Disruptions in ovarian function are related to depression and cardiometabolic risk during premenopause

Traffic pollution, reproductive health, and depressive symptoms in a healthy multiethnic sample of reproductive age women in the Ovarian Aging Study

OBJECTIVE

This study aimed to determine whether exposure to traffic-related air pollution (TRAP) is associated with depressive symptoms while also characterizing the contribution of key explanatory factors related to sociodemographics and health. In addition, it aimed to also explore the role of reproductive health as a pathway through which exposure to TRAP may relate to depressive symptoms.

METHODS

Participants were 688 healthy reproductive-age women in the Ovarian Aging Study. TRAP was derived from distance-weighted traffic counts using residential addresses. Depressive symptoms were assessed by the Center for Epidemiological Studies Depression scale. Explanatory factors were assessed by interview and clinic measures, including demographics (age, race/ethnicity), socioeconomic status (SES) (individual SES, neighborhood SES), general health (smoking, body mass index), and reproductive health (menarcheal age, contraceptive use, parity, menstrual cycle characteristics).

RESULTS

In cross-sectional, step-wise multivariate regression analyses, greater exposure to TRAP was related to more depressive symptoms (b = 0.779, P = 0.015). Lower individual SES, longer menstrual cycle length, and experiencing change (vs no change) in menstrual cycle length were also related to more depressive symptoms (P's < 0.05). Examination of each model step showed that variance in depressive symptoms was attributable to TRAP (1.2%, P = 0.004), demographics (1.0%, P = 0.217), SES (1.4%, P = 0.007), general health (0.3%, P = 0.356), and reproductive health (2.0%, P = 0.015). Finally, menstrual cycle length, a marker of reproductive health status, partially mediated effects of TRAP on depressive symptoms (indirect effect: b = 0.064, P = 0.020).

CONCLUSIONS

Findings showed that exposure to TRAP is associated with depression, along with SES and reproductive health factors, and that reproductive health may be a pathway through which TRAP relates to depression.

Higher Depressive Symptoms in Irregular Menstrual Cycles: Converging Evidence from Cross-Sectional and Prospective Assessments

BACKGROUND

Menstrual cycle regularity is an important marker of reproductive health and associated with physiological and psychological illnesses, as well as experiencing stress. We hypothesized that individuals with irregular menstrual cycles report higher depressive symptom severity, after controlling for stress occurrence.

METHODS

The hypothesis was examined through two measurement approaches: a cross-sectional and a prospective, longitudinal study. In the cross-sectional study, participants (n = 394) reported depressive symptoms and their overall menstrual cycle regularity. In the longitudinal study, participants (n = 77) completed questionnaires on depressive symptoms and stress during the mid-follicular and periovulatory phase of one menstrual cycle. Depressive symptoms were compared between participants with regular and irregular cycles through a Welch t test and an ANCOVA.

RESULTS

Participants with irregular menstrual cycles reported more depressive symptoms in the cross-sectional analysis. Similarly, in the longitudinal analysis, the group with a current irregular menstrual cycle reported more depressive symptoms after controlling for stress occurrence. When including only complete data sets without multiple imputation (n = 52), the direction of the effects remained but did not reach statistical significance.

CONCLUSIONS

The results indicate an association between depressive symptoms and menstrual cycle irregularity. Limitations were that although we investigated the menstrual cycle prospectively, it would have been more precise to include two or more cycles and daily sex hormone measurements. Further limitations were the suboptimal statistical power and the data collection during the COVID pandemic. We give recommendations on how to incorporate the association of depressive symptoms and cycle irregularity in future study designs on women's mental health.

The impact of COVID-19-related mental health issues on menstrual cycle characteristics of female healthcare providers

Aim

To investigate the association between menstrual cycle regularity in healthcare providers and COVID‐19 pandemic‐related anxiety, depression, stress.

