High Serum Cortisol Levels in Exercise-Associated Amenorrhea

Abstract

Objective: To determine whether basal Cortisol levels are elevated in exercise-associated amenorrhea.

Design: Survey, with hormone levels measured weekly for 1 month and patients followed clinically for 6 months.

Setting: Volunteers were recruited through media advertisements and fliers.

Participants: Ninety-two women were enrolled; 71 (77%) completed the study. Subjects were grouped by menstrual and activity histories reported by a self-administered questionnaire. After 6 months, final groups were assigned: amenorrhea athletes, 19; eumenorrheic athletes, 35; a transition group of amenorrheic athletes who had resumed menses after entering the study, 7; and normal cyclic nonathletes, 10.

Interventions: Four weekly resting blood samples (0800 to 1000 hours) were obtained and measured for Cortisol, estradiol, progesterone, and prolactin levels. Lumbar bone mineral density was measured by dual-photon densitometry.

Measurements and Main Results: Mean (±SE) Cortisol levels were higher in amenorrheic athletes (585±33 nmol/L) than in eumenorrheic athletes (411±14 nmol/L), transition athletes (378±33 nmol/L), or nonathletic women (397±30 nmol/L) (P <0.01). Of nine women with abnormally high Cortisol levels (greater than 579 nmol/L), eight were amenorrheic athletes, and one was a eumenorrheic athlete. Bone mineral density was lower in amenorrheic athletes than in the other three groups (P <0.01).

Conclusions: Increased glucocorticoid levels may be an etiologic factor in exercise-associated amenorrhea. High Cortisol levels could also contribute to decreased bone density. The failure of amenorrheic athletes with hypercortisolemia to regain menses within 6 months suggests that they are at risk for a prolonged acyclic state.