Skip to main content
British Journal of Sports Medicine logoLink to British Journal of Sports Medicine
. 2005 Mar;39(3):141–147. doi: 10.1136/bjsm.2003.011338

Participation in leanness sports but not training volume is associated with menstrual dysfunction: a national survey of 1276 elite athletes and controls

M Torstveit 1, J Sundgot-Borgen 1
PMCID: PMC1725151  PMID: 15728691

Abstract

Objective: To examine the prevalence of menstrual dysfunction in the total population of Norwegian elite female athletes and national representative controls in the same age group.

Methods: A detailed questionnaire that included questions on training and/or physical activity patterns, menstrual, dietary, and weight history, oral contraceptive use, and eating disorder inventory subtests was administered to all elite female athletes representing the country at the junior or senior level (aged 13–39 years, n = 938) and national representative controls in the same age group (n = 900). After exclusion, a total of 669 athletes (88.3%) and 607 controls (70.2%) completed the questionnaire satisfactorily.

Results: Age at menarche was significantly (p<0.001) later in athletes (13.4 (1.4) years) than in controls (13.0 (1.3) years), and differed among sport groups. A higher percentage of athletes (7.3%) than controls (2.0%) reported a history of primary amenorrhoea (p<0.001). A similar percentage of athletes (16.5%) and controls (15.2%) reported present menstrual dysfunction, but a higher percentage of athletes competing in leanness sports reported present menstrual dysfunction (24.8%) than athletes competing in non-leanness sports (13.1%) (p<0.01) and controls (p<0.05).

Conclusions: These novel data include virtually all eligible elite athletes, and thus substantially extend previous studies. Age at menarche occurred later and the prevalence of primary amenorrhoea was higher in elite athletes than in controls. A higher percentage of athletes competing in sports that emphasise thinness and/or a specific weight reported present menstrual dysfunction than athletes competing in sports focusing less on such factors and controls. On the basis of a comparison with a previous study, the prevalence of menstrual dysfunction was lower in 2003 than in 1993.

Full Text

The Full Text of this article is available as a PDF (93.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baxter-Jones A. D., Helms P., Baines-Preece J., Preece M. Menarche in intensively trained gymnasts, swimmers and tennis players. Ann Hum Biol. 1994 Sep-Oct;21(5):407–415. doi: 10.1080/03014469400003422. [DOI] [PubMed] [Google Scholar]
  2. Beals Katherine A., Manore Melinda M. Disorders of the female athlete triad among collegiate athletes. Int J Sport Nutr Exerc Metab. 2002 Sep;12(3):281–293. doi: 10.1123/ijsnem.12.3.281. [DOI] [PubMed] [Google Scholar]
  3. Bennell K., White S., Crossley K. The oral contraceptive pill: a revolution for sportswomen? Br J Sports Med. 1999 Aug;33(4):231–238. doi: 10.1136/bjsm.33.4.231. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Brooks-Gunn J., Warren M. P. Mother-daughter differences in menarcheal age in adolescent girls attending national dance company schools and non-dancers. Ann Hum Biol. 1988 Jan-Feb;15(1):35–43. doi: 10.1080/03014468800009441. [DOI] [PubMed] [Google Scholar]
  5. Burr D. B., Yoshikawa T., Teegarden D., Lyle R., McCabe G., McCabe L. D., Weaver C. M. Exercise and oral contraceptive use suppress the normal age-related increase in bone mass and strength of the femoral neck in women 18-31 years of age. Bone. 2000 Dec;27(6):855–863. doi: 10.1016/s8756-3282(00)00403-8. [DOI] [PubMed] [Google Scholar]
  6. Cavanaugh D. J., Kanonchoff A. D., Bartels R. L. Menstrual irregularities in athletic women may be predictable based on pre-training menses. J Sports Med Phys Fitness. 1989 Jun;29(2):163–169. [PubMed] [Google Scholar]
  7. Constantini N. W., Warren M. P. Menstrual dysfunction in swimmers: a distinct entity. J Clin Endocrinol Metab. 1995 Sep;80(9):2740–2744. doi: 10.1210/jcem.80.9.7673417. [DOI] [PubMed] [Google Scholar]
  8. Constantini N. W., Warren M. P. Special problems of the female athlete. Baillieres Clin Rheumatol. 1994 Feb;8(1):199–219. doi: 10.1016/s0950-3579(05)80232-8. [DOI] [PubMed] [Google Scholar]
  9. De Souza M. J., Miller B. E., Loucks A. B., Luciano A. A., Pescatello L. S., Campbell C. G., Lasley B. L. 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 Dec;83(12):4220–4232. doi: 10.1210/jcem.83.12.5334. [DOI] [PubMed] [Google Scholar]
  10. Dusek T. Influence of high intensity training on menstrual cycle disorders in athletes. Croat Med J. 2001 Feb;42(1):79–82. [PubMed] [Google Scholar]
  11. Farmosi I. Data concerning the menarche-age of Hungarian female athletes. J Sports Med Phys Fitness. 1983 Mar;23(1):89–94. [PubMed] [Google Scholar]
  12. Fogelholm M., Van Marken Lichtenbelt W., Ottenheijm R., Westerterp K. Amenorrhea in ballet dancers in the Netherlands. Med Sci Sports Exerc. 1996 May;28(5):545–550. doi: 10.1097/00005768-199605000-00002. [DOI] [PubMed] [Google Scholar]
  13. Frisch R. E., Gotz-Welbergen A. V., McArthur J. W., Albright T., Witschi J., Bullen B., Birnholz J., Reed R. B., Hermann H. