Depressive symptoms and their relationship with endogenous reproductive hormones and sporadic anovulation in premenopausal women

Ankita Prasad; Enrique F Schisterman; Karen C Schliep; Katherine A Ahrens; Lindsey A Sjaarda; Neil J Perkins; Rebecca Matyas; Jean Wactawski-Wende; Sunni L Mumford

doi:10.1016/j.annepidem.2014.10.005

Reproductive Endocrinology Neuroendocrinology

Depressive symptoms and their relationship with endogenous reproductive hormones and sporadic anovulation in premenopausal women

Prasad A, Schisterman EF, Schliep KC, Ahrens KA, Sjaarda LA, Perkins NJ, Matyas R, Wactawski-Wende J, Mumford SL

Published December 2014 Annals of epidemiology, 24(12), 920-924

DOI 10.1016/j.annepidem.2014.10.005 PMID 25453349 PMC PMC4355057

RRM Academy Synopsis

Depressive symptoms showed no link to ovulation in healthy women

Depressive symptoms showed no link to hormone levels or to cycles without ovulation in a cohort of 248 women with regular cycles and no clinical depression. Researchers followed the women for up to two cycles and took blood samples up to eight times per cycle.

Key Findings

Of 248 women, 19 (8%) scored 16 or higher on the 20-item CES-D questionnaire at baseline, and 229 (92%) scored below 16; together they contributed 488 cycles.
Estradiol was higher by 26.6% (95% CI: 8.1, 48.3) in women with depressive symptoms before adjustment, and by 11.7% (95% CI: −6.0, 32.7) after adjustment, which was not significant.
Luteinizing hormone, follicle-stimulating hormone, testosterone, and progesterone showed no significant differences between women with and without depressive symptoms, before or after adjustment for covariates.
Of 38 cycles from women with depressive symptoms, 4 (10.5%) lacked ovulation, against 38 of 450 cycles (8.4%) in women without; the adjusted odds ratio was 1.1.
Women with depressive symptoms reported 30% higher mood-related menstrual cycle symptom scores overall (20.7 vs. 15.9; P < 0.001), a difference that was not dependent on cycle phase.

Interpretation

This prospective cohort study followed 248 healthy women with regular cycles for up to two cycles. None had recent clinical depression. Depressive symptoms were measured once, at baseline. After adjusting for age, race, body weight, stress, and alcohol use, they showed no significant link to hormone levels or ovulation. The authors note the study may be underpowered, since few women had depressive symptoms. The findings support larger studies of mood and the menstrual cycle, including in women with diagnosed depression or cycle disorders.

RRM Context

Restorative reproductive medicine treats the ovulatory cycle as a vital sign and reads symptoms against the cycle. In this cohort, mood-related symptom scores varied by cycle phase. Scores were lowest in the ovulatory and luteal phases (15.6 in each). Clinic visits were timed to cycle phases, with home fertility monitors guiding the midcycle visit.

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

Abstract

Purpose

To determine whether depressive symptoms are associated with ovulation or reproductive hormone concentrations in eumenorrheic women without a reported diagnosis of clinical depression.

Methods

A prospective cohort of 248 regularly menstruating women, aged 18 to 44 years (27.3 ± 8.2) were evaluated for depressive symptoms at baseline using the 20-item Center for Epidemiological Studies Depression (CES-D) scale and categorized dichotomously (<16, no depressive symptoms [92%] vs. ≥ 16, depressive symptoms [8%]). Serum concentrations of estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone were measured up to eight times per cycle for up to two menstrual cycles. Linear mixed models estimated associations between depressive symptoms and hormone concentrations, whereas generalized linear mixed models assessed their relationship with sporadic anovulation.

Results

No significant associations were identified between depressive symptoms and reproductive hormone levels (all P > .05) or the odds of sporadic anovulation (adjusted odds ratio, 1.1; 95% confidence interval, [0.02-5.0]), after adjusting for age, race, body mass index, perceived stress level, and alcohol consumption.

Conclusions

Despite reported associations between mental health and menstrual cycle dysfunction, depressive symptoms were not associated with reproductive hormone concentrations or sporadic anovulation in this cohort of regularly menstruating women with no recent (within 1 year) self-reported history of clinical depression.

Topics

Reproductive Endocrinology › Neuroendocrinology › Hypothalamic Pituitary Axis · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances · Diagnostics › Hormone Testing › Serum Panels

Ankita Prasad, Enrique F Schisterman, Karen C Schliep, Katherine A Ahrens, Lindsey A Sjaarda, Neil J Perkins, Rebecca Matyas, Jean Wactawski-Wende, Sunni L Mumford

A Prasad, E Schisterman, K Schliep, Kathy Ahrens, Kate Ahrens, Katie Ahrens, K Ahrens, L Sjaarda, N Perkins, Becky Matyas, R Matyas, J Wactawski-Wende, S Mumford

PMID 25453349 25453349 DOI 10.1016/j.annepidem.2014.10.005 10.1016/j.annepidem.2014.10.005 Prasad et al. 2014, Prasad 2014

Depressive symptoms and their relationship with endogenous reproductive hormones and sporadic anovulation in premenopausal women

Depressive symptoms showed no link to ovulation in healthy women

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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