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1 Departments of Psychiatry, Cell Biology and Physiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States; Department of Kinesiology, Penn State University, University Park, Pennsylvania, United States
2 Departements of Psychiatry, and Obstetrics, Gynecology and Reproductive Sciences, Univeristy of Pittsburgh, Pittsburgh, Pennsylvania, United States; Departments of Gynecology and Obstetrics and Psychiatry, Emory University School of Medicine, Atlanta, Georgia, United States
3 Departments of Psychiatry, Cell Biology and Physiology, and Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States; Divisions of Reproductive Sciences and Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Oregon, United States
* To whom correspondence should be addressed. E-mail: cameronj{at}ohsu.edu.
The role of energy imbalance versus psychosocial stress in the pathogenesis of female reproductive dysfunction characterized by anovulation and amenorrhea remains controversial. In women, functional hypothalamic amenorrhea can develop in the absence of significant weight loss, excessive exercise, or profound psychosocial disruption. We posited, therefore, that commonplace, seemingly minor stressors, that alone would have minimal impact upon reproductive function, might interact synergistically such that combinations of stressors would cause a greater impairment of the reproductive axis than any single stressor alone. We developed a monkey model to test this hypothesis. Female cynomolgus monkeys with normal menstrual cycles were randomized into three experimental groups and studied over four menstrual cycles. Groups were: low level psychosocial stress (i.e., moving to a new housing environment; Move; n = 8), moderate energy imbalance (Exercise + Diet; n=9); and all stressors in combination (Move + Exercise + Diet; n=10). Food intake, body weight, menstrual cyclicity, and reproductive hormones were assessed for two control menstrual cycles followed by two experimental cycles during which monkeys experienced the stressors. Abnormal cycles were considered to be abnormally long or anovulatory cycles. Few abnormal cycles occurred in the Move group (1/8 monkeys) and in the Exercise + Diet group (1/9 monkeys). In contrast, 7/10 monkeys in the Move + Exercise + Diet group displayed at least one abnormal cycle (
2 = 9.61; P = 0.008). These findings suggest that infertility due to hypothalamic hypogonadism can result from the combination of commonplace, seemingly minor, stressors that often escape clinical attention.
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