Stress and Menstrual Health

May 4, 2026 updated by: Duke University

The Influence of Non-energetic Stressors on Human Menstrual Function

The goal of this experimental study is to determine how stressors that do not directly impact energy state or energy demands (hereafter called "non-energetic stressors") affect reproductive health in pre-menopausal women. It aims to do this by answering the following main questions: Do non-energetic stressors create a stress response? How does the stress response impact sex hormone concentration and thus menstrual dysfunction? If stress caused by non-energetic stressors does impact sex hormone concentration, does it do so primarily at the level of the brain or the level of the ovary? Participants will be enrolled in this study for 6 months. For two of these months, they will undergo a short stress intervention and provide samples to measure hormone concentration and total energy expenditure.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

The Reproductive Suppression Model posits that due to the high cost and failure rate of human reproduction, the female body maximizes lifetime reproductive fitness by suppressing reproduction during poor conditions (where likelihood of offspring survival is low) until conditions are more favorable. The hormonal mechanism for this suppression when calories are scarce and the female body is in low energy availability (LEA) has been studied. However, the mechanism for this suppression in the presence of stressors unrelated to low energy availability, but which could still negatively impact offspring survival, is much less clear. The investigators define such stressors, which do not impact energy state or energetic demands, as "non-energetic stressors." Thus, the aim of this study is to determine if non-energetic stressors drive reproductive suppression in humans. The investigators will assess this by testing the impact of a stress intervention on the stress hormones cortisol and norepinephrine, and in turn if the levels of these stress hormones predict the levels of sex hormones associated with the menstrual cycle. Finally, the investigators will assess if changes in stress hormones change total and basal energy expenditure.

Study Type

Interventional

Enrollment (Estimated)

600

Phase

  • Not Applicable

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

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Adult pre-menopausal females, 18-45 years old
  • Habitually sedentary (less than 60 minutes MVPA/week) for Exercise cohort

Exclusion Criteria:

  • Individuals on hormonal birth control (oral contraception, injection, implant, or intrauterine device)
  • Individuals with incidence in the last 6 months of childbirth, lactation, pregnancy, or functional hypothalamic amenorrhea (FHA)
  • Individuals with reproductive disorders (e.g. endometriosis, polycystic ovarian syndrome (PCOS))
  • Individuals taking thyroid medications
  • Individuals who have undergone or are undergoing menopause
  • MVPA >60 min/week (for Exercise cohort)

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

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Heat Stress
Heat stress via 70-80°C sauna exposure for 45-min sessions on 5 consecutive days (days 4-8 or 5-9 of follicular phase).
Other: Heat stress
Stress-Heat participants will undergo supervised 40-min sessions in a 70-80˚C sauna
Experimental: Sleep Stress
Sleep restriction to 4-6 hours/night for 5 consecutive nights (on days 3-8 or 4-9 of follicular phase).
Other: Sleep stress
Stress-Sleep participants will be asked to sleep for between 4 and 6 hours per night, with compliance monitored via their activity monitors and self-reported sleep diaries. Participants will be requested to maintain normal wake cycles without midday sleep.
Experimental: Exercise Stress
One-hour cycling at 60-75% predicted max HR for 5 consecutive days (days 4-8 or 5-9 of follicular phase).
Other: Exercise stress
Stress-Exercise participants will come to the Pontzer Lab to complete a one-hour cycling workout on a Lode Corival CPET ergometer/exercise bike at 60-75% predicted maximum heart rate.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Total daily energy expenditure (TDEE)
Time Frame: Baseline (Month 2), Intervention (Month 4)
TDEE (kcal) will be measured over a 7-day period during the Baseline and first Intervention month using the doubly-labeled water (DLW) method. DLW is a safe and reliable method for capturing free-living TDEE and has been validated for human studies. The DLW method adds a known amount of stable isotopes, oxygen-18 (18O) and deuterium (2H), to a participant's total body water (TBW) via ingestion and then measures the depletion rate of these isotopes as they are removed from the body via urine and exhalation.
Baseline (Month 2), Intervention (Month 4)
Basal metabolic rate (BMR)
Time Frame: Baseline (Month 2), Control (Month 3), Intervention (Months 4-5), and Follow-up (Month 6)
BMR (kcal/d) will be estimated via indirect calorimetry. Participants will be asked to come in for a lab visit on a day of their choice within 2-7 days post-ovulation prior to consuming breakfast or any non-water beverage and after having refrained from exercise for 24 hours pre-measurement. Participants will lie on an exam bed in the Pontzer Lab and have a clear plastic hood connected to a COSMED Quark RMR machine placed over their head for approximately 25-30 minutes. This hood will collect exhaled air, which will be measured for CO2 production to estimate BMR.
Baseline (Month 2), Control (Month 3), Intervention (Months 4-5), and Follow-up (Month 6)
Sex hormone concentration (estradiol)
Time Frame: Baseline (Month 2), Control (Month 3), Intervention (Months 4-5), and Follow-up (Month 6)
Samples will be assayed via enzyme-linked immunosorbent assay (ELISA) in the Pontzer Lab.
Baseline (Month 2), Control (Month 3), Intervention (Months 4-5), and Follow-up (Month 6)
Sex hormone concentration (progesterone)
Time Frame: Baseline (Month 2), Control (Month 3), Intervention (Months 4-5), and Follow-up (Month 6)
Samples will be assayed via enzyme-linked immunosorbent assay (ELISA) in the Pontzer Lab.
Baseline (Month 2), Control (Month 3), Intervention (Months 4-5), and Follow-up (Month 6)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Stress hormone concentration (norepinephrine)
Time Frame: Baseline (Month 2), Control (Month 3), Intervention (Months 4-5), and Follow-up (Month 6)
Samples will be assayed via enzyme-linked immunosorbent assay (ELISA) in the Pontzer Lab.
Baseline (Month 2), Control (Month 3), Intervention (Months 4-5), and Follow-up (Month 6)
Stress hormone concentration (cortisol)
Time Frame: Baseline (Month 2), Control (Month 3), Intervention (Months 4-5), and Follow-up (Month 6)
Samples will be assayed via enzyme-linked immunosorbent assay (ELISA) in the Pontzer Lab.
Baseline (Month 2), Control (Month 3), Intervention (Months 4-5), and Follow-up (Month 6)
Stress hormone concentration (salivary alpha-amylase)
Time Frame: Baseline (Month 2), Control (Month 3), Intervention (Months 4-5), and Follow-up (Month 6)
Samples will be assayed via enzyme-linked immunosorbent assay (ELISA) in the Pontzer Lab.
Baseline (Month 2), Control (Month 3), Intervention (Months 4-5), and Follow-up (Month 6)
Sex hormone concentration (luteinizing hormone (LH))
Time Frame: Baseline (Month 2), Control (Month 3), Intervention (Months 4-5), and Follow-up (Month 6)
Samples will be assayed via enzyme-linked immunosorbent assay (ELISA) in the Pontzer Lab.
Baseline (Month 2), Control (Month 3), Intervention (Months 4-5), and Follow-up (Month 6)
Sex hormone concentration (follicle-stimulating hormone (FSH))
Time Frame: Baseline (Month 2), Control (Month 3), Intervention (Months 4-5), and Follow-up (Month 6)
Samples will be assayed via enzyme-linked immunosorbent assay (ELISA) in the Pontzer Lab.
Baseline (Month 2), Control (Month 3), Intervention (Months 4-5), and Follow-up (Month 6)

Collaborators and Investigators

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

Sponsor

Duke University

Investigators

  • Principal Investigator: Herman Pontzer, PhD, Duke University Evolutionary Anthropology Department

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 (Estimated)

May 1, 2026

Primary Completion (Estimated)

August 1, 2028

Study Completion (Estimated)

August 1, 2029

Study Registration Dates

First Submitted

April 29, 2026

First Submitted That Met QC Criteria

April 29, 2026

First Posted (Actual)

May 5, 2026

Study Record Updates

Last Update Posted (Actual)

May 7, 2026

Last Update Submitted That Met QC Criteria

May 4, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Pro00119656

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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