Energetic And Hormonal Predictors Of Advanced Menstrual Recovery In Exercising Women With Oligo/Amenorrhea

PURPOSE: To determine the predictors of advanced menstrual recovery (AMR), defined as experiencing two consecutive menstrual cycles of <36 days, in exercising women with functional hypothalamic oligo/amenorrhea (FHOA). METHODS: FHOA exercising women (21.8 ± 0.7 years; n = 25) from the intervention group of the REFUEL study (a 12-month randomized clinical trial that increased energy intake [mean ± SEM +330 ± 65 kcal/day]) who experienced AMR during the study were considered recovered (REC), and otherwise non-recovered (non-REC). Potential AMR predictors were measured at baseline (BL) and pre-recovery (PRE). PRE was defined as the intervention time point (month 1, 2, 3, 6, or 9) that preceded either AMR (REC), or the two last measured menstrual cycles (non-REC). Predictors were: body composition (dual-energy x-ray absorptiometry/DXA); energy and macronutrient intake, and energy availability, calculated from self-report logs; resting metabolic rate (RMR), RMR/lean body mass, and DXA-predicted RMR ratio; daily urinary estrone-1-glucuronide (E1G) and pregnanediol glucuronide (PdG); and serum total triiodothyronine, insulin-like growth factor 1 (IGF-1), leptin, ghrelin, peptide YY, and ghrelin/PYY ratio. T-tests, Mann-Whitney tests, and logistic regressions determined group differences and AMR predictors. RESULTS: BL fat mass (FM: 14.7 ± 0.7 vs 11.6 ± 0.7 kg, p < 0.01) and percent fat (25.7 ± 1.0 vs 21.8 ± 1.0 %, p < 0.01), and FM at PRE (15.3 ± 0.6 vs 13.4 ± 0.5 kg, p = 0.02) were higher in REC than non-REC. At BL only, REC consumed proportionally less carbohydrates (54.7 ± 1.6 vs 62.2 ± 2.2 %, p = 0.02), and more proteins (16.0 ± 0.7 vs 13.8 ± 0.7 %, p = 0.05) and fats (28.1 ± 1.4 vs 22.7 ± 2.1 %, p = 0.04) than non-REC. Leptin and IGF-1 at PRE were higher in REC than non-REC (7.5 ± 1.3 vs 4.6 ± 0.7 ng/mL, p = 0.03; 273.1 ± 13.5 vs 229.6 ± 19.3 ng/mL, p = 0.04). E1G and PdG were similar, but increased only in REC (from 27.6 ± 4.5 to 35.3 ± 5.0 ng/mL, p < 0.01; from 1.2 ± 0.2 to 1.3 ± 0.2 ng/mL, p < 0.01). No other differences were observed. Predictors of AMR were BL percent fat and FM, and FM and IGF-1 at PRE (p < 0.05). CONCLUSIONS: Advanced menstrual recovery was associated with an increase in E1G and PdG. Higher FM may play an important role for AMR to be achieved. IGF-1 and leptin are potential markers to be assessed during treatment to monitor recovery from FHOA. Supported by: This work was supported by the U.S. Department of Defense: U.S. Army Medical Research and Material Command [grant number PR054531, NCT00392873]