difficult to measure in natural populations, especially in humans. Here, we used longitudinal data on individual life-histories and annual crop yield variation collected from pre-industrial Finnish populations experiencing natural mortality and fertility to test the validity of first birth interval (FBI; time between marriage and first birth) as a surrogate measure of nutritional status. We evaluated whether women with different socio-economic groups differ in length of FBI, whether women of poorer socio-economic status and experiencing lower crop yields conceive slower following marriage, and whether shorter FBI is associated with higher lifetime breeding success. We found that poorer women had longer FBI and reduced probability of giving birth in months with low food availability, while the FBI of richer women was not affected by variation in food availability. Women with shorter FBI achieved higher lifetime breeding success and a faster reproductive rate. This is, to our knowledge, the first study to show a direct relationship between environmental conditions and speed of childbirth following marriage, highlighting the value of FBI as an indicator of nutritional status when direct data are lacking.

The evolution of sexuality in chimpanzees and bonobos

The evolution of nonconceptive sexuality in bonobos and chimpanzees is discussed from a functional perspective. Bonobos and chimpanzees have three functions of sexual activity in common (paternity confusion, practice sex, and exchange for favors), but only bonobos use sex purely for communication about social relationships. Bonobo hypersexuality appears closely linked to the evolution of female-female alliances. I suggest that these alliances were made possible by relaxed feeding competition, that they were favored through their effect on reducing sexual coercion, and that they are ultimately responsible for the relaxed social conditions that allowed the evolution of "communication sex."

Gene x environment interactions impact endometrial function and the menstrual cycle: PROGINS, life history, anthropometry, and physical activity

OBJECTIVES

We assessed the impact of a high frequency, functionally significant allelic variant of the progesterone receptor gene (PROGINS) on endometrial function and menstrual cycle characteristics. Further we asked whether PROGINS moderates the impact of life history characteristics, anthropometric measures, and physical activity on endometrial function.

METHODS

Fifty-two women were genotyped for the PROGINS variant, provided life history information, and had anthropometric measurements made. Women monitored their menstrual bleeding for three cycles, performed mid-cycle urinary ovulation tests, and recorded physical activity. A subset of women provided daily saliva samples and had mid-luteal endometrial thickness measurements taken during the third menstrual cycle. Salivary progesterone was assayed using ELISAs. The direct impact of PROGINS on endometrial and menstrual cycle characteristics was determined via independent t-tests with Bonferroni correction. Interactions between PROGINS and covariates were assessed by moderated regression.

RESULTS

PROGINS did not directly impact any indicator of endometrial function. However, PROGINS caused an increase in menstrual cycle length with increasing mid-luteal progesterone levels; the opposite relationship was present in noncarriers (P < 0.05). Additionally, PROGINS interacted with four of six anthropometric measures (BMI, waist circumference, height, and waist-hip ratio) to impact endometrial function, however, interactions between PROGINS and life history variables, or physical activity was limited.

CONCLUSIONS

The gene x environment interactions we report suggest that PROGINS alters endometrial sensitivity to maternal energetic condition. Thus, the possibility of genetically-based variation in sensitivity to energetic stress should be considered in future adaptive models of women's reproduction.

Darwin's legacy: an evolutionary view of women's reproductive and sexual functioning

On the Origin of species, published just over 150 years ago, has deeply influenced thinking in both scientific and wider communities. Darwin's legacy includes recognition of the fact that all organisms evolve; that variation within and between species is natural and normal; and that an evolutionary approach to understanding the sources and consequences of this variation comprises theoretical frameworks, testable hypotheses, and rigorously collected evidence. With an eye toward facilitating communication and productive collaboration among researchers from different intellectual traditions who nonetheless share a common interest in women's reproductive and sexual functioning, we discuss evolutionary concepts and models, summarize the known variability in ovarian functioning and consider the implications of this variability for conducting sex research, and evaluate the relative merits of various biomarkers that serve as proxy measurements of a woman's reproductive and hormonal status. With these perspectives and methods from reproductive ecology at hand, we examine several contentious issues: the links between hormones and sexuality in premenopausal and perimenopausal women, the causes of premenstrual syndrome, and the existence (or not) of menstrual synchrony. In none of these cases is as much known as is often claimed. In each, there are abundant opportunities for innovative, albeit challenging, research.

A factor analysis approach to examining relationships among ovarian steroid concentrations, gonadotrophin concentrations and menstrual cycle length characteristics in healthy, cycling women

STUDY QUESTION

How are ovarian steroid concentrations, gonadotrophins and menstrual cycle characteristics inter-related within normal menstrual cycles?

SUMMARY ANSWER

Within cycles, measures of estradiol production are highly related to one another, as are measures of progesterone production; however, the two hormones also show some independence from one another, and measures of cycle length and gonadotrophin concentrations show even greater independence, indicating minimal integration within cycles.

WHAT IS KNOWN ALREADY

The menstrual cycle is typically conceptualized as a cohesive unit, with hormone levels, follicular development and ovulation all closely inter-related within a single cycle. Empirical support for this idea is limited, however, and to our knowledge, no analysis has examined the relationships among all of these components simultaneously.

STUDY DESIGN, SIZE, DURATION

A total of 206 healthy, cycling Norwegian women participated in a prospective cohort study (EBBA-I) over the duration of a single menstrual cycle. Of these, 192 contributed hormonal and cycle data to the current analysis.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Subjects provided daily saliva samples throughout the menstrual cycle from which estradiol and progesterone concentrations were measured. FSH and LH concentrations were measured in serum samples from three points in the same menstrual cycle and cycle length characteristics were calculated based on hormonal data and menstrual records. A factor analysis was conducted to examine the underlying relationships among 22 variables derived from the hormonal data and menstrual cycle characteristics.

MAIN RESULTS AND THE ROLE OF CHANCE

Six rotated factors emerged, explaining 80% of the variance in the data. Of these, factors representing estradiol and progesterone concentrations accounted for 37 and 13% of the variance, respectively. There was some association between measures of estradiol and progesterone production within cycles; however, cycle length characteristics and gonadotrophin concentrations showed little association with any measure of ovarian hormone concentrations.

LIMITATIONS, REASONS FOR CAUTION

Our summary measures of ovarian hormones may be imprecise in women with extremely long or short cycles, which could affect the patterns emerging in the factor analysis. Given that we only had data from one cycle on each woman, we cannot address how cycle characteristics may covary within individual women across multiple cycles.

WIDER IMPLICATIONS OF THE FINDINGS

Our findings are generalizable to other healthy populations with typical cycles, however, may not be applicable to cycles that are anovulatory, extreme in length or otherwise atypical. The results support previous findings that measures of estradiol production are highly correlated across the cycle, as are measures of progesterone production. Estradiol and progesterone concentrations are associated with one another, furthermore. However factor analysis also revealed more complex underlying patterns in the menstrual cycle, highlighting the fact that gonadotrophin concentrations and cycle length characteristics are virtually independent of ovarian hormones. These results suggest that despite integration of follicular and luteal ovarian steroid production across the cycle, cycle quality is a multi-faceted construct, rather than a single dimension.

STUDY FUNDING/COMPETING INTEREST(S)

The EBBA-I study was supported by a grant from the Norwegian Cancer Society (49 258, 05087); Foundation for the Norwegian Health and Rehabilitation Organizations (59010-2000/2001/2002); Aakre Foundation (5695-2000, 5754-2002) and Health Region East. The current analyses were completed under funding from the National Institutes of Health (K12 ES019852). No competing interests declared.

Susceptibility to nausea and motion sickness as a function of the menstrual cycle

PURPOSE

The present study examined whether susceptibility to nausea and other symptoms of vection-induced motion sickness vary as a function of phase of the menstrual cycle, as research findings in this area are sparse and contradictory.

DESIGN

Ninety young women (42 current users of oral contraceptives) were exposed to a rotating optokinetic drum during the peri-menses or peri-ovulatory phase of the menstrual cycle in an independent-groups, quasi-experimental design. Nausea and motion sickness symptoms were assessed using the Nausea Profile (NP) and the Subjective Symptoms of Motion Sickness (SSMS) questionnaire.

RESULTS

Among women not on oral contraceptives, reports of nausea and motion sickness by women in the peri-menses phase were more severe than reports by women in the peri-ovulatory phase. By contrast, among women taking oral contraceptives, reports of nausea and motion sickness did not differ by the same categorical phase of the menstrual cycle.

CONCLUSIONS

We speculate that fluctuating estrogen levels over the course of the menstrual cycle may influence the experience of or susceptibility to nausea and motion sickness during illusory self-motion and other nauseogenic contexts.

Interpopulation, interindividual, intercycle, and intracycle natural variation in progesterone levels: a quantitative assessment and implications for population studies

Methodological challenges in studying sex steroid hormones in premenopausal women result from the existence of variation at three levels: among women from the same population, among menstrual cycles recorded for women at different times of the year, and among days of the same cycle. We partitioned, for a Polish rural population, the natural, nonpathological, variation in salivary progesterone concentrations (measured during 14 days of the luteal phase) into the intracycle component (which accounts for 65% of the total variation) and the among-cycle component (the remaining 35% of the total variation). Out of the among-cycle variation in salivary progesterone, as much as 46% is expressed as differences among individual women (interindividual component); the remaining 54% of variation is due to differences among cycles of individual women (intercycle, within-women component). Such intercycle variation is probably caused by a seasonality of agricultural workload and is much higher than in nonseasonal, industrial populations. We also used bootstrap analyses to generate heuristic recommendations for choosing sample sizes of the number of subjects, number of cycles per woman, and number of days per cycle. Studies in populations with seasonal lifestyles should rely on measurements of at least three cycles per woman. Given the substantial intracycle amplitude in hormone levels to reliably assess biologically and medically relevant variation in ovarian function, at least 7-8 days/cycle should be measured.

Potential use of biomarkers for analyzing interpopulation and cross-cultural variability in reproductive aging

OBJECTIVE

The aims of this study were (1) to document the extent of variability in physiological aspects of reproductive aging; (2) to outline those areas where more work is needed to expand our knowledge of this variability; (3) to outline available biomarkers that can be used to measure aspects of reproductive aging, such as ovarian reserve and declining hormone levels; and (4) to note potential problems with the use of these biomarkers in cross-cultural settings.

DESIGN

Literature review of English and French publications using PubMed with no date restrictions.

RESULTS

Substantial variability exists in both cultural and physiological aspects of reproductive aging and menopause. However, the extent of variability across populations for many areas of reproductive aging needs better documentation as well as explanation of sources of this variability. Several biomarkers exist for use in cross-cultural research, including ovarian characteristics such as ovarian volume, ovarian reserve, follicular development, and atresia, and levels of hormones such as follicle-stimulating hormone, inhibin B, and anti-mullerian hormone.

CONCLUSION

We urge that further work be undertaken to evaluate and describe variability in physiological aspects of reproductive aging in cross-cultural settings. Some problems exist in the use of biomarkers to record this variability, particularly in remote settings with few logistical resources.

CYP17 genotypes differ in salivary 17-beta estradiol levels: a study based on hormonal profiles from entire menstrual cycles

Variation in the levels of sex-steroid hormones results from differences in developmental conditions, adult lifestyle, and genetic polymorphism. Genes involved in sex-steroid biosynthesis have been implicated to influence levels of hormones in premenopausal women, but the results were inconclusive. We tested variation among women in levels of salivary estradiol (E(2)) corresponding to CYP17 genotypes. CYP17 encodes cytochrome P450c17alpha, which mediates two enzymes important in E(2) synthesis. In contrast to the earlier studies that relied on one or a few samples for assessing the E(2) levels of an individual woman, our study is based on daily collected saliva samples for one entire menstrual cycle. Sixty Polish women, ages 24 to 36 years, with regular menstrual cycles and no reported fertility problems participated in the study. Women with A2/A2 genotype had 54% higher mean E(2) levels than women with A1/A1 genotype (P = 0.0001) and 37% higher than women with A1/A2 genotype (P = 0.0008). Heterozygous A1/A2 women had 13 % higher E(2) levels than homozygous A1/A1 women (but this difference was significant only in a nonparametric test). Levels of E(2) during the day with highest E(2) (day -1) were 72% higher in A2/A2 compared with A1/A1 (P = 0.01) and 52 % higher compared with A1/A2 (P = 0.03). Our results suggest that CYP17 genotype may serve as a biomarker of endocrine function in women of reproductive age. (Cancer Epidemiol Biomarkers Prev 2006;15(11):2131-5).

Childhood conditions influence adult progesterone levels

BACKGROUND

Average profiles of salivary progesterone in women vary significantly at the inter- and intrapopulation level as a function of age and acute energetic conditions related to energy intake, energy expenditure, or a combination of both. In addition to acute stressors, baseline progesterone levels differ among populations. The causes of such chronic differences are not well understood, but it has been hypothesised that they may result from varying tempos of growth and maturation and, by implication, from diverse environmental conditions encountered during childhood and adolescence.

METHODS AND FINDINGS

To test this hypothesis, we conducted a migrant study among first- and second-generation Bangladeshi women aged 19-39 who migrated to London, UK at different points in the life-course, women still resident in Bangladesh, and women of European descent living in neighbourhoods similar to those of the migrants in London (total n = 227). Data collected included saliva samples for radioimmunoassay of progesterone, anthropometrics, and information from questionnaires on diet, lifestyle, and health. Results from multiple linear regression, controlled for anthropometric and reproductive variables, show that women who spend their childhood in conditions of low energy expenditure, stable energy intake, good sanitation, low immune challenges, and good health care in the UK have up to 103% higher levels of salivary progesterone and an earlier maturation than women who develop in less optimal conditions in Sylhet, Bangladesh (F9,178 = 5.05, p < 0.001, standard error of the mean = 0.32; adjusted R(2) = 0.16). Our results point to the period prior to puberty as a sensitive phase when changes in environmental conditions positively impact developmental tempos such as menarcheal age (F2,81 = 3.21, p = 0.03) and patterns of ovarian function as measured using salivary progesterone (F2,81 = 3.14, p = 0.04).

CONCLUSIONS

This research demonstrates that human females use an extended period of the life cycle prior to reproductive maturation to monitor their environment and to modulate reproductive steroid levels in accordance with projected conditions they might encounter as adults. Given the prolonged investment of human pregnancy and lactation, such plasticity (extending beyond any intrauterine programming) enables a more flexible and finely tuned adjustment to the potential constraints or opportunities of the later adult environment. This research is the first, to our knowledge, to demonstrate a postuterine developmental component to variation in reproductive steroid levels in women.

Facial symmetry detection ability changes across the menstrual cycle

The effects of menstrual cycle phase and hormones on women's visual ability to detect symmetry and visual preference for symmetry were examined. Participants completed tests of symmetry detection and preference for male facial symmetry at two of three menstrual cycle phases (menses, periovulatory, and luteal). Women were better at detecting facial symmetry during the menses than luteal phase of their cycle. A trend indicated the opposite pattern for dot symmetry detection. Similarly, change in salivary progesterone levels across the cycle was negatively related to change in facial symmetry detection scores. However, there was no clear evidence of a greater preference for facial symmetry at any cycle phase, despite an overall preference for facial symmetry across phases. These findings suggest a menses phase advantage and a low progesterone advantage in women's ability to detect facial symmetry. The results are discussed in the context of hormonal, evolutionary mate selection, and functional neurocognitive theories.

Parental age at delivery and incidence of breast cancer: a prospective cohort study

BACKGROUND

Studies on parental age at delivery in relation to breast cancer risk have had mixed results, but prospective data are limited. No study has explored the associations with subtypes of breast cancer defined by hormonal receptor status.

METHODS

109,773 women in the Nurses' Health Study were followed from 1976 to 2002. We used Cox proportional hazards model to examine the association between parental age at delivery and daughters' risk of breast cancer.

RESULTS

6,827 incident cases of invasive breast cancer occurred in this cohort during 2,581,098 person-years. Adjusting for other early life exposures and family history of breast cancer, the hazard ratio for breast cancer in women born to mothers aged 21-25, 26-30, 31-35, and > or =36 years was, respectively, 1.08 (95% CI: 0.99-1.18), 1.12 (95% CI: 1.03-1.23), 1.17 (95% CI: 1.06-1.29), and 1.12 (95% CI: 1.01-1.25), compared to women born to mothers aged < or =20 years (P for trend = 0.008). Similarly, advanced paternal age was associated with increased incidence of breast cancer (P for trend = 0.03), but the association disappeared when conditioning on maternal age. The positive association between maternal age and incidence of breast cancer was stronger for estrogen receptor-positive and progesterone receptor-positive tumors (P for trend = 0.003) than for tumors with both receptors negative (P for trend = 0.78), and was more consistent among postmenopausal women, women without a family history and women who were first born.

CONCLUSION

Our findings support a modest positive association between maternal age and daughter's risk of breast cancer, possibly mediated by hormonal factors.

Monitoring reproductive aging in a 5-year prospective study: aggregate and individual changes in steroid hormones and menstrual cycle lengths with age

OBJECTIVE

We describe a 5-year prospective study of reproductive aging, and present analyses of steroid hormone and menstrual cycle changes with age.

DESIGN

Participants were college-educated white women, primarily of northern European ancestry, recruited from the Tremin Research Program on Women's Health (n = 156, 25-58 years). In each of 5 consecutive years, they collected daily urine specimens for 6 months and recorded menstrual bleeds for all months. Urine specimens were assayed for estrone-3-glucuronide (E1G) and pregnanediol-3-glucuronide (PDG), urinary metabolites of estradiol and progesterone. Using multilevel models, we estimated hormone and cycle-length trajectories for individual women and within- and between-woman variance by age.

RESULTS

At the aggregate level, PDG declined beginning in the 30s, E1G increased into the 40s before declining, and cycle length became more variable with age. Individual-level models revealed substantial hormonal variation across women, in both absolute levels and rates of change. Most women showed declining E1G by the late 40s, declining PDG in the 30s, and increasing mean cycle length in the 40s. Hormonal variation decreased with age; cycle length variation decreased and then increased. Within individual women, cycle lengths were highly variable while hormone levels were more stable. Women differed more from each other in hormone levels than for cycle lengths.

CONCLUSIONS

Aggregate-level analyses show general changes in steroid hormones and cycle length but cannot show variation within and across women. Individuals' cycle lengths were too variable to predict hormone levels. Clinicians should obtain more data on individual women's hormonal patterns when determining fertility or menopause treatments.

Hormonal Contraception and Physiology: A Research-based Theory of Discontinuation Due to Side Effects

Side effects influence the acceptability and continuation of hormonal contraceptives. Counseling the client about the management of side effects is a principal approach advocated for increasing continuation. Evidence of a biological basis for variation in women's tolerance of hormonal contraceptives argues, however, that greater attention should be given to altering the product rather than principally attempting to alter a woman's ability to deal with the product. Discontinuation rates for hormonal contraceptives, largely attributable to side effects and health concerns, are high in nearly all less-developed countries for which Demographic and Health Survey data are available. Oral contraceptives appear to be particularly problematic for Latin American women, most notably in Bolivia. Clinical trials suggest substantial variation in the physiological response to exogenous hormones, and new evidence confirms the hypothesis that the normal hormonal profiles of Bolivian women are significantly lower than those of women in the United States. These findings suggest a need for more population-specific physiological research linked to analyses of the possible association between endogenous hormone differences and contraceptive continuation. Appropriately adjusting the level of the steroid delivered may benefit women's health and improve the acceptability and continuation of hormonal contraceptives.

Interpopulational differences in progesterone levels during conception and implantation in humans

Clinical studies of women from the United States demonstrate a sensitivity of the ovarian system to energetic stress. Even moderate exercise or caloric restriction can lead to lower progesterone levels and failure to ovulate. Yet women in many nonindustrial populations experience as many as a dozen pregnancies in a lifetime despite poor nutritional resources, heavy workloads, and typical progesterone levels only about two-thirds of those of U.S. women. Previous cross-sectional studies of progesterone may, however, suffer from inadvertent selection bias. In a noncontracepting population, the most fecund women, who might be expected to have the highest progesterone, are more likely to be pregnant or breastfeeding and hence unavailable for a cross-sectional study of the ovarian cycle. The present longitudinal study was designed to ascertain whether lower progesterone also characterizes conception, implantation, and gestation in women from nonindustrialized populations. We compared rural Bolivian Aymara women (n = 191) to women from Chicago (n = 29) and found that mean-peak-luteal progesterone in the ovulatory cycles of Bolivian women averaged approximately 71% that of the women from Chicago. In conception cycles, progesterone levels in Bolivian women during the periovulatory period were approximately 63%, and during the peri-implantation period were approximately 50%, those of the U.S. women. These observations argue that lower progesterone levels typically characterize the reproductive process in Bolivian women and perhaps others from nonindustrialized populations. We discuss the possible proximate and evolutionary explanations for this variation and note the implications for developing suitable hormonal contraceptives and elucidating the etiology of cancers of the breast and reproductive tract.

Energetic factors and seasonal changes in ovarian function in women from rural Poland

Female mammals can optimize their fitness by temporal suppression of reproductive function in response to unfavorable environmental conditions. Since reproduction is energetically demanding for a human female, ovarian function is expected to be sensitive to factors influencing energy availability and metabolism. Dieting and exercise in women from industrial countries, and low-calorie diet and workload in women from developing countries, are often associated with ovarian suppression. This study shows that in Polish rural women seasonal changes in workload correlate with seasonal changes in indices of ovarian function (progesterone measured in saliva samples collected daily for six menstrual cycles for each subject). Mean levels of energy expenditure of the most work demanding weeks of the summer exceeded mean levels of energy expenditure during winter by 37%. Energy intake in this population was sufficient throughout the year. During the summer, when physical work was most intense, low values of progesterone levels were observed (178.2 pmol/L in July and 182.2 pmol/L in August), indicating ovarian suppression. Mean progesterone levels rose to 234.6 pmol/L in October when levels of energy expenditure were lower due to cessation of harvest-related activities. As indicated by several causal models tested through path analysis, energy expenditure was the only variable responsible for suppressed progesterone levels during the summer. Variables describing the nutritional status and energy balance did not correlate significantly with progesterone levels; neither body weight nor body fat or seasonal changes of these variables seem to influence ovarian function in this population. Thus work-related energy expenditure does not need to lead to negative energy balance in order to cause suppression of reproductive function in women.

Interhemispheric integration during the menstrual cycle: failure to confirm progesterone-mediated interhemispheric decoupling

A recent theory proposed that high levels of progesterone during the menstrual cycle may lead to functional decoupling of the cerebral hemispheres [Neuropsychologia 38 (2000) 1362]. The present study tested this theory with a well-validated behavioral measure of interhemispheric communication administered to 55 naturally-cycling women at the luteal or menstrual phase of the cycle. Neither between-subjects nor within-subjects analyses found significant differences in interhemispheric communication between the menstrual and luteal phases (F < 1). Correlations between salivary progesterone levels and interhemispheric communication also failed to support the theory. Although negative affect (NA) was associated with decreased effectiveness of interhemispheric communication, mood variables could not account for the lack of relationship between hormonal and interhemispheric variables. In summary, despite a rigorous and valid test, the theory that progesterone leads to interhemispheric decoupling found no support.

Stress and female reproductive function: A study of daily variations in cortisol, gonadotrophins, and gonadal steroids in a rural Mayan population

We report here on a longitudinal study of stress and women's reproduction in a small Kaqchikel Mayan community in rural Guatemala. Current understanding of the effects of stress on the reproductive axis in women is mostly derived from clinical studies of individual stressors. Little is known, however, about the cumulative effects of "real life" stress. Cortisol increases in response to a broad variety of individual stressors (Tilbrook et al., 2002). In this article, we evaluate the association between daily fluctuations in women's urinary cortisol and reproductive hormones: estrone conjugates (E(1)C), pregnandiol glucuronide (PdG), luteinizing hormone (LH), and follicle stimulating hormone (FSH). To assess the association between daily changes in cortisol levels and changes in the profiles of the reproductive hormones, we used a random coefficients model based on polynomial regression. The sample includes 92 menstrual cycles provided by 24 participants over a year-long prospective study. Increases in urinary cortisol levels were associated with significant increases in gonadotrophin and progestin levels during the follicular phase. Also, in a time window between days 4 and 10 after ovulation, increased cortisol levels were associated with significantly lower progestin levels. These results are significant because untimely increases in gonadotrophins and low midluteal progesterone levels have previously been reported to impinge on the ovulatory and luteinization processes and to reduce the chances of successful implantation (Ferin, 1999; Baird et al., 1999). Future research should consider the possibility that stress may affect fecundability and implantation without necessarily causing amenorrhoea or oligomenorrhoea.

Menstrual disturbances in athletes: a focus on luteal phase defects

Subtle menstrual disturbances that affect the largest proportion of physically active women and athletes include luteal phase defects (LPD). Disorders of the luteal phase, characterized by poor endometrial maturation as a result of inadequate progesterone (P4) production and short luteal phases, are associated with infertility and habitual spontaneous abortions. In recreational athletes, the 3-month sample prevalence and incidence rate of LPD and anovulatory menstrual cycles is 48% and 79%, respectively. A high proportion of active women present with LPD cycles in an intermittent and inconsistent manner. These LPD cycles are characterized by reduced follicle-stimulating hormone (FSH) during the luteal-follicular transition, a somewhat blunted luteinizing hormone surge, decreased early follicular phase estradiol excretion, and decreased luteal phase P4 excretion both with and without a shortened luteal phase. LPD cycles in active women are associated with a metabolic hormone profile indicative of a hypometabolic state that is similar to that observed in amenorrheic athletes but not as comprehensive or severe. These metabolic alterations include decreased serum total triiodothyronine (T3), leptin, and insulin levels. Bone mineral density in these women is apparently not reduced, provided an adequate estradiol environment is maintained despite decreased P4. The high prevalence of LPD warrants further investigation to assess health risks and preventive strategies.

Salivary progesterone levels and rate of ovulation are significantly lower in poorer than in better-off urban-dwelling Bolivian women

BACKGROUND

Agriculturalists in less-developed countries (LDC) have lower progesterone levels than urban industrialized populations. However, it is unknown if urban LDC populations are also relatively lower. We tested whether urban Bolivia samples-poorer (Bol-p) and better-off (Bol-b)-have lower progesterone than a Chicago (USA) sample, and whether progesterone and rate of ovulation are lower in Bol-p than in Bol-b.

METHODS

Serial salivary samples collected from Bolivians, screened according to strict exclusion criteria during two complete menstrual cycles, were radioimmunoassayed for progesterone; anthropometrics were collected at mid-follicular and mid-luteal phases.

RESULTS

Progesterone levels are lower in the Bolivia samples, and higher in the Bol-b than Bol-p; ovulation rate is greater in Bol-b than Bol-p. For only ovulatory cycles, mean-follicular-P (pmol/l), mean-luteal-P (pmol/l), and mean-peak-P (pmol/l) are respectively 65, 142 and 208 in Bol-p; 76, 167 and 232 in Bol-b; and 96, 240 and 330 in Chicago. Principal components representing body-size and progesterone level are positively correlated (r = 0.404, P = 0.005).

CONCLUSIONS

Progesterone levels appear to be influenced by chronic and acute ecological conditions, evidenced by the association with body-size and the probability of ovulation respectively. These findings have implications for understanding cancer aetiology, developing population-appropriate hormonal contraceptives, and modelling the evolution and functioning of the reproductive system.

Vaginal bleeding patterns among rural highland Bolivian women: relationship to fecundity and fetal loss

Among the most common reasons given for discontinued use of some contraceptive methods is a disturbance in the menstrual cycle, particularly changes in vaginal bleeding. Work to date suggests marked populational variation in menses duration, but few data have been collected from South America. This longitudinal study of non-contracepting Aymara women (n = 189 providing 837 non-truncated bleeding episodes) identified conceptions and fetal loss via urine tests for human chorionic gonadotropin and classified episodes accordingly to test the hypotheses that (a) vaginal bleeding patterns differ between lactating and non-lactating women, (b) duration of vaginal bleeding accompanying fetal loss differs from that of menstruation, (c) menses preceding a conception are longer than those not followed by a conception. Compared to published values, mean menses duration (3.5 days) in these women was relatively short. Menses duration was not significantly correlated with current age, age at menarche or first birth, parity, time postpartum, or menstrual segment length. Mean menses duration (not preceding a conception) was comparable for lactating and non-lactating women. Mean duration of fetal loss bleeding did not differ from that of menses. Pre-conception episodes were significantly longer than those not followed by conception. Thus, because the rate of conceptions was twice as great among lactating than non-lactating women, the mean duration of all menses (irrespective of conception) was significantly longer in lactating women. Bolivian, and perhaps other South American, women may be particularly disinclined to accept contraceptives (e.g., intrauterine devices) that modify an otherwise relatively brief menses duration. Therefore, a wide variety of contraceptive choices accompanied by population-specific informed counseling is essential. In addition, these findings suggest that studies of fecundability limited to non-lactating women may be biased toward those of relatively lower fecundity and that menses duration may be predictive of risk for some cancers.

