OR21-1 Does Estrogen Replacement Improve Verbal Memory and Executive Control in Oligo-Amenorrheic Athletes?

Program: Abstracts - Orals, Poster Previews, and Posters
Session: OR21-Markers and Consequences of Ovulatory (dys)Function
Saturday, April 2, 2016: 11:45 AM-1:15 PM
Presentation Start Time: 11:45 AM
Room 162 (BCEC)

Outstanding Abstract Award
Charu Baskaran*1, Brooke Cunningham2, Franziska Plessow3, Vibha Singhal4, Kathryn E Ackerman4, Elizabeth A. Lawson3, Kamryn T. Eddy3 and Madhusmita Misra4
1Massachusetts General Hospital for Children, Boston, MA, 2University of Connecticut School of Medicine, 3Massachusetts General Hospital/Harvard Medical School, Boston, MA, 4Massachusetts General Hospital and Harvard Medical School, Boston, MA
Background: Both estrogen and exercise may have cognition enhancing benefits. Although results of hormone replacement in postmenopausal women are inconclusive, improved non-verbal processing speed has been reported in girls with Turner syndrome (a younger population) who receive estrogen replacement. Young athletes who develop amenorrhea secondary to energy deficit are estrogen deficient, and are a model of exercise with associated hypoestrogenism. However, the impact of estrogen replacement on cognitive function in young oligo-amenorrheic athletes (OA) has not been evaluated.

Objective: To determine whether 6 months of estrogen replacement will impact cognitive domains in OA. We hypothesized that estrogen replacement would improve verbal memory and executive control in OA.

Methods: We performed cognitive assessments at baseline and after 6 months in 48 OA aged 14-25 years randomized to estrogen (EST+) (oral 30 mcg ethinyl estradiol (n=16) or transdermal 100 mcg 17-beta estradiol patch (n=13)), or no estrogen (EST-) (n=19) in an ongoing clinical trial. Neurocognitive testing included tests for crystallized and fluid intelligence [Wechsler Abbreviated Scale of Intelligence (WASI)], verbal learning and memory [California Verbal Learning Test II (CVLT-II)], and executive control [Delis-Kaplan Executive Function System Color-Word Interference Test (DKEFS-CWIT)]. We first compared EST+ and EST- groups followed by a post-hoc analysis of transdermal vs. oral estrogen and no treatment.

Results: Subjects (age: 19.9±3.1 years (Mean±SD), BMI: 20.6±2.3 kg/m2) participated in an average of 10.3±5.9 hours/week of weight-bearing activities of lower limbs. WASI scores and baseline (BL) scores for CVLT-II and DKEFS-CWIT did not differ in EST+ and EST- groups.  Improvements in CVLT-II verbal memory scores for immediate recall over 6 months of therapy were greater in the EST+ group compared to EST- (p<0.05). These differences persisted for immediate recall after controlling for BL scores and age. Changes in D-KEFS CWIT over 6 months did not differ between EST+ and EST- groups. However, the EST+ group had greater improvements in inhibition switching completion time over 6 months compared with the EST- group after controlling for BL scores and age (p=0.01). On post-hoc analyses, improvements in CVLT-II immediate recall (adjusted for BL scores +/- age) and DKEFS-CWIT inhibition switching completion (adjusted for BL scores and age) were observed with transdermal estrogen (p≤0.05 compared with no estrogen) but not oral estrogen (p>0.10 compared with no estrogen).

Conclusion:OA show improvements in verbal memory and executive control following 6 months of estrogen replacement, with transdermal estrogen performing better than oral estrogen. Our findings in these athletes, who are in their prime of neurocognitive development, underscore the need for future studies exploring cognition in OA.

Nothing to Disclose: CB, BC, FP, VS, KEA, EAL, KTE, MM

*Please take note of The Endocrine Society's News Embargo Policy at https://www.endocrine.org/news-room/endo-annual-meeting/pr-resources-for-endo

Sources of Research Support: NIH Training grant T32 DK007028 5 R01 HD060827  5 K24 HD071843