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Lecture 22: WomenLecture 22: Women’’s Health Issuess Health Issues
•• Breast CancerBreast Cancer
•• DepressionDepression
•• Stress and female Stress and female
fecundityfecundity
(Behavioral Biology of Women-2007)
What is Breast Cancer?What is Breast Cancer? Symptoms of Breast CancerSymptoms of Breast Cancer
•• Change in outline, Change in outline, shape or size of breastshape or size of breast
•• Puckering of dimpling Puckering of dimpling of skinof skin
•• Lump or thickening in Lump or thickening in the breast or armpitthe breast or armpit
•• Flaking skin or Flaking skin or discharge from nippledischarge from nipple
•• UnusualUnusual pain or pain or discomfortdiscomfort
Breast Cancer in MenBreast Cancer in Men
22
Breast Cancer is related Breast Cancer is related
toto Ovarian Hormone Ovarian Hormone
ExposureExposure
WhatWhat risk factors risk factors
increase exposure to increase exposure to
ovarian hormones?ovarian hormones?
Population variation in progesterone Population variation in progesterone
and breast cancer incidenceand breast cancer incidence
2.4
2.9
3.4
3.9
4.4
Log mid-luteal progesterone (pmol/l)
Log breast cancer incidence rate
(per 100,000)
5.3 5.4 5.5 5.6 5.7 5.8 6.0
U.S.A. (87.1)
Poland (36.0)
Nepal (21.2)
Bolivia (21.5)
Congo (10.7)
Jasienska & Thune 2001
Population Differences in Exposure to EstrogenPopulation Differences in Exposure to Estrogen
Individual Differences in Ovarian Hormone Individual Differences in Ovarian Hormone
Exposure in Same PopulationExposure in Same Population
100
200
300
400
500
600
700
-18 -16 -14 -12 -10 -8 -6 -4 -2
reverse cycle day
Salivary progesterone (pmol/L)
Cycle Differences within Cycle Differences within
one Womanone Woman
100
300
500
700
Salivary progesterone (pmol/L)
-18 -16 -14 -12 -10 -8 -6 -4 -2
Reverse cycle day
October
September
August
July
33
WhatWhat risk factors risk factors
increase exposure to increase exposure to
ovarian hormones?ovarian hormones?
��DietDiet
Breast Cancer and DietBreast Cancer and Diet
Dietary constituents or increased hormonal Dietary constituents or increased hormonal
levels because of high calorie intake?levels because of high calorie intake?
Tea Drinking and Tea Drinking and EstradiolEstradiol
Mary Mary CassattCassatt, 1880, 1880
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
Kapiszewska, Thune, Ellison & Jasienska (submitted)
•• Flavonoids Flavonoids found in found in
high levels in teahigh levels in tea
•• Inhibit Inhibit aromatase aromatase of of
androgen to androgen to
estrogenestrogen
•• Bind with estrogen Bind with estrogen
receptorsreceptors
Tea Drinking and Tea Drinking and EstradiolEstradiol
Aligned day of menstrual cycle
-8 -6 -4 -2 +2 +4 +6 +80
10
20
30
40
Salivary Estradiol (pmol/L)
low consumption
high consumption
Kapiszewska, Thune, Ellison & Jasienska (submitted)
•• Flavonoids Flavonoids found in found in
high levels in teahigh levels in tea
•• Inhibit Inhibit aromatase aromatase of of
androgen to estrogenandrogen to estrogen
•• Bind with estrogen Bind with estrogen
receptorsreceptors
•• Lowers estrogen levelsLowers estrogen levels
WhatWhat risk factors risk factors
increase exposure to increase exposure to
ovarian hormones?ovarian hormones?
��DietDiet
��ExerciseExercise
Breast Cancer and ExerciseBreast Cancer and Exercise
•• Lower ovarian Lower ovarian
hormone productionhormone production
•• Later menarcheLater menarche
•• Lower set points?Lower set points?
44
Progesterone profiles: women with high Progesterone profiles: women with high
and moderateand moderate physical activityphysical activity
Jasienska & Ellison, Proc. Royal Soc. London (1998)
Estradiol Estradiol profiles: women with low, profiles: women with low,
moderate or high physical activitymoderate or high physical activity
High Activity
Moderate Activity
Low Activity
Aligned Days of Menstrual Cycle
15
20
25
30
35
Estradiol (pmol/L)
-8 -6 -4 -2 0 +2 +4 +6 +8
Jasienska et al submitted
WhatWhat risk factors risk factors
increase exposure to increase exposure to
ovarian hormones?ovarian hormones?
��DietDiet
��ExerciseExercise
��Reproductive Reproductive
HistoryHistory
Breast Cancer Risk FactorsBreast Cancer Risk Factors
•• Early menarcheEarly menarche
•• Late menopauseLate menopause
•• Low parityLow parity
•• Late age of first Late age of first
fullfull--term pregnancyterm pregnancy
((KvaleKvale, 1992), 1992)
Breast Cancer Risk Breast Cancer Risk
and Age at First and Age at First
BirthBirth
Subsistence Patterns and Life History: Subsistence Patterns and Life History:
Differences in Exposure to EstrogenDifferences in Exposure to Estrogen
55
WhatWhat risk factors risk factors
increase exposure to increase exposure to
ovarian hormones?ovarian hormones?
��DietDiet
��ExerciseExercise
��Reproductive Reproductive
HistoryHistory
��LactationLactation
Breast Feeding and Lower Breast Breast Feeding and Lower Breast
Cancer RatesCancer Rates
•• Lower risk withLower risk with
��Increased duration of Increased duration of breast feedingbreast feeding
��Number of children Number of children breast fedbreast fed
WhatWhat risk factors risk factors
increase exposure to increase exposure to
ovarian hormones?ovarian hormones?
��DietDiet
��ExerciseExercise
��Reproductive Reproductive
HistoryHistory
��LactationLactation
��Body Body
CompositionComposition
MidMid--cycle cycle estradiol estradiol in women with different in women with different
combinations of breast size and WHRcombinations of breast size and WHR
5
10
15
20
25
30salivary estradiol (pmol/L)
narrow waist large
breasts
narrow waist small breasts
broad waist large
breasts
broad waist small breasts
Jasienska et al 2004
salivary estradiol (pmol/L)
10
20
30
40
50
cycle day
0 4 8-4-8
narrow waist
broad waist
Jasienska et al 2004
Estradiol Estradiol in women with in women with
low and high waistlow and high waist--hip ratiohip ratioProgesterone in women with Progesterone in women with
low and high waistlow and high waist--hip ratiohip ratio
salivary progesterone (pmol/L)
50
100
150
200
250
reverse cycle day
-1-5-9-13
narrow waist
broad waist
Jasienska et al 2004
66
Estradiol Estradiol in women with in women with
larger and smaller breastslarger and smaller breasts
larger breasts
smaller breasts
10
20
30
40
50
salivary estradiol (pmol/L)
aligned cycle day
0 4 8-4-8
Jasienska et al 2004
WhatWhat risk factors risk factors
increase exposure to increase exposure to
ovarian hormones?ovarian hormones?
��DietDiet
��ExerciseExercise
��Reproductive Reproductive
HistoryHistory
��LactationLactation
��Body Body
CompositionComposition
��Birth WeightBirth Weight
Estradiol Estradiol in relation to size at birthin relation to size at birth
Low Moderate High
14
16
18
20
Ponderal index tertiles
Estradiol (pmol/L)
Jasienska et al Jasienska et al AmerAmer. J. Human Biology. J. Human Biology (2006)(2006)
What can we do about breast cancer?What can we do about breast cancer?
What can we do about it?What can we do about it? Estradiol Estradiol in relation toin relation to size at birth and size at birth and
physical activityphysical activity
high activitymoderate activitylow activity
Small size Large size
12
16
20
24
Estradiol (pmol/L)
Jasienska et al. submitted
77
What can we do about it?What can we do about it? What can we do about it?What can we do about it?
•• Hormone therapy:Hormone therapy:
��PikePike’’s Pills Pill
What can we do about it?What can we do about it?
•• Hormone therapy:Hormone therapy:
��PikePike’’s Pills Pill
What can we do about it?What can we do about it?
•• Hormone therapy:Hormone therapy:
��PikePike’’s Pills Pill
��Shot of progesteroneShot of progesterone
What can we do What can we do
about it?about it?
•• Hormone therapy:Hormone therapy:
��PikePike’’s Pills Pill
��Shot of progesteroneShot of progesterone
��TamoxifenTamoxifen
What can we do about it?What can we do about it?
•• Make lactation Make lactation
easier for mothers:easier for mothers:
��Allow time and Allow time and space to pump space to pump breast milk at breast milk at workwork
��Provide onProvide on--site site child care so can child care so can breast feed at breast feed at workwork
��Longer maternity Longer maternity leaveleave
88
Biology of depression, psychosocial stress Biology of depression, psychosocial stress
and female fecundityand female fecundity
DSM Criteria for Depression DSM Criteria for Depression
DiagnosisDiagnosis
Beck Depression InventoryBeck Depression Inventory
•• The most common measure used in large The most common measure used in large
research surveys is the Beck Depression research surveys is the Beck Depression
Inventory.Inventory.
•• Take it if you want toTake it if you want to--
Beck Depression InventoryBeck Depression Inventory
5 minutes, score yourself5 minutes, score yourself
•• Average for college populations is Average for college populations is
12.56 with a SD of 9.93.12.56 with a SD of 9.93.
•• 00--13 minimal, 1413 minimal, 14--19 mild, 2019 mild, 20--28 28
moderate, 29moderate, 29--63 severe63 severe
•• If youIf you’’re feeling depressed, re feeling depressed,
Harvard provides free help at UHS Harvard provides free help at UHS
mental health, stop in or call 5mental health, stop in or call 5--
20422042
Biology of DepressionBiology of Depression
��Sex DifferencesSex Differences
Sex Differences in Depression?Sex Differences in Depression?
•• Epidemiological studies Epidemiological studies indicate that 12 percent of indicate that 12 percent of U.S. women compared to U.S. women compared to 6 percent of U.S. men 6 percent of U.S. men have suffered a have suffered a significant clinical significant clinical depression. depression.
•• Many studies suggest that Many studies suggest that
this is a low estimate this is a low estimate
based on people who seek based on people who seek
treatment.treatment.
99
Impact of Depression on WomenImpact of Depression on Women
•• World Health World Health
Organization found Organization found
depression to be THE depression to be THE
leading cause of leading cause of
““disease burdendisease burden””
among women, noting among women, noting
that if affects 20% of that if affects 20% of
women in developed women in developed
world.world.
Impact of Depression on WomenImpact of Depression on Women
•• 15% of depressed women 15% of depressed women attempt suicideattempt suicide
Impact of Depression on WomenImpact of Depression on Women
•• NIMH estimates that NIMH estimates that depression claims $30.4 depression claims $30.4 billion in treatment and billion in treatment and lost productivity each yearlost productivity each year
Why is depression more common Why is depression more common
in women?in women?
��Hormonal (some evidence)Hormonal (some evidence)
��Learned helplessness, Learned helplessness,
��Power/status, oppression, abuse, Power/status, oppression, abuse,
povertypoverty
��RuminationRumination……still not clear.still not clear.
Biology of DepressionBiology of Depression
��Sex DifferencesSex Differences
�� CrossCross--cultural?cultural?
Cross Cultural Evidence of Sex Cross Cultural Evidence of Sex
DifferenceDifference
•• Important to examine Important to examine
rates of depression in rates of depression in
men and women men and women
outside the West to outside the West to
determine how determine how
widespread the sex widespread the sex
difference is. difference is.
