Restricted (Penn State Only)
Allaway, Heather Christina
Graduate Program:
Doctor of Philosophy
Document Type:
Date of Defense:
March 15, 2017
Committee Members:
  • Mary Jane De Souza, Dissertation Advisor
  • Mary Jane De Souza, Committee Chair
  • Nancy I. Williams, Committee Member
  • Connie J. Rogers, Committee Member
  • Lorah D. Dorn, Outside Member
  • Reproductive Health
  • Reduced Sample Collection Frequency
  • Combined Oral Contraception
  • Contraceptive Vaginal Ring
  • IGF-1 Generation Test
  • Functional Hypothalamic Amenorrhea
  • Resumption of Menses
  • Insulin-like Growth Factor-1
  • Estrone-1-Glucuronide
  • Pregnanediol Glucuronide
  • Body Composition
  • Dual X-Ray Absorptiometry
The purpose of this dissertation was to explore how endocrinologic and reproductive health in premenopausal women is influenced by combined hormonal contraceptive (CHC) use and changes in body composition, respectively. In addition, we explored methods to improve the assessment of reproductive health in female populations of varying age. To this end, this dissertation includes four studies that 1) retrospectively assess the agreement between daily and reduced sample collection frequencies of estrone-1-glucuronide (E1G) and pregnanediol glucuronide (PdG) exposure, 2) prospectively assess the compliance to reduced sample collection frequencies, 3) evaluate the impact of combine hormonal contraceptive (CHC) use on hepatic insulin-like growth factor-1 (IGF-1) production, and 4) determine if non-traditional dual x-ray absorptiometry (DXA) measures of body composition predict menstrual recovery in exercising women with functional hypothalamic amenorrhea (FHA). We observed the following main findings: 1) with perfect collection all three reduced sample collection frequencies had good agreement with daily sample collection regarding E1G and PdG exposure and integrated mean; 2) adolescent girls were more compliant to collecting 3 samples/week than to 2 samples/week, which enabled us to observe evidence of luteal activity in 32% of the adolescent menstrual cycles, 3) route of CHC administration suppresses hepatic IGF-1 production, such that a reduction was observed following combined oral contraceptive (COC) use but not contraceptive vaginal ring (CVR) use, 4) the strongest predictor of resumption of menses is post-study body fat percentage in exercising young women with FHA, while post-study leg percent fat was an additional strong predictor of menstrual recovery. Overall, research evaluating reproductive status in adolescent and young, adult women can utilize a reduced sampling frequency; however, use of 2 samples/week is not recommended due to low compliance to the specified collection dates. Additionally, evaluating the long-term effect of CHC use on bone physiology requires continued, vested interest with the development of new therapies. Similar interventions with larger samples and longer in duration are necessary to confirm and expand the findings of CHC route of administration influence on IGF-1 and bone heath, as well as in understanding whether non-traditional body composition measures are more indicative of the potential for the resumption of menses within the complex interplay of body composition and energetic signals.