nach oben

Sports Medicine

Erschienen in:

01.09.2005 | Leading Article

Menstrual Disorders in Athletes

verfasst von: Leanne M. Redman, Prof. Anne B. Loucks

Erschienen in: Sports Medicine | Ausgabe 9/2005

Einloggen, um Zugang zu erhalten

Abstract

The various menstrual disorders in athletes may reflect different degrees of exposure to a disrupting factor or differences in the susceptibility of various women to disruption. The incidences of these disorders are not well documented, but they appear to be highest in aesthetic, endurance and weight-class sports, and at younger ages, higher training volumes and lower bodyweights. The morbid effects of these disorders include infertility, low bone mass, impaired endothelium-dependent vasodilation, and impaired skeletal muscle oxidative metabolism. The high incidences of menstrual disorders in athletes may derive in part from the self-selection of extraneously affected women into athletics, but many women acquire their menstrual disorders in athletics by failing to adequately increase dietary energy intake in compensation for exercise energy expenditure. Applied research is needed to develop effective dietary interventions that are acceptable to athletes.

Vollman RF. The menstrual cycle. Philadelphia (PA): WB Saunders Company, 1977

Matsumoto SN, Nogami Y, Ohkuri S. Statistical studies of menstruation: a criticism on the definition of normal menstruation. Gunma J Med Sci 1962; 11: 294–318

Speroff L, Glass RH, Kase NG. Clinical gynecologic endocrinology and infertility. 6th ed. Philadelphia (PA): Lippincott Williams & Wilkins, 1999

Jensen TK, Scheike T, Keiding N, et al. Fecundability in relation to body mass and menstrual cycle patterns. Epidemiology 1999; 10 (4): 422–8PubMedCrossRef

De Souza MJ, Miller BE, Loucks AB, et al. High frequency of luteal phase deficiency and anovulation in recreational women runners: blunted elevation in follicle-stimulating hormone observed during luteal-follicular transition. J Clin Endocrinol Metab 1998; 83 (12): 4220–32PubMedCrossRef

Loucks AB, Mortola JF, Girton L, et al. Alterations in the hypothalamic-pituitary-ovarian and the hypothalamic-pituitary-adrenal axes in athletic women. J Clin Endocrinol Metab 1989; 68 (2): 402–11PubMedCrossRef

Ellison PT, Lager C. Moderate recreational running is associated with lowered salivary progesterone profiles in women. Am J Obstet Gynecol 1986; 154: 1000–3PubMed

Prior JC, Cameron K, Yuen BH, et al. Menstrual cycle changes with marathon training: anovulation and short luteal phase. Can J Appl Sport Sci 1982; 7 (3): 173–7PubMed

Bonen A, Belcastro AN, Ling WY, et al. Profiles of selected hormones during menstrual cycles of teenage athletes. J Appl Physiol 1981; 50 (3): 545–51PubMed

10.

Practice Committee of the American Society for Reproductive Medicine. Current evaluation of amenorrhea. Fertil Steril 2004; 82 (1): 266–72CrossRef

11.

Williams NI, Caston-Balderrama AL, Helmreich DL, et al. Longitudinal changes in reproductive hormones and menstrual cyclicity in cynomolgus monkeys during strenuous exercise training: abrupt transition to exercise-induced amenorrhea. Endocrinology 2001; 142 (6): 2381–9PubMedCrossRef

12.

Bullen BA, Skrinar GS, Beitins IZ, et al. Induction of menstrual disorders by strenuous exercise in untrained women. N Engl J Med 1985; 312 (21): 1349–53PubMedCrossRef

13.

Chen EC, Brzyski RG. Exercise and reproductive dysfunction. Fertil Steril 1999; 71 (1): 1–6PubMedCrossRef

14.

Bullen BA, Skrinar GS, Beitins IZ, et al. Endurance training effects on plasma hormonal responsiveness and sex hormone excretion. J Appl Physiol 1984; 56 (6): 1453–63PubMed

15.

Bonen A. Exercise-induced menstrual cycle changes: a functional, temporary adaptation to metabolic stress. Sports Med 1994; 17 (6): 373–92PubMedCrossRef

16.

Baker ER, Mathur RS, Kirk RF, et al. Female runners and secondary amenorrhea: correlation with age, parity, mileage, and plasma hormonal and sex-hormone-binding globulin concentrations. Fertil Steril 1981; 36 (2): 183–7PubMed

17.

