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Sports Medicine
Published in: Sports Medicine 10/2023

30-06-2023 | Amenorrhoea | Systematic Review

The Prevalence of Menstrual Cycle Disorders and Menstrual Cycle-Related Symptoms in Female Athletes: A Systematic Literature Review

Authors: Bernadette Cherianne Taim, Ciarán Ó Catháin, Michèle Renard, Kirsty Jayne Elliott-Sale, Sharon Madigan, Niamh Ní Chéilleachair

Published in: Sports Medicine | Issue 10/2023

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Abstract

Background

Menstrual cycle (MC) disorders and MC-related symptoms can have debilitating effects on the health and performance of female athletes. As the participation of women in sports continues to increase, understanding the prevalence of a range of MC disorders and MC-related symptoms may guide preventive strategies to protect the health and optimise the performance of female athletes.

Objective

To examine the prevalence of MC disorders and MC-related symptoms among female athletes who are not using hormonal contraceptives and evaluate the assessment methods used to identify MC disorders and MC-related symptoms.

Methods

This systematic review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Six databases were searched until September 2022 for all original research that reported the prevalence of MC disorders and/or MC-related symptoms in athletes not using hormonal contraceptives, which included the definitions of the MC disorders examined, and the assessment methods used. MC disorders included amenorrhoea, anovulation, dysmenorrhoea, heavy menstrual bleeding (HMB), luteal phase deficiency (LPD), oligomenorrhoea, premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). MC-related symptoms included any affective and physical symptoms related to the MC that do not cause significant personal, interpersonal or functional impairment. The prevalence data across eligible studies were combined, and all studies were qualitatively synthesised to evaluate the assessment methods and tools used to identify MC disorders and MC-related symptoms. The methodological quality of studies was assessed using a modified Downs and Black checklist.

Results

Sixty studies involving 6380 athletes were included. A wide range of prevalence was observed for all types of MC disorders, with a dearth of data on anovulation and LPD. Based on pooled data, dysmenorrhoea (32.3%; range 7.8–85.6%) was the most prevalent MC disorder. Studies reporting MC-related symptoms mostly examined the premenstrual and menstruation phases, where affective symptoms appeared more prevalent than physical symptoms. A larger proportion of athletes reported symptoms during the initial days of menstruation compared with the premenstrual phase. MC disorders and MC-related symptoms were retrospectively assessed using self-report methods in 90.0% of studies. Most studies (76.7%) in this review were graded as moderate quality.

Discussion

MC disorders and MC-related symptoms are commonplace among female athletes, warranting further research examining their impact on performance and preventive/management strategies to optimise athlete health. To increase the quality of future studies, researchers should adopt standardised definitions of MC disorders and assessment methods such as a combination of calendar counting, urinary ovulation tests and a mid-luteal phase serum progesterone measurement when assessing menstrual function. Similarly, standardised diagnostic criteria should be used when examining MC disorders such as HMB, PMS and PMDD. Practically, implementing prospective cycle monitoring that includes ovulation testing, mid-luteal blood sampling (where feasible) and symptom logging throughout the MC could support athletes and practitioners to promptly identify and manage MC disorders and/or MC-related symptoms.