•• PsychologicalPsychological
AnthroplogyAnthroplogy
1010
Cross Cultural Evidence of Sex Cross Cultural Evidence of Sex
DifferenceDifference
•• If sex difference is not If sex difference is not
found in other places found in other places
or if there is a pattern, or if there is a pattern,
may point to social, may point to social,
environmental causes.environmental causes.
Cross Cultural Evidence of Sex Cross Cultural Evidence of Sex
DifferenceDifference
•• Prof. Randy Prof. Randy Nesse Nesse at at
U of Michigan U of Michigan
believes that social believes that social
differences between differences between
now and EEA may now and EEA may
lead to increases in lead to increases in
anxiety and anxiety and
depression.depression.
Cross Cultural Evidence of Sex Cross Cultural Evidence of Sex
DifferenceDifference
•• However, almost all societies However, almost all societies studied studied -- show a higher prevalence show a higher prevalence of depression in women.of depression in women.
Cross Cultural Evidence of Sex Cross Cultural Evidence of Sex
DifferenceDifference
•• Almost all societies studied Almost all societies studied --show a higher prevalence of show a higher prevalence of depression in women.depression in women.
•• A few donA few don’’t:t:
–– In the U.S.: In the U.S.:
__ Old Order Amish, Old Order Amish,
__ college studentscollege students
__ widowed adultswidowed adults
Cross Cultural Evidence of Sex Cross Cultural Evidence of Sex
DifferenceDifference
•• Also, cross culturally, studies in Nigeria and Iran Also, cross culturally, studies in Nigeria and Iran
have shown no sex difference in depression rates. have shown no sex difference in depression rates.
Biology of DepressionBiology of Depression
��Sex DifferencesSex Differences
�� CrossCross--cultural?cultural?
��GeneticsGenetics
1111
Genetics of DepressionGenetics of Depression
Some evidence of genetic influenceSome evidence of genetic influence--depression runs in familiesdepression runs in families
•• Specific genes involved unknownSpecific genes involved unknown
•• No evidence that females are No evidence that females are
disproportionately likely to disproportionately likely to ““inheritinherit””
depressive tendencies, but females are still depressive tendencies, but females are still
twice as likely to be depressed.twice as likely to be depressed.
Genetics of DepressionGenetics of Depression
•• Study of 2,060 female Study of 2,060 female twins. Two groups twins. Two groups those with family those with family history and those history and those without. without.
•• Compared women in Compared women in both groups who had both groups who had experienced recent experienced recent trauma (e.g divorce, trauma (e.g divorce,
death of loved one, etc).death of loved one, etc).
Genetics of DepressionGenetics of Depression
Twin studyTwin study-- Effect of family history on vulnerability to Effect of family history on vulnerability to
depression after trauma (divorce, death of loved one, etc.)depression after trauma (divorce, death of loved one, etc.)
0
2
4
6
8
10
12
14
Depression Rate in
Response to Trauma
twins without family history twins with family history
Genetics of DepressionGenetics of Depression
Biology of DepressionBiology of Depression
��Sex DifferencesSex Differences
�� CrossCross--cultural?cultural?
��GeneticsGenetics
��HormonesHormones
Hormones Implicated in Biology Hormones Implicated in Biology
of Depressionof Depression
•• MelatoninMelatonin
•• CortisolCortisol
•• Reproductive hormones Reproductive hormones (estrogen?)(estrogen?)
1212
Hormones: MelatoninHormones: Melatonin
•• Hormone secreted by the pineal gland Hormone secreted by the pineal gland when it is darkwhen it is dark
Hormones: MelatoninHormones: Melatonin
•• Melatonin levels drop in the morning when Melatonin levels drop in the morning when light hits the retinalight hits the retina
•• During winter months with less light, wild During winter months with less light, wild animals show more melatoninanimals show more melatonin
Hormones: Melatonin and Hormones: Melatonin and
DepressionDepression•• SAD (seasonal affective SAD (seasonal affective
disorder) disorder) –– 3 times more 3 times more common in womencommon in women
•• Women might be more Women might be more responsive to changes in responsive to changes in light/dark cycle.light/dark cycle.
•• Sex differenceSex difference-- artificial light artificial light seems to act like natural light seems to act like natural light on menon men’’s melatonin levels but s melatonin levels but not on womennot on women’’s.s.
•• UV light boxes seem to help!UV light boxes seem to help!
Hormones: MelatoninHormones: Melatonin
•• Common supplement Common supplement
available at health available at health
food storesfood stores
•• Often used for jet lagOften used for jet lag
•• Unregulated by FDAUnregulated by FDA
•• Be careful! No good Be careful! No good
studies of long term studies of long term
use.use.
Cortisol Cortisol
HPA axisHPA axis
HPA axis hyperactivity and HPA axis hyperactivity and
depressiondepression
•• Many (about half of all) depressed patients Many (about half of all) depressed patients
exhibit elevated levels of exhibit elevated levels of cortisolcortisol
1313
HPA axis hyperactivity and HPA axis hyperactivity and
depressiondepression
•• Many (about half of all) depressed patients Many (about half of all) depressed patients
exhibit elevated levels of exhibit elevated levels of cortisolcortisol
•• Even more depressed patients show HPA Even more depressed patients show HPA
hyperactivityhyperactivity-- negative feedback negative feedback
mechanisms sluggish (feedback resistance)mechanisms sluggish (feedback resistance)
Hormones: Hormones: Cortisol Cortisol and and
depressiondepression
•• 19701970’’s, many depressed patients exhibited s, many depressed patients exhibited
elevated levels of elevated levels of cortisolcortisol
•• Even more depressed patients how HPA Even more depressed patients how HPA
hyperactivityhyperactivity-- negative feedback mechanisms negative feedback mechanisms
sluggishsluggish
•• Hyperactive Hyperactive Corticotropin Corticotropin Releasing Factor Releasing Factor
(CRF)(CRF)--producing neurons in hypothalamus might producing neurons in hypothalamus might
be the culprit be the culprit -- studies of suicidal brains show studies of suicidal brains show
more CRF neurons.more CRF neurons.
Hormones: Do reproductive Hormones: Do reproductive
hormones influence depression? hormones influence depression?
Estrogen and DepressionEstrogen and Depression
•• Prenatal hormone Prenatal hormone
exposure might influence exposure might influence
brain development in a brain development in a
way that creates different way that creates different
vulnerabilities and hence vulnerabilities and hence
the sex difference in the sex difference in
depressiondepression
Hormones: Do reproductive Hormones: Do reproductive
hormones influence depression? hormones influence depression?
Estrogen and DepressionEstrogen and Depression
•• Sex difference in Sex difference in
depression shows up at depression shows up at
pubertypuberty
Hormones: Do reproductive hormones influence Hormones: Do reproductive hormones influence
depression? Estrogen and Depressiondepression? Estrogen and Depression
•• High depression rates High depression rates are common at times are common at times of changing of changing hormones:hormones:
��PubertyPuberty
��PregnancyPregnancy
��PostPost--partumpartum
��PerimenopausallyPerimenopausally
Does estrogen influence Does estrogen influence cortisolcortisol? ?
•• Evidence that estrogen might increase Evidence that estrogen might increase
cortisol cortisol secretion.secretion.
•• Estrogen seems to decreaseEstrogen seems to decrease cortisolcortisol’’s s negative feedback mechanismnegative feedback mechanism
•• If estrogen raisesIf estrogen raises cortisol cortisol after stressful after stressful events and then decreasesevents and then decreases cortisolcortisol’’s s ability ability to shut down, then estrogen might make to shut down, then estrogen might make women more prone to depressionwomen more prone to depression
1414
Do you think that Do you think that
psychological stress has ever psychological stress has ever
influenced your menstrual influenced your menstrual
cycle?cycle?