Sanborn CF, Martin BJ, Wagner Jr WW. Is athletic amenorrhea specific to runners? Am J Obstet Gynecol 1982; 143 (8): 859–61PubMed

18.

Klentrou P, Plyley M. Onset of puberty, menstrual frequency, and body fat in elite rhythmic gymnasts compared with normal controls. Br J Sports Med 2003; 37 (6): 490–4PubMedCrossRef

19.

Burrows M, Nevill AM, Bird S, et al. Physiological factors associated with low bone mineral density in female endurance runners. Br J Sports Med 2003; 37 (1): 67–71PubMedCrossRef

20.

Rosetta L, Harrison GA, Read GF. Ovarian impairments of female recreational distance runners during a season of training. Ann Hum Biol 1998; 25 (4): 345–57PubMedCrossRef

21.

Bachmann GA, Kemmann E. Prevalence of oligomenorrhea and amenorrhea in a college population. Am J Obstet Gynecol 1982; 144 (1): 98–102PubMed

22.

Pettersson F, Fries H, Nillius SJ. Epidemiology of secondary amenorrhea I: incidence and prevalence rates. Am J Obstet Gynecol 1973; 117 (1): 80–6PubMed

23.

Singh KB. Menstrual disorders in college students. Am J Obstet Gynecol 1981; 140 (3): 299–302PubMed

24.

Dusek T. Influence of high intensity training on menstrual cycle disorders in athletes. Croat Med J 2001; 42 (1): 79–82PubMed

25.

Chumlea WC, Schubert CM, Roche AF, et al. Age at menarche and racial comparisons in US girls. Pediatrics 2003; 111 (1): 110–3PubMedCrossRef

26.

Beals KA, Manore MM. Disorders of the female athlete triad among collegiate athletes. Int J Sport Nutr Exerc Metab 2002; 12 (3): 281–93PubMed

27.

Otis CL, Drinkwater B, Johnson M, et al. American College of Sports Medicine position stand: the female athlete triad. Med Sci Sports Exerc 1997; 29 (5): i-ixPubMedCrossRef

28.

Bennell KL, Brukner PD. Epidemiology and site specificity of stress fractures. Clin Sports Med 1997; 16 (2): 179–96PubMedCrossRef

29.

Warren MP, Brooks-Gunn J, Fox RP, et al. Persistent osteopenia in ballet dancers with amenorrhea and delayed menarche despite hormone therapy: a longitudinal study. Fertil Steril 2003; 80 (2): 398–404PubMedCrossRef

30.

Cumming DC. Exercise-associated amenorrhea, low bone density, and estrogen replacement therapy. Arch Intern Med 1996; 156 (19): 2193–5PubMedCrossRef

31.

Rickenlund A, Carlstrom K, Ekblom B, et al. Effects of oral contraceptives on body composition and physical performance in female athletes. J Clin Endocrinol Metab 2004; 89 (9): 4364–70PubMedCrossRef

32.

Zanker CL, Swaine IL. Bone turnover in amenorrhoeic and eumenorrhoeic women distance runners. Scand J Med Sci Sports 1998; 8 (1): 20–6PubMedCrossRef

33.

Okano H, Mizunuma H, Soda M, et al. Effects of exercise and amenorrhea on bone mineral density in teenage runners. Endocr J 1995; 42 (2): 271–6PubMedCrossRef

34.

Myerson M, Gutin B, Warren MP, et al. Resting metabolic rate and energy balance in amenorrheic and eumenorrheic runners. Med Sci Sports Exerc 1991; 23: 15–22PubMed

35.

Loucks AB, Laughlin GA, Mortola JF, et al. Hypothalamic-pituitary-thyroidal function in eumenorrheic and amenorrheic athletes. J Clin Endocrinol Metab 1992; 75 (2): 514–8PubMedCrossRef

36.

Laughlin GA, Yen SSC. Nutritional and endocrine-metabolic aberrations in amenorrheic athletes. J Clin Endocrinol Metab 1996; 81 (12): 4301–9PubMedCrossRef

37.

Compston JE. Sex steroids and bone. Physiol Rev 2001; 81 (1): 419–47PubMed

38.

Hoch AZ, Dempsey RL, Carrera GF, et al. Is there an association between athletic amenorrhea and endothelial cell dysfunction? Med Sci Sports Exerc 2003; 35 (3): 377–83CrossRef

39.

Hoch AZ, Jurva J, Staton M, et al. Is endothelial dysfunction that is associated with athletic amenorrhea reversible? [abstract]. Med Sci Sports Exerc 2003; 35: S12

40.

Harber VJ, Petersen SR, Chilibeck PD. Thyroid hormone concentrations and muscle metabolism in amenorrheic and eumenorrheic athletes. Can J Appl Physiol 1998; 23: 293–306PubMedCrossRef

41.

Reindollar RH, Lalwani SI. Abnormalities of female pubertal development. Endotext.com [online]. Available from URL: http://www.mdtext.com/female/female2/femaleframe2.htm [Accessed 2004 Dec 26]

42.

Malina RM. Menarche in athletes: a synthesis and hypothesis. Ann Hum Biol 1983; 10 (1): 1–24PubMedCrossRef

43.

Constantini NW, Warren MP. Menstrual dysfunction in swimmers: a distinct entity. J Clin Endocrinol Metab 1995; 80 (9): 2740–4PubMedCrossRef

44.

Rickenlund A, Carlstrom K, Ekblom B, et al. Hyperandrogenicity is an alternative mechanism underlying oligomenorrhea or amenorrhea in female athletes and may improve physical performance. Fertil Steril 2003; 79 (4): 947–55PubMedCrossRef

45.

Veldhuis JD, Evans WS, Demers LM, et al. Altered neuroendocrine regulation of gonadotropin secretion in women distance runners. J Clin Endocrinol Metab 1985; 61 (3): 557–63PubMedCrossRef

46.

Frisch RE, McArthur JW. Menstrual cycles: fatness as determinant of minimum weight for height necessary for their maintenance or onset. Science 1974; 185: 949–51PubMedCrossRef

47.

Bronson FH, Manning JM. The energetic regulation of ovulation: a realistic role for body fat. Biol Reprod 1991; 44 (6): 945–50PubMedCrossRef

48.

Baer JT. Endocrine parameters in amenorrheic and eumenorrheic adolescent female runners. Int J Sports Med 1993; 14 (4): 191–5PubMedCrossRef

49.

Chin NW, Chang FE, Dodds WG, et al. Acute effects of exercise on plasma catecholamines in sedentary and athletic women with normal and abnormal menses. Am J Obstet Gynecol 1987; 157 (4 Pt 1): 938–44PubMed

50.

De Souza MJ, Maresh CM, Abraham A, et al. Body compositions of eumenorrheic, oligomenorrheic and amenorrheic runners. J Appl Sport Sci Res 1988; 2 (1): 13–5

51.

De Souza MJ, Maguire MS, Rubin KR, et al. Effects of menstrual phase and amenorrhea on exercise performance in runners. Med Sci Sports Exerc 1990; 22 (5): 575–80PubMedCrossRef

52.

Deuster PA, Kyle SB, Moser PB, et al. Nutritional intakes and status of highly trained amenorrheic and eumenorrheic women runners. Fertil Steril 1986; 46 (4): 636–43PubMed

53.

Dixon G, Eurman P, Stern BE, et al. Hypothalamic function in amenorrheic runners. Fertil Steril 1984; 42 (3): 377–83PubMed

54.

Drinkwater BL, Nilson K, Chesnut III CH, et al. Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med 1984; 311 (5): 277–81PubMedCrossRef

55.

Fisher EC, Nelson ME, Frontera WR, et al. Bone mineral content and levels of gonadotropins and estrogens in amenorrheic running women. J Clin Endocrinol Metab 1986; 62 (6): 1232–6PubMedCrossRef

56.

Harber VJ, Webber CE, Sutton JR, et al. The effect of amenorrhea on calcaneal bone density and total bone turnover in runners. Int J Sports Med 1991; 12 (5): 505–8PubMedCrossRef

57.

Jenkins PJ, Ibanez-Santos X, Holly J, et al. IGFBP-1: a metabolic signal associated with exercise-induced amenorrhoea. Neuroendocrinology 1993; 57 (4): 600–4PubMedCrossRef

58.

Linnell SL, Stager JM, Blue PW, et al. Bone mineral content and menstrual regularity in female runners. Med Sci Sports Exerc 1984; 16 (4): 343–8PubMed

59.

