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Reproductive Hormones and Menstrual Changes with Exercise in Female Athletes

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Summary

The endocrine equilibrium which regulates reproductive function in women can be affected by physical and psychological factors. Blood levels of hormones depend on a balance between production, metabolism and clearance rates. Intensive physical exercise may affect this balance via different mechanisms, such as stress associated with competition, dieting, reduction of body fat and body weight, production of heat or hypoxia.

Women who engage in regular high intensity exercise may be at risk, as a consequence of these hormonal changes, of developing menstrual disturbances such as oligomenorrhoea, delayed menarche and amenorrhoea. Impaired production of gonadotrophins, which leads to luteal phase deficiency and anovulation, is a common hormonal finding with exercise-induced menstrual disturbances, but several other hormones may show significant alterations.

In this article we have reviewed the recent literature on the effects of intensive physical exercise on the menstrual cycle, on some important physical parameters such as bone mineral density and bodyweight, and on those hormones (gonadotrophins, prolactin, melatonin, opioid peptides and steroids) which regulate, directly or indirectly, the reproductive function in women.

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References

  1. Bonen A, Ling WY, MacIntyre KP, et al. Effects of exercise on the serum concentration of FSH, LH, progesterone and oestradiol. Eur J Appl Physiol 1979; 42: 15–25

    CAS  Google Scholar 

  2. Montagnani CF, Arena B, Maffulli N. Oestradiol and progesterone during exercise in healthy untrained women. Med Sci Sports Exerc 1992 24: 764–8

    PubMed  CAS  Google Scholar 

  3. Howlett TA. Hormonal responses to exercise and training: a short review. Clin Endocrinol 1987; 26: 723–42

    CAS  Google Scholar 

  4. Feicht CB, Johnson TS, Martin BJ, et al. Secondary amenorrhoa in athletes [correspondence]. Lancet 1978; 2: 1145–6

    PubMed  CAS  Google Scholar 

  5. Bullen A, Skrinar GS, Berlins IZ, et al. Induction of menstrual disorders by strenuous exercise in untrained women. New EnglJ Med 1985; 312: 1349–53

    CAS  Google Scholar 

  6. Prior JC. Exercise in women. Med North Am Sports 1987; 16–23

    Google Scholar 

  7. Sanborn CF, Martin BJ, Wagner WW. Is athletic amenorrhoea specific to runners? Am J Obstet Gynecol 1982; 143: 859–61

    PubMed  CAS  Google Scholar 

  8. Webb JL, Millan DL, Stoltz CJ. Gynecological survey of the american female athletes competing at the Montreal Olympic Games. J Sports Med Phys Fitness 1979; 19: 405–12

    PubMed  CAS  Google Scholar 

  9. Dale F, Gerlach DM, Wilwhite AL. Menstrual dysfunction in distance runners. Obst Gynecol 1979; 54: 47–53

    CAS  Google Scholar 

  10. Keizer HA, Poortman J, Bunnik GSJ. Influence of physical exercise on sex hormone metabolism. J Appl Physiol 1980; 48: 765–9

    PubMed  CAS  Google Scholar 

  11. Keizer HA, Rogol AD. Physical exercise and menstrual cycle alterations: what are the mechanisms? Sports Med 1990: 10(4): 218–35

    PubMed  CAS  Google Scholar 

  12. Carbon RJ. Exercise, amenorrhoea and skeleton. Br Med Bull 1992; 48(3): 546–60

    PubMed  CAS  Google Scholar 

  13. Dugowson CE, Drinkwater BL, Clark JM. Nontraumatic femur fracture in an oligomenorrheic athlete. Med Sci Sports Exerc 1991; 23(12): 1323–5

    PubMed  CAS  Google Scholar 

  14. 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): 505–8

    PubMed  CAS  Google Scholar 

  15. Berning J, Sanborn CF, Brooks SM, et al. Caloric deficit in distance runners. Med Sci Sports Exerc 1985; 17(2): 242

    Google Scholar 

  16. Warren MP, Brooks-Gunn J, Fox RP, et al. Lack of bone accretion and amenorrhea: evidence for a relative osteopenia in weight-bearing bones. J Clin Endocrinol Metab 1991; 72(4): 847–53

    PubMed  CAS  Google Scholar 

  17. Snead DB, Weltman A, Weltman JY, et al. Reproductive hormones and bone mineral density in women runners. J Appl Physiol 1992; 72(6): 2149–56

    PubMed  CAS  Google Scholar 

  18. Prior JC, Vigna YM, Schechter MT, et al. Spinal bone loss and ovulation disturbances. New Engl J Med 1990; 323: 1221–7

    PubMed  CAS  Google Scholar 

  19. Prior JC, Vigna YM, McKay DW. Reproduction for the athletic woman: new understandings of physiology and management. Sports Med 1992; 14(3): 190–9

    PubMed  CAS  Google Scholar 

  20. Creatsas G, Salakos N, Averkiou M, et al. Endocrinological profile of oligomenorrheic strenuously exercising adolescents. Int J Gynecol Obstet 1992; 38(3): 215–21

    CAS  Google Scholar 

  21. Glass AR, Deuster PA, Kyle SP, et al. Amenorrhoea in Olympic marathon runners. Fertil Steril 1987; 48(5): 740–5

    PubMed  CAS  Google Scholar 

  22. Pearson RM. Bionic ballerinas. Lancet 1985; 1: 481–2

    Google Scholar 

  23. Abraham S, Beaumont PJ, Fraser IF, et al. Body weight, exercise and menstrual states among ballet dancers in training. Br J Obstet Gynaecol 1982: 99: 507–10

    Google Scholar 

  24. Carlberg KA, Buckman MT, Peake GT, et al. Body composition of oligo-amenorrhoeic athletes. Med Sci Sports Exerc 1983; 15: 215–7

    PubMed  CAS  Google Scholar 

  25. Frisch RE, Gotz-Welbergen AV, McArthur JW, et al. Delayed menarche and amenorrhoea of college athletes in relation to age of onset of training. JAMA 1981; 246: 1559–63

    PubMed  CAS  Google Scholar 

  26. Malina RM, Harper AB, Avent HH. Age at menarche in athletes and non-athletes. Med Sci Sports Exerc 1973; 5: 11–3

    CAS  Google Scholar 

  27. Warren MP. The effects of exercise on pubertal progression and reproductive function in girls. J Clin Endocrinol Metab 1980; 51: 1150–7

    PubMed  CAS  Google Scholar 

  28. Warren MP, Brooks-Gunn J, Hamilton LH, et al. Scoliosis and fractures in young ballet dancers. New Engl J Med 1986; 314: 1348–53

    PubMed  CAS  Google Scholar 

  29. Wolman RL, Clark P, McNally E, et al. Menstrual state and exercise as determinants of spinal trabecular bone density in female athletes. BMJ 1990; 301: 516–8

    PubMed  CAS  Google Scholar 

  30. Warren MP. The effects of altered nutritional states, stress and systemic illness on reproduction in women. In: Vaitukaitos, editor. Clinical reproductive neuroendocrinology. New York: Elsevier Biomedical, 1982

    Google Scholar 

  31. Schwartz Rebar RW, Yen SSC. Amenorrhoea and long distance running [abstract]. Fertil Steril 1980; 34(3): 306

    Google Scholar 

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

    PubMed  Google Scholar 

  33. Maffulli N, Arena B. Menstrual cycle and performance in female athletes. Obstet Gynaecol Today 1993; 4(1): 6–9

    Google Scholar 

  34. Lata GF, Hu HK, Bagshaw G, et al. Equilibrium and kinetic characteristics of steroid interactions with human plasma sex binding protein. Arch Biochem Biophys 1980; 199: 220–7

    PubMed  CAS  Google Scholar 

  35. Baker E. Menstrual dysfunction and hormonal status in athletic women: a review. Fertil Steril 1981; 36: 691–6

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  37. Loucks AB. Athletic amenorrhoea: research summary and evaluation. Athlet Amenorrhea Bull 1983; 2: 1–12

