Original research
Three-step method for menstrual and oral contraceptive cycle verification

https://doi.org/10.1016/j.jsams.2016.08.013Get rights and content

Abstract

Objectives

Fluctuating endogenous and exogenous ovarian hormones may influence exercise parameters; yet control and verification of ovarian hormone status is rarely reported and limits current exercise science and sports medicine research. The purpose of this study was to determine the effectiveness of an individualised three-step method in identifying the mid-luteal or high hormone phase in endogenous and exogenous hormone cycles in recreationally-active women and determine hormone and demographic characteristics associated with unsuccessful classification.

Design

Cross-sectional study design.

Methods

Fifty-four recreationally-active women who were either long-term oral contraceptive users (n = 28) or experiencing regular natural menstrual cycles (n = 26) completed step-wise menstrual mapping, urinary ovulation prediction testing and venous blood sampling for serum/plasma hormone analysis on two days, 6–12 days after positive ovulation prediction to verify ovarian hormone concentrations.

Results

Mid-luteal phase was successfully verified in 100% of oral contraceptive users, and 70% of naturally-menstruating women. Thirty percent of participants were classified as luteal phase deficient; when excluded, the success of the method was 89%. Lower age, body fat and longer menstrual cycles were significantly associated with luteal phase deficiency.

Conclusions

A step-wise method including menstrual cycle mapping, urinary ovulation prediction and serum/plasma hormone measurement was effective at verifying ovarian hormone status. Additional consideration of age, body fat and cycle length enhanced identification of luteal phase deficiency in physically-active women. These findings enable the development of stricter exclusion criteria for female participants in research studies and minimise the influence of ovarian hormone variations within sports and exercise science and medicine research.

Introduction

Fluctuations in endogenous oestrogen and progesterone throughout the menstrual cycle, and in exogenous hormones such as those present in oral contraceptives (OC), may influence exercise performance.1 Furthermore, hormone status in physically-active women is highly individual and commonly influenced by OC use, anovulation, luteal phase deficiency, or menstrual disturbances such as amenorrhoea. Indeed, research investigating the influence of hormone status on exercise performance in women has yielded inconsistent data; this, at least in part, can be attributed to poor control and/or verification of menstrual cycle phase.2

Early-follicular menstrual phase is simply identified by the onset of menstruation, and does not provide insight into luteal function and high ovarian hormone conditions, therefore the present method focuses on mid-luteal menstrual phase. Direct methods for identifying mid-luteal menstrual phase, such as ultrasound of follicular development and endometrial biopsies,3, 4 combined with frequent measures of serum/plasma ovarian hormone concentrations are time-consuming, costly and invasive. In applied exercise science and sports medicine research, indirect methods of menstrual cycle verification and/or control have been employed, including calendar cycle tracking,5 basal body temperature fluctuations,6 and use of ovulation prediction tests.7 In isolation, these methods have low success and significant limitations, especially within physically-active women, who are at higher risk of experiencing anovulation or luteal phase deficiency.8, 9 Furthermore, without specifically measuring circulating oestradiol and progesterone levels, accurate identification of cycle phase is unlikely.8, 10 There is a clear need to develop more accurate methods for cycle verification given this is a significant limitation in female specific research.

The primary aim of this study was to investigate the effectiveness of an individualised three-step method of hormonal cycle verification for determination of mid-luteal or high ovarian hormone phase in both endogenous and exogenous ovarian cycles in physically-active women. The secondary aim was to explore hormonal and demographic characteristics associated with successful or unsuccessful classification of mid-luteal or high hormone phase in both endogenous and exogenous ovarian hormone cycles from the three-step method of menstrual cycle verification.

Section snippets

Methods

Fifty-four recreationally-active women (≥150 min week−1 of physical activity) who were either long-term (minimum six months) oral contraceptive users (OC-group; n = 28) or experiencing regular natural menstrual cycles 25–40 days in length, with no OC use for a minimum of six months prior to study inclusion (MC-group; n = 26) participated in the study. All experimental procedures were approved by the Institutional Medical Human Research Ethics Committee (ethical clearance #2012001438) and participants

Results

There were no differences (p > 0.05) between OC- and MC-groups for age, body mass index or body composition (Table 1). Following serum/plasma hormone analysis, the MC-group was sub-divided into ‘normal’ (MCNORM; n = 18; 70%) and luteal phase deficient (i.e. not meeting minimum progesterone concentration criteria for mid-luteal phase; MCLPD; n = 8; 30%) groups. MCLPD participants were younger (p = 0.024), had lower body mass (p = 0.048) than MCNORM participants, were shorter than OC participants (p = 

Discussion

The present three-step method for hormone cycle verification was successful in identifying mid-luteal menstrual phase in 70% of participants experiencing natural menstrual cycles. In the remaining 30% of cases, even though participants reported positive urinary ovulation prediction testing, serum/plasma hormone concentrations did not satisfy the criterion for mid-luteal phase. The findings suggest there are significant hormonal, body composition and menstrual cycle characteristic differences

Conclusion

Our findings suggest the three-step method comprising menstrual cycle mapping, home urinary ovulation prediction testing and serum/plasma hormone measurement is effective at verifying hormone status in women using OC 100% of the time, and 70% of the time in naturally-menstruating women. Once luteal phase deficient participants were excluded the method was successful 90% of the time in normally-menstruating women. If tight control of ovarian hormones is required within a study design, women

Practical implications

  • •

    Step-wise menstrual cycle mapping, urinary ovulation prediction testing, and serum/plasma hormone verification are an effective combination for accurate verification of mid-luteal menstrual phase. Identification of mid-luteal phase is essential to determine the influence of ovarian hormone concentrations on both acute and chronic physiological and performance adaptations in sport and exercise science and medicine.

  • •

    We recommend testing seven–nine days following positive ovulation prediction

Acknowledgements

The authors wish to thank Mr Gary Wilson and Ms Ade Popoola for their assistance with analysing serum/plasma hormones. No external funding was received for this work.

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