Trial Registration

This review has been registered in the PROSPERO database (CRD42021268757).
Appendix
Available only for authorised users
Literature
1.
2.
Broekmans FJ, Visser JA, Laven JSE, Broer SL, Themmen APN, Fauser BC. Anti-Müllerian hormone and ovarian dysfunction. Trends Endocrinol Metab. 2008;19:340–7.PubMedCrossRef
3.
4.
Goldman MB, Hatch MC. Women and Health. Berlin: Elsevier; 1999.
5.
Ellison PT. Human ovarian function and reproductive ecology: new hypotheses. Am Anthropolog. 1990;92:933–52.CrossRef
6.
7.
Biggs WS, Demuth RH. Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Phys. 2011;84:918–24.
8.
Manore MM. Dietary recommendations and athletic menstrual dysfunction. Sports Med. 2002;32:887–901.PubMedCrossRef
9.
Otis CL, Drinkwater B, Johnson M, Loucks A, Wilmore J. American College of Sports Medicine position stand. The Female Athlete Triad. Med Sci Sports Exerc. 1997;29:i–ix.PubMedCrossRef
10.
Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP. American College of Sports Medicine position stand. The female athlete triad. Med Sci Sports Exerc. 2007;39:1867–82.PubMed
11.
12.
De Souza MJ, West SL, Jamal SA, Hawker GA, Gundberg CM, Williams NI. The presence of both an energy deficiency and estrogen deficiency exacerbate alterations of bone metabolism in exercising women. Bone. 2008;43:140–8.PubMedCrossRef
13.
O’Donnell E, Harvey PJ, Goodman JM, De Souza MJ. Long-term estrogen deficiency lowers regional blood flow, resting systolic blood pressure, and heart rate in exercising premenopausal women. Am J Physiol Endocrinol Metab. 2007;292:E1401-1409.PubMedCrossRef
14.
Rickenlund A, Eriksson MJ, Schenck-Gustafsson K, Hirschberg AL. Amenorrhea in female athletes is associated with endothelial dysfunction and unfavorable lipid profile. J Clin Endocrinol Metab. 2005;90:1354–9.PubMedCrossRef
15.
16.
Karlsson TS, Marions LB, Edlund MG. Heavy menstrual bleeding significantly affects quality of life. Acta Obstet Gynecol Scand. 2014;93:52–7.PubMedCrossRef
17.
Gao M, Zhang H, Gao Z, Cheng X, Sun Y, Qiao M, et al. Global and regional prevalence and burden for premenstrual syndrome and premenstrual dysphoric disorder. Medicine (Baltimore). 2022;101: e28528.PubMedCrossRef
18.
Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiol Rev. 2014;36:104–13.PubMedCrossRef
19.
Bruinvels G, Goldsmith E, Blagrove R, Simpkin A, Lewis N, Morton K, et al. Prevalence and frequency of menstrual cycle symptoms are associated with availability to train and compete: a study of 6812 exercising women recruited using the Strava exercise app. Br J Sports Med. 2021;55:438–43.PubMedCrossRef
20.
Armour M, Parry KA, Steel K, Smith CA. Australian female athlete perceptions of the challenges associated with training and competing when menstrual symptoms are present. Int J Sports Sci Coach. 2020;15:316–23.CrossRef
21.
Warren MP, Perlroth NE. The effects of intense exercise on the female reproductive system. J Endocrinol. 2001;170:3–11.PubMedCrossRef
22.
De Souza MJ, Toombs RJ, Scheid JL, O’Donnell E, West SL, Williams NI. High prevalence of subtle and severe menstrual disturbances in exercising women: confirmation using daily hormone measures. Hum Reprod. 2010;25:491–503.PubMedCrossRef
23.
Torstveit MK, Sundgot-Borgen J. The female athlete triad exists in both elite athletes and controls. Med Sci Sports Exerc. 2005;37:1449–59.PubMedCrossRef
24.
McNulty KL, Elliott-Sale KJ, Dolan E, Swinton PA, Ansdell P, Goodall S, et al. The effects of menstrual cycle phase on exercise performance in eumenorrheic women: a systematic review and meta-analysis. Sports Med. 2020;50:1813–27.PubMedPubMedCentralCrossRef
25.
