Amenorrhea Research Activities and Advances

Several NICHD organizational units support and conduct research on amenorrhea and the conditions for which it is a symptom.

DIPHR's Epidemiology Branch is also studying sporadic amenorrhea among normally menstruating women to determine the connection between amenorrhea and polycystic ovary syndrome (PCOS). The BioCycle Study found that normally menstruating women may also experience the endocrine disturbances that lead to PCOS.^1,2,3 Researchers hope to determine how the disturbances can help improve diagnoses and treatment for women with PCOS.

The NICHD Unit on Reproductive and Regenerative Medicine, part of the Program in Reproductive and Adult Endocrinology (PRAE) within the NICHD Division of Intramural Research (DIR), leads numerous studies to advance understanding of primary ovarian insufficiency (POI) and Fragile X-associated ovarian insufficiency (FXPOI). In one study, researchers were able to slow an immune system attack on the ovaries of mice by "teaching" the animals' immune systems to recognize the ovarian protein MATER (a maternal antigen that embryos require) as part of its own tissues. Researchers hope to one day be able to screen and explore fertility-sparing options in women who are at risk for autoimmune FXPOI. Other studies focus on the increased risk for osteoporosis in women with FXPOI as compared to normally menstruating women. A late diagnosis of FXPOI contributes to reduced bone density by delaying proper therapy. Additional studies by this NICHD research group focus on the menstrual cycle as an indicator of overall health.

The Unit on Reproductive Endocrinology and Infertility, also within the NICHD DIR, is studying loss of ovarian function and secondary amenorrhea among women who receive chemotherapy for cancer. Recent studies indicate that mice pretreated with gonadotropin-releasing hormone (GnRH) therapy prior to chemotherapy had their ovarian function preserved and restored after chemotherapy ended. A clinical trial is under way to determine whether giving GnRH therapy to women prior to chemotherapy also restores ovarian function after the therapy ends.

The Fertility and Infertility (FI) Branch supports the Reproductive Medicine Network (RMN), which studies PCOS and other conditions that may include secondary amenorrhea as a symptom. In addition, the Branch supports studies on neuroendocrine regulation of menstruation in women with and without related conditions, such as PCOS; on the regulation of pubertal onset and factors, including lifestyle issues such as caloric restriction or excessive exercise or stress, that influence menstruation initiation or cycling; and on physiological processes beyond pregnancy, breastfeeding, and menopause that may cause or contribute to amenorrhea.

• The National Centers for Translational Research in Reproduction and Infertility (NCTRI) (Formerly the Specialized Cooperative Centers Program in Reproduction and Infertility Research [SCCPIR]) is a national network of research-based centers, supported through the FI Branch, that promote interactions between basic and clinical scientists, with the goal of improving reproductive health. Several NCTRI sites study amenorrhea as a condition and as a symptom of other conditions such as polycystic ovary syndrome (PCOS).
• The FI Branch also supports the Fertility Preservation Research Program, which funds research on several areas. These include the incidence and prevalence of infertility in women who have undergone chemotherapy or radiation therapy, which can cause short- and long-term amenorrhea, and the development of biomarkers and clinical parameters to better predict ovarian reserve and thus the potential success of in vitro fertilization (IVF).
• Through the NCTRI, NICHD also supports the Human Endometrial Tissue and DNA Bank . The Tissue Bank stores donated human endometrial tissue, blood, and DNA as a resource for researchers to use in in vitro and in situ studies and experiments. Specimens are catalogued according to histology and clinical parameters.