    Google Scholar 

  38. Galle PC, Freeman EW, Galle MG, et al. Physiologie and psychologic profiles in a survey of women runners. Fertil Steril 1983; 39: 633–9

    PubMed  CAS  Google Scholar 

  39. Sinning WE, Little KD, Wilson JR, et al. Body composition and menstrual function in women athletes. Med Sci Sports Exerc 1985; 17(2): 214

    Google Scholar 

  40. Carlberg KA, Buckman MT, Peake GT, et al. A survey of menstrual function in athletes. Eur J Physiol 1983; 51: 211–22

    Google Scholar 

  41. Galbo H, Christensen NJ, Mikines KJ, et al. The effect of fasting on the hormonal response to graded exercise. J Clin Endocrinol Metab 1981; 52: 1106–12

    PubMed  CAS  Google Scholar 

  42. Johannessen A, Hagen C, Galbo H. Prolactin, growth hormone, thyrotropin, 3,5,3′-triiodothyronine and thyroxine responses to exercise after fat- and carbohydrate-enriched diet. J Clin Endocrinol Metab 1981; 52: 56–61

    PubMed  CAS  Google Scholar 

  43. Gadpaille WJ, Sanborn CF, Wagner WW. Athletic amenorrhoea, major affective disorders and eating disorders. Am J Psychiatr 1987; 144: 939–42

    PubMed  CAS  Google Scholar 

  44. Broocks A, Pirke KM, Schweiger U, et al. Cyclic ovarian function in recreational athletes. J Appl Physiol 1990; 68: 2083–6

    PubMed  CAS  Google Scholar 

  45. Jones GES. Some newer aspects of the management of infertility. JAMA 1949; 141: 1123–9

    CAS  Google Scholar 

  46. Cumming DC, Vickovic MM, Wall SR, et al. The effect of acute exercise on pulsatile release of luteinising hormone in women runners. Am J Obst Gynecol 1985; 153: 482–5

    CAS  Google Scholar 

  47. Cumming DC, Vickovic MM, Wall SR, et al. Defects of pulsatile LH release in normally menstruating runners. J Clin Endocrin Metab 1985; 60: 810–2

    CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  49. Boyden TW, Pamenter RW, Stanforth P, et al. Impaired gonadotropin responses to gonadotropin releasing hormone stimulation in endurance-trained women. Fertil Steril 1984; 41: 359–63

    PubMed  CAS  Google Scholar 

  50. Jurkowski JE, Jones NL, Walker WC, et al. Ovarian hormonal responses to exercise. J Appl Physiol 1978; 44: 109–14

    PubMed  CAS  Google Scholar 

  51. Bullen A, Skrinar GS, Berlins IZ, et al. Endurance training effects on plasma hormonal responsiveness and sex hormone excretion. J Appl Physiol 1984; 56: 1453–63

    PubMed  CAS  Google Scholar 

  52. Baker ER, Mathur RS, Kirk RF, et al. Plasma gonadotrophins, prolactin and steroid hormone concentrations in female runners after a long distance run. Fertil Steril 1982; 38: 38–41

    PubMed  CAS  Google Scholar 

  53. Bonen A, Keizer HA. Pituitary, ovarian and adrenal hormone responses to marathon running. Int J Sports Med 1987; 8: 161–7

    PubMed  CAS  Google Scholar 

  54. Hale RW, Kosasa T, Krieger J, et al. A marathon: the immediate effect on female runners’ luteinizing hormone, follicle stimulating hormone, prolactin, testosterone and cortisol levels. Am J Obstet Gynecol 1983; 146: 550–6

    PubMed  CAS  Google Scholar 

  55. Fries H, Nillius SJ, Petterson F. Epidemiology of secondary amenorrhoea. Am J Obstet Gynecol 1974; 118: 473–9

    PubMed  CAS  Google Scholar 

  56. Cumming DC, Rebar RW. Exercise and reproductive function in women. Am J Ind Med 1983; 4: 113–25

    PubMed  CAS  Google Scholar 

  57. Keizer HA, Menheere P, Kuipers H. Changes in pulsatile LH secretion after exhaustive exercise and training. Med Sci Sports Exerc 1987; 19 (Suppl.): 216

