Effects of short-term strenuous endurance exercise upon corpus luteum function

PURPOSE

The present study tested whether short-term, abruptly initiated training can cause corpus luteum dysfunction when exercise is limited to either the follicular or luteal phase of the cycle.

METHODS

Reproductive hormone excretion and menstrual characteristics were studied in sedentary women who exercised only during the follicular (N = 5) or the luteal (N = 4) phase. Six women served as controls, three of whom exercised at a low volume and three who remained sedentary. Weekly progressive increments in exercise volume continued until either ovulation (follicular group) or menses (luteal group) occurred. Physical activity and nutrient intake were closely monitored with the intent to maintain body weight.

RESULTS

No luteal phase disturbances occurred in any of the control subjects, whereas 40% of follicular and 50% of luteal exercisers experienced luteal defects. The proportion of menstrual cycles disrupted was not different between luteal and follicular exercisers (50% vs 30%, respectively) but was significantly greater than the proportion of cycles disrupted in control subjects (P < 0.05).

CONCLUSIONS

These results suggest that exposure to abrupt onset of training can alter luteal function, regardless of the menstrual cycle phase in which exercise occurs. This study also demonstrates that a relatively low volume of exercise suffices to induce mild disturbances in luteal function.

Effects of follicular phase exercise on luteinizing hormone pulse characteristics in sedentary eumenorrhoeic women

OBJECTIVE

Current studies reveal little regarding the inception of exercise-induced LH changes during physical training. This study aimed to assess the susceptibility of the hypothalamic-pituitary axis to the acute physical stress of exercise in untrained, physically inactive women. The acute effects of submaximal endurance exercise upon the pulsatile LH secretion in the follicular phase were compared with those accompanying leisurely strolling for a similar time period.

SUBJECTS

All subjects were eumenorrhoeic, as determined by biphasic temperature patterns, detection of the urinary LH surge, and mid-luteal serum progesterone levels. Subjects were not physically active and had little history of strenuous exercise (VO2max = 38.0 +/- 1.8) (mean +/- SEM) ml/kg/min).

DESIGN

All women completed a 13.5-hour pulsatility test which included three consecutive 20-minute runs on a treadmill at 50, 60 and 70% of the subjects' maximum oxygen uptake (n = 16). Six of these same subjects completed a separate test on another occasion in which one hour of leisurely strolling was substituted for exercise. Blood was sampled every 10 minutes via an indwelling cannula for 4.5 hours before and 8 hours after one hour of exercise and or strolling.

MEASUREMENTS

A pulse algorithm (Pulsar) was used to quantify LH pulse characteristics.

RESULTS

Exercise produced no significant effects upon LH pulse frequency or mean serum LH concentration. However, exercise of moderate intensity caused a significant increase in LH pulse amplitude (P < 0.05). Strolling produced no significant changes in LH secretion.

CONCLUSION

Acute exercise of moderate intensity in the follicular phase of untrained women is an insufficient stimulus to inhibit the GnRH pulse generator in the post-exercise period, yet may produce a slight stimulatory effect on the amount of LH released per pulse.

Nalmefene enhances LH secretion in a proportion of oligo-amenorrheic athletes

The influence upon LH secretion of doses of nalmefene, an orally effective congener of naloxone, and a placebo was compared in nine oligo-amenorrheic athletes with that in five regularly menstruating non-athletic women as a test for periodic elevations in hypothalamic opioid tone. After a 360-min control period, LH levels were followed for an additional 360 min following ingestion of the medications in random order approximately six weeks apart, 10-min blood sampling being employed throughout. The mean amplitude post-nalmefene in the athletes was significantly greater than pre (p < 0.05), although there were no differences in the frequency of LH pulses after placebo or nalmefene ingestion. Subjects were labelled as "responders" if their peak AUC after treatment exceeded their pretreatment AUC for LH by more than 1.96 SD (p < 0.05). There were no placebo responders, but 5/9 of the athletes and 1/5 of the menstruating controls were classified as nalmefene responders (p < 0.05). In addition, a variable proportion of the athletes (but none of the controls) experienced symptoms suggestive of narcotic withdrawal 1-4 h after ingesting nalmefene and again 12-18 h later. It appears that demonstrable increases in opioid tone occur at least transiently in a proportion of oligo-amenorrheic athletes.

