Association between Physical Activity and Menstrual Cycle Disorders in Young Athletes

 

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Abstract

Our study aims to evaluate clinical predictors of menstrual cycle disorders in female athletes who compete in running disciplines. This is a prospective observational study. Women were recruited between January and May 2022. Fifty-three patients were enrolled and completed a questionnaire about menstrual cycle, physical activity, and food habit characteristics. Of the women in our population, 39.6% had menstrual irregularities and reported a significantly higher number of kilometers run per week (67 vs. 35, p:0.02). The number of kilometers run per week was associated with menstrual irregularities (for 10 km, OR 1.35; IC95% 1.05–1.73; p: 0.02) after adjusting for BMI, age, level of sport and caloric intake. The variable of “km run per week” appeared as a diagnostic indicator of irregular menstrual cycle with statistical significance (AUC ROC curve 0.71, IC95% 0.54–0.86, p-value=0.01) and the cut-off of 65 km run per week is a good indicator of the presence of irregular menstrual cycle (sensitivity (SE) and specificity (SP) of 55% and 81.48%). Menstrual cycle disorders are very frequent in female athletes, and the variable of km run per week may play a role in screening endurance athletes at high risk for these disorders.

Publication History

Received: 28 November 2023

Accepted: 17 January 2024

Accepted Manuscript online:
28 February 2024

Article published online:
28 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Kodama S, Saito K, Tanaka S. et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: A meta-analysis. JAMA 2009; 301: 2024-2035
  CrossrefPubMedGoogle Scholar
• 2 Nunan D, Mahtani KR, Roberts N. et al. Physical activity for the prevention and treatment of major chronic disease: An overview of systematic reviews. Syst Rev 2013; 2: 56
  CrossrefPubMedGoogle Scholar
• 3 World Health Organization. WHO guidelines on physical activity and sedentary behaviour: At a glance. Who; 2020. 535.
  Google Scholar
• 4 Garber CE, Blissmer B, Deschenes MR. et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 2011; 43: 1334-1359
  CrossrefPubMedGoogle Scholar
• 5 Yeager KK, Agostini R, Nattiv A. et al. The female athlete triad: Disordered eating, amenorrhea, osteoporosis. Med Sci Sports Exerc 1993; 25: 775-777
  CrossrefPubMedGoogle Scholar
• 6 Nattiv A, Loucks AB, Manore MM. et al. American College of Sports Medicine position stand. The female athlete triad. Med Sci Sports Exerc 2007; 39: 1867-1882
  PubMedGoogle Scholar
• 7 Ackerman KE, Holtzman B, Cooper KM. et al. Low energy availability surrogates correlate with health and performance consequences of Relative Energy Deficiency in Sport. Br J Sports Med 2019; 53: 628-633
  CrossrefPubMedGoogle Scholar
• 8 Mountjoy M, Sundgot-Borgen J, Burke L. et al. The IOC consensus statement: beyond the Female Athlete Triad--Relative Energy Deficiency in Sport (RED-S). Br J Sports Med 2014; 48: 491-497
  CrossrefPubMedGoogle Scholar
• 9 Warren MP, Perlroth NE. The effects of intense exercise on the female reproductive system. J Endocrinol 2001; 170: 3-11
  CrossrefPubMedGoogle Scholar
• 10 Loucks AB, Thuma JR. Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women. J Clin Endocrinol Metab 2003; 88: 297-311
  CrossrefPubMedGoogle Scholar
• 11 Williams NI, Leidy HJ, Hill BR. et al. Magnitude of daily energy deficit predicts frequency but not severity of menstrual disturbances associated with exercise and caloric restriction. Am J Physiol Endocrinol Metab 2015; 308: E29-E39
  CrossrefPubMedGoogle Scholar
• 12 Ackerman KE, Cano Sokoloff N, DE Nardo Maffazioli G. et al. Fractures in Relation to Menstrual Status and Bone Parameters in Young Athletes. Med Sci Sports Exerc 2015; 47: 1577-1586