    Google Scholar 

  58. Beitins IZ, McArthur JW, Turnbull BA, et al. Exercise induces two types of human luteal dysfunction: confirmation by urinary free progesterone. J Clin Endocrinol Metab 1991; 72(6): 1350–8

    PubMed  CAS  Google Scholar 

  59. Prior JCK, Cameron Yuen, et al. Menstrual cycle changes with marathon training: anovulation and short luteal phase. Can J Appl Sports Sci 1982; 7: 173–7

    CAS  Google Scholar 

  60. Grossman A. Brain opiates and neuroendocrine function. Clin Endocrinol Metab 1983; 12: 725–46

    PubMed  CAS  Google Scholar 

  61. Howlett TA, Rees LH. Endogenous opioid peptides and hypothalamo-pituitary function. Annu Rev Physiol 1986; 48: 527–36

    PubMed  CAS  Google Scholar 

  62. Baker ER, Mathur RS, Kirk RF, et al. Female runners and secondary amenorrhoea: correlation with age, parity, mileage and plasma hormonal and SHBG concentrations. Fertil Steril 1981; 36: 183–7

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  64. Bergen H, Leung PCK. Norepinephrine inhibition of pulsatile LH release: receptor specificity. Am J Physiol 1986; 250 (Endocrinol Metab 13)

  65. Culler MD, Negro-Villar A. Evidence that pulsatile follicle stimulating hormone secretion is independent of endogenous luteinising hormone-releasing hormone. Endocrinology 1986; 118: 609–12

    PubMed  CAS  Google Scholar 

  66. Trager L. Steroid Hormonen. Berlin: Springer Verlag, 1977

    Google Scholar 

  67. Bullen BA, Skrinar GS, McArthur W, et al. Exercise effect upon plasma melatonin levels in women: possible physiological significance. Can J Appl Sports Sci 1982; 7: 90–7

    CAS  Google Scholar 

  68. Brandenberger G, Follenius M, Muzet A, et al. Interactions between spontaneous and provoked cortisol secretory episodes in man. J Clin Endocrinol Metab 1984; 59: 406–11

    PubMed  CAS  Google Scholar 

  69. Ding KH, Scheckter CB, Drinkwater BL, et al. Higher serum cortisol levels in exercise associated amenorrhoea. Ann Intern Med 1988; 108: 530–4

    PubMed  CAS  Google Scholar 

  70. Keizer HA, Beckers E, Des Haan et al. Exercise induced changes in the percentage of free testosterone and estradiol in trained and untrained women. Int J Sports Med 1987; 8: 151–5

    PubMed  CAS  Google Scholar 

  71. 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): 2378–87

    PubMed  Google Scholar 

  72. Chang FE, Dodds WG, Sullivan M, et al. The acute effects of exercise on prolactin and growth hormone secretion: comparison between sedentary women and women runners with normal and abnormal menstrual cycles. J Clin Endocrinol Metab 1986; 62: 551–6

    PubMed  CAS  Google Scholar 

  73. De Meirleir KL, Bayens L, L’Hermite-Baleriaux M, et al. Exercise induced prolactin release is related to anaerobiosis. J Clin Endocrinol Metab 1985; 60: 1250–2

    PubMed  Google Scholar 

  74. Shangold M, Freeman R, Thysen B, et al. The relationship between long distance running, plasma progesterone and midluteal phase length. Fertil Steril 1979; 31: 130–3

    PubMed  CAS  Google Scholar 

  75. Evans WS, Cronin MJ, Thorner MO. Hypogonadism in hyperprolactinaemia: proposed mechanisms. In: Ganong WF, Martini L, editors. Frontiers in endocrinology, vol. 7. New York: Raven, 1982: 77–159

    Google Scholar 

  76. Boyden TW, Pamenter RW, Grosso D, et al. Prolactin responses, menstrual cycles and body composition of women runners. J Clin Endocrinol Metab 1982; 54: 711–4

    PubMed  CAS  Google Scholar 

  77. Chang F, Richards S, Kim M, et al. Twenty-four hour prolactin profiles and prolactin responses to dopamine in long distance running women. J Clin Endocrinol Metab 1984; 59: 631–8

    PubMed  CAS  Google Scholar 

  78. Schiebinger RJ, Chrousos GP, Cutter GB, et al. The effect of serum prolactin on plasma adrenal androgens and the production and metabolic clearance rate of dehydroepiandrosterone sulfate in normal and hyperprolactinemic subjects. J Clin Endocrinol Metab 1986; 62: 202–9

    PubMed  CAS  Google Scholar 

  79. Highet R. Athletic amenorrhoea: an update on aetiology, complications and management. Sports Med 1989; 7: 82–108

    PubMed  CAS  Google Scholar 

  80. Laughlin GA, Loucks AB, Yen SS. Marked augmentation of nocturnal melatonin secretion in amenorrheic athletes but not in cycling athletes: unaltered by opioidergic or dopaminergic blockade. J Clin Endocrinol Metab 1991; 73(6): 1321–6

    PubMed  CAS  Google Scholar 

  81. Vaughan GM, McDonald SD, Jordan RM, et al. Melatonin, pituitary function and stress in humans. Psychoneuroendocrinology 1979; 4: 351–62

    PubMed  CAS  Google Scholar 

  82. Cumming DC, Rebar RW. Hormonal changes with acute exercise and with training in women. Semin Reprod Endocrinol 1985; 3: 55–64

    CAS  Google Scholar 

  83. McArthur JW, Bullen BA, Bettins IZ, et al. Hypothalamic amenorrhoea in runners of normal body distribution. Endocrinol Res Commun 1980; 7: 13–25

    CAS  Google Scholar 

  84. Samuels MH, Sanborn CF, Hofeldt F, et al. The role of endogenous opiates in athletic amenorrhea. Fertil Steril 1991; 55(3): 507–12

    PubMed  CAS  Google Scholar 

  85. Grossman A, Moult PJA, Mclntyre H, et al. Opiate mediation of amenorrhoea in hyperprolactinaemia and in weight loss related amenorrhoea. Clin Endocrinol 1982; 17: 379–88

    CAS  Google Scholar 

  86. Surbey GD, Andrew GM, Cervenko FW, et al. The effect of naloxone on the performance of intense exercise [abstract]. Med Sci Sports Exerc 1983; 15: 150

    Google Scholar 

  87. Grossman A, Bouloux P, Price P, et al. The role of opioid peptides in the hormonal response to acute exercise in man. Clin Science 1984; 67: 483–91

    CAS  Google Scholar 

  88. Howlett TA, Tomlin S, Ngahfoong L, et al. Release of betaendorphin and metenkephalin during exercise in normal women: response to training. BMJ 1984; 288; 1950–2

    PubMed  CAS  Google Scholar 

  89. McArthur JW. Amenorrhoeic athletes: at risk of developing osteoporosis. Br J Sports Med 1984; 18: 253–5

    PubMed  CAS  Google Scholar 

  90. Moll GW, Rosenfield RL, Heike JH. Oestradiol-testosterone binding interactions and free plasma estradiol under physiological conditions. J Clin Endocrinol Metab 1978; 47: 263–7

    Google Scholar 

  91. Dunn JF, Nisula BC, Rodbard D. Transport of steroid hormones: binding of endogenous steroids to both globulin and cortico-steroid-binding globulin in human plasma. J Clin Endocrinol Metab 1981; 53: 56–68

    Google Scholar 

  92. Farber M, Millan VG, Turskoy RN, et al. Diagnostic evaluation of hirsutism in women. Clin Obstet Gynecol 1977; 20: 1–9

    PubMed  CAS  Google Scholar 

  93. Longcope CL, Pratt JH, Schneider SJ, et al. The in vivo metabolism of androgens by muscle and adipose tissue of normal men. Steroids 1976: 28: 521–33

    PubMed  CAS  Google Scholar 

  94. Gurpide E. Tracer methods in hormone research. Endocrinology (8). Berlin: Springer Verlag, 1975

    Google Scholar 

  95. Williams RH, editor. Textbook of endocrinology. 6th ed. New York: WB Saunders, 1981

    Google Scholar 

  96. Cumming DC, Wall SR, Galbraith MA, et al. Reproductive hormone responses to resistance exercise. Med Sci Sports Exerc 1987; 19: 234–8

    PubMed  CAS  Google Scholar 

  97. Rowell LB, Blackmon JR, Bruce RA. Indocyanine green clearance and estimated hepatic blood flow during mild to maximal exercise in upright position. J Clin Invest 1964; 43: 1677–90

    PubMed  CAS  Google Scholar 

  98. Longcope C, Pratt JH, Schneider SH, et al. Aromatization of androgens by muscle and adipose tissue in vivo. J Clin Endocrinol Metab 1978: 46: 146–56

    PubMed  CAS  Google Scholar 

  99. Russel JB, Mitchell DE, Musey PI, et al. The relationship of exercise to anovulatory cycles in female athletes: hormonal and physical characteristics. Obstet Gynecol 1984; 63: 452–6

    Google Scholar 

  100. Russel JB, Mitchell DE, Musey PI, et al. The role of beta-endorphins and catecholestrogens on the hypothalamic-pituitary axis in female athletes. Fertil Steril 1984; 42: 690–5

    Google Scholar 

  101. Schwartz B, Cumming DC, Riordan E, et al. Exercise-associated amenorrhoea: a distinct entity? Am J Obstet Gynecol 1981; 141: 662–70

    PubMed  CAS  Google Scholar 

  102. Maresh CM, Wang BC, Goetz KL. Plasma vasopressin, renin activity and aldosterone responses to maximal exercise in active college females. Eur J Appl Physiol 1985; 54: 398–403

    CAS  Google Scholar 

  103. Korenman SG. Comment. Recent Progr Horm Res 1970; 26: 48–51

    Google Scholar 

  104. Jayle MF. Exploration biochimique du rp jaune. Gynecol Pratique 1956; 7: 145–55

    CAS  Google Scholar 

  105. Goldstein D, Zuckerman H, Harpaz S, et al. Correlation between estradiol and progesterone in cycles with luteal phase deficiency. Fertil Steril 1982; 37: 348–54

    PubMed  CAS  Google Scholar 

  106. Horta JHL, Fernandez JG, De Soto LB. Direct evidence of luteal insufficiency in women with abitual abortion. Obstet Gynecol 1977; 49: 705

    PubMed  CAS  Google Scholar 

  107. Di Zerega GS, Hodgen GD. Luteal phase dysfunction infertility: a sequel to aberrant follicuologenesis. Fertil Steril 1981; 35: 489

    Google Scholar 

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

    PubMed  CAS  Google Scholar 

  109. Prior JC. Endocrine ‘conditioning’ with endurance training, a preliminary review. Can J Appl Sports Sci 1982; 7: 148–57

    CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Women and Infants’ Hospital, Brown University, Providence, Rhode Island, USA

    Bruno Arena

  2. Sports Medicine Laboratory, Institute of Child Health, University of London, London, England

    Nicola Maffulli

  3. Second Medical School, University ‘Federico II’, Naples, Italy

    Francesco Maffulli

  4. Department of Clinical Chemistry, Civil Hospital, Piacenza, Italy

    Maria Antonietta Morleo

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  1. Bruno Arena
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  2. Nicola Maffulli
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  3. Francesco Maffulli
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  4. Maria Antonietta Morleo
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Arena, B., Maffulli, N., Maffulli, F. et al. Reproductive Hormones and Menstrual Changes with Exercise in Female Athletes. Sports Med. 19, 278–287 (1995). https://doi.org/10.2165/00007256-199519040-00005

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