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

Abstract

BACKGROUNDMenstrual 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.METHODSAge- 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).RESULTSBefore 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).CONCLUSIONSOC 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.

Menstrual function in sports

“…95 Furthermore, a study of a small cohort of endurance athletes with menstrual disorders treated with low dose OC suggested that OC treatment increases body fat mass and improves metabolic balance. 96 The central role of leptin in the pathophysiology of exercise-related menstrual disorders has introduced novel approaches in the management of athletic amenorrhea. Exogenous leptin (recombinant r-metHuLeptin) administration managed to improve the reproductive function of a small cohort of women with hypothalamic amenorrhea caused by strenuous exercise or low weight, suggesting a possible therapeutic role.…”

A perspective on current research investigating the effects of hormonal contraceptives on determinants of female athlete performance

“…A recent meta-analysis showed that OC use reduced free testosterone by 61% compared to non-users 44 , possibly due to an increase in sex hormone binding globulin concentration, which binds to testosterone rendering it inactive. OC use increases GH concentrations [45][46] with second (30 µg EE and 0.125 mg Levonorgestrel) and fourth generation (30 µg EE and 2 mg Dienogest) OCs reducing concentrations of IGF-1, but not a ecting IGF binding protein-1 concentrations 45 . e generation of contraceptive in uences the response of IGF-1; 30% reduction following fourth generation OC use compared to 12% reduction following second generation use 46 , possibly as the androgenic Levonorgestrel opposes the e ects of oestrogen on IGF-1 concentrations.…”

“…OC use increases GH concentrations [45][46] with second (30 µg EE and 0.125 mg Levonorgestrel) and fourth generation (30 µg EE and 2 mg Dienogest) OCs reducing concentrations of IGF-1, but not a ecting IGF binding protein-1 concentrations 45 . e generation of contraceptive in uences the response of IGF-1; 30% reduction following fourth generation OC use compared to 12% reduction following second generation use 46 , possibly as the androgenic Levonorgestrel opposes the e ects of oestrogen on IGF-1 concentrations. In addition, twelve weeks use of a transdermal oestrogen patch (Estraderm) and oral oestrogen (Estrace) has also been shown to increase GH release 47 .…”

Aktuelle Möglichkeiten der hormonalen Kontrazeption – Was wissen wir über den Nutzen für Sportlerinnen?

“…Pearl-Index [10,24]. Gesichert dagegen ist der die Knochendichte signifikant vermindernde Effekt der Depotgestagene (z.B.…”