Origins and health consequences of stress-induced ovarian dysfunction

Normal ovarian function is thought to protect women against coronary heart disease (CHD) and osteoporosis by delaying the pathobiological processes underlying these conditions. Supporting this proposition is the observation that, following menopause (i.e. the loss of cyclic ovarian function), these diseases accelerate and ultimately comprise a major portion of the health burden of older women. However, while all women eventually go through complete ovarian failure at menopause, many also experience episodes of cyclic ovarian disruption during their reproductive years (i.e. ages 18-40). These disruptions are relatively common and often are attributed to psychogenic factors (stress, anxiety, depression, or other emotional disturbance). This article hypothesizes that, to the extent that cyclic ovarian function affords protection against CHD and osteoporosis, ovulatory abnormalities associated with estrogen deficiency in young women - even if mild and subclinical - prematurely accelerate development of these two diseases of 'aging'. Consistent with this hypothesis are observations in group-housed, premenopausal monkeys confirming that reproductive deficits are commonly induced by psychosocial stress (social subordination), and, in the presence of a typical Western diet, accelerate the development of CHD and bone loss. Furthermore, in this model premenopausal disease extent predicts postmenopausal health outcomes irrespective of postmenopausal treatment, emphasizing the pathobiological importance of the premenopausal portion of the life cycle. Finally, data from both women and nonhuman primates suggest that reproductive deficits of the sort described here are adaptive when triggered appropriately, but detrimental when activated in an environment (e.g. sedentary lifestyle, high-fat diet) permissive to the development of chronic disease.