Alcohol intake, reproductive hormones, and menstrual cycle function: a prospective cohort study

Karen C Schliep; Shvetha M Zarek; Enrique F Schisterman; Jean Wactawski-Wende; Maurizio Trevisan; Lindsey A Sjaarda; Neil J Perkins; Sunni L Mumford

doi:10.3945/ajcn.114.102160

Reproductive Endocrinology Ovarian Hormones

Alcohol intake, reproductive hormones, and menstrual cycle function: a prospective cohort study

Schliep KC, Zarek SM, Schisterman EF, Wactawski-Wende J, Trevisan M, Sjaarda LA, Perkins NJ, Mumford SL

Published October 2015 The American journal of clinical nutrition, 102(4), 933-42

DOI 10.3945/ajcn.114.102160 PMID 26289438 PMC PMC4588737

RRM Academy Synopsis

Recent alcohol intake was linked to higher estradiol in healthy women

Alcohol drunk the day before was linked to higher estradiol, testosterone, and luteinizing hormone in a cohort of 259 healthy premenopausal women. They were followed for up to two cycles. Their average alcohol intake had no statistically significant link to ovulation, cycle length, or heavy bleeding.

Key Findings

Each additional drink the previous day was associated with 5.26% higher total estradiol (95% CI: 1.27%, 9.41%) and 5.82% higher free estradiol (95% CI: 1.81%, 9.99%), after adjustment for confounders.
Each additional drink was also associated with 1.56% higher total testosterone (95% CI: 0.23%, 2.90%), 1.42% higher free testosterone (95% CI: 0.02%, 2.84%), and 6.18% higher luteinizing hormone (95% CI: 2.02%, 10.52%).
Binge drinking (four or more drinks a day) versus nonbinge drinking was associated with 64.35% higher total estradiol (95% CI: 18.09%, 128.71%).
The 24-hour recalls held 27 reports of binge drinking, from 11 women (4.2%). Luteal progesterone, follicle-stimulating hormone, and sex hormone binding globulin showed no significant association with alcohol.
Women averaging more than 1 drink per day had 1.49 times the risk (95% CI: 0.97, 2.29) of heavy menses compared with nonconsumers, a nonsignificant difference.

Interpretation

This prospective cohort study, the BioCycle Study, followed 259 healthy premenopausal women aged 18 to 44 with regular cycles, no known gynecologic problems or infertility, and no plan to conceive within three months. Median alcohol intake among consumers was 0.1 drinks per day. The outcomes were hormone concentrations and menstrual cycle markers. The authors note that the small number of moderate and heavy drinkers weakened the power to assess high, acute alcohol intake and binge drinking. The authors call for longer-term studies of reproductive function and fertility.

RRM Context

Restorative reproductive medicine treats the ovulatory cycle as a vital sign. The study timed its blood draws to the luteinizing hormone surge and ovulation with fertility monitors, so each reading matches a cycle phase, much as cycle charting does. Daily habits such as alcohol are among the factors a cause-based evaluation can weigh.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Although habitual low-to-moderate alcohol intake has been linked with reduced all-cause mortality and morbidity, the effect of recent alcohol intake on female reproductive function has not been clearly established.

Objective

We assessed the relation between acute alcohol consumption, reproductive hormones, and markers of menstrual cycle dysfunction including sporadic anovulation, irregular cycle length, luteal phase deficiency, long menses, and heavy blood loss.

Design

A total of 259 healthy, premenopausal women from Western New York were followed for ≤2 menstrual cycles (2005-2007) and provided fasting blood specimens during ≤8 visits/cycle and four 24-h dietary recalls/cycle. Linear mixed models were used to estimate associations between previous day's alcohol intake and hormone concentrations, whereas Poisson regression was used to assess RR of cycle-average alcohol intake and menstrual cycle function.

Results

For every alcoholic drink consumed, the geometric mean total and free estradiol, total and free testosterone, and luteinizing hormone were higher by 5.26% (95% CI: 1.27%, 9.41%), 5.82% (95% CI: 1.81%, 9.99%), 1.56% (95% CI: 0.23%, 2.90%), 1.42% (95% CI: 0.02%, 2.84%), and 6.18% (95% CI: 2.02%, 10.52%), respectively, after adjustment for age, race, percentage of body fat, perceived stress, pain-medication use, sexual activity, caffeine, and sleep. Binge compared with nonbinge drinking (defined as reporting ≥4 compared with <4 drinks/d, respectively) was associated with 64.35% (95% CI: 18.09%, 128.71%) and 63.53% (95% CI: 17.41%, 127.73%) higher total and free estradiol. No statistically significant associations were shown between cycle-average alcohol intake and menstrual cycle function.

Conclusion

Although recent moderate alcohol intake does not appear to have adverse short-term effects on menstrual cycle function, including sporadic anovulation, potential protective and deleterious long-term effects of alterations in reproductive hormones on other chronic diseases warrant additional investigation.

Topics

Reproductive Endocrinology › Ovarian Hormones › Estrogen · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances · Lifestyle and Environment › Substances › Alcohol

Karen C Schliep, Shvetha M Zarek, Enrique F Schisterman, Jean Wactawski-Wende, Maurizio Trevisan, Lindsey A Sjaarda, Neil J Perkins, Sunni L Mumford

K Schliep, S Zarek, E Schisterman, J Wactawski-Wende, M Trevisan, L Sjaarda, N Perkins, S Mumford

PMID 26289438 26289438 DOI 10.3945/ajcn.114.102160 10.3945/ajcn.114.102160 Schliep et al. 2015, Schliep 2015

Alcohol intake, reproductive hormones, and menstrual cycle function: a prospective cohort study

Recent alcohol intake was linked to higher estradiol in healthy women

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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