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1.
J Endocr Soc ; 7(10): bvad108, 2023 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-37646011

RESUMEN

5α-reductase-1 catalyzes production of various steroids, including neurosteroids. We reported previously that expression of its encoding gene, Srd5a1, drops in murine ovaries and hypothalamic preoptic area (POA) after early-life immune stress, seemingly contributing to delayed puberty and ovarian follicle depletion, and in the ovaries the first intron was more methylated at two CpGs. Here, we hypothesized that this CpG-containing locus comprises a methylation-sensitive transcriptional enhancer for Srd5a1. We found that ovarian Srd5a1 mRNA increased 8-fold and methylation of the same two CpGs decreased up to 75% between postnatal days 10 and 30. Estradiol (E2) levels rise during this prepubertal stage, and exposure of ovarian cells to E2 increased Srd5a1 expression. Chromatin immunoprecipitation in an ovarian cell line confirmed ESR1 binding to this differentially methylated genomic region and enrichment of the enhancer modification, H3K4me1. Targeting dCas9-DNMT3 to this locus increased CpG2 methylation 2.5-fold and abolished the Srd5a1 response to E2. In the POA, Srd5a1 mRNA levels decreased 70% between postnatal days 7 and 10 and then remained constant without correlation to CpG methylation levels. Srd5a1 mRNA levels did not respond to E2 in hypothalamic GT1-7 cells, even after dCas9-TET1 reduced CpG1 methylation by 50%. The neonatal drop in POA Srd5a1 expression occurs at a time of increasing glucocorticoids, and treatment of GT1-7 cells with dexamethasone reduced Srd5a1 mRNA levels; chromatin immunoprecipitation confirmed glucocorticoid receptor binding at the enhancer. Our findings on the tissue-specific regulation of Srd5a1 and its methylation-sensitive control by E2 in the ovaries illuminate epigenetic mechanisms underlying reproductive phenotypic variation that impact life-long health.

2.
Hum Nat ; 34(1): 1-24, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-36882630

RESUMEN

Recent studies in social endocrinology have explored the effects of social relationships on female reproductive steroid hormones-estradiol and progesterone-investigating whether they are suppressed in partnered and parous women. Results have been mixed for these hormones although evidence is more consistent that partnered women and women with young children have lower levels of testosterone. These studies were sequential to earlier research on men, based on Wingfield's Challenge Hypothesis, which showed that men in committed relationships, or with young children, have lower levels of testosterone than unpartnered men or men with older or no children. The study described here explored associations between estradiol and progesterone with partnership and parity among women from two different ethnicities: South Asian and white British. We hypothesized that both steroid hormones would be lower among partnered and/or parous women with children ≤3 years old, regardless of ethnicity. In this study we analyzed data from 320 Bangladeshi and British women of European origin aged 18 to 50 who participated in two previous studies of reproductive ecology and health. Levels of estradiol and progesterone were assayed using saliva and/or serum samples and the body mass index calculated from anthropometric data. Questionnaires provided other covariates. Multiple linear regressions were used to analyze the data. The hypotheses were not supported. We argue here that, unlike links between testosterone and male social relationships, theoretical foundations for such relationships with female reproductive steroid hormones are lacking, especially given the primary role of these steroids in regulating female reproductive function. Further longitudinal studies are needed to explore the bases of independent relationships between social factors and female reproductive steroid hormones.


Asunto(s)
Estradiol , Progesterona , Embarazo , Femenino , Masculino , Humanos , Preescolar , Paridad , Testosterona , Estudios Longitudinales
3.
BMC Biol ; 20(1): 11, 2022 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-34996447

