menstrual problems in athletes

Menstrual problems in athletes

In a previous issue of Peak Performance, we reported on a large population-based study from Norway, showing that six out of 10 elite female athletes of reproductive age were at risk of the so- called ‘female athlete triad’ – disordered eating, amenorrhoea and osteoporosis (PP211).

Now the same research group, using data from the same subjects, has come up with the more encouraging finding that the prevalence of menstrual dysfunction has fallen dramatically over the past decade, from 42% to 17% in athletes and from 28% to 15% in age-matched controls.

The study included data from a total of 669 elite athletes aged 13-39, representing national teams at junior or senior level, and 607 non-athlete controls, all of whom completed detailed questionnaires including questions on menstrual, dietary and weight history, eating patterns, body dissatisfaction and drive for thinness.

The key findings about menstrual dysfunction (MD) – including delayed, absent and irregular menstruation – were as follows:

  • Age at menarche (first period) occurred later in athletes (13.4 years) than controls (13.0 years). However, athletes competing in ‘leanness sports’ (endurance, aesthetic, weight-class and anti- gravitational) started their periods later (13.7 years) than those in technical, ball game and power sports (13.3 years);
  • More athletes (7.3%) than controls (2.0%) reported a history of primary amenorrhoea (delayed menstruation). Again the prevalence was highest in leanness sports (11.7%);
  • A similar percentage of athletes (16.5%) and controls (15.2%) reported current MD, but while the prevalence in leanness sports was considerably higher (24.8%), that in non-leanness sports was actually lower than in the controls (13.1%).

When comparing their results with those of the only comparable study, published in 1993, the researchers noted the dramatic reduction in the prevalence of menstrual problems in athletes and non-athletes mentioned above.

What can account for this welcome development? The researchers mention three potential interacting factors:

  1. Increased awareness of the dangers of the female athlete triad among medical staff, coaches and athletes;
  2. Fear of injury risk as a result of bone loss, motivating athletes with menstrual problems to either increase their energy intake – lack of energy being thought to be the main cause of MD – or seek help at an earlier stage;
  3. Increased use of oral contraceptives to regulate athletes’ menstrual cycles and prevent bone loss and injuries.

‘The difference in the prevalence of MD between elite athletes and controls is not as large as previously assumed,’ conclude the researchers, ‘and, in addition, the prevalence of MD is lower in both athletes and controls compared with one decade ago.

‘We believe that MD prevention should not only be aimed at athletes in general, and especially athletes competing in leanness sports, but also at women in the general population.’

Br J Sports Med 2005; 39:141-147

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