Vigil Pilar, Meléndez Jaime, Soto Hugo, Petkovic Grace, Bernal Yanara A, Molina Santiago
Reproductive Health Research Institute (RHRI), Santiago, Chile.
Fundación Médica San Cristóbal, Santiago, Chile.
Front Glob Womens Health. 2022 May 23;3:866104. doi: 10.3389/fgwh.2022.866104. eCollection 2022.
Stress is known to be associated with adverse health outcomes. The COVID-19 pandemic and its associated lockdowns are examples of chronic stressors. Lockdown measures inadvertently caused significant psychological distress and became a powerful source of anxiety/stress, sleep disturbances, nutritional changes and weight gain. Stress is known to impact women's health specifically, through hypothalamic-pituitary-gonadal (HPG) axis dysfunction and resultant ovulatory dysfunction. Such dysfunction may manifest in menstrual irregularities and/or infertility due to hypothalamic hypogonadism. Here, we review the key physiological mediators of stress and associated ovulatory dysfunction. The kisspeptinergic system is comprised of sets of neurons located in the hypothalamus, the rostral periventricular region of the third ventricle (RP3V) and the arcuate nucleus (ARC). This system links nutrition, reproductive signals and stress. It plays a key role in the function of the HPG axis. During chronic stress, the kisspeptinergic system affects the HPG axis, GnRH pulsatility, and, therefore, ovulation. Leptin, insulin and corticotrophin-releasing hormone (CRH) are thought to be additional key modulators in the behavioral responses to chronic stress and may contribute to stress-related ovulatory dysfunction. This mini-review also summarizes and appraises the available evidence on the negative impact of chronic stress as a result of the COVID-19 pandemic lockdowns. It proposes physiological mechanisms to explain the observed effects on women's reproductive health and well-being. The review suggests areas for future research.
已知压力与不良健康后果相关。2019年冠状病毒病（COVID-19）大流行及其相关的封锁措施就是慢性应激源的例子。封锁措施无意中造成了严重的心理困扰，并成为焦虑/压力、睡眠障碍、营养变化和体重增加的强大来源。已知压力会特别影响女性健康，通过下丘脑-垂体-性腺（HPG）轴功能障碍以及由此导致的排卵功能障碍。这种功能障碍可能表现为月经不规律和/或由于下丘脑性性腺功能减退导致的不孕。在此，我们综述压力及相关排卵功能障碍的关键生理介质。促性腺激素释放激素神经元系统由位于下丘脑、第三脑室室周吻侧区（RP3V）和弓状核（ARC）的神经元组构成。该系统连接营养、生殖信号和压力。它在HPG轴的功能中起关键作用。在慢性应激期间，促性腺激素释放激素神经元系统会影响HPG轴、促性腺激素释放激素（GnRH）的脉冲性，进而影响排卵。瘦素、胰岛素和促肾上腺皮质激素释放激素（CRH）被认为是对慢性应激行为反应中的额外关键调节因子，可能导致与压力相关的排卵功能障碍。本综述还总结并评估了关于COVID-19大流行封锁导致慢性压力产生负面影响的现有证据。它提出了生理机制来解释观察到的对女性生殖健康和幸福感的影响。该综述提出了未来研究的方向。