Changes in body consciousness relate to regularity of exercise training

Previous work has indicated improvement for scores on self-reported measures of body consciousness as aerobic fitness increased. To test whether exercise sufficient to improve aerobic fitness must be sustained on a regular basis to achieve positive changes in body consciousness, two separate periods of exercise training of 2 or 3 weeks duration were completed by nine female volunteers. The two exercise sessions were separated by 10 days of no exercise. Five women, as controls, did not exercise. Despite significant physiological improvement in the exercisers, no changes in self-perceived body self-consciousness were observed. Such changes may depend on the maintenance of a regular exercise regimen or the magnitude of physiological improvement.

Exercise induces two types of human luteal dysfunction: confirmation by urinary free progesterone

We have previously reported that during 2 months of strenuous exercise, untrained young women with documented ovulatory menstrual cycles developed secondary oligoamenorrhea and luteal phase defects. In this study we tested the hypothesis that such abnormalities arise by altered neuroendocrine regulation of menstrual hormone secretion and that weight loss potentiates such effects. We supply a detailed analysis of the 20 cycles, of the total of 53, in which luteal phase abnormalities occurred. During the control month and 2 exercise months, all subjects collected daily overnight urine samples for the determination of LH, FSH, estriol (E3), and free progesterone (P) excretion by RIAs and creatinine by chemical assay. The characteristics of the abnormal luteal phase cycles were determined by comparing the excreted hormone levels and patterns during the control cycles with those of exercise cycles. The area under the curve (AUC) for each hormone was calculated for the follicular and luteal phases of each cycle. Six of the exercise cycles exhibited an inadequate luteal phase. This was characterized by a mean integrated P area of 202.4 (SEM, -61.8) nmol/day.nmol creatinine, compared with 331.7 (SEM, 64.7) during the corresponding control cycles, over a period of 9 or more days after the urinary LH peak to the onset of menses. Fourteen of the exercise cycles exhibited a short luteal phase. This was characterized by a mean integrated P area of 75.9 (30.9) nmol/day.nmol creatinine, compared to 267 (61.7) during the corresponding control cycles, over a span of 8 days or less from the urinary LH peak to the onset of menses. Additional abnormalities occurred only in the short luteal phase cycles. These included an increase in the length and AUC for E3 of the follicular phase and a decrease in the AUC of LH during the luteal phase. We conclude that the initiation of strenuous endurance training in previously ovulating untrained women frequently leads to corpus luteum dysfunction associated with insufficient P secretion and, in the case of short luteal phase cycles, decreased luteal phase length. That exercise may alter the neuroendocrine system is suggested by a delay in the ovulatory LH peak in spite of increased E3 excretion; moreover, less LH is excreted during the luteal phase. The lack of positive feedback to estrogens and decreased LH secretion during the luteal phase could compromise corpus luteum function. In contrast, decreased free P excretion was the sole abnormality noted in menstrual cycles with an inadequate luteal phase.

Effect of acute exercise on plasma neurotensin levels

Neurotensin (NT) levels were examined in five aerobically untrained females aged 20-36 engaged in acute graded exercise testing. In addition to radioimmunoassay measurements, high pressure liquid chromatography was performed to further characterize plasma NT-like immunoreactivity (NTLI). Epinephrine (E), norepinephrine (NE), and lactate (L) responses were also determined. Exercise testing consisted of one hour of treadmill running subdivided into three 20-minute segments representing 50, 60, and 70%, respectively, of the previously determined maximal aerobic capacity. Mock testing established baseline values for each subject. Three components of NTLI were evaluated: NT(1-13), NT(1-8), and NT(1-11). Resting NT(1-13) concentrations averaged 5.8 +/- 4.2 fmol/ml, while mean NT(1-8) values were 13.0 +/- 5.2 fmol/ml, and NT(1-11) averaged 5.8 +/- 3.2 fmol/ml. Peak exercise values were: for NT(1-13), 5.4 +/- 2.0 fmol/ml, for NT(1-8), 13.5 +/- 2.8 fmol/ml, and for NT(1-11), 5.9 +/- 0.5 fmol/ml. Analysis of variance with repeated measures detected no changes in these levels with exercise. Four-fold increases in E (36 +/- 3 pg/ml to 121 +/- 51 pg/ml), NE (340 +/- 95 pg/ml to 1431 +/- 319 pg/ml), and L (0.8 +/- 0.1 mM to 4.3 +/- 1.7 mM) confirmed the stress of exercise on the body in general, and the sympatho-adrenal system in particular. While other research has associated peripheral NT metabolite elevations with stressful stimuli in laboratory animals, the results of the present study suggest either that NT is not released from the human adrenal medulla during exercise, or that peripheral sampling precludes detection of any increases in NT from the adrenal medulla with currently available radioimmunoassay systems.

Melatonin response to exercise training in women

Previous human studies have indicated that daytime melatonin levels increase when the organism is subjected to the stress of fasting and exercise. Melatonin, epinephrine, and norepinephrine levels were measured during a mock run and in the course of treadmill exercise performed before (T-1), during (T-2), and following (T-3) a progressive conditioning (running) program. Hormonal responses to the training program were determined by comparing values at T-1 and T-3. Plasma melatonin, epinephrine, and norepinephrine levels rose significantly (P less than .01) from baseline values for each exercise intensity during all three treadmill runs. While a dose-response trend was observed in each of the norepinephrine and epinephrine trials, there appeared to be a progressive diminution of this relationship in melatonin between intensities. Further, as training progressed, the peak melatonin concentration was decreased by 52% from T-1 to T-3, while peak epinephrine and norepinephrine values diminished only 19% and 8%, respectively. These results suggest that vigorous exercise training may attenuate rather than augment the secretion of pineal melatonin. Development of a human model of pineal responsiveness to exercise may contribute to the elucidation of exercise-associated reproductive disorders.

Effects of endurance training on body-consciousness in women

The Body Consciousness Questionnaire by Miller, Murphy, and Buss in 1981 was employed to assess the effects of intensive endurance training on changes in self-perception in 13 women volunteers aged 20 to 30 yr. The participants engaged in an intensive progressive running program for 6 to 8 wk. Additional moderate exercise (softball or volleyball) was engaged in for 3 1/2 hr. per day. Before and after the training subjects completed the questionnaire on self-perceived attributes of internal body consciousness, public body consciousness, and body competence. Aerobic fitness, measured pre- and posttraining, significantly increased while body fat and weight significantly decreased. In consonance with these physiological changes, rated self-perception of internal body consciousness and body competence increased significantly while public body consciousness remained unchanged. Self-report of internal body consciousness tended to increase in proportion to changes in fitness (r = 0.53). These results suggest that endurance and moderate exercise training contribute to increased self-perception specifically with regard to perceived internal and body competence.

Induction of menstrual disorders by strenuous exercise in untrained women

We performed a prospective study of 28 initially untrained college women with documented ovulation and luteal adequacy to determine whether strenuous exercise spanning two menstrual cycles would induce menstrual disorders. To ascertain the influence, if any, that weight loss might exert, we randomly assigned the subjects to weight-loss and weight-maintenance groups. Subjects were expected to run 4 miles (6.4 km) per day, progressing to 10 miles (16.1 km) per day by the fifth week, and to engage daily in 31/2 hours of moderate-intensity sports. The normalcy of the menstrual cycles during the period of exercise was judged independently according to clinical and hormonal criteria, the latter comprising serial measurements of gonadotropin and sex-steroid excretion. A higher percentage of abnormalities proved to be detectable by hormonal means (P less than 0.02). Only four subjects (three in the weight-maintenance group) had a normal menstrual cycle during training. In the weight-loss group, the number of women who had luteal abnormalities as compared with those who lost the surge in luteinizing hormone altered significantly over time, the latter occurring more frequently (P less than 0.01) as training progressed. Within six months of termination of the study, all subjects were again experiencing normal menstrual cycles. We conclude that vigorous exercise, particularly if compounded by weight loss, can reversibly disturb reproductive function in women.