Psychosocial Stress & Ovarian FunctionPsychosocial Stress & Ovarian Function Is there good Is there good scientificscientific evidence that evidence that
psychosocial stress influences psychosocial stress influences
ovarian function?ovarian function?
•• Not really Not really ---- Lots of studies, some find an Lots of studies, some find an
effect of psychological stress some doneffect of psychological stress some don’’t.t.
Is there good scientific evidence Is there good scientific evidence
that psychosocial stress influences that psychosocial stress influences
ovarian function?ovarian function?
•• Not really Not really ---- Lots of studies, some find an Lots of studies, some find an
effect of psychological stress some doneffect of psychological stress some don’’t.t.
•• Clarvit Clarvit (l988) followed female medical (l988) followed female medical
students for a year and found no effect of students for a year and found no effect of
examinations or perceived stress on examinations or perceived stress on
menstrual cycles.menstrual cycles.
Is there good scientific evidence that Is there good scientific evidence that
psychosocial stress influences psychosocial stress influences
ovarian function?ovarian function?
•• Not really Not really ---- Lots of studies, some find an effect of psychological Lots of studies, some find an effect of psychological stress some donstress some don’’t.t.
•• Clarvit Clarvit (l988) followed female medical students for a year and (l988) followed female medical students for a year and found no effect of examinations or perceived stress on menstrualfound no effect of examinations or perceived stress on menstrualcycles.cycles.
•• Harlow and Harlow and Mantanoski Mantanoski (l991) followed 1st year (l991) followed 1st year college women and found an increased risk of college women and found an increased risk of long cycles in response to higher stress levels.long cycles in response to higher stress levels.
•• Fenster Fenster et al. (l999) found that work place stress et al. (l999) found that work place stress was associated with shorter menstrual cycles. was associated with shorter menstrual cycles.
MCAT StudyMCAT Study
•• Recruited Harvard women taking the Recruited Harvard women taking the
MCAT and same age matched controls not MCAT and same age matched controls not
taking the MCATtaking the MCAT
(Ellison & Lipson, in prep)(Ellison & Lipson, in prep)
MCAT studyMCAT study
•• Recruited Harvard women taking the MCAT Recruited Harvard women taking the MCAT
and same age matched controls not taking and same age matched controls not taking
the MCATthe MCAT
•• Wanted to test whether or Wanted to test whether or
not the stress of taking the not the stress of taking the
MCAT would affect MCAT would affect
perceived stress,perceived stress, cortisol cortisol
levels and/or ovarian levels and/or ovarian
function both between and function both between and
within women.within women.
(Ellison & Lipson, in prep)(Ellison & Lipson, in prep)
1515
MCAT studyMCAT study
•• Recruited Harvard women taking the MCAT Recruited Harvard women taking the MCAT
and same age matched controls not taking the and same age matched controls not taking the
MCATMCAT
•• Wanting to test whether or not the stress of Wanting to test whether or not the stress of
taking the MCAT would affect perceived stress,taking the MCAT would affect perceived stress,
cortisol cortisol levels and/or ovarian function both levels and/or ovarian function both
between and within women.between and within women.
•• No hormonal differences between No hormonal differences between
MCAT takers and controlsMCAT takers and controls
(Ellison & Lipson, in prep)(Ellison & Lipson, in prep)
Does Psychosocial stress reduce fecundity?Does Psychosocial stress reduce fecundity?
Psychosocial Stress & Ovarian FunctionPsychosocial Stress & Ovarian Function Does Psychosocial Does Psychosocial
Stress/Depression influence Stress/Depression influence
female fecundity?female fecundity?
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Adopt Didn't Adopt
% Conceived
(Lamb & Leurgans, 1979)
Study of Adoption and FecundityStudy of Adoption and Fecundity
1616
Why would psychosocial Why would psychosocial
stress/depression ?stress/depression ?
•• Wasser Wasser and colleagues (l986, l992, l994, and colleagues (l986, l992, l994,
l999) put forth l999) put forth Reproductive SuppressionReproductive Suppression
ModelModel to explain why social animals, to explain why social animals,
including humans might suppress including humans might suppress
reproduction when there is insufficient reproduction when there is insufficient
social support to help with child rearing.social support to help with child rearing.
Why would psychosocial Why would psychosocial
stress/depression ?stress/depression ?
•• Wasser Wasser and colleagues (l986, l992, l994, l999) and colleagues (l986, l992, l994, l999)
put forth put forth Reproductive SuppressionReproductive Suppression ModelModel to to
explain why social animals, including humans explain why social animals, including humans
might suppress reproduction when there is might suppress reproduction when there is
insufficient social support to help with child insufficient social support to help with child
rearing.rearing.
•• Similar adaptive reasoning Similar adaptive reasoning
used to explain suppression used to explain suppression
due to energetic stressors.due to energetic stressors.
Does Psychosocial stress reduce fecundity?Does Psychosocial stress reduce fecundity?
0
0.1
0.2
0.3
0.4
0.5
0.6
Support Cog/Behav Control
% Conceived •• Mind/Body Medical Mind/Body Medical
Institute at Beth Israel Institute at Beth Israel
Deaconess HospitalDeaconess Hospital
•• 10 week stress reduction 10 week stress reduction
program program
(cognitive/behavioral (cognitive/behavioral
changes) for infertile changes) for infertile
womenwomen
•• 3 groups: control, 3 groups: control,
support and support and
cognitive/behavioralcognitive/behavioralDomar et al
Mechanism of the Mind/Body Mechanism of the Mind/Body
InstituteInstitute’’s Higher Conception Rates?s Higher Conception Rates?
•• Recruited 16 women Recruited 16 women
who had been trying to who had been trying to
conceive for at least 12 conceive for at least 12
months who were not months who were not
taking fertility taking fertility
medications and medications and
wanted a free Mind wanted a free Mind
Body groupBody group
0
0.1
0.2
0.3
0.4
0.5
0.6
Support Cog/Behav Control
% Conceived
Mechanism of the Mind/Body Mechanism of the Mind/Body
InstituteInstitute’’s Higher Conception Rates?s Higher Conception Rates?
•• Recruited 16 women who had been trying to Recruited 16 women who had been trying to
conceive for at least 12 months who were conceive for at least 12 months who were
not taking fertility medications and wanted not taking fertility medications and wanted
a free Mind Body group a free Mind Body group
•• Collected daily salivaCollected daily saliva’’s one month before s one month before
and one month after.and one month after.
Mechanism of the Mind/Body Mechanism of the Mind/Body
InstituteInstitute’’s Higher Conception Rates?s Higher Conception Rates?
•• Recruited 16 women who had been trying to Recruited 16 women who had been trying to conceive for at least 12 months who were conceive for at least 12 months who were not taking fertility medications and wanted not taking fertility medications and wanted a free Mind Body group a free Mind Body group
•• Collected daily salivaCollected daily saliva’’s one month before s one month before and one month after.and one month after.
•• Measured Measured cortisolcortisol, estradiol and , estradiol and progesteroneprogesterone
1717
ResultsResults
0
0.2
0.4
0.6
0.8
1
1.2
before MB after MB
cortisol
progesterone
estradiol
coital freq
• No significant change in any of the hormone measures
• Coital frequency increased 33% the month after the M/B
group compared to before
Does Psychosocial stress reduce fecundity?Does Psychosocial stress reduce fecundity?
Why would psychosocial stress reduce Why would psychosocial stress reduce
fecundity?fecundity?
Why is the data so confusing?Why is the data so confusing?
The relationship between The relationship between
psychosocial stress and ovarian psychosocial stress and ovarian
function is not a simple one!function is not a simple one!
What are potential mechanisms What are potential mechanisms
through which psychosocial stress through which psychosocial stress
might suppress fecundity?might suppress fecundity?
•• BehavioralBehavioral�� SmokingSmoking
�� CaffeineCaffeine
�� Coital frequencyCoital frequency
•• PhysiologicalPhysiological
��EndocrineEndocrine
__ Ovarian function?Ovarian function?
EducationalEducational
Poster forPoster for
ExpectantExpectant
MothersMothers
National
Child Welfare
Assoc., 1919
Prenatal stress in rhesus monkeysPrenatal stress in rhesus monkeys
•• Offspring had Offspring had –– lower birth weights, lower birth weights,
–– impaired impaired neuromotor neuromotor development, development,
–– attention deficits, attention deficits,
–– impaired cognitive function impaired cognitive function
–– higher frequency of abnormal coping higher frequency of abnormal coping behaviors behaviors
–– impaired social behaviors impaired social behaviors
1818
Are there prenatal stress effects Are there prenatal stress effects
on human infants/children?on human infants/children?
•• Studies have included pregnant Studies have included pregnant
women who were women who were
–– exposed to unpredictable aircraft exposed to unpredictable aircraft
noise, noise,
–– familial and family discord familial and family discord
–– and death of a husband during and death of a husband during
WWIIWWII
Humans Humans -- Maternal stress during Maternal stress during
pregnancy is pregnancy is correlatedcorrelated with infants with infants
that have:that have:
•• Reduced birth weightsReduced birth weights
•• Developmental delaysDevelopmental delays
•• Attentional Attentional deficits, deficits,
•• HyperanxietyHyperanxiety
•• Impaired social Impaired social
behaviorsbehaviors
(reviewed in(reviewed in Weinstock Weinstock et al., l997)et al., l997)
Exposure to high Exposure to high glucocorticoids glucocorticoids (i.e. CRH (i.e. CRH Corticotropin Corticotropin
Releasing Hormone)Releasing Hormone) during pregnancyduring pregnancy
•• Associated with low birth Associated with low birth
weight weight
•• Low birth weight Low birth weight
associated with increased associated with increased
risk of adult cardiovascular risk of adult cardiovascular
disease, hypertension, disease, hypertension,
insulin resistance, insulin resistance,
hyperlipidemia hyperlipidemia
Are there prenatal stress effects Are there prenatal stress effects
on human infants/children?on human infants/children?
•• However However …… Most studies are Most studies are
retrospective and lack suitable retrospective and lack suitable
control groupcontrol group
Erickson et al. (2001) JCEM 86(6)
CRHCRH Levels Related to Levels Related to
Preterm BirthPreterm Birth
• Low level of education, public assistance, working and/or walking/standing more than 6 hours per day. and not wearing a seat belt were all significantly associated with preterm birth –
• Interestingly, self-reported social stress was not
Cortisol Cortisol and Early Pregnancy Lossand Early Pregnancy Loss
•• Women with unsuccessful Women with unsuccessful pregnancy had highest pregnancy had highest cortisol cortisol levelslevels
•• Unsuccessful pregnancies Unsuccessful pregnancies had higher had higher cortisol cortisol peakspeaks
•• Pregnancies with Pregnancies with increased increased cortisol cortisol compared to baseline compared to baseline were 2.7 x as likely to endwere 2.7 x as likely to endin miscarriagein miscarriage
•• But But …… dondon’’t know cause t know cause of high of high cortisol cortisol in these in these womenwomen
(Nepomnaschy et al., 2006)
1919
•• BehaviorBehavior
–– Birth and childcare practices Birth and childcare practices
–– Violence against womenViolence against women
–– Female infanticide and neglectFemale infanticide and neglect
•• PhysiologyPhysiology
–– Breast CancerBreast Cancer
–– WHRWHR
–– InfertilityInfertility
•• WomenWomen’’s Lives: Choices for s Lives: Choices for work and Motherhoodwork and Motherhood
Next Time...Next Time...How does Behavioral Biology Affect us Today?How does Behavioral Biology Affect us Today?
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