  CrossrefPubMedGoogle Scholar
• 13 Gibbs JC, Williams NI, Mallinson RJ. et al. Effect of high dietary restraint on energy availability and menstrual status. Med Sci Sports Exerc 2013; 45: 1790-1797
  CrossrefPubMedGoogle Scholar
• 14 Barrack MT, Rauh MJ, Nichols JF. Prevalence of and traits associated with low BMD among female adolescent runners. Med Sci Sports Exerc 2008; 40: 2015-2021
  CrossrefPubMedGoogle Scholar
• 15 Austin TM, Reinking MF, Hayes AM. Menstrual function in female high school cross-country athletes. Int J Adolesc Med Health 2009; 21: 555-565
  CrossrefPubMedGoogle Scholar
• 16 Tenforde AS, Fredericson M, Sayres LC. et al. Identifying sex-specific risk factors for low bone mineral density in adolescent runners. Am J Sports Med 2015; 43: 1494-1504
  CrossrefPubMedGoogle Scholar
• 17 NHS. What should my daily intake of calories be? 2023-09-28. Internet: https://www.nhs.uk/common-health-questions/food-and-diet/what-should-my-daily-intake-of-calories-be/#:~:text=An ideal daily intake of women and 2% 2C500 for men; accessed: Jan. 11, 2023
  PubMed
• 18 Nur Azurah AG, Sanci L, Moore E. et al. The Quality of Life of Adolescents with Menstrual Problems. J Pediatr Adolesc Gynecol 2013; 26: 102-108
  CrossrefPubMedGoogle Scholar
• 19 Lake JK, Power C, Cole TJ. Women’s reproductive health: The role of body mass index in early and adult life. Int J Obes Relat Metab Disord J Int Assoc Study Obes 1997; 21: 432-438
  CrossrefPubMedGoogle Scholar
• 20 Bronson FH, Manning JM. The energetic regulation of ovulation: A realistic role for body fat. Biol Reprod 1991; 44: 945-950
  CrossrefPubMedGoogle Scholar
• 21 Ravi S, Waller B, Valtonen M. et al. Menstrual dysfunction and body weight dissatisfaction among Finnish young athletes and non-athletes. Scand J Med Sci Sport 2021; 31: 405-417
  CrossrefPubMedGoogle Scholar
• 22 Dadgostar H, Razi M, Aleyasin A. et al. The relation between athletic sports and prevalence of amenorrhea and oligomenorrhea in Iranian female athletes. Sports Med Arthrosc Rehabil Ther Technol 2009; 1: 16
  PubMedGoogle Scholar
• 23 Joubert L, Warme A, Larson A. et al. Prevalence of amenorrhea in elite female competitive climbers. Front Sport Act living 2022; 4: 895588
  CrossrefPubMedGoogle Scholar
• 24 Miyamoto M, Hanatani Y, Shibuya K. Relationship among Nutritional Intake, Anxiety, and Menstrual Irregularity in Elite Rowers. Nutrients 2021; 13: 3436
  CrossrefPubMedGoogle Scholar
• 25 Thein-Nissenbaum JM, Rauh MJ, Carr KE. et al. Menstrual irregularity and musculoskeletal injury in female high school athletes. J Athl Train 2012; 47: 74-82
  CrossrefPubMedGoogle Scholar
• 26 De Souza MJ, Nattiv A, Joy E. et al. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana. Br J Sports Med 2014; 48: 289
  CrossrefPubMedGoogle Scholar
• 27 Torstveit MK, Rosenvinge JH, Sundgot-Borgen J. Prevalence of eating disorders and the predictive power of risk models in female elite athletes: A controlled study. Scand J Med Sci Sports 2008; 18: 108-118
  CrossrefPubMedGoogle Scholar
• 28 Karlsson E, Alricsson M, Melin A. Symptoms of eating disorders and low energy availability in recreational active female runners. BMJ Open Sport Exerc Med 2023; 19: e001623 DOI: 10.1136/bmjsem-2023-001623. . eCollection 2023
  CrossrefPubMedGoogle Scholar
• 29 Barrack MT, Van Loan MD, Rauh M. et al. Disordered Eating, Development of Menstrual Irregularity, and Reduced Bone Mass Change After a 3-Year Follow-Up In Female Adolescent Endurance Runners. Int J Sport Nutr Exerc Metab 2021; 31: 337-344
  CrossrefPubMedGoogle Scholar
• 30 Fahrenholtz IL, Melin AK, Wasserfurth P. et al. Risk of Low Energy Availability, Disordered Eating, Exercise Addiction, and Food Intolerances in Female Endurance Athletes. Front Sport Act Living 2022; 4: 1-11
  CrossrefPubMedGoogle Scholar