The home team advantage: reproduction in women indigenous to high altitude

Although there is substantial evidence that environmental conditions disrupt reproductive function among newcomers to hypoxic settings, it is not certain that low oxygen pressure reduces fertility among those indigenous to high altitude. Even when fertility does appear to be relatively lower, numerous behavioral and sociocultural factors may be responsible. These are best examined within demographic frameworks that delineate a finite list of the proximate determinants of fertility. The findings presented here are based on several studies of indigenous Andean populations (Peruvian Quechua at 4000m, Bolivian Quechua at 3100m, Bolivian Aymara at 4000m). Data on ovarian function suggest that neither progesterone levels nor menstrual cycle length or regularity are significantly different from those of women at lower altitudes. Data on two behavioral factors that determine fertility levels, coital frequency and infant feeding practices, suggest that the former is not likely to be of significance in co-habitating couples, but that variation in breastfeeding patterns has probably made a substantial contribution to differences in fertility among at least some populations at high altitude.

Relationship between salivary progesterone, 17-hydroxyprogesterone, and cortisol levels throughout the normal menstrual cycle of healthy postmenarcheal girls

OBJECTIVE

To determine the usefulness of salivary P and 17 alpha-hydroxyprogesterone (17-OHP) for the assessment of ovarian function. In addition, salivary cortisol (F) levels were measured to assess the role of the adrenal cortex throughout the menstrual cycle.

DESIGN

Prospective study.

SETTING

Outpatients in hospital for children and adolescents.

PATIENT(S)

Thirty young women with regular menstrual cycles.

INTERVENTION(S)

Saliva collection in the early morning from day 1 of menstrual bleeding until next menses.

MAIN OUTCOME MEASURE(S)

Salivary P, 17-OHP, and F measured by RIAs.

RESULT(S)

During days 1-12 of the follicular phase, P and 17-OHP levels remained unchanged (P: 9-29.3 pg/mL; 17-OHP: 8-31 pg/mL). Thereafter, P increased exponentially from day 13 onward, reaching a plateau (mean +/- SEM, 70.1 +/- 9.0 pg/mL) between day 16 and 20, followed by a constant decrease until end of the cycle. The 17-OHP levels increased between day 14 and 17 (maximum: 45.8 +/- 4.5 pg/mL), decreasing rapidly thereafter. The F levels remained unchanged (follicular: 7.5 +/- 1.1 ng/mL; luteal 7.2 +/- 1.1 ng/mL). There was a significant correlation between P and 17-OHP (r(2) = 0.43; P<.001). When calculating ratios of P/F and 17-OHP/F, linear regression yielded a much stronger correlation (r(2) = 0.74; P<.001), although F did not show any correlation to P or 17-OHP.

CONCLUSION(S)

Changes in salivary 17-OHP levels throughout the menstrual cycle reflect ovarian but not adrenal function.

Does hypoxia impair ovarian function in Bolivian women indigenous to high altitude?

Fertility appears to be reduced in at least some high altitude populations relative to their counterparts at lower elevations. Inferring from the difficulties with reproduction of newcomers to high altitude and from animal experiments, it has been hypothesized that this apparent reduction is the result of hypoxia acting to reduce fecundity and/or increase fetal loss. In humans, however, several behavioral as well as biological factors may affect fertility levels. These many factors have been organized by demographers into a framework of seven proximate determinants that includes fecundability (the monthly probability of conception) of which successful ovulation is one component. To test whether ovarian function is impaired in women indigenous to high altitude, we measured salivary progesterone (P) in a sample (n = 20) of Quechua women (aged 19-42 years) residing at 3,100 m. It was found that mean luteal P = 179 pmol/L and mean midluteal P = 243 pmol/L, levels that fall about midway in the range of known values for several populations and are higher than some lower altitude populations. These findings suggest that hypoxia does not appear to significantly impair ovarian function in those with lifelong residence at high altitude. There are, however, several factors common to many high altitude populations that may act to reduce fecundability and fertility including intercourse patterns (affected by marriage and migration practices), prolonged lactation, dietary insufficiency, and hard labor.

