Evaluation of the Association Between the Menstrual Cycle and Weight Loss in Healthy, Overweight Premenopausal Women (MENSTRALEAN)

January 13, 2016 updated by: Arne Astrup, University of Copenhagen

Evaluation of the Association Between the Menstrual Cycle and Weight Loss in Healthy, Overweight Premenopausal Women - A 6-Month Intervention

Achievement and maintenance of weight loss in obese individuals has proven difficult. Many hypotheses have suggested potential biological mechanisms to explain why weight loss attempts often fail, and the surrounding obesogenic environment also seems an obvious candidate. Among the biological factors proposed is gender, and weight loss trials have frequently shown that females are less successful than males at losing weight and at maintaining weight loss.

Women's weight is influenced by the menstrual cycle, in which changes in hormonal levels and interactions work to modulate fertility. These hormones control the menstrual cycle and coordinate the required changes in energy intake, expenditure, and storage, whilst preparing the body for pregnancy every month. As reproduction is a primary biological function, these hormones may be such strong mediators of eating behavior that they influence the outcome of a weight loss attempt. The menstrual cycle should therefore be taken into consideration as a factor in the physiology of energy balance in premenopausal women.

The cycle can be divided into three phases: menstruation or early follicular phase (days 1-5), late follicular phase that lasts until ovulation (~days 6-14, and the luteal phase (days 15-28).

Studies have shown that in the luteal phase of the menstrual cycle, women's energy intake and energy expenditure are increased and women experience more frequent cravings for foods, particularly those high in carbohydrate and fat, than during the follicular phase. A trend towards reduced carbohydrate utilization and increased fat oxidation in the luteal phase has also been reported, together with prolonged time to exhaustion when exercising at submaximal intensities. This suggests that the potential of the underlying physiology related to each phase of the menstrual cycle may be worth considering as an element in strategies to optimize weight loss.

In 2010 the investigators carried out a 90-day randomized, controlled pilot study in order to gain feedback on and assess acceptance of the meal and exercise plans being used and to observe if less control visits than planed in the main study were sufficient to achieve good compliance. Twenty eight were sreened and 24 were included. Subjects were randomized to either program A (given meal and exercise plans in relation to phases of their menstrual cycles) or Program B (a reduced calorie diet, calorie-matched to program A). The pilot study showed that Group A (The Menstralean group) tended to have a greater average weight loss at 60 days (-5.29 vs -3.57 kg, p = 0.06) and 90 days (-4.22 vs -2.75 kgs, p = 0.2) compared to the control groups. There was a dropout rate of 27%. This was primarily due to an inadequate number of control visits and contact with the subjects. Thus the Menstralean program seems to have the potential to enhance weight loss in overweight and obese women. However, the main study has to be carried out with more subjects in each group in a longer duration and with more support and contact with the subjects.

The aim of the present trial is to examine the impact of the menstrual cycle on weight loss attempts in healthy overweight (BMI > 27 kg/m2) premenopausal women (18-40 years) randomized to two different weight management programs for a period of 6 months.

Study Overview

Study Type

Interventional

Enrollment (Actual)

60

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Frederiksberg, Denmark, 1958
        • Department of Human Nutrition, Faculty of Science, University of Copenhagen, Denmark

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 40 years (Adult)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • Healthy females between the ages of 18-40 (inclusive)
  • BMI > 27 kg/m².
  • Regular menstrual cycle (28 ± 4 days - with a maximum of 4 days within-subject variation in menstrual cycle duration.
  • Weight stable (within ± 3-kg) 2 months prior to study inclusion
  • Must use barrier contraception (e.g. male/female condom) for the study's duration
  • Must be willing to follow the prescribed diet/exercise plan for the study's duration

Exclusion Criteria:

  • On hormonal contraceptives (IUD are allowed) or any other daily use of medications which can make the subject unsuitable for inclusion in the study.
  • Any significant health problem (history of cancer, HIV/AIDS, Diabetes, cardiovascular disease, untreated hypothyroidism, etc.)
  • Restrictions against participating in cardiovascular exercise and strength training
  • Any condition, which in the opinion of the investigator makes the subject unsuitable for inclusion in the study.
  • Women who are pregnant,lactating, or planning to become pregnant during the study period

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Menstralean group

Represents a program which is designed to induce weight loss by taking into account the physiology of each menstrual phase in terms of adjusting diet and physical activity to the body's cyclic changes in energy demands.