RESUMEN

BACKGROUND: Women facing increased energetic demands in childhood commonly have altered adult ovarian activity and shorter reproductive lifespan, possibly comprising a strategy to optimize reproductive success. Here, we sought to understand the mechanisms of early-life programming of reproductive function, by integrating analysis of reproductive tissues in an appropriate mouse model with methylation analysis of proxy tissue DNA in a well-characterized population of Bangladeshi migrants in the UK. Bangladeshi women whose childhood was in Bangladesh were found to have later pubertal onset and lower age-matched ovarian reserve than Bangladeshi women who grew-up in England. Subsequently, we aimed to explore the potential relevance to the altered reproductive phenotype of one of the genes that emerged from the screens. RESULTS: Of the genes associated with differential methylation in the Bangladeshi women whose childhood was in Bangladesh as compared to Bangladeshi women who grew up in the UK, 13 correlated with altered expression of the orthologous gene in the mouse model ovaries. These mice had delayed pubertal onset and a smaller ovarian reserve compared to controls. The most relevant of these genes for reproductive function appeared to be SRD5A1, which encodes the steroidogenic enzyme 5α reductase-1. SRD5A1 was more methylated at the same transcriptional enhancer in mice ovaries as in the women's buccal DNA, and its expression was lower in the hypothalamus of the mice as well, suggesting a possible role in the central control of reproduction. The expression of Kiss1 and Gnrh was also lower in these mice compared to controls, and inhibition of 5α reductase-1 reduced Kiss1 and Gnrh mRNA levels and blocked GnRH release in GnRH neuronal cell cultures. Crucially, we show that inhibition of this enzyme in female mice in vivo delayed pubertal onset. CONCLUSIONS: SRD5A1/5α reductase-1 responds epigenetically to the environment and its downregulation appears to alter the reproductive phenotype. These findings help to explain diversity in reproductive characteristics and how they are shaped by early-life environment and reveal novel pathways that might be targeted to mitigate health issues caused by life-history trade-offs.


Asunto(s)
3-Oxo-5-alfa-Esteroide 4-Deshidrogenasa/metabolismo , Colestenona 5 alfa-Reductasa , Kisspeptinas , Proteínas de la Membrana/metabolismo , Adaptación Fisiológica , Animales , Colestenona 5 alfa-Reductasa/genética , Colestenona 5 alfa-Reductasa/metabolismo , Epigénesis Genética , Femenino , Hormona Liberadora de Gonadotropina/genética , Hormona Liberadora de Gonadotropina/metabolismo , Humanos , Kisspeptinas/genética , Kisspeptinas/metabolismo , Ratones
4.
Am J Hum Biol ; 34(3): e23631, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-34174012

RESUMEN

INTRODUCTION: While many aspects of female ovarian function respond to environmental stressors, estradiol (E2) appears less sensitive to stressors than progesterone, except under extreme ecological conditions. However, earlier studies relied on saliva samples, considered less sensitive than blood. Here, we investigated E2 variation among 177 Bangladeshi and UK white women, aged 35-59, using single serum samples. Bangladeshi women either grew up in Sylhet, Bangladesh (exposed to poor sanitation, limited health care, and higher pathogen loads but not poor energy availability), or in the UK. METHODS: We collected samples on days 4-6 of the menstrual cycle in menstruating women and on any day for post-menopausal women. Participants included: (i) Bangladeshi sedentees (n = 36), (ii) Bangladeshis who migrated to the UK as adults (n = 52), (iii) Bangladeshis who migrated as children (n = 40), and (iv) UK white women matched for neighborhood residence to the migrants (n = 49). Serum was obtained by venipuncture and analyzed using electrochemiluminescence. We collected anthropometrics and supplementary sociodemographic and reproductive data through questionnaires. We analyzed the data using multivariate regression. RESULTS: E2 levels did not differ between migrant groups after controlling for age, BMI, physical activity, psychosocial stress, parity, and time since last birth (parous women). Paralleling results from salivary E2, serum E2 did not differ among women who experienced varying developmental conditions. CONCLUSION: Our results reinforce the hypothesis that E2 levels are stable under challenging environmental conditions. Interpopulation variation may only arise under chronic conditions of extreme nutritional scarcity, energy expenditure, and/or high disease burdens.


