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Hum. Reprod. Advance Access published online on October 19, 2009
Human Reproduction, doi:10.1093/humrep/dep350
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Effects of oral contraceptives on diurnal profiles of insulin, insulin-like growth factor binding protein-1, growth hormone and cortisol in endurance athletes with menstrual disturbance

A. Rickenlund1, M. Thorén2, Å. Nybacka3, J. Frystyk3 and A. Lindén Hirschberg1,4

1 Department of Woman and Child Health, Division of Obstetrics and Gynecology, Karolinska Institutet, SE-171 76 Stockholm, Sweden 2 Department of Molecular Medicine and Surgery, Endocrine Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden 3 Medical Research Laboratories, Medical Department, Aarhus University Hospital, Norrebrogade, DK-8000 Aarhus, Denmark

4 Correspondence address. Tel: +46-8-517-733-26; Fax: +46-8-517-742-52; E-mail: angelica.linden-hirschberg{at}karolinska.se

BACKGROUND: Menstrual disturbances in female athletes are often explained as a consequence of energy deficiency. Oral contraceptive (OC) treatment may have favorable metabolic effects. We evaluated effects of OCs on diurnal secretions of insulin, insulin-like growth factor binding protein 1 (IGFBP-1), growth hormone (GH) and cortisol in relation to changes in body composition in athletes with menstrual disturbance compared with regularly menstruating athletes and controls.

METHODS: Age- and BMI-matched groups of endurance athletes with menstrual disturbance (OAM, n = 9) and regularly cycling athletes (RM, n = 8) and sedentary controls (CTRL, n = 8) were examined, and hormone levels measured, before and after 8 months of treatment with a low-dose combined OC (30 µg ethinyl estradiol + 150 µg levonorgestrel).

RESULTS: Before OC treatment, the diurnal profile of insulin was lower (P < 0.01) and levels of IGFBP-1 (P < 0.05) and cortisol (P < 0.05) were higher in OAM athletes than in CTRL, whereas GH secretion was higher than in RM athletes (P < 0.05). After treatment, diurnal secretions of these hormones were similar between groups with an increase of IGFBP-1 in the regularly menstruating subjects only (P < 0.001). OC treatment increased body fat mass in OAM athletes (P < 0.01 versus baseline). The change in total fat mass correlated positively with pretreatment diurnal levels of GH (rs = 0.67, P < 0.01) and cortisol (rs = 0.64, P < 0.01).

CONCLUSIONS: OC treatment in endurance athletes with menstrual disturbance increases body fat mass and results in diurnal levels of insulin, IGFBP-1, GH and cortisol that are comparable to those in regularly menstruating subjects. These results suggest that OCs improve metabolic balance in OAM athletes.

Key words: oral contraceptives/female athletes/menstrual disturbances/insulin-like growth factor binding protein 1/body fat

Submitted on January 25, 2009; resubmitted on August 16, 2009; accepted on September 9, 2009.


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