Perceived stress, reproductive hormones, and ovulatory function: a prospective cohort study

Karen C. Schliep; Sunni L. Mumford; Catherine J. Vladutiu; Katherine A. Ahrens; Neil J. Perkins; Lindsey A. Sjaarda; Kerri A. Kissell; Ankita Prasad; Jean Wactawski-Wende; Enrique F. Schisterman

doi:10.1097/EDE.0000000000000238

Reproductive Endocrinology · Ovulation Physiology

Perceived stress, reproductive hormones, and ovulatory function: a prospective cohort study

Schliep KC, Mumford SL, Vladutiu CJ, Ahrens KA, Perkins NJ, Sjaarda LA, Kissell KA, Prasad A, Wactawski-Wende J, Schisterman EF

Published March 2015 Epidemiology

DOI 10.1097/EDE.0000000000000238 PMC PMC4315337

RRM Academy Synopsis

Daily stress is associated with more cycles without ovulation

A prospective cohort of 259 healthy women followed for two menstrual cycles found that higher daily stress was associated with hormone changes and more cycles without ovulation. About 10 out of 100 cycles with high daily stress lacked ovulation, compared with about 6 out of 100 cycles with low daily stress.

Key Findings

After adjustment for age, race, body fat, depression score and exercise, high daily stress was associated with lower estradiol, luteal progesterone and luteinizing hormone, and with higher follicle-stimulating hormone.
Sporadic anovulation occurred in 40 (7.9%) of 507 cycles: 23 of 227 cycles (10.1%) with high daily stress and 16 of 279 cycles (5.7%) with low daily stress.
Each increase in daily stress level was associated with 70% higher adjusted odds of a cycle without ovulation (OR=1.7, 95% CI 1.1 to 2.4).
The 4-item Perceived Stress Scale gave similar but attenuated hormone results. The baseline 14-item scale gave null hormone findings, and both scales showed near-null associations with a lack of ovulation.
Among 21 women with one ovulatory and one anovulatory cycle, cycles with high daily stress had higher matched odds of anovulation than cycles with low stress (OR = 3.0; P = 0.24).

Interpretation

The BioCycle Study was a prospective cohort conducted in 2005 to 2007, and its results are associations between recent stress and cycle measures. Participants were women aged 18 to 44 years from Western New York with regular cycles and no known reproductive disorders. Of these women, 87% had post-secondary education, and recent users of hormonal contraception were excluded. The authors note that few women reported high stress and state that a larger study following women for more than two cycles should be considered.

RRM Context

Restorative reproductive medicine treats ovulation as a vital sign of cycle health. It approaches a change in cycle function as a question about underlying causes and considers the whole person. The BioCycle findings add recent daily stress to the factors linked with altered hormones and ovulation in healthy women. Creighton Model charting records the observable signs of each cycle as it unfolds.

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

Abstract

Background

Stress has been shown to suppress ovulation in experimental models, but its effect on human reproduction at the population level is unclear.

Methods

Healthy women (n = 259), aged 18-44 years from Western New York, were followed for 2 menstrual cycles (2005-2007). Women completed daily perceived stress assessments, a 4-item Perceived Stress Scale (PSS-4) up to 4 times each cycle, and a 14-item PSS at baseline. Mixed model analyses were used to assess effects of stress on log reproductive hormone concentrations and sporadic anovulation.

Results

High versus low daily stress was associated with lower estradiol (-9.5% [95% confidence interval (CI) = -15.6% to -3.0%]), free estradiol (-10.4% [-16.5% to -3.9%]), and luteinizing hormone (-14.8% [-21.3% to -7.7%]) and higher follicle-stimulating hormone (6.2% [95% CI = 2.0% to 10.5%]) after adjusting for age, race, percent body fat, depression score, and time-varying hormones and vigorous exercise. High versus low daily stress was also associated with lower luteal progesterone (-10.4% [95% CI = -19.7% to -0.10%]) and higher odds of anovulation (adjusted odds ratio = 2.2 [95% CI = 1.0 to 4.7]). For each unit increase in daily stress level, women had a 70% higher odds of an anovulatory episode (odds ratio = 1.7 [1.1 to 2.4]). Similar but attenuated results were found for the association between the PSS-4 and reproductive hormones, while null findings were found for the baseline PSS.

Conclusion

Daily perceived stress does appear to interfere with menstrual cycle function among women with no known reproductive disorders, warranting further research to explore potential population-level impacts and causal biologic mechanisms.

Topics

Reproductive Endocrinology › Ovulation Physiology › Anovulation · Lifestyle and Environment › Stress and Allostatic Load › Stress and Ovulation · Menstrual Cycle › Cycle Physiology › Ovulation

Karen C. Schliep, Sunni L. Mumford, Catherine J. Vladutiu, Katherine A. Ahrens, Neil J. Perkins, Lindsey A. Sjaarda, Kerri A. Kissell, Ankita Prasad, Jean Wactawski-Wende, Enrique F. Schisterman

K Schliep, S Mumford, Cathy Vladutiu, Kate Vladutiu, C Vladutiu, Kathy Ahrens, Kate Ahrens, Katie Ahrens, K Ahrens, N Perkins, L Sjaarda, K Kissell, A Prasad, J Wactawski-Wende, E Schisterman

DOI 10.1097/EDE.0000000000000238 10.1097/EDE.0000000000000238 Schliep et al. 2015, Schliep 2015

Perceived stress, reproductive hormones, and ovulatory function: a prospective cohort study

Daily stress is associated with more cycles without ovulation

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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