Menstrual patterns and fecundity among non-lactating and lactating cycling women in rural highland Bolivia: implications for contraceptive choice

Choosing an appropriate contraceptive method, particularly one based on fertility awareness, depends in part upon the degree of a woman's cycling regularity. However, while the suppressive effect of lactation on ovarian function is well established, the potential influence of continued breastfeeding on menstrual patterns once post-partum cycling has resumed is largely unexamined. This longitudinal study in a population of non-contracepting Aymara women (n = 191 providing 665 non-truncated menstrual segments) identified conceptions and fetal loss via urine tests for hCG and classified segments accordingly to test the hypotheses that (1) cycles in lactating women are significantly different in length and regularity from those of non-lactating women, and (2) cycles in women living at high altitude are significantly different in length and regularity from those at lower altitudes. Analyses found that segments are significantly longer and regularity tends to be less common among lactating than non-lactating women; however, the rate of conception is twice as great among the former than the latter, and the distribution of conception outcomes does not differ between the two groups. Menstrual regularity is not the norm in this population, even among those who are not currently breastfeeding. High altitude per se does not appear to influence menstrual cycling as both regularity and segment length are comparable to other populations, hence women indigenous to high altitude are suitable candidates for a wide variety of contraceptive choices. In addition, these findings suggest that studies of fecundability limited to non-lactating women may be biased towards those of relatively lower fecundity.

Physical work causes suppression of ovarian function in women

The suppression of reproductive function is known to occur in women engaging in activities that require high energetic expenses, such as sport participation and subsistence work. It is still unclear, however, if reproductive suppression is a response to high levels of energy expenditure, or only to the resulting state of negative energy balance. To our knowledge, this study provides the first evidence that work-related energy expenditure alone, without associated negative energy balance, can lead to the suppression of reproductive function in women. We document suppression of ovarian function expressed as lowered salivary progesterone levels in women from an agricultural community who work hard, but remain in neutral energy balance. We propose two alternative evolutionary explanations (the 'pre-emptive ovarian suppression' hypothesis and the 'constrained down-regulation' hypothesis) for the observed results.

Ovarian impairments of female recreational distance runners during a season of training

This study was carried out to investigate the relationship between the level of training and the impairment of ovarian function among female recreational distance runners, and its reversibility. Thirty-six female distance runners self-recorded, for 7 consecutive days each month, the duration and distance of daily running from October 1989 to May 1990 in Great Britain. During the last 3 months of the survey, saliva samples were taken for progesterone assay and a subsample was measured for body composition. No trend in weight loss was observed over the season of training. Amenorrheic (AM) and oligomenorrheic (Oligo) runners had a significantly lower body mass index than eumenorrheic (EU) and irregularly menstruating (IM) runners. The amenorrheic and oligomenorrheic subjects did not show any rise in progesterone, at any time, during the 3 months of sampling. The eumenorrheic subjects showed evidence of a rise in progesterone, though the mean level was always significantly lower than that of sedentary controls. The most severely impaired runners (AM and Oligo) ran more than EU or irregularly menstruating runners in this sample, had lower body weight, a younger age and had a significantly lower body mass index (BMI). They tended to run faster during training sessions than those with apparently normal menstrual cycle or just irregular periods. It is suggested that low BMI, which is an indicator of body energy stores, reflects the intensity of regular training runs among female athletes with a stable body weight. It is possible that repeated elevations of beta-endorphins or other suppressors of gonadotropin release, secreted above a level of training commonly exceeded by long distance runners, when concurrent with energy restriction, could contribute to impairment of menstrual cycle.

Developmental influences on adult ovarian hormonal function

The hypothesis is advanced that levels of ovarian hormonal function in adult women are associated with the tempo of growth and maturation in childhood and adolescence. Empirical data are presented documenting a correlation between menarcheal age and adult ovarian hormonal function both within and between populations. It is noted that this relationship is compatible with current understanding of the mechanisms underlying pubertal maturation of ovarian hormonal function. Functionally, such a relationship could serve the purpose of modulating adult fecundity to chronic environmental conditions. Alternative hypotheses include the possibility that the relationship is not causal but rather reflects either confounded effects of some common cause or the persistence of acute environmental effects through time. Proper testing of such alternative hypotheses will require longitudinal data on migrant populations, changing environments, or secular trends within populations. The importance of establishing the relationship between development and adult ovarian hormonal function is not limited to issues of fecundity and fertility, but includes other areas of female general and reproductive health. © 1996 Wiley-Liss, Inc.

The end of fertility: age, fecundity and fecundability in women

Onset of capacity for childbearing in women is dated biologically by menarche, although actual onset may be delayed. The end of childbearing is less understood but recent demographic and biological research on fertility at older ages in clarifying the end of fertility. The demographic view of declining fertility with age is based on age-specific fertility in natural fertility populations, artificial insemination and pregnancy rates by age and World Fertility Survey data. New data from the Demographic and Health Surveys on exposure to the risk of pregnancy shows that whereas older women biologically need longer exposure to pregnancy, exposure declines on behavioural grounds such as duration of marriage. Actual fecundity is obscured by factors of fecundability. Recent research on medically assisted conception is adding to the understanding of declining fecundity with age, especially the relative contributions of endometrial and ovarian ageing. This paper reviews the available information on declining fertility with age and discusses the implications of the extension of fertility through new medical technologies.