Asunto(s)
Pueblo Asiatico , Progesterona , Adulto , Bangladesh , Niño , Estradiol , Femenino , Humanos , Persona de Mediana Edad , Reino Unido
5.
Nat Rev Endocrinol ; 16(9): 519-533, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32620937

RESUMEN

Reproductive function adjusts in response to environmental conditions in order to optimize success. In humans, this plasticity includes age of pubertal onset, hormone levels and age at menopause. These reproductive characteristics vary across populations with distinct lifestyles and following specific childhood events, and point to a role for the early-life environment in shaping adult reproductive trajectories. Epigenetic mechanisms respond to external signals, exert long-term effects on gene expression and have been shown in animal and cellular studies to regulate normal reproductive function, strongly implicating their role in these adaptations. Moreover, human cohort data have revealed differential DNA methylation signatures in proxy tissues that are associated with reproductive phenotypic variation, although the cause-effect relationships are difficult to discern, calling for additional complementary approaches to establish functionality. In this Review, we summarize how adult reproductive function can be shaped by childhood events. We discuss why the influence of the childhood environment on adult reproductive function is an important consideration in understanding how reproduction is regulated and necessitates consideration by clinicians treating women with diverse life histories. The resolution of the molecular mechanisms responsible for human reproductive plasticity could also lead to new approaches for intervention by targeting these epigenetic modifications.


Asunto(s)
Adaptación Fisiológica/genética , Ambiente , Epigénesis Genética/fisiología , Reproducción/genética , Envejecimiento , Animales , Metilación de ADN , Femenino , Fertilidad , Desarrollo Fetal , Humanos , Estilo de Vida , Masculino , Fenómenos Fisiologicos Nutricionales Maternos , Fenotipo , Embarazo , Progesterona/sangre , Pubertad/genética , Reproducción/fisiología , Testosterona/sangre , Migrantes
6.
Artículo en Inglés | MEDLINE | ID: mdl-32069802

RESUMEN

Timing of breast development (or thelarche) and its endogenous and exogenous determinants may underlie global variation in breast cancer incidence. The study objectives were to characterize endogenous estrogen levels and bisphenol A (BPA) exposure using a migrant study of adolescent girls and test whether concentrations explained differences in thelarche by birthplace and growth environment. Estrogen metabolites (EM) and BPA-glucuronide (BPA-G) were quantified in urine spot samples using liquid chromatography tandem mass spectrometry (LC-MS/MS) from a cross-sectional study of Bangladeshi, first- and second-generation Bangladeshi migrants to the UK, and white British girls aged 5-16 years (n = 348). Thelarche status at the time of interview was self-reported and defined equivalent to Tanner Stage ≥2. We compared geometric means (and 95% confidence interval (CIs)) of EM and BPA-G using linear regression and assessed whether EM and BPA-G explained any of the association between exposure to the UK and the age at thelarche using hazard ratios and 95% confidence intervals. Average EM decreased with exposure to the UK, whereas BPA-G increased and was significantly higher among white British (0.007 ng/mL, 95% CI: 0.0024-0.0217) and second-generation British-Bangladeshi girls (0.009 ng/mL, 95% CI: 0.0040-0.0187) compared to Bangladeshi girls (0.002 ng/mL, 95% CI: 0.0018-0.0034). Two of four EM ratios (16-pathway/parent and parent/all pathways) were significantly associated with thelarche. The relationship between exposure to the UK and thelarche did not change appreciably after adding EM and BPA-G to the models. While BPA-G is often considered a ubiquitous exposure, our findings suggest it can vary based on birthplace and growth environment, with increasing levels for girls who were born in or moved to the UK. Our study did not provide statistically significant evidence that BPA-G or EM concentrations explained earlier thelarche among girls who were born or raised in the UK.


Asunto(s)
Compuestos de Bencidrilo , Mama , Estrógenos , Fenoles , Espectrometría de Masas en Tándem , Adolescente , Bangladesh , Compuestos de Bencidrilo/toxicidad , Mama/crecimiento & desarrollo , Niño , Preescolar , Cromatografía Liquida , Estudios Transversales , Estrógenos/metabolismo , Femenino , Humanos , Menarquia , Fenoles/toxicidad , Reino Unido , Población Blanca
7.
Maturitas ; 89: 43-51, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27180159

RESUMEN

INTRODUCTION: Evidence suggests that hot flushes are associated with fluctuating levels of oestradiol (E2) during menopause, as well as changes in the levels of follicle-stimulating hormone (FSH) and inhibin B. The relationship between hot flushes and anti-Müllerian hormone (AMH) is unknown. AIM: To examine specific hormone levels and ethnic differences in relation to hot flushes. METHODS: Data were drawn from 108 women aged 40-59 years. There were three groups of participants: European women in London, UK; Bangladeshi women in Sylhet, Bangladesh; and Bangladeshi women who had migrated to London as adults. Symptom information was collected via questionnaires. Serum blood samples were collected to detect inhibin B, AMH, FSH, and E2. RESULTS: AMH and FSH were significantly associated with the experience of hot flushes in the past 2 weeks. Inhibin B and E2 were not associated with hot flushes. Body mass index (BMI), ethnicity, and education level were associated with both the occurrence and the frequency hot flushes. Menopausal status was also associated with the frequency of hot flushes. CONCLUSION: Relationships between AMH, FSH and symptoms are indicative of women's progress through the menopausal transition. The influence of BMI and education suggest that lifestyle changes may contribute to the management of symptoms. This merits further research.


Asunto(s)
Sofocos/sangre , Menopausia/sangre , Adulto , Hormona Antimülleriana/sangre , Pueblo Asiatico , Bangladesh/epidemiología , Estradiol/sangre , Femenino , Hormona Folículo Estimulante/sangre , Sofocos/epidemiología , Humanos , Inhibinas/sangre , Londres/epidemiología , Estudios Longitudinales , Persona de Mediana Edad , Población Blanca
8.
Breast Cancer Res ; 16(6): 469, 2014 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-25398700

RESUMEN

INTRODUCTION: Earlier menarche is related to subsequent breast cancer risk, yet international differences in the age and tempo of other pubertal milestones and their relationships with body mass index (BMI) are not firmly established in populations at differing risk for breast cancer. We compared age and tempo of adrenarche, thelarche, pubarche, and menarche in a migrant study of Bangladeshi girls to the United Kingdom (UK) and assessed whether differences by migration were explained by differences in BMI. METHODS: Included were groups of Bangladeshi (n =168), British-Bangladeshi (n =174) and white British (n =54) girls, aged 5 to 16 years. Interviewer-administered questionnaires obtained pubertal staging; height and weight were measured. Salivary dehydroepiandrosterone-sulfate concentrations >400 pg/ml defined adrenarche. Median ages of pubertal milestones and hazard ratios (HR) with 95% confidence intervals (CI) were estimated from Weibull survival models. RESULTS: In all three groups, adrenarche occurred earliest, followed by thelarche, pubarche, and finally menarche. Neither median age at adrenarche (Bangladeshi = 7.2, British-Bangladeshi = 7.4, white British = 7.1; P-trend = 0.70) nor at menarche (Bangladeshi = 12.5, British-Bangladeshi = 12.1, white British = 12.6; P-trend = 0.70) differed across groups. In contrast, median age at thelarche (Bangladeshi = 10.7, British-Bangladeshi = 9.6, white British = 8.7; P-trend <0.01) occurred earlier among girls living in the UK. Compared with Bangladeshi girls, HRs (95% CI) for earlier thelarche were 1.6 (1.1 to 2.4) for British-Bangladeshi girls and 2.6 (1.5 to 4.4) for white British girls (P-trend <0.01), but were attenuated after adjustment for BMI (British-Bangladeshi = 1.1 (0.7 to 1.8), white British = 1.7(1.0 to 3.1); P-trend =0.20). CONCLUSIONS: Thelarche occurred earlier, but puberty progressed slower with increasing exposure to the UK environment; differences were partially explained by greater BMI. The growth environment might account for much of the ethnic differences in pubertal development observed across and within countries.


Asunto(s)
Adrenarquia/metabolismo , Neoplasias de la Mama , Mama/crecimiento & desarrollo , Sulfato de Deshidroepiandrosterona/análisis , Emigrantes e Inmigrantes , Menarquia , Saliva/química , Adolescente , Factores de Edad , Bangladesh/etnología , Niño , Preescolar , Femenino , Humanos , Modelos de Riesgos Proporcionales , Pubertad , Factores de Tiempo , Reino Unido
9.
Am J Hum Biol ; 20(1): 2-14, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-17957763

