De Souza M J, Miller B E, Loucks A B, Luciano A A, Pescatello L S, Campbell C G, Lasley B L
Center for Fertility and Reproductive Endocrinology, New Britain General Hospital, Connecticut 06050, USA.
J Clin Endocrinol Metab. 1998 Dec;83(12):4220-32. doi: 10.1210/jcem.83.12.5334.
The purposes of this investigation were to evaluate the characteristics of three consecutive menstrual cycles and to determine the frequency ofluteal phase deficiency (LPD) and anovulation in a sample of sedentary and moderately exercising, regularly menstruating women. For three consecutive menstrual cycles, subjects collected daily urine samples for analysis of FSH, estrone conjugates (E1C), pregnanediol-3-glucuronide (PdG), and creatinine (Cr). Sedentary (n=11) and exercising (n=24) groups were similar in age (27.0+/-1.3 yr), weight (60.3+/-3.1 kg), gynecological age (13.8+/-1.2 yr), and menstrual cycle length (28.3+/-0.8 days). Menstrual cycles were classified by endocrine data as ovulatory, LPD, or anovulatory. No sedentary women (0%) had inconsistent menstrual cycle classifications from cycle to cycle, but 46% of the exercising women were inconsistent. The sample prevalence of LPD in the exercising women was 48%, and the 3-month sample incidence was 79%. In the sedentary women, 90% of all menstrual cycles were ovulatory (SedOvul; n=28), whereas in the exercising women only 45% were ovulatory (ExOvul; n=30); 43% were LPD (ExLPD; n=28), and 12% were anovulatory (ExAnov; n=8). In ExLPD cycles, the follicular phase was significantly longer (17.9+/-0.7 days), and the luteal phase was significantly shorter (8.2+/-0.5 days) compared to ExOvul (14.8+/-0.9 and 12.9+/-0.3 days) and SedOvul (15.9+/-0.6 and 12.9+/-0.4 days) cycles. Luteal phase PdG excretion was lower (P < 0.001) in ExLPD (2.9+/-0.3 microg/mg Cr) and ExAnov (0.8+/-0.1 microg/mg Cr) cycles compared to SedOvul cycles (5.0+/-0.4 microg/mg Cr). ExOvul cycles also had less (P < 0.01) PdG excretion during the luteal phase (3.7+/-0.3 microg/mg Cr) than the SedOvul cycles. E1C excretion during follicular phase days 2-5 was lower (P=0.05) in ExOvul, ExLPD, and ExAnov cycles compared to SedOvul cycles and remained lower (P < 0.02) in the ExLPD and ExAnov cycles during days 6-12. The elevation in FSH during the luteal-follicular transition was lower (P < 0.007) in ExLPD (0.7+/-0.1 ng/mg Cr) cycles compared to SedOvul and ExOvul cycles (1.0+/-0.1 and 1.1+/-0.1 ng/mg Cr, respectively). Energy balance and energy availability were lower (P < 0.05) in ExAnov cycles than in other menstrual cycle categories. The blunted elevation in FSH during the luteal-follicular transition in exercising women with LPD may explain their lower follicular estradiol levels. These alterations in FSH may act in concert with disrupted LH pulsatility as a primary and proximate factor in the high frequency of luteal phase and ovulatory disturbances in regularly menstruating, exercising women.
本研究的目的是评估三个连续月经周期的特征，并确定久坐不动和适度运动、规律月经的女性样本中黄体期缺陷（LPD）和无排卵的发生率。在三个连续月经周期中，受试者每天收集尿液样本，用于分析促卵泡激素（FSH）、雌酮结合物（E1C）、孕二醇-3-葡萄糖醛酸苷（PdG）和肌酐（Cr）。久坐组（n = 11）和运动组（n = 24）在年龄（27.0±1.3岁）、体重（60.3±3.1千克）、妇科年龄（13.8±1.2岁）和月经周期长度（28.3±0.8天）方面相似。月经周期根据内分泌数据分为排卵型、LPD型或无排卵型。没有久坐女性（0%）的月经周期分类在不同周期之间不一致，但46%的运动女性存在不一致。运动女性中LPD的样本患病率为48%，3个月的样本发病率为79%。在久坐女性中，所有月经周期的90%为排卵型（SedOvul； n = 28），而在运动女性中只有45%为排卵型（ExOvul； n = 30）；43%为LPD型（ExLPD； n = 28），12%为无排卵型（ExAnov； n = 8）。在ExLPD周期中，与ExOvul（14.8±0.9天和12.9±0.3天）和SedOvul（15.9±0.6天和12.9±0.4天）周期相比，卵泡期明显更长（17.9±0.7天），黄体期明显更短（8.2±0.5天）。与SedOvul周期（5.0±0.4μg/mg Cr）相比，ExLPD（2.9±0.3μg/mg Cr）和ExAnov（0.8±0.1μg/mg Cr）周期中黄体期PdG排泄较低（P < 0.001）。ExOvul周期在黄体期的PdG排泄（3.7±0.3μg/mg Cr）也比SedOvul周期少（P < 0.01）。与SedOvul周期相比，ExOvul、ExLPD和ExAnov周期在卵泡期第2 - 5天的E1C排泄较低（P = 0.05），并且在第6 - 12天的ExLPD和ExAnov周期中仍然较低（P < 0.02）。与SedOvul和ExOvul周期（分别为1.0±0.1和1.1±0.1 ng/mg Cr）相比，ExLPD（0.7±0.1 ng/mg Cr）周期中黄体 - 卵泡过渡期FSH的升高较低（P < 0.007）。ExAnov周期中的能量平衡和能量可利用性比其他月经周期类别更低（P < 0.05）。LPD运动女性在黄体 - 卵泡过渡期FSH升高减弱可能解释了她们较低的卵泡期雌二醇水平。FSH的这些改变可能与LH脉冲性紊乱协同作用，作为规律月经、运动女性黄体期和排卵紊乱高发生率的主要和直接因素。
