Reproduction Application Integration.pptx

Application of reproductive disorders

1. Physiology 144 PART IV – INTEGRATION & APPLICATION

2. The female athlete triad Also called the Relative Energy Deficiency in Sports (RED-S) Female athlete triad – components: Low energy availability Menstrual dysfunction Low bone mineral density Complicated diagnosis and treatment – requires a multi-disciplinary team 2

3. The female athlete triad: Low energy availability Low energy availability = a state in which the body does not have enough energy left to support all physiological functions needed to maintain optimal health (i.e. the energy that is available after accounting for energy expenditure from exercise). Can occur with or without the presence of disordered eating . Disordered eating – diagnosed/undiagnosed Anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder, and many others. Athletes may unknowingly fail to attain their energy requirements. Disordered eating common in sports that emphasize leanness, aesthetics, weight class or endurance sports. Examples: gymnastics, ballet, figure skating, endurance running. 3

4. The female athlete triad: menstrual dysfunction Menstrual dysfunction – range of disorders Most common = amenorrhea “a”= no, “men”= month, “ rhoia ” = flow Absence of menses for 3 months or longer Causes: a variety of diseases genetic abnormalities energy deficiency and stress 4 Stress Caloric restriction / Energy Deficiency Weight loss Over exercise Hypothalamus Anterior Pituitary Ovary ↓Estrogen ↓Progesterone ↓LH ↓FSH CRH   GnRH   Functional hypothalamic amenorrhea Suppression of hypothalamic-pituitary-ovarian axis ↓ GnRH release  disrupts LH release from the pituitary ↓ estrogen release from ovaries Result = estrogen deficiency

5. Other definitions of menstrual function 5 Definition Eumenorrhea Menstrual cycle occurs at intervals near the median for young adult women (28 ± 7 days) Amenorrhea Primary = no menses by age 15 yrs in the presence of normal sexual development Secondary = loss of menses for > 90 days after the first occurrence of menstruation Anovulation Absence of ovulation usually due to impaired follicular development Luteal-phase defect An asymptomatic condition caused by a shortened luteal phase and/or a low concentration of progesterone – affects fertility Oligomenorrhea Menstrual cycle occurs at intervals > 35 days for young adult women.

6. The female athlete triad: Low bone mineral density (BMD) Menstrual dysfunction – amenorrhea & oligomenorrhea  low estrogen state 6 Estrogen Formation Resorption Bone mineral density is stable Normal conditions Estrogen Formation   Resorption   Bone mineral density decreases Low estrogen conditions bone strength risk of stress fractures   Resorption > formation Inhibits Stimulates

7. Complications of the female athlete triad Menstrual dysfunction  infertility Low estrogen levels  Risk for cardiovascular disease ↓ immune function Impaired skeletal muscle metabolism ↓ muscle strength & mass ↓ endurance ↑ likelihood of injuries & stress fractures  frequently the tibia   7 ↓ Athletic Performance ↓ Overall health

8. Relative energy deficiency in Sport (RED-S) The male athlete triad is a subset of the relative energy deficiency in sport (RED-S) The male athlete triad - components : Low energy availability Low bone mineral density Functional hypothalamic hypogonadism Consequences of the male athlete triad: spermatogenesis, reduced sperm count infertility facial hair bone mineral density  risk for stress fractures ↓ muscle strength & mass   8 Stress Caloric restriction / Energy Deficiency Weight loss Over exercise Hypothalamus Anterior Pituitary Testis ↓Testosterone ↓LH ↓FSH CRH   GnRH  

9. Menopause Ovulation and menses cease entirely, and reproductive capabilities are eliminated Normally occurs between ages of 46 and 54 yrs. Stages: Perimenopause – gradual decline in estrogen, resulting in irregular menstruation. Menopause – complete absence of menstruation (amenorrhea) for 1 year. Post menopause – after menopause, permanent amenorrhea. 9 Age in years Estrogen level Perimenopause Menopause Post Menopause 35-45 50 Amenorrhea Irregular menses

10. Menopause 10 Menopause Changed energy homeostasis / metabolism Muscle mass & strength   Altered bone remodelling Accelerated sarcopenia risk for osteoporosis   Body composition changes – weight gain   Symptoms: Hot flashes Weight gain Mood swings, headaches, depression Sleep disturbances Joint pain Brittle nails Vaginal dryness Loss of libido Estrogen deficiency ↑ Risk for cardiovascular disease Musculoskeletal health Metabolic health Cardiovascular health

11. The influence of estrogen on skeletal muscle 11 Satellite cell (muscle stem cell) activation & proliferation   Protect muscle membranes from EIMD Maintenance of muscle mass and strength EIMD = Exercise-induced muscle damage Estrogen Antioxidant & membrane stabilizer Resolves the inflammatory response - immune cells in the muscle after EIMD   Facilitate repair & regeneration from EIMD NB – this slide is just for interest!