RESUMEN

Women living in energetically stressful conditions have significantly lower baseline salivary steroid levels compared to those in affluent environments. Developmental hypotheses suggest that interpopulation variation in ovarian function results from contrasting environments experienced during growth. We use a migrant study of Bangladeshi women to test this hypothesis. We compared middle-class women (19-39 years) who migrated to London, UK, at different life-stages (pre and postmenarche), with Bangladeshi sedentees, second-generation British-Bangladeshis, and white British women living in similar London neighborhoods (total n = 227). We analyzed levels of salivary estradiol for one menstrual cycle, together with data on anthropometry, diet, lifestyle, and migration and reproductive histories. Results from multiple linear regression models, controlling for anthropometric and reproductive variables, show no significant differences in baseline estradiol levels between groups whether all cycles or just ovulatory cycles are analyzed. We also found no correlation between age at migration or time since migration on estradiol levels, nor between adult estradiol levels and age at menarche. Our results differ from previous reports of significantly lower salivary estradiol levels in populations living in more extreme ecological settings. They also contrast with our previous findings of significant intergroup differences in baseline levels of salivary progesterone. However, women who spent their childhood in Sylhet have a lower proportion of ovulatory cycles compared to women who developed in Britain. These group differences in ovulation frequency indicate more qualitative effects of contrasting developmental environments. We discuss possible explanations for differences in response between progesterone and estradiol, as well as broader implications of our findings.


Asunto(s)
Estradiol/metabolismo , Ciclo Menstrual/metabolismo , Progesterona/metabolismo , Saliva/química , Adulto , Bangladesh/etnología , Estudios Transversales , Emigrantes e Inmigrantes , Estradiol/análisis , Femenino , Humanos , Londres , Características de la Residencia , Saliva/metabolismo , Clase Social , Factores Socioeconómicos , Estrés Psicológico/fisiopatología
10.
PLoS Med ; 4(5): e167, 2007 May.
Artículo en Inglés | MEDLINE | ID: mdl-17503960

RESUMEN

BACKGROUND: Average profiles of salivary progesterone in women vary significantly at the inter- and intrapopulation level as a function of age and acute energetic conditions related to energy intake, energy expenditure, or a combination of both. In addition to acute stressors, baseline progesterone levels differ among populations. The causes of such chronic differences are not well understood, but it has been hypothesised that they may result from varying tempos of growth and maturation and, by implication, from diverse environmental conditions encountered during childhood and adolescence. METHODS AND FINDINGS: To test this hypothesis, we conducted a migrant study among first- and second-generation Bangladeshi women aged 19-39 who migrated to London, UK at different points in the life-course, women still resident in Bangladesh, and women of European descent living in neighbourhoods similar to those of the migrants in London (total n = 227). Data collected included saliva samples for radioimmunoassay of progesterone, anthropometrics, and information from questionnaires on diet, lifestyle, and health. Results from multiple linear regression, controlled for anthropometric and reproductive variables, show that women who spend their childhood in conditions of low energy expenditure, stable energy intake, good sanitation, low immune challenges, and good health care in the UK have up to 103% higher levels of salivary progesterone and an earlier maturation than women who develop in less optimal conditions in Sylhet, Bangladesh (F9,178 = 5.05, p < 0.001, standard error of the mean = 0.32; adjusted R(2) = 0.16). Our results point to the period prior to puberty as a sensitive phase when changes in environmental conditions positively impact developmental tempos such as menarcheal age (F2,81 = 3.21, p = 0.03) and patterns of ovarian function as measured using salivary progesterone (F2,81 = 3.14, p = 0.04). CONCLUSIONS: This research demonstrates that human females use an extended period of the life cycle prior to reproductive maturation to monitor their environment and to modulate reproductive steroid levels in accordance with projected conditions they might encounter as adults. Given the prolonged investment of human pregnancy and lactation, such plasticity (extending beyond any intrauterine programming) enables a more flexible and finely tuned adjustment to the potential constraints or opportunities of the later adult environment. This research is the first, to our knowledge, to demonstrate a postuterine developmental component to variation in reproductive steroid levels in women.


Asunto(s)
Ciclo Menstrual/fisiología , Progesterona/metabolismo , Adolescente , Adulto , Factores de Edad , Antropometría , Bangladesh , Niño , Dieta , Emigración e Inmigración , Ingestión de Energía , Metabolismo Energético , Femenino , Indicadores de Salud , Humanos , Estilo de Vida , Modelos Lineales , Londres/etnología , Ovario/fisiología , Saliva/química , Encuestas y Cuestionarios
11.
J Immigr Minor Health ; 9(4): 299-306, 2007 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-17431783

RESUMEN

This study evaluated the effects of socio-economic variables and migration history on the prevalence of betel nut and smokeless tobacco use in both UK- and Bangladeshi born migrant women resident in London. No significant difference in betel nut use prevalence was found among women of different generations. However, in all groups betel nut users were significantly older and less educated than non-users. Among first generation women there was no effect of either length of time living in the UK or age at migration on use of betel nut, even after controlling for current age. No significant differences in prevalence use due to language spoken, occupation, marital status or borough of residence in London were found. We conclude that, although there are some indications of a change in behavior among younger individuals, betel nut chewing is a practice very much present among Bangladeshi women born and brought up in a bicultural context.


Asunto(s)
Areca , Emigración e Inmigración , Tabaco sin Humo , Adulto , Bangladesh/etnología , Femenino , Humanos , Relaciones Intergeneracionales , Prevalencia , Factores Socioeconómicos , Reino Unido
12.
Am J Phys Anthropol ; 132(2): 311-5, 2007 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-17133435

RESUMEN

The measurement of steroids in saliva is both simple and non-invasive and has been widely used in field and clinical-based research. The observance of particular cultural practices by some populations, however, may hamper accurate hormonal analyses. The present study evaluated the effects of one such practice-the chewing of betel nut-on the accurate measurement of salivary progesterone and estradiol. A time series experiment was conducted among Bangladeshi women who are regular users of betel nut. Salivary steroids were analyzed by radioimmunoassay in samples collected prior to and then 30, 60, 120, and 240 min following betel quid use. Results show no significant difference between basal steroid levels and those obtained 60, 120, and 240 min after chewing betel nut. We conclude that with specific collection protocols that take into account time since chewing, salivary steroid analyses can be undertaken in populations among whom the practice of chewing betel nut is endemic.


Asunto(s)
Areca , Estradiol/análisis , Progesterona/análisis , Saliva/efectos de los fármacos , Adolescente , Adulto , Femenino , Hábitos , Humanos , Preparaciones de Plantas/farmacología , Radioinmunoensayo/normas , Saliva/metabolismo
13.
Hum Reprod ; 17(7): 1906-13, 2002 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-12093859

RESUMEN

BACKGROUND: Agriculturalists in less-developed countries (LDC) have lower progesterone levels than urban industrialized populations. However, it is unknown if urban LDC populations are also relatively lower. We tested whether urban Bolivia samples-poorer (Bol-p) and better-off (Bol-b)-have lower progesterone than a Chicago (USA) sample, and whether progesterone and rate of ovulation are lower in Bol-p than in Bol-b. METHODS: Serial salivary samples collected from Bolivians, screened according to strict exclusion criteria during two complete menstrual cycles, were radioimmunoassayed for progesterone; anthropometrics were collected at mid-follicular and mid-luteal phases. RESULTS: Progesterone levels are lower in the Bolivia samples, and higher in the Bol-b than Bol-p; ovulation rate is greater in Bol-b than Bol-p. For only ovulatory cycles, mean-follicular-P (pmol/l), mean-luteal-P (pmol/l), and mean-peak-P (pmol/l) are respectively 65, 142 and 208 in Bol-p; 76, 167 and 232 in Bol-b; and 96, 240 and 330 in Chicago. Principal components representing body-size and progesterone level are positively correlated (r = 0.404, P = 0.005). CONCLUSIONS: Progesterone levels appear to be influenced by chronic and acute ecological conditions, evidenced by the association with body-size and the probability of ovulation respectively. These findings have implications for understanding cancer aetiology, developing population-appropriate hormonal contraceptives, and modelling the evolution and functioning of the reproductive system.


Asunto(s)
Ovulación , Pobreza , Progesterona/metabolismo , Saliva/metabolismo , Población Urbana , Adulto , Anovulación/epidemiología , Composición Corporal , Constitución Corporal , Bolivia/epidemiología , Femenino , Humanos , Ciclo Menstrual/fisiología , Ovulación/fisiología , Prevalencia
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