Elliott-Sale KJ, McNulty KL, Ansdell P, Goodall S, Hicks KM, Thomas K, et al. The effects of oral contraceptives on exercise performance in women: a systematic review and meta-analysis. Sports Med. 2020;50:1785–812.PubMedPubMedCentralCrossRef
26.
Elliott-Sale KJ, Ross E, Burden R, Hicks K. The BASES Expert Statement on conducting and implementing female athlete-based research. Sport Exerc Sci. 2020;65:6–7.
27.
Pitchers G, Elliott-sale K. Considerations for coaches training female athletes. Prof Strength Cond. 2019;55:19–30.
28.
29.
De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, 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, CA, May 2012, and 2nd International Conference held in Indianapolis, IN, May 2013. Clin J Sport Med. United States; 2014;24:96–119.
30.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10:89.PubMedPubMedCentralCrossRef
31.
Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377–84.PubMedPubMedCentralCrossRef
32.
McKay AKA, Stellingwerff T, Smith ES, Martin DT, Mujika I, Goosey-Tolfrey VL, et al. Defining Training and performance caliber: a participant classification framework. Int J Sports Physiol Perform. 2022;17:317–31.PubMedCrossRef
33.
Smith ES, McKay AKA, Ackerman KE, Harris R, Elliott-Sale KJ, Stellingwerff T, et al. Methodology review: a protocol to audit the representation of female athletes in sports science and sports medicine research. Int J Sport Nutr Exerc Metab. 2022;1:1–14.
34.
Master-Hunter T, Heiman DL. Amenorrhea: evaluation and treatment. Am Family Phys. 2006;73:1374–82.
35.
Practice Committee of American Society for Reproductive Medicine. Current evaluation of amenorrhea. Fertil Steril. 2008;90:S219-225.CrossRef
36.
37.
Klein DA, Poth MA. Amenorrhea: an approach to diagnosis and management. AFP. 2013;87:781–8.
38.
Janse DE, Jonge X, Thompson B, Han A. Methodological recommendations for menstrual cycle research in sports and exercise. Med Sci Sports Exerc. 2019;51:2610–7.CrossRef
39.
40.
ACOG Committee Opinion No. 760: Dysmenorrhea and endometriosis in the adolescent. Obstet Gynecol. 2018;132:e249–58.CrossRef
41.
Dawood MY. Primary dysmenorrhea: advances in pathogenesis and management. Obstet Gynecol. 2006;108:428–41.PubMedCrossRef
42.
Kadian S, O’Brien S. Classification of premenstrual disorders as proposed by the International Society for Premenstrual Disorders. Menopause Int. 2012;18:43–7.PubMedCrossRef
43.
Dickerson LM, Mazyck PJ, Hunter MH. Premenstrual syndrome. AFP. 2003;67:1743–52.
44.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Arlington: American Psychiatric Association; 2013.CrossRef
45.
Lanhers C, Courteix D, Valente-Dos-Santos J, Ferry B, Gracia-Marco L, Pereira B, et al. Gonadal hormones may predict structural bone fragility in elite female soccer player. J Sports Sci. 2020;38:827–37.PubMedCrossRef
46.
Bacchi E, Spiazzi G, Zendrini G, Bonin C, Moghetti P. Low body weight and menstrual dysfunction are common findings in both elite and amateur ballet dancers. J Endocrinol Invest. 2013;36:343–6.PubMed
47.
Barrack MT, Van Loan MD, Rauh MJ, Nichols JF. Physiologic and behavioral indicators of energy deficiency in female adolescent runners with elevated bone turnover. Am J Clin Nutr. 2010;92:652–9.PubMedCrossRef
48.
Beals KA, Manore MM. Disorders of the female athlete triad among collegiate athletes. Int J Sport Nutr Exerc Metab. 2002;12:281–93.PubMedCrossRef
49.
Brooks-Gunn J, Warren MP, Hamilton LH. The relation of eating problems and amenorrhea in ballet dancers. Med Sci Sports Exerc. 1987;19:41–4.PubMedCrossRef
50.
Calabrese LH, Kirkendall DT, Floyd M, Rapoport S, Williams GW. Menstrual abnormalities, nutritional patterns, and body composition in female classical ballet dancers. Phys Sportsmed. 1983;11:86–90.PubMedCrossRef
51.
Cook SD, Harding AF, Thomas KA, Morgan EL, Schnurpfeil KM, Haddad RJ Jr. Trabecular bone density and menstrual function in women runners. Am J Sports Med. 1987;15:503–7.PubMedCrossRef
52.
Czajkowska M, Drosdzol-Cop A, Gałązka I, Naworska B, Skrzypulec-Plinta V. Menstrual cycle and the prevalence of premenstrual syndrome/premenstrual dysphoric disorder in adolescent athletes. J Pediatr Adolesc Gynecol. 2015;28:492–8.PubMedCrossRef
53.
Czajkowska M, Plinta R, Rutkowska M, Brzęk A, Skrzypulec-Plinta V, Drosdzol-Cop A. Menstrual cycle disorders in professional female rhythmic gymnasts. Int J Environ Res Public Health. 2019;16:1470.PubMedPubMedCentralCrossRef
54.
Dusek T. Influence of high intensity training on menstrual cycle disorders in athletes. Croat Med J. 2001;42:79–82.PubMed
55.
Egan E, Reilly T, Whyte G, Giacomoni M, Cable NT. Disorders of the menstrual cycle in elite female ice hockey players and figure skaters. Biol Rhythm Res. 2003;34:251–64.CrossRef
56.
Fogelholm M, Van Marken LW, Ottenheijm R, Westerterp K. Amenorrhea in ballet dancers in the Netherlands. Med Sci Sports Exerc. 1996;28:545–50.PubMed
57.
Foster R, Vaisberg M, Araújo MP, Martins MA, Capel T, Bachi ALL, et al. Relationship between Anxiety and Interleukin 10 in Female Soccer Players with and Without Premenstrual Syndrome (PMS). Rev Bras Ginecol Obstet. 2017;39:602–7.PubMedPubMedCentralCrossRef
58.
Frisch RE, Albright T, Gotz-Welbergen AV, Witschi J, McArthur JW. Delayed menarche and amenorrhea of college athletes in relation to age of onset of training. J Am Med Assoc. 1981;246:1559–63.CrossRef
59.
Goodwin Y, Monyeki MA, Boit MK, De Ridder JH, Toriola AL, Mwangi FM, et al. Association between energy availability and menstrual function in elite Kenyan runners. Afr J Phys Health Educ Recreat Dance. 2014;20:291–307.
60.
Guler F, Hascelik Z. Menstrual dysfunction rate and delayed menarche in top athletes of team games. Sports Med Train Rehabil. 1993;4:99–106.CrossRef
61.
Hagmar M, Berglund B, Brismar K, Hirschberg AL. Hyperandrogenism may explain reproductive dysfunction in olympic athletes. Med Sci Sports Exerc. 2009;41:1241–8.PubMedCrossRef
62.
Hammar ML, Hammar-Henriksson MB, Frisk J, Rickenlund A, Wyon YA. Few oligo-amenorrheic athletes have vasomotor symptoms. Maturitas. 2000;34:219–25.PubMedCrossRef
63.
Harber VJ, Webber CE, Sutton JR, MacDougall JD. The effect of amenorrhea on calcaneal bone density and total bone turnover in runners. Int J Sports Med. 1991;12:505–8.PubMedCrossRef
64.
Hoch AZ, Pajewski NM, Moraski L, Carrera GF, Wilson CR, Hoffmann RG, et al. Prevalence of the female athlete triad in high school athletes and sedentary students. Clin J Sport Med. 2009;19:421–8.PubMedPubMedCentralCrossRef
65.
Ihalainen JK, Kettunen O, McGawley K, Solli GS, Hackney AC, Mero AA, et al. Body composition, energy availability, training, and menstrual status in female runners. Int J Sports Physiol Perform. 2021;16:1043–8.PubMedCrossRef
66.
Jenkins PJ, Ibanez-Santos X, Holly J, Cotterill A, Perry L, Wolman R, et al. IGFBP-1: a metabolic signal associated with exercise-induced amenorrhoea. Neuroendocrinology. 1993;57:600–4.PubMedCrossRef
67.
Kishali NF, Imamoglu O, Katkat D, Atan T, Akyol P. Effects of menstrual cycle on sports performance. Int J Neurosci. 2006;116:1549–63.PubMedCrossRef
68.
Maïmoun L, Coste O, Georgopoulos NA, Roupas ND, Mahadea KK, Tsouka A, et al. Despite a high prevalence of menstrual disorders, bone health is improved at a weight-bearing bone site in world-class female rhythmic gymnasts. J Clin Endocrinol Metab. 2013;98:4961–9.PubMedCrossRef
69.
Martin D, Sale C, Cooper SB, Elliott-Sale KJ. Period Prevalence and perceived side effects of hormonal contraceptive use and the menstrual cycle in elite athletes. Int J Sports Physiol Perform. 2018;13:926–32.PubMedCrossRef
70.
Melin A, Tornberg ÅB, Skouby S, Møller SS, Sundgot-Borgen J, Faber J, et al. Energy availability and the female athlete triad in elite endurance athletes. Scand J Med Sci Sports. 2015;25:610–22.PubMedCrossRef
71.
Möller-Nielsen J, Hammar M. Women’s soccer injuries in relation to the menstrual cycle and oral contraceptive use. Med Sci Sports Exerc. 1989;21:126–9.PubMed
72.
Molnár AH, Vidiczki-Dóczi A, Petrovszki Z, Győri F. Prevalence of eating disorders and menstrual irregularities among female football players. Arena J Phys Activ. 2016;5:16–27.
73.
Momma R, Nakata Y, Sawai A, Takeda M, Natsui H, Mukai N, et al. Comparisons of the prevalence, severity, and risk factors of dysmenorrhea between Japanese female athletes and non-athletes in universities. Int J Environ Res Public Health. 2021;19:52.PubMedPubMedCentralCrossRef
74.
Mukherjee P, Mishra SK, Ray S. Menstrual characteristics of adolescent athletes: a study from West Bengal, India. Coll Antropol. 2014;38:917–23.PubMed
75.
Myburgh KH, Berman C, Novick I, Noakes TD, Lambert EV. Decreased Resting Metabolic Rate in Ballet Dancers With Menstrual Irregularity. Int J Sport Nutr. 1999;9:285.PubMedCrossRef
76.
Nichols JF, Rauh MJ, Lawson MJ, Ji M, Barkai HS. Prevalence of the female athlete triad syndrome among high school athletes. Arch Pediatr Adolesc Med. 2006;160:137–42.PubMedCrossRef
77.
Nose-Ogura S, Yoshino O, Dohi M, Kigawa M, Harada M, Kawahara T, et al. Low bone mineral density in elite female athletes with a history of secondary amenorrhea in their teens. Clin J Sport Med. 2020;30:245–50.PubMed
78.
Oxfeldt M, Dalgaard LB, Jørgensen AA, Hansen M. Hormonal contraceptive use, menstrual dysfunctions, and self-reported side effects in elite athletes in Denmark. Int J Sports Physiol Perform. 2020;15:1377–84.PubMedCrossRef
79.
Parker LJ, Elliott-Sale KJ, Hannon MP, Morton JP, Close GL. An audit of hormonal contraceptive use in Women’s Super League soccer players; implications on symptomology. Sci Med Footb. 2022;6:153–8.PubMedCrossRef
80.
Pollock N, Grogan C, Perry M, Pedlar C, Cooke K, Morrissey D, et al. Bone-mineral density and other features of the female athlete triad in elite endurance runners: a longitudinal and cross-sectional observational study. Int J Sport Nutr Exerc Metab. 2010;20:418–26.PubMedCrossRef
81.
Quah YVMS, Poh BKP, Ng LODP, Noor MIP. The female athlete triad among elite Malaysian athletes: prevalence and associated factors. Asia Pac J Clin Nutr. 2009;18:200–8.PubMed
82.
Roberts TA, Glen J, Kreipe RE. Disordered eating and menstrual dysfunction in adolescent female athletes participating in school-sponsored sports. Clin Pediatr. 2003;42:561–4.CrossRef
83.
84.
Rutherford OM. Spine and total body bone mineral density in amenorrheic endurance athletes. J Appl Physiol. 1993;74:2904–8.PubMedCrossRef
85.
Schtscherbyna A, Soares EA, de Oliveira FP, Ribeiro BG. Female athlete triad in elite swimmers of the city of Rio de Janeiro, Brazil. Nutrition. 2009;25:634–9.PubMedCrossRef
86.
Stefani L, Galanti G, Lorini S, Beni G, Dei M, Maffulli N. Female athletes and menstrual disorders: a pilot study. Muscles Ligaments Tendons J (MLTJ). 2016;6:183–7.PubMedCrossRef
87.
Stokic E, Srdic B, Barak O. Body mass index, body fat mass and the occurrence of amenorrhea in ballet dancers. Gynecol Endocrinol. 2005;20:195–9.PubMedCrossRef
88.
Sygo J, Coates AM, Sesbreno E, Mountjoy ML, Burr JF. Prevalence of indicators of low energy availability in elite female sprinters. Int J Sport Nutr Exerc Metab. 2018;28:490–6.PubMedCrossRef
89.
Takeda T, Imoto Y, Nagasawa H, Muroya M, Shiina M. Premenstrual SYNDROME AND PREMENSTRUAL DYSPHORIC DISORDER in Japanese Collegiate Athletes. J Pediatr Adolesc Gynecol. 2015;28:215–8.PubMedCrossRef
90.
Takeda T, Imoto Y, Nagasawa H, Takeshita A, Shiina M. Stress fracture and premenstrual syndrome in Japanese adolescent athletes: a cross-sectional study. BMJ Open. 2016;6: e013103.PubMedPubMedCentralCrossRef
91.
Takeda T, Ueno T, Uchiyama S, Shiina M. Premenstrual symptoms interference and equal production status in Japanese collegiate athletes: a cross-sectional study. J Obstet Gynaecol Res. 2018;44:488–94.PubMedCrossRef
92.
Thompson SHEC. Characteristics of the Female Athlete Triad in Collegiate Cross-Country Runners. J Am Coll Health. 2007;56:129–36.PubMedCrossRef
93.
Toriola AL. Survey of menstrual function in young Nigerian athletes. Int J Sports Med. 1988;9:29–34.PubMedCrossRef
94.
Toriola AL, Mathur DN. Menstrual dysfunction in Nigerian athletes. Br J Obstet Gynaecol. 1986;93:979–85.PubMedCrossRef
95.
Tsukahara Y, Torii S, Yamasawa F, Iwamoto J, Otsuka T, Goto H, et al. Bone parameters of elite athletes with oligomenorrhea and prevalence seeking medical attention: a cross-sectional study. J Bone Miner Metab. 2021;39:1009–18.PubMedCrossRef
96.
Wakat DK, Sweeney KA, Rogol AD. Reproductive system function in women cross-country runners. Med Sci Sports Exerc. 1982;14:263–9.PubMedCrossRef
97.
Yamada K, Takeda T. Low Proportion of Dietary Plant Protein among Athletes with Premenstrual Syndrome-Related Performance Impairment. Tohoku J Exp Med. 2018;244:119–22.PubMedCrossRef
98.
Feldmann JM, Belsha JP, Eissa MA, Middleman AB. Female adolescent athletes’ awareness of the connection between menstrual status and bone health. J Pediatr Adolesc Gynecol. 2011;24:311–4.PubMedCrossRef
99.
Muia EN, Wright HH, Onywera VO, Kuria EN. Adolescent elite Kenyan runners are at risk for energy deficiency, menstrual dysfunction and disordered eating. J Sports Sci. 2016;34:598–606.PubMedCrossRef
100.
101.
Snyder AC, Wenderoth MP, Johnston CC, Hui SL. Bone mineral content of elite lightweight amenorrheic oarswomen. Hum Biol. 1986;58:863–9.PubMed
102.
Takeda T, Imoto Y, Nagasawa H, Takeshita A, Shiina M. Fish consumption and premenstrual syndrome and dysphoric disorder in Japanese Collegiate Athletes. J Pediatr Adolesc Gynecol. 2016;29:386–9.PubMedCrossRef
103.
Takeda T, Yoshimi K, Imoto Y, Shiina M. Associations between sleep habits and interference of premenstrual symptoms in athletic performance in Japanese adolescent athletes: a cohort study over a 2-year period. Gynecol Endocrinol. 2020;36:885–9.PubMedCrossRef
104.
Vannuccini S, Fondelli F, Clemenza S, Galanti G, Petraglia F. Dysmenorrhea and heavy menstrual bleeding in elite female athletes: quality of life and perceived stress. Reprod Sci. 2020;27:888–94.PubMedCrossRef
105.
de Oliveira FP, Bosi MLM, dos Vigário PS, Vieira da RS. Comportamento alimentar e imagem corporal em atletas. Rev Bras Med Esporte. 2003;9:348–56.CrossRef
106.
O’Brien PMS, Bäckström T, Brown C, Dennerstein L, Endicott J, Epperson CN, et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health. 2011;14:13–21.PubMedPubMedCentralCrossRef
107.
108.
109.
Casey ML, MacDonald PC, Mitchell MD. Despite a massive increase in cortisol secretion in women during parturition, there is an equally massive increase in prostaglandin synthesis. A paradox? J Clin Invest. 1985;75:1852–7.PubMedPubMedCentralCrossRef
110.
Pascoe MC, Thompson DR, Ski CF. Yoga, mindfulness-based stress reduction and stress-related physiological measures: a meta-analysis. Psychoneuroendocrinology. 2017;86:152–68.PubMedCrossRef
111.
Bhatia SC, Bhatia SK. Diagnosis and treatment of premenstrual dysphoric disorder. AFP. 2002;66:1239.
112.
McNamara A, Harris R, Minahan C. ‘That time of the month’… for the biggest event of your career! Perception of menstrual cycle on performance of Australian athletes training for the 2020 Olympic and Paralympic Games. BMJ Open Sport Exerc Med. 2022;8: e001300.PubMedPubMedCentralCrossRef
113.
Findlay R, Macrae E, Whyte I, Easton C, Forrest (née Whyte) L. How the menstrual cycle and menstruation affect sporting performance: experiences and perceptions of elite female rugby players. Br J Sports Med. 2020;54:1108–13.
114.
Logue CM, Moos RH. Positive perimenstrual changes: Toward a new perspective on the menstrual cycle. J Psychosom Res. 1988;32:31–40.PubMedCrossRef
115.
116.
Nazem TG, Ackerman KE. The female athlete triad. sports. Health. 2012;4:302–11.
117.
Mallinson R, Souza MJD. Current perspectives on the etiology and manifestation of the “silent” component of the Female Athlete Triad. Int J Women’s Health. 2014;6:451–67.
118.
De Souza MJ. Menstrual disturbances in athletes: a focus on luteal phase defects. Med Sci Sports Exerc. 2003;35:1553–63.PubMedCrossRef
119.
Russell M, Misra M. Influence of ghrelin and adipocytokines on bone mineral density in adolescent female athletes with amenorrhea and eumenorrheic athletes. Med Sport Sci. 2010;55:103–13.PubMedPubMedCentralCrossRef
120.
Barrack MT, Gibbs JC, De Souza MJ, Williams NI, Nichols JF, Rauh MJ, et al. Higher incidence of bone stress injuries with increasing female athlete triad-related risk factors: a prospective multisite study of exercising girls and women. Am J Sports Med. 2014;42:949–58.PubMedCrossRef
121.
Vanheest JL, Rodgers CD, Mahoney CE, De Souza MJ. Ovarian suppression impairs sport performance in junior elite female swimmers. Med Sci Sports Exerc. 2014;46:156–66.PubMedCrossRef
122.
Mansour D, Hofmann A, Gemzell-Danielsson K. A Review of clinical guidelines on the management of iron deficiency and iron-deficiency anemia in women with heavy menstrual bleeding. Adv Ther. 2021;38:201–25.PubMedCrossRef
123.
124.
Davies J, Kadir RA. Heavy menstrual bleeding: An update on management. Thromb Res. 2017;151:S70–7.PubMedCrossRef
125.
Franchini E, Brito CJ, Artioli GG. Weight loss in combat sports: physiological, psychological and performance effects. J Int Soc Sports Nutr. 2012;9:52.PubMedPubMedCentralCrossRef
126.
Thomas S, Gonzalez A, Ghigiarelli J. The Relationship between weight cutting and the female athlete triad in combat sport athletes. Int J Kinesiol Sports Sci. 2021;9:9.CrossRef
127.
Gordon CM, Ackerman KE, Berga SL, Kaplan JR, Mastorakos G, Misra M, et al. Functional hypothalamic amenorrhea: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017;102:1413–39.PubMedCrossRef
128.
Sharps FRJ, Wilson LJ, Graham CA-M, Curtis C. Prevalence of disordered eating, eating disorders and risk of low energy availability in professional, competitive and recreational female athletes based in the United Kingdom. Eur J Sport Sci. 2022;22:1445–51.PubMedCrossRef
129.
Meng K, Qiu J, Benardot D, Carr A, Yi L, Wang J, et al. The risk of low energy availability in Chinese elite and recreational female aesthetic sports athletes. J Int Soc Sports Nutr. 2020;17:13.PubMedPubMedCentralCrossRef
130.
131.
Kuikman MA, Mountjoy M, Burr JF. Examining the relationship between exercise dependence, disordered eating, and low energy availability. Nutrients. 2021;13:2601.PubMedPubMedCentralCrossRef
132.
Hagmar M, Berglund B, Brismar K, Hirschberg AL. Hyperandrogenism may explain reproductive dysfunction in olympic athletes. Med Sci Sports Exerc United States. 2009;41:1241–8.CrossRef
133.
134.
Small CM, Manatunga AK, Marcus M. Validity of self-reported menstrual cycle length. Ann Epidemiol. 2007;17:163–70.PubMedCrossRef
135.
Taffe J, Dennerstein L. Retrospective self-report compared with menstrual diary data prospectively kept during the menopausal transition. Climacteric. 2000;3:183–91.PubMedCrossRef
136.
137.
Zakherah MS, Sayed GH, El-Nashar SA, Shaaban MM. Pictorial blood loss assessment chart in the evaluation of heavy menstrual bleeding: diagnostic accuracy compared to alkaline hematin. GOI Karger Publishers. 2011;71:281–4.
138.
Higham JM, O’Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol. 1990;97:734–9.PubMedCrossRef
139.
Hald K, Lieng M. Assessment of Periodic Blood Loss: Interindividual and Intraindividual Variations of Pictorial Blood Loss Assessment Chart Registrations. J Minim Invasive Gynecol. 2014;21:662–8.PubMedCrossRef
140.
Herman MC, Mol BW, Bongers MY. Diagnosis of heavy menstrual bleeding. Womens Health (Lond Engl). 2016;12:15–20.PubMedCrossRef
141.
Magnay JL, O’Brien S, Gerlinger C, Seitz C. Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: a systematic literature review. BMC Womens Health. 2020;20:24.PubMedPubMedCentralCrossRef
142.
Sokol ER, Casele H, Haney EI. Ultrasound examination of the postpartum uterus: what is normal? J Matern Fetal Neonatal Med. 2004;15:95–9.PubMedCrossRef
143.
Hofmeister S, Bodden S. Premenstrual syndrome and premenstrual dysphoric disorder. AFP. 2016;94:236–40.
144.
Diaz A, Laufer MR, Breech LL, American College of Obstetricians and Gynecologists Committee on Adolescent Health Care. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics. 2006;118:2245–50.PubMedCrossRef
145.
Jamieson MA. Disorders of Menstruation in Adolescent Girls. Pediatr Clin N Am. 2015;62:943–61.CrossRef
146.
147.
Armour M, Dahlen HG, Smith CA. More than needles: the importance of explanations and self-care advice in treating primary dysmenorrhea with acupuncture. Evid Based Complement Altern Med. 2016;2016:3467067.CrossRef
148.
As-Sanie S, Black R, Giudice LC, Gray Valbrun T, Gupta J, Jones B, et al. Assessing research gaps and unmet needs in endometriosis. Am J Obstet Gynecol. 2019;221:86–94.PubMedCrossRef
149.
Hudelist G, Fritzer N, Thomas A, Niehues C, Oppelt P, Haas D, et al. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod. 2012;27:3412–6.PubMedCrossRef
150.
Ramos-Pichardo JD, Ortega-Galán ÁM, Iglesias-López MT, Abreu-Sánchez A, Fernández-Martínez E. Why do some spanish nursing students with menstrual pain fail to consult healthcare professionals? Int J Environ Res Public Health. 2020;17:8173.PubMedPubMedCentralCrossRef
151.
Frankovich RJ, Lebrun CM. Menstrual cycle, contraception, and performance. Clin Sports Med. 2000;19:251–71.PubMedCrossRef
152.
153.
Davis AR, Westhoff C, O’Connell K, Gallagher N. Oral contraceptives for dysmenorrhea in adolescent girls: a randomized trial. Obstet Gynecol. 2005;106:97–104.PubMedCrossRef
Metadata
Title
The Prevalence of Menstrual Cycle Disorders and Menstrual Cycle-Related Symptoms in Female Athletes: A Systematic Literature Review
Authors
Bernadette Cherianne Taim
Ciarán Ó Catháin
Michèle Renard
Kirsty Jayne Elliott-Sale
Sharon Madigan
Niamh Ní Chéilleachair
Publication date
30-06-2023
Publisher
Springer International Publishing
Published in
Sports Medicine / Issue 10/2023
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-023-01871-8

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