Release of beta endorphin and met-enkephalin during exercise in normal women: response to training

Plasma beta endorphin and met-enkephalin concentrations were measured in response to treadmill exercises in 15 normal women before, during, and after an intensive programme of exercise training. Significant release of beta endorphin occurred in all three test runs, and the pattern and amount of release were not altered by training. Before training dramatic release of met-enkephalin was observed in seven subjects and smaller rises observed in a further four, and this response was almost abolished by training. This represents the first observed "physiological" stimulus to met-enkephalin release. Endogenous opioid peptides play a part in adaptive changes to exercise training and probably contribute to the menstrual disturbances of women athletes.

Endurance training effects on plasma hormonal responsiveness and sex hormone excretion

A prospective study of the hormonal effects of a moderate exercise training program (4-wk control, 8-wk training) was conducted in seven young women. Sixty-minutes continuous bicycle ergometer tests of fixed relative intensity were performed at the beginning, middle, and end of the training period. The capacity of these acute bouts of exercise to affect circulating levels of stress markers, reproductive hormones, and hormones with possible antireproductive potential was measured. In addition, the urinary excretion of reproductive hormones was monitored continuously via serial overnight urine collections. Within testing sessions, plasma concentrations of all stress markers and antireproductive hormones rose significantly. Across testing sessions, only beta-endorphin + beta-lipotropin and cortisol exhibited an increment in peak responses as training progressed. Plasma reproductive hormone levels showed insignificant acute changes, and cyclic menstruation and preovulatory gonadotropin surges continued in all subjects. However, ovarian function was disturbed in four subjects as evidenced by a decreased excretion of estriol, free progesterone, or both. Transient infertility is a known clinical accompaniment of hormonal changes of comparable subtlety.

Fructose and glucose ingestion and muscle glycogen use during submaximal exercise

Substrate utilization after fructose, glucose, or water ingestion was examined in four male and four female subjects during three treadmill runs at approximately 75% of maximal O2 uptake. Each test was preceded by three days of a carbohydrate-rich diet. The runs were 30 min long and were spaced at least 1 wk apart. Exercise began 45 min after ingestion of 300 ml of randomly assigned 75 g fructose (F), 75 g glucose (G), or control (C). Muscle glycogen depletion determined by pre- and postexercise biopsies (gastrocnemius muscle) was significantly (P less than 0.05) less during the F trial than during C or G. Venous blood samples revealed a significant increase in serum glucose (P less than 0.05) and insulin (P less than 0.01) within 45 min after the G drink, followed by a decrease (P less than 0.05) in serum glucose during the first 15 min of exercise, changes not observed in the C or F trials. Respiratory exchange ratio was higher (P less than 0.05) during the G than C or F trials for the first 5 min of exercise and lower (P less than 0.05) during the C trial compared with G or F for the last 15 min of exercise. These data suggest that fructose ingested before 30 min of submaximal exercise maintains stable blood glucose and insulin concentrations, which may lead to the observed sparing of muscle glycogen.

Exercise effect upon plasma melatonin levels in women: possible physiological significance

The pattern of changes in plasma concentrations of melatonin was followed in 7 initially untrained young women subjected to periodic acute exercise testing during the course of an 8 weeks' progressive aerobic exercise training program. Training comprised cycle ergometry 2 days/week and running 4 days/week for increasingly prolonged periods of intense exercise eliciting 85% of maximum heart rate. Acute exercise tests consisted of one-hour graded submaximal endurance rides on a bicycle ergometer. After a mock ride for familiarization purposes, three test rides were conducted during the early follicular phase of three consecutive menstrual cycles at the beginning, middle and end of the training program. Blood was sampled atraumatically before the rides, at their conclusion and 30 minutes into recovery. During the rides, the plasma concentrations of melatonin rose significantly above baseline control values. Exercise-enhanced melatonin levels may contribute to impaired reproductive function in women engaging in endurance sports.

Hypothalamic amenorrhea in runners of normal body composition

Three amenorrheic runners of normal body weight, in whom organic disease had been excluded, were found to exhibit: (1) normal body composition, (2) low baseline concentrations of serum LH and normal concentrations of FSH, (3) normal to hyper-responsiveness of LH and FSH to GnRH testing, and (4) normal and possibly increased frequency of LH pulsations. In one of the 3 runners, the administration of naloxone was followed by a pronounced increase in the amplitude of the LH pulsations.