The menstrual cycle is a marker of female fertility potential and can serve to monitor female workers who never attempt or achieve a pregnancy, but whose reproductive function and risk of hormone-related chronic disease may nonetheless be affected by the work environment. this application requests monies to investigate menstrual function in women workers and to study effects of physical and mental job stress, and stress-related behaviors like caffeine consumption, on cycle characteristics and ovarian hormone patterns. Stress i s pervasive occupational exposure and one that potentially can be prevented or reduced. It has been implicated in menstrual disorders and has also been cited as a possible alternative explanation for adverse pregnancy outcomes among workers exposed to other agents (e.g. VDTs). Job stress may be a particular problem for women, whose added responsibility for the so-called """"""""second shift"""""""" does not readily allow for recovery from stress during nonwork hours. the project we are proposing thus addresses two important issues: (1) job stress in females - an exposure whose effect needs rigorous investigation both on its own merits and to help disentangle stress effects from effects of other work place agents; and (2) the need to develop biological markers of menstrual function in order to identify and prevent work-related disorders among non-pregnant women (much as semen analysis has served to monitor male occupational exposures). We propose to enroll 100 female nurses, 50 each drawn from high and low stress areas of Memorial Sloan-Kettering Cancer Center (MSKCC), for three consecutive menstrual cycles. Subjects will be asked to record basal body temperature, collect a small aliquot of urine daily and maintain a structured menstrual diary. To evaluate ovulatory and luteal function, urine samples will be analyzed for estrone-3-glucuronide (E1G), pregnanediol-3-glucuronide (pdG), luteinizing hormone (LH) and creatinine (Cr). Nurses were selected as the target population because of high job stress levels, and because high caffeine intake and willingness to comply with a demanding regimen also seemed likely; a feasibility study conducted at MSKCC supports this. Subjects will be recruited by a nurse-field director on-site at MSKCC who will identify high and low stress units on the basis of archival material and discussions with administrators. Data analyses will evaluate the relations in the intensity of job-related stressors, caffeine consumption, and exposure to antineoplastics, and several measures of menstrual function (cycle length; ovulation; and luteal phase adequacy). Absolute levels and rates of change in E1G and PdG will also be compared in relation to exposure. Finally, to aid in the design of future menstrual studies, the validity of basal body temperature and prospectively ascertained reports of menstrual cycles will be assessed, using the urinary hormone data as a gold standard.