12. The menstrual cycle – Potential effects on training and performance outcomes? Maximal strength appears to be greater in the follicular phase and at ovulation than in the luteal phase. Recovery and regeneration of muscle fibers has been shown to be faster in the mid-follicular phase vs the luteal phase after eccentric exercise. Studies demonstrate that resistance training conducted in the follicular phase may be superior to luteal phase-based training in terms of enhancing muscle strength and mass. But - the current evidence concerning phase-based training is limited and there is no consensus yet. Keep up to date with current literature & advances! 12 Fluctuating ovarian hormone levels during the ovarian cycle Gonadotropin (FSH and LH) levels during the ovarian cycle NB – this slide is just for interest!

13. Anabolic-androgenic steroids A group of molecules that have very similar structure and function to testosterone. Bind to androgen receptors to signal cellular processes  increased protein synthesis & development of male secondary sex characteristics. Androgenic = refers to effects that produce male secondary sex characteristics Anabolic = refers to the making of proteins. There is a limit to how much testosterone can be made naturally = limit to muscular growth. Synthetic anabolic steroids  mimic the effects of testosterone. 13 Cross-sectional area (CSA)   Protein synthesis   Anabolic Steroid Strength   [Hypertrophy] [In response to exercise]

14. Anabolic-androgenic steroids Use of anabolic steroids = banned/prohibited in sport - both in an out of competition. Are considered a Performance enhancing drug (PED) Side-effects of anabolic steroid use: Supresses secretion of gonadotropin hormones which control the development and function of the gonads (testes and ovaries) In men: Testicular atrophy, decreased secretion of testosterone, reduced sperm count and impotence Increased risk for prostate cancer Inability to produce sufficient levels of testosterone after steroid use has stopped . In women: Irregular menstrual cycles Masculinization such as breast regression, enlargement of clitoris, deepening of the voice, growth of facial hair Cardiac hypertrophy, cardiomyopathy, heart attacks Liver damage Personality changes – aggression (“Roid rage”)

15. Differences in sex development (DSD) Genetic sex and phenotypic sex is usually compatible. Phenotype = Observable physical traits/characteristics DSD = a term used for conditions in which there is a discrepancy between the genetic and anatomic sexes because of differences in sexual differentiation. Occurs early in pregnancy at the time when reproductive organs develop into either testicles or ovaries. Can occur due to either genetic factors or sex hormone factors. Associated with atypical development of internal and external genital structures. 15 XX XY Sex determination

16. Differences in sex development (DSD) Androgen insensitivity syndrome (AIS) Occurs in genetic XY male Testis fail to develop properly and fail to secrete hormones  reproductive tract & genitalia develop/ differentiate along female lines. Or target cells lack the receptors for testosterone  reproductive tract & genitalia develop/ differentiate along female lines. Congenital adrenal hyperplasia (CAH) Occurs in genetic XX female High levels of androgens produced by adrenal glands because of an enzyme not working properly (or another reason for high levels of androgens). Reproductive tracts & genitalia differentiate along male lines. Mixed gonadal dysgenesis Sex chromosome DSD  some cells have 46, XY pattern and others have 45, X pattern. Some cells have lost one sex chromosome Gonads develop on a less typical path & sometimes have underdeveloped gonads 16 NB - There are many more variations of DSD! These are just a few.

17. Recap questions: What are the components of the female athlete triad and define each component? What are the complications of the female athlete triad, and how does this impact sport performance? Define amenorrhea. What is oligomenorrhea? Describe the side effects of anabolic-androgenic steroids in both males and females. What is menopause and describe the stages? What are the physiological consequences of menopause? Define what is meant by differences in sex development (DSD) and explain how this can happen by using one example of DSD. Work through these questions at home