Longitudinal sex and stress hormone profiles among reproductive age and post-menopausal women after severe TBI: A case series analysis

Abstract

Primary objectives: To describe hormone profiles for pre-/post-menopausal women, to monitor time to resumption of menstruation among pre-menopausal women and to describe cortisol associated LH suppression and phasic variation in other sex hormones over timeMethods and procedures: This study determined amenorrhea duration and characterized acute (days 0–7) and chronic (months 1–6) gonadotropins [luteinizing hormone and follicle stimulating hormone (LH, FSH)], sex hormones (progesterone, estradiol) and stress hormone (cortisol) profiles. Women were pre-menopausal (n = 3) or post-menopausal (n = 3). Among pre-menopausal women, menstrual cycle resolution and phase association (luteal/follicular) was monitored using self-report monthly reproductive history questionnaires. This study compared post-TBI hormone profiles, stratified by menopausal status, to hormone levels from seven controls and described 6- and 12-month outcomes for these women.Main outcomes and results: Consistent with functional hypothalamic amenorrhea (FHA), menstruation resumption among pre-menopausal women occurred when serum cortisol normalized to luteal phase control levels. For post-menopausal women, serum cortisol reductions corresponded with resolution of suppressed LH levels.Conclusions: The stress of TBI results in anovulation and central hypothalamic-pituitary-ovarian (HPG) axis suppression. Future work will examine acute/chronic consequences of post-TBI hypercortisolemia and associated HPG suppression, the temporal association of HPG suppression with other neuroendocrine adaptations and how HPG suppression impacts multidimensional recovery for women with TBI.

Keywords:

• Hypogonadism
• sex hormone physiology
• traumatic brain injury
• cortisol
• amenorrhea
• luteal hormone
• functional hypothalamic amenorrhea

Acknowledgements

The authors thank the UPMC Trauma Registry for data collection and Mary Synnott for the construction of figures.

Declaration of interest

The authors report no conflicts of interest. This work was supported by CDC: R49 CCR 323155, DOD: W81XWH-071-0701, NIDRR H133A120087, University of Pittsburgh Women’s Studies Faculty Research Fund.