Sex Hormones and Orthostatic Tolerance

This study is designed to determine the causes of "orthostatic intolerance" which occurs more commonly in women than in men. Orthostatic tolerance is the ability to remain standing up right for long periods of time, or to avoid dizziness when moving to standing from a seated or lying position.

Study Overview

• Status: Completed
• Conditions: Orthostatic Intolerance
• Intervention / Treatment: Drug: Ganirelix acetate; Drug: 17β-Oestradiol; Drug: Progesterone

Detailed Description

In this study we are interested in determining the impact of female reproductive hormones (estrogen and progesterone) on orthostatic tolerance (described above) so we administer these hormones to participants. We also test participants' orthostatic tolerance in our laboratory and use this information to place subjects into groups.

• Study Type: Interventional
• Enrollment (Actual): 109
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Connecticut
    • New Haven, Connecticut, United States, 06519
      • John B. Pierce Laboratory

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 34 years (ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Healthy, English-speaking non-smoking women age 18- 34 with regular menses

Exclusion Criteria:

• Gynecologic:

  1. current or past estrogen-dependent neoplasia,
  2. unexplained vaginal bleeding,
  3. history of uterine fibroids,
  4. current pregnancy,
  5. known or suspected breast or uterine cancer,
  6. partial or complete hysterectomy

• Cardiac:

  1. myocardial infarction, ventricle tachycardia or fibrillation,
  2. angina,
  3. valvular disease,
  4. congestive heart failure, orthopnea, paroxysmal nocturnal dyspnea,
  5. current arrhythmias,
  6. prosthetic valves

• Pulmonary:

  1. current cigarette smokers, or pipe or cigar smokers,
  2. chronic obstructive pulmonary disease,
  3. adult asthma,
  4. dyspnea on exertion,
  5. current bronchitis, pneumonia, or tuberculosis,
  6. lung carcinoma,
  7. pulmonary embolus, recent

• Vascular:

  1. claudication or history of peripheral vascular disease,
  2. abdominal or thoracic aortic aneurysm, or repair of same,
  3. cerebral aneurysm, vascular malformations,
  4. hypertension, systolic or diastolic, or strong family history of hypertension

• Gastrointestinal:

  1. GI malignancy,
  2. hepatitis, current,
  3. splenomegaly from any cause,
  4. Cholecystitis,
  5. current diverticulosis or diverticulitis, inflammatory bowel disease, ulcerative colitis, Crohn's Disease,
  6. previous gastrointestinal surgery
• Infectious Disease: any intercurrent infection

• Hematologic/Oncologic:

  1. receiving chemotherapy or radiation therapy,
  2. any metastatic malignancy,
  3. anemia (hematocrit < 35),
  4. thrombocytopenia or thrombocytosis,
  5. neutropenia,
  6. hematologic malignancy,
  7. bleeding dyscrasia

• Neurologic:

  1. history of cerebral vascular accident with any neurologic sequels,
  2. uncontrolled seizures (e.g. more than 1 seizure/year),
  3. transient ischemic attacks,
  4. dementia,
  5. neurologic conditions producing dyscoordination, peripheral neuropathy, or myopathy,
  6. severe migraine headaches

• Endocrine:

  1. diabetes mellitus,
  2. any untreated endocrinopathy

• Renal:

  1. chronic renal disease,
  2. any history of renal disease or impairment,
  3. current urinary tract infection

• Musculoskeletal:

  1. inflammatory arthritis history (e.g., rheumatoid, psoriatic, Reiters),
  2. any history of pathologic fractures, including vertebral compression fractures

• Pharmacologic:

  1. any illegal drug use,
  2. alcohol use greater than an average of 4 oz/day over 30 days,
  3. coumadin or heparin use,
  4. current systemic antifungal use

Study Plan

How is the study designed?

Design Details

• Primary Purpose: BASIC_SCIENCE
• Allocation: NON_RANDOMIZED
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Ganirelix acetate; Subjects were given 250 μg in 0.5ml normal saline for 16 days. (Organon, Roseland, NJ, USA)	Drug: Ganirelix acetate; Ganirelix acetate: .25 ml/day by subcutaneous injection; Other Names: Antagon
EXPERIMENTAL: 17β-Oestradiol, E2; The same women added 17β-Oestradiol, E2; 0.2 mg day-1 patch (Vivelle; CIBA Pharmaceuticals, Summit, NJ) for days 4-16.	Drug: 17β-Oestradiol; 17 beta estradiol: 0.2 mg/day (patches); Other Names: estradiol; 17 beta estradiol
EXPERIMENTAL: Progesterone; The same women added progesterone (P4, 200 mg day-1 Prometrium, oral, Solvay Pharmaceuticals, Marietta, GA, USA) on days 13-16.	Drug: Progesterone; progesterone, 200 mg day-1 oral; Other Names: Prometrium; P4

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Orthostatic Tolerance	We used a measure called cumulative stress index to determine orthostatic tolerance, which is the amount of time at a level of negative pressure each subject can maintain before feeling as if she is going to pass out. This is calculated by multiplying the pressure in mm Hg by the time in min.	2 months
Baroreceptor Function	This is a measure of how the body responds to changes in pressure induced by changes in position such as sitting, lying standing. The pressure changes are induced by gravity. The measurement described below to assess baroreceptor function is units of change in forearm vascular resistance for a given change in lower body negative pressure. This allows us to determine how good the body is at sending signals to the periphery to respond to postural changes. Baroreflex sensitivity is defined as the change in interbeat interval (IBI) in milliseconds per unit change in BP. For example, when the BP rises by 10 mmHg and IBI increases by 100 ms, BRS would be 100/10 = 10 ms/mmHg.	2 months
Skin Microvascular Responses	Changes in blood flow in the small vessel in the skin are measured in response to sequential heat and drug stimulation. It is measured in volts, and then corrected for a maximum level and expressed as "% max." This is measured with a Laser Doppler probes, which measures volts.	2 months

Collaborators and Investigators

• Sponsor: Yale University
• Collaborators: National Heart, Lung, and Blood Institute (NHLBI)

Study record dates

Study Major Dates

• Study Start: February 1, 2006
• Primary Completion (ACTUAL): December 1, 2012
• Study Completion (ACTUAL): May 1, 2013

Study Registration Dates

• First Submitted: June 28, 2010
• First Submitted That Met QC Criteria: June 29, 2010
• First Posted (ESTIMATE): June 30, 2010

Study Record Updates

• Last Update Posted (ACTUAL): December 13, 2018
• Last Update Submitted That Met QC Criteria: November 15, 2018
• Last Verified: November 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nervous System Diseases; Neurologic Manifestations; Autonomic Nervous System Diseases; Primary Dysautonomias; Orthostatic Intolerance; Physiological Effects of Drugs; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Estrogens; Hormone Antagonists; Contraceptive Agents, Hormonal; Contraceptive Agents; Reproductive Control Agents; Contraceptive Agents, Female; Progestins; Estradiol; Progesterone; Estradiol 17 beta-cypionate; Estradiol 3-benzoate; Polyestradiol phosphate; Ganirelix
• Other Study ID Numbers: 0512000875a; 2R01HL071159-04 (NIH)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Our data are stored in locked files, and our spreadsheets and raw data are available should they be requested