The diet will be adjusted to match one menstrual cycle in duration (approx. 1 month) and will be separated into three phases corresponding to three menstrual phases: menstruation (days 1-5), the follicular phase (days 6-14), and the luteal phase (days 15-28). All women in this group will start the program at day 1 in their cycle. The diet will be repeated six times for each woman, which equals six months.

2-arm parallel 6 month study with the obejective to examine the impact of the menstrual cycle on weight loss attempts in healthy overweight premenopausal women randomized to two different weight management programs. The women may not use hormonal contraceptive agents other than an IUD.
Active Comparator: Control Group:

Represents a program where subjects engage in a similar diet and exercise program as the Menstralean Group, specifically based on the educational diet system "Eat for Life". Importantly, the subjects in Control group will start the program at a random time in their menstrual cycles.

Eat for Life is a simple tool for controlling the energy content and nutritional composition of your diet. The method is based on a system of counters that ensure strict control of the diet whilst still allowing a great deal of freedom of choice. The subjects in the Control Group will also receive exactly the same attention and undergo the same visits and measurements as the Menstralean Group.

2-arm parallel 6 month study with the obejective to examine the impact of the menstrual cycle on weight loss attempts in healthy overweight premenopausal women randomized to two different weight management programs. The women may not use hormonal contraceptive agents other than an IUD.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in body weight (kg)
Time Frame: will be measured at baseline and week 2, 4, 8, 12, 16, 20, 24 and at follow up (8 months after initiation)
Assessment of body weight will be carried on a digital scale to the nearest 0.05 kg. The measurement will be carried out after the subjects have emptied their bladder and only wearing underwear.
will be measured at baseline and week 2, 4, 8, 12, 16, 20, 24 and at follow up (8 months after initiation)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in waist circumference (cm)
Time Frame: measurement will be carried out at baseline and week 2, 12, 24 and at follow up (8 months after initiation)
Assessment of waist circumference will be carried with a measuring tape to the nearest 0.5 cm. The measurement will be carried out after the subjects have emptied their bladder and only wearing underwear.
measurement will be carried out at baseline and week 2, 12, 24 and at follow up (8 months after initiation)
Height (cm)
Time Frame: measurement will be carried out at screening
Height of the subject will measured in a up-right position without shoes to the nearest 0.5 cm.
measurement will be carried out at screening
Change in body mass index (BMI)
Time Frame: measurement will be carried out at baseline and week 2, 4, 8, 12, 16, 20, 24 and at follow up (8 months after initiation)
BMI is based on the measurement of height and body weight: weight (kg)/ (height (cm)* height (cm))
measurement will be carried out at baseline and week 2, 4, 8, 12, 16, 20, 24 and at follow up (8 months after initiation)
Assessment of Well-being/quality of life
Time Frame: measurement will be carried out at screening, baseline and week 12 and 24 and after 8 months (follow up)
Quality of life will be assessed by IWQOL-Lite questionnaire at screening, baseline, week 12, week 24 and at follow-up 8 month after initiation of intervention.
measurement will be carried out at screening, baseline and week 12 and 24 and after 8 months (follow up)
Assessment of Impact of Weight on Quality of Life
Time Frame: measurement will be carried out at screening, baseline and week 12 and 24 and after 8 months (follow up)
'Impact of Weight on Quality of Life' will be assessed by IWQOL-Lite questionnaire at screening, baseline, week 12, week 24 and at follow-up 8 month after initiation of intervention.
measurement will be carried out at screening, baseline and week 12 and 24 and after 8 months (follow up)
Assessment of Food cravings
Time Frame: measurement will be carried out at screening, baseline and week 12 and 24 and after 8 months (follow up)
'Impact of Weight on Quality of Life' will be assessed by FCI-II questionnaire at screening, baseline, week 12, week 24 and at follow-up 8 month after initiation of intervention.
measurement will be carried out at screening, baseline and week 12 and 24 and after 8 months (follow up)
Drop-out rate during the first 24 weeks
Time Frame: measured during the 24-week intervention
measured during the 24-week intervention

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

September 1, 2011

Primary Completion (Actual)

May 1, 2013

Study Completion (Actual)

May 1, 2013

Study Registration Dates

First Submitted

June 14, 2012

First Submitted That Met QC Criteria

June 15, 2012

First Posted (Estimate)

June 18, 2012

Study Record Updates

Last Update Posted (Estimate)

January 14, 2016

Last Update Submitted That Met QC Criteria

January 13, 2016

Last Verified

January 1, 2016

More Information

Terms related to this study

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