Methods

A cross‐sectional study was conducted by administrating online questionnaires to female healthcare workers in Turkey. Women aged 18–40 years with regular menstrual cycles for more than 1 year before the beginning of the pandemic were included in the study and they were divided into two groups according to menstrual cycle regularity during the pandemic. The questionnaires included sociodemographic characteristics, medical and reproductive history, lifestyle information of participants, COVID‐19 Stress Scales (CSS), and a short version of the Depression Anxiety Stress Scale (DASS‐21).

Results

A total of 952 women were included in the study, 679 had regular menstrual cycles, and 273 had irregular menstrual cycles. The prevalence of irregular menses among Turkish women healthcare workers aged 18–40 years was 28.7%. The CSS subdimensions and total scores were significantly higher in the irregular menstruation group than in women with regular menstruation (p < 0.001). The DASS‐21 depression, anxiety, and stress subdimensions were likewise significantly higher in women with irregular menstruation (p < 0.001). Besides, both the univariable and the multivariable logistic regression results showed the relationship between irregular menstruation and CSS total score.

Conclusion

The current study showed the association between the COVID‐19 pandemic‐induced anxiety, perceived stress, depressive symptoms, and increased prevalence of menstrual cycle irregularity among healthcare providers.

Management of perimenopause disorders: hormonal treatment

Perimenopause represents a transition period of a woman's life during which physiological, affective, psychological, and social changes mark progression from a woman's fertile life to menopause, with wide sexual hormones fluctuations until the onset of hypergonadotropic hypogonadic amenorrhea. Contraception during menopause should not only avoid unwanted pregnancies, but also improve quality of life and prevent wide range of condition affecting this population. Hormonal contraceptives confer many noncontraceptive benefits for women approaching menopause: treatment of abnormal uterine bleeding, relief from vasomotor symptoms, endometrial protection in women using estrogen therapy, musculoskeletal protection, and mood disorders protection. The main point remains selecting the most adequate contraceptive option for each woman, considering her risk factor, comorbidities, and keeping in mind the possibility of continuing contraception until reaching menopause and even further, creating a bridge between perimenopause and menopause hormonal therapy. Correct perimenopause management should rely on individualized medical therapy and multidisciplinary approach considering lifestyle and food habits as part of general good health of a woman.

Gonadotropin levels reduced in seven days immobilization stress-induced depressive-like behavior in female rats

OBJECTIVES

Reproduction is one of the physiological functions that are often negatively affected by chronic stress. We aimed to examine effects of two distinct 7-day chronic immobilization stress (IMO) models on gonadotropins levels and depression-like behaviors in female rats.

METHODS

Adult Wistar albino female rats were divided into three groups as follows (n=7 for each group): control, IMO-1 (45 min daily for 7-day) and IMO-2 (45 min twice a day for 7-day). Neuropsychiatric behaviors were determined by using forced swimming test (FST) and open field test (OFT). Gonadotropins were analyzed using ELISA tests.

RESULTS

In FST, swimming was lower, and immobility was higher in the IMO-1 group and IMO--2 group. Climbing score of the IMO-2 group was higher compared to the control group. In OFT, there was no significant alteration in the mean velocity, total distance, duration of time spent in the central area and duration of latency in the central area between the stress groups and the control group. Final body weight and percentage of body weight change were lower in both stress groups. The follicle-stimulating hormone level was lower only in the IMO-2 group, and the luteinizing hormone concentrations were significantly lower in the IMO-1 group and IMO-2 group.

CONCLUSIONS

Our results indicated that depression-like behaviors increased, and gonadotropins decreased in the female rats exposed to 7-day chronic IMO.

Melatonin: Multi-Target Mechanism Against Diminished Ovarian Reserve Based on Network Pharmacology

BACKGROUND

Diminished ovarian reserve (DOR) significantly increases the risk of female infertility and contributes to reproductive technology failure. Recently, the role of melatonin in improving ovarian reserve (OR) has attracted widespread attention. However, details on the pharmacological targets and mechanisms of melatonin-improved OR remain unclear.

OBJECTIVE

A systems pharmacology strategy was proposed to elucidate the potential therapeutic mechanism of melatonin on DOR at the molecular, pathway, and network levels.

METHODS

The systems pharmacological approach consisted of target identification, data integration, network construction, bioinformatics analysis, and molecular docking.

RESULTS

From the molecular perspective, 26 potential therapeutic targets were identified. They participate in biological processes related to DOR development, such as reproductive structure development, epithelial cell proliferation, extrinsic apoptotic signaling pathway, PI3K signaling, among others. Eight hub targets (MAPK1, AKT1, EGFR, HRAS, SRC, ESR1, AR, and ALB) were identified. From the pathway level, 17 significant pathways, including the PI3K-Akt signaling pathway and the estrogen signaling pathway, were identified. In addition, the 17 signaling pathways interacted with the 26 potential therapeutic targets to form 4 functional modules. From the network point of view, by regulating five target subnetworks (aging, cell growth and death, development and regeneration, endocrine and immune systems), melatonin could exhibit anti-aging, anti-apoptosis, endocrine, and immune system regulation effects. The molecular docking results showed that melatonin bound well to all hub targets.

CONCLUSION

This study systematically and intuitively illustrated the possible pharmacological mechanisms of OR improvement by melatonin through anti-aging, anti-apoptosis, endocrine, and immune system regulation effects.

Dietary intake and menstrual cycle changes in international level young athletes

BACKGROUND

Few studies have examined the influence of nutritional status and mental stress on menstrual cycle characteristics. The purpose of this study was to describe the impact of low energy availability (EA) and mental health problems on the menstrual cycles of elite female rowing competitors during a survey period.

METHODS

We enrolled sixteen subjects (16-18 years old) who were elite female rowing competitors preparing for an international competition. This study provides the first long-term assessment of dietary intake, body mass/composition, state of anxiety, and menstrual cycle in international level female athletes.

RESULTS

Dietary energy intake increased significantly during the investigation period (P<0.001). CHO intake increased significantly during the investigation period (P<0.005). EA significantly increased during the investigation period (P<0.01). The percentage of athletes with menstrual dysfunction was 20.0% in April 2018 (2 of 10), but none of the athletes reported menstrual dysfunction in October 2019. The mental status measured by state anxiety index (STAI) did not change significantly during this survey period (P>0.05).

CONCLUSIONS

There was no athlete who has menstrual disfunction after sufficient CHO intake during this survey period. These findings of this study suggest that adequate EA levels and sufficient CHO intake might lead to improved menstrual function. In addition, the impact of psychological factors on menstrual dysfunction at normal levels may be less than the effects of nutritional status.

Measuring Fertility Health Knowledge in University Students: Development and Testing of a Survey Tool

BACKGROUND AND PURPOSE

Few surveys address fertility health in both men and women. This report details development of a fertility knowledge assessment tool for clinical and research settings that would sensitize young adults to habits that would promote healthy fertility.

METHODS

A pilot study (N = 31) followed by a larger study of students at three schools (N = 465, 335, & 375) at a midwestern university using a new 30-item survey.

RESULTS

Face and content validity of the survey tool were determined by a panel of experts. Internal consistency and reliability were acceptable for a new instrument (α = .81 for the total group; α = .80 for each school.

CONCLUSIONS

This instrument is a valid and reliable short screening tool that can be used to assess knowledge of fertility and possibly open discussions about fertility self-care.

Sex differences in antidepressant efficacy

Sex differences have been observed across many psychiatric diseases, especially mood disorders. For major depression, the most prevalent psychiatric disorder, females show a roughly two-fold greater risk as compared to males. Depression is sexually dimorphic with males and females exhibiting differences in clinical presentation, course, and response to antidepressant treatment. In this review, we first discuss sex differences observed in depressed patients, as well as animal models that reveal potential underlying mechanisms. We then discuss antidepressant treatments including their proposed mechanism of action and sex differences observed in treatment response. We include possible mechanisms underlying these sex differences with particular focus on synaptic transmission.

Exploring the Ovarian Reserve Within Health Parameters: A Latent Class Analysis

The process of ovarian aging is influenced by a complex and poorly understood interplay of endocrine, metabolic, and environmental factors. The purpose of this study was to explore the feasibility of using latent class analysis to identify subgroups based on cardiometabolic, psychological, and reproductive parameters of health and to describe patterns of anti-Müllerian hormone levels, a biomarker of the ovarian reserve, within these subgroups. Sixty-nine lean (body mass index [BMI] ⩽ 25 kg/m2) and severely obese (BMI ⩾ 40 kg/m2) postpartum women in Edinburgh, Scotland, were included in this exploratory study. The best fitting model included three classes: Class 1, n = 23 (33.5%); Class 2, n = 30 (42.2%); Class 3, n = 16 (24.3%). Postpartum women with lower ovarian reserve had less favorable cardiometabolic and psychological profiles. Examining the ovarian reserve within distinct subgroups based on parameters of health that affect ovarian aging may facilitate risk stratification in the context of ovarian aging.

Associations of mental health and sleep duration with menstrual cycle irregularity: a population-based study

This study aimed to examine whether the characteristics of mental health and sleep duration, alone or in combination, are associated with menstrual cycle irregularity. This population-based, cross-sectional study analyzed the data from 4445 women aged 19-49 years, who participated in the Korea National Health and Nutrition Examination Survey 2010-2012. A structured questionnaire was used to assess mental health characteristics, sleep duration, and menstrual cycle irregularity. A multivariable logistic regression analysis was performed. High stress, depressive mood, and suicidal ideation were associated with increased risk of menstrual cycle irregularity after adjusting for confounding variables (odds ratio [95% confidence interval] = 1.33 [1.07-1.65], 1.56 [1.17-2.07], and 1.37 [1.01-1.87], respectively). Short sleep duration (≤ 5 h a day) was significantly associated with higher odds of severe menstrual cycle irregularity with menstrual interval of greater than 3 months (2.67 [1.35-5.27]). Participants with sleep duration of ≤ 5 h a day with psychological stress, depressive mood, or suicidal ideation had higher odds of menstrual cycle irregularity (1.96 [1.26-3.05], 2.86 [1.50-5.44], and 2.25 [1.18-4.29]). This study suggests positive associations of mental health problems and short sleep duration with menstrual cycle irregularity among Korean female adults. Therefore, strategies to deal with psychological stress, depressive mood, and sleep duration are needed for improving the reproductive health of women suffering from menstrual disturbances.

Mental health, psychotropic medication use, and menstrual cycle characteristics

Purpose

To examine the influence of depressive symptoms, perceived stress, and psychotropic medication use on prospectively assessed menstrual cycle regularity and length.

Participants and methods

Data were obtained from Pregnancy Study Online, a prospective cohort study of pregnancy planners from North America. At baseline, women reported information on demographics, anthropometrics, lifestyle, and medical history, including their use of psychotropic medications. They also completed the Major Depression Inventory and the Perceived Stress Scale. Every 8 weeks for up to 12 months or until conception, women completed follow-up questionnaires to assess changes in psychotropic medication use, perceived stress, and menstrual cycle characteristics (ie, cycle regularity and length). Women who completed at least one follow-up questionnaire from 2013 to 2018 (n=3,346) were included in the primary analyses. A total of 5,439 women were included in secondary analyses utilizing baseline data only. Primary analyses estimated prevalence ratios (PR) and 95% CIs using log-binomial regression models.

Results

Women with severe depressive symptoms at baseline, regardless of psychotropic medication use, had an 80% greater prevalence of irregular cycles during follow-up than women with no or low depressive symptoms (PR =1.80, 95% CI =1.48–2.19). Perceived stress was also associated with the prevalence of irregular cycles during follow-up (PR =1.33, 95% CI =1.14–1.55). Psychotropic medication use was not appreciably associated with menstrual characteristics after controlling for history of diagnosed depression and/or anxiety. Depressive symptoms, perceived stress, and psychotropic medication use showed little association with menstrual cycle length.

Conclusion

Higher levels of depressive symptoms and perceived stress were associated with irregular menstrual cycles, but not appreciably associated with menstrual cycle length. Use of psychotropic medications was not meaningfully associated with cycle regularity or length.

Consistent ovulation may not be enough to make women healthy when approaching menopause: an update from the Study of Women's Health Across the Nation

OBJECTIVE

This study aims to test the hypothesis that consistently ovulatory premenopausal/perimenopausal women have a more favorable cardiometabolic profile than anovulatory women.

METHODS

The first four collections from the Study of Women's Health Across the Nation Daily Hormone Study (DHS) were used. DHS enrollees annually completed a daily collection of first morning voided urine for an entire menstrual cycle or up to 50 days (whichever comes first). A woman was categorized as consistently ovulatory annually (COA) if four ovulatory cycles or two to three ovulatory cycles followed by the final menstrual period (FMP) were observed. A woman was categorized as not consistently ovulatory annually (nCOA) if at least one anovulatory year was observed. Cross-sectional and longitudinal differences were compared between COA and nCOA women. Data were centered at FMP and adjusted for age and body mass index (BMI).

RESULTS

Six hundred thirty-six DHS participants (mean [SD] age, 47.3 [2.5] y; mean [SD] BMI, 27.4 [7.1] kg/m(2)) were included. Thirty-six percent of the DHS participants were COA women. On the fourth follow-up collection, COA women had lower high-density lipoprotein than nCOA women (mean [95% CI], 55.7 [54.0-57.4] vs 59.5 [57.9-61.0] mg/dL, P = 0.002, respectively), which persisted after adjustment. Among 460 women with FMP, 39% were COA women. COA women were slightly older (52.9 vs 52.0 y, P = 0.002) and had lower BMI (geometric mean, 26.1 vs 27.5 kg/m(2), P = 0.06) than nCOA women at FMP. Other cardiometabolic factors did not significantly differ by COA status through FMP.

CONCLUSIONS

Consistent ovulation across the menopausal transition does not seem to reflect superior cardiometabolic health.

Case-control study of glucocorticoid receptor and corticotrophin-releasing hormone receptor gene variants and risk of perinatal depression

Background

Depression during pregnancy or after childbirth is the most frequent perinatal illness affecting women of reproductive age. It could result in unfavourable outcomes for both women and their newborns. The incidence of perinatal depression is higher for those with family history of depression and other mental illness, suggesting the contribution of genetic factors. There is postulation that disruption or fluctuation of reproductive hormones could play a part in women who are sensitive to such changes.

Methods

This is a case-control study comparing the frequencies of candidate gene variants in patients with perinatal depression with controls. Patients of Chinese descent (N = 725) were recruited from the outpatient clinics of the hospital between 2010 and 2013. Controls were patients who came for postnatal consultations at the obstetrics clinics and scored ≤ 7 on the Edinburgh Postnatal Depression Scale (EPDS) at the postnatal screening programme of the hospital. Cases with confirmed diagnosis of clinical (major) depression related to pregnancy/postpartum were recruited from the hospital’s outpatient clinic. Genomic DNA was extracted from saliva samples and genotyped for the polymorphisms of interest. Differences between groups were assessed by chi-square analysis.

Results

CRHR1 rs242939 and rs1876828 were not polymorphic in the study population. There was no statistically significant association of perinatal depression for CRHR1 rs242941 and GR rs41423247 (BclI). When all subjects were grouped based on family history of mental illness, there was a statistically significant association of CRHR1 rs242941 with family history regardless of depression status (P = 0.043). There was also a statistically significant difference for GR rs41423247 and regularity of menstrual periods (P < 0.000). Although not statistically significant, women with perinatal depression showed a trend towards higher frequency of self-reported menstrual irregularity.

Conclusions

No evidence was found for the association of any of the genetic markers with perinatal depression in this study cohort. Instead, the possible genetic links were found in women with positive family history of mental illness and menstrual irregularity, suggesting these could be identifying risk markers for women.

Depressive symptoms and their relationship with endogenous reproductive hormones and sporadic anovulation in premenopausal women

PURPOSE

To determine whether depressive symptoms are associated with ovulation or reproductive hormone concentrations in eumenorrheic women without a reported diagnosis of clinical depression.

METHODS

A prospective cohort of 248 regularly menstruating women, aged 18 to 44 years (27.3 ± 8.2) were evaluated for depressive symptoms at baseline using the 20-item Center for Epidemiological Studies Depression (CES-D) scale and categorized dichotomously (<16, no depressive symptoms [92%] vs. ≥ 16, depressive symptoms [8%]). Serum concentrations of estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone were measured up to eight times per cycle for up to two menstrual cycles. Linear mixed models estimated associations between depressive symptoms and hormone concentrations, whereas generalized linear mixed models assessed their relationship with sporadic anovulation.

RESULTS

No significant associations were identified between depressive symptoms and reproductive hormone levels (all P > .05) or the odds of sporadic anovulation (adjusted odds ratio, 1.1; 95% confidence interval, [0.02-5.0]), after adjusting for age, race, body mass index, perceived stress level, and alcohol consumption.

CONCLUSIONS

Despite reported associations between mental health and menstrual cycle dysfunction, depressive symptoms were not associated with reproductive hormone concentrations or sporadic anovulation in this cohort of regularly menstruating women with no recent (within 1 year) self-reported history of clinical depression.

Spanish consensus on premature menopause

INTRODUCTION

While we recognise that the term premature menopause is more accepted by most non-specialist health care providers and by the general population, 'primary ovarian insufficiency' (POI) is currently considered the most apposite term to explain the loss of ovarian function, because it better explains the variability of the clinical picture, does not specify definitive failure, and highlights the specific ovarian source. Its pathogenesis involves a congenital reduction in the number of primordial follicles, poor follicle recruitment, or accelerated follicular apoptosis. However, its cause is unknown in most cases.

AIM

This guide analyses the factors associated with the diagnosis and treatment of POI and provides recommendations on the most appropriate diagnostic and therapeutic measures for women under 40 years of age who experience POI.

METHODOLOGY

A panel of experts from various Spanish scientific societies related to POI (Spanish Menopause Society, Spanish Fertility Society, and Spanish Contraception Society) met to reach a consensus on these issues.

RESULTS

Hormonal therapy (HT) is considered the treatment of choice to alleviate the symptoms of hypoestrogenism and to prevent long-term consequences. We suggest that HT should be continued until at least age 51, the average age at natural menopause. The best treatment to achieve pregnancy is oocyte/embryo donation. If a patient is to undergo treatment that will reduce her fertility, she should be informed of this issue and the available techniques to preserve ovarian function, mainly vitrification of oocytes.

Classical and newly recognised non-contraceptive benefits of combined hormonal contraceptive use in women over 40

Although age is the most crucial predictor of a woman's reproductive capacity, it is assumed that there is still a risk of pregnancy in menopause transition, as occasional spontaneous ovulation is possible. Moreover, age alone is not sufficient to contraindicate the use of any contraceptive method, whether hormonal or not. The use of new CHC in women over 40 has not only been associated with an improved safety profile but has also been associated with other non-contraceptive benefits or the consolidation of already-known benefits. The studies with new CHC have demonstrated that efficacy and safety do not differ from the corresponding parameters observed in younger women. Additionally, the new CHC offers specific and especially useful benefits for women over 40 in the treatment of menstrual disorders. Finally, interest is currently focused on the potential of early diagnosis and the prevention of cardiovascular disease and depression, both of which may be alleviated by the CHC.