SFEBES2019 ORAL POSTER PRESENTATIONS Reproductive Endocrinology and Biology (4 abstracts)
Hypothalamic-pituitary-gonadal (HPG) axis suppression during basic military training in women despite increased adiposity and insulin resistance
Robert M Gifford 1, , Thomas J O'Leary 3 , Sophie L Wardle 3 , Julie P Greeves 3 , Richard A Anderson 4 , David R Woods 2, & Rebecca M Reynolds 1
1University/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK; 2Research & Clinical Innovation, Royal Centre for Defence Medicine, Lichfield, UK; 3Department of Army Health and Physical Performance Research, Andover, UK; 4MRC Centre for Reproductive Health, Edinburgh, UK; 5Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
Background: Low energy availability (LEA) in female athletes can result in HPG axis suppression. Basic military training (BMT) is physically arduous and associated with amenorrhoea and low-trauma fractures. We hypothesised that women undergoing BMT would demonstrate evidence of LEA and suppressed HPG function.
Design: Prospective study of 61 women undertaking 11-month BMT. Subjects acted as their own controls at baseline (all measures). Body composition measurement (DXA) was repeated after 3, 7 and 11 months; fasting blood (glucose, insulin (for homeostatic model of insulin resistance, HOMA2), leptin, inhibin B, estradiol, anti-Müllerian hormone (AMH), and FSH) after 7 and 11 months, and dynamic 1-h 10 µg GnRH test measuring LH and FSH after 7 months. Menstruation and ovulation were assessed in non-contraceptive pill-users (n=22) using diaries and weekly urinary progesterone : creatinine ratio, respectively.
Results: 52 women, aged 24.0±0.3 years, completed the study. Fat mass decreased 0.8 kg from baseline to month 3, increased 1.8 kg to month 7 and reverted to baseline by month 11 (P<0.001). Fat-free mass did not change (P=0.13). HOMA2 and leptin increased (both P<0.001), as did estradiol and inhibin B (P<0.05) while AMH was unchanged (P=0.6) (Table). Maximum and area-under-the-curve fold-responses of LH and FSH to GnRH were suppressed after 7 months (both P<0.001). Findings were unaffected by contraceptive use (effect × time P=0.8). Seven participants (32%) became oligo/amenorrhoeic. 87% of regular (23–35d) cycles were anovulatory.
| Baseline | 7 months | 11 months | |
| HOMA2 | 1.77±0.52 | 1.85±0.30* | 2.06±0.61* |
| Leptin, ng.ml−1 | 8.09±3.11 | 11.37±4.10* | 12.52±4.12* |
| Inhibin B, pg.ml−1 | 26.8±10.9 | 54.0±30.8* | 42.3±27.6* |
| Estradiol, pmol.l−1 | 83±46 | 145±73* | 95±64 |
| AMH, pmol.l−1 | 24.1±18.6 | 22.5±14.3 | 22.4±14.8 |
Conclusion: Evidence of adiposity-related adaptation suggests non-LEA stressors contributed to HPG axis suppression and follicular dysgenesis. Further studies are required to deliniate causes of reproductive dysfunction and associated pathology in military women.
Volume 65
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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