Loucks AB, Horvath SM. Exercise-induced stress responses of amenorrheic and eumenorrheic runners. J Clin Endocrinol Metab 1984; 59 (6): 1109–20PubMedCrossRef

60.

Marcus R, Cann C, Madvig P, et al. Menstrual function and bone mass in elite women distance runners: endocrine and metabolic features. Ann Intern Med 1985; 102 (2): 158–63PubMed

61.

Myburgh KH, Bachrach LK, Lewis B, et al. Low bone mineral density at axial and appendicular sites in amenorrheic athletes. Med Sci Sports Exerc 1993; 25 (11): 1197–202PubMed

62.

Myerson M, Gutin B, Warren MP, et al. Total body bone density in amenorrheic runners. Obstet Gynecol 1992; 79 (6): 973–8PubMed

63.

Sanborn CF, Albrecht BH, Wagner Jr WW. Athletic amenorrhea: lack of association with body fat. Med Sci Sports Exerc 1987; 19 (3): 207–12PubMed

64.

Snyder AC, Wenderoth MP, Johnston Jr CC, et al. Bone mineral content of elite lightweight amenorrheic oarswomen. Hum Biol 1986; 58 (6): 863–9PubMed

65.

Stacey E, Korkia P, Hukkanen MVJ, et al. Decreased nitric oxide levels and bone turnover in amenorrheic athletes with spinal osteopenia. J Clin Endocrinol Metab 1998; 83 (9): 3056–61PubMedCrossRef

66.

Thong FS, McLean C, Graham TE. Plasma leptin in female athletes: relationship with body fat, reproductive, nutritional, and endocrine factors. J Appl Physiol 2000; 88 (6): 2037–44PubMed

67.

Warren MP, Brooks-Gunn J, Fox RP, et al. Osteopenia in exercise-associated amenorrhea using ballet dancers as a model: a longitudinal study. J Clin Endocrinol Metab 2002; 87 (7): 3162–8PubMedCrossRef

68.

Waters DL, Qualls CR, Dorin R, et al. Increased pulsatility, process irregularity, and nocturnal trough concentrations of growth hormone in amenorrheic compared to eumenorrheic athletes. J Clin Endocrinol Metab 2001; 86 (3): 1013–9PubMedCrossRef

69.

Wilmore JH, Wambsgans KC, Brenner M, et al. Is there energy conservation in amenorrheic compared with eumenorrheic distance runners? J Appl Physiol 1992; 72 (1): 15–22PubMed

70.

Yahiro J, Glass AR, Fears WB, et al. Exaggerated gonadotropin response to luteinizing hormone-releasing hormone in amenorrheic runners. Am J Obstet Gynecol 1987; 156 (3): 586–91PubMed

71.

Selye H. The effect of adaptation to various damaging agents on the female sex organs in the rat. Endocrinology 1939; 25: 615–24CrossRef

72.

Rivier C, Rivest S. Effect of stress on the activity of the hypothalamic-pituitary-gonadal axis: peripheral and central mechanisms. Biol Reprod 1991; 45: 523–32PubMedCrossRef

73.

Ding J-H, Scheckter CB, Drinkwater BL, et al. High serum cortisol levels in exercise-associated amenorrhea. Ann Intern Med 1988; 108: 530–4PubMed

74.

De Souza MJ, Maguire MS, Maresh CM, et al. Adrenal activation and the prolactin response to exercise in eumenorrheic and amenorrheic runners. J Appl Physiol 1991; 70 (6): 2378–87PubMed

75.

De Souza MJ, Luciano AA, Arce JC, et al. Clinical tests explain blunted cortisol responsiveness but not mild hypercortisolism in amenorrheic runners. J Appl Physiol 1994; 76 (3): 1302–9PubMed

76.

Manning JM, Bronson FH. Effects of prolonged exercise on puberty and luteinizing hormone secretion in female rats. Am J Physiol 1989; 257 (6 Pt 2): R1359–64

77.

Manning JM, Bronson FH. Suppression of puberty in rats by exercise: effects on hormone levels and reversal with GnRH infusion. Am J Physiol 1991; 260 (4 Pt 2): R717–23

78.

Loucks AB, Redman LM. The effect of stress on menstrual function. Trends Endocrinol Metab 2004; 15 (10): 466–71PubMedCrossRef

79.

Slentz CA, Davis JM, Settles DL, et al. Glucose feedings and exercise in rats: glycogen use, hormone responses, and performance. J Appl Physiol 1990; 69: 989–94PubMed

80.

Tabata I, Ogita F, Miyachi M, et al. Effect of low blood glucose on plasm CRF, ACTH, and cortisol during prolonged physical exercise. J Appl Physiol 1991; 71: 1807–12PubMed

81.

Laughlin GA, Yen SSC. Hypoleptinemia in women athletes: absence of a diurnal rhythm with amenorrhea. J Clin Endocrinol Metab 1997; 82 (1): 318–21PubMedCrossRef

82.

Loucks AB, Verdun M, Heath EM. Low energy availability, not stress of exercise, alters LH pulsatility in exercising women. J Appl Physiol 1998; 84 (1): 37–46PubMed

83.

Williams NI, Helmreich DL, Parfitt DB, et al. Evidence for a causal role of low energy availability in the induction of menstrual cycle disturbances during strenuous exercise training. J Clin Endocrinol Metab 2001; 86 (11): 5184–93PubMedCrossRef

84.

Friedl KE, Moore RJ, Hoyt RW, et al. Endocrine markers of semistarvation in healthy lean men in a multistressor environment. J Appl Physiol 2000; 88 (5): 1820–30PubMed

85.

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 (1): 297–311PubMedCrossRef

86.

Ihle R, Loucks AB. Dose-response relationships between energy availability and bone turnover in young exercising women. J Bone Miner Res 2004; 19 (8): 1231–40PubMedCrossRef

87.

Wade GN, Jones JE. Lessons from experimental disruption of estrous cycles and behaviors. Med Sci Sports Exerc 2003; 35: 1573–80PubMedCrossRef

88.

Wade GN, Schneider JE. Metabolic fuels and reproduction in female mammals. Neurosci Biobehav Rev 1992; 16 (2): 235–72PubMedCrossRef

89.

Schneider JE. Energy balance and reproduction. Physiol Behav 2004; 81 (2): 289–317PubMedCrossRef

90.

Wade GN, Schneider JE, Li HY. Control of fertility by metabolic cues. Am J Physiol 1996; 270 (1 Pt 1): E1–19

91.

Wade GN, Jones JE. Neuroendocrinology of nutritional infertility. Am J Physiol Regul Integr Comp Physiol 2004; 287 (6): R1277–96CrossRef

92.

Jenkins AB, Markovic TP, Fleury A, et al. Carbohydrate intake and short-term regulation of leptin in humans. Diabetologia 1997; 40 (3): 348–51PubMedCrossRef

93.

Mueller WM, Gregoire FM, Stanhope KL, et al. Evidence that glucose metabolism regulates leptin secretion from cultured rat adipocytes. Endocrinology 1998; 139 (2): 551–8PubMedCrossRef

94.

Griffin ML, South SA, Yankov VI, et al. Insulin-dependent diabetes mellitus and menstrual dysfunction. Ann Med 1994; 26 (5): 331–40PubMedCrossRef

95.

Welt CK, Chan JL, Bullen J, et al. Recombinant human leptin in women with hypothalamic amenorrhea. N Engl J Med 2004; 351 (10): 987–97PubMedCrossRef

96.

Gottsch ML, Clifton DK, Steiner RA. Galanin-like peptide as a link in the integration of metabolism and reproduction. Trends Endocrinol Metab 2004; 15 (5): 215–21PubMedCrossRef

97.

Szymanski LA, Schneider JE, Rao A, et al. Rapid restoration of luteinizing hormone pulses in refed chronically undernourished ewes occurs without alterations in plasma leptin concentrations. Soc Neurosci Abstr 2003; 33: 827.11

98.

Williams NI, Lancas MJ, Cameron JL. Stimulation of luteinizing hormone secretion by food intake: evidence against a role for insulin. Endocrinology 1996; 137 (6): 2565–71PubMedCrossRef

Titel: Menstrual Disorders in Athletes
verfasst von: Leanne M. Redman
Prof. Anne B. Loucks
Publikationsdatum: 01.09.2005
Verlag: Springer International Publishing
Erschienen in: Sports Medicine / Ausgabe 9/2005
Print ISSN: 0112-1642
Elektronische ISSN: 1179-2035
DOI: https://doi.org/10.2165/00007256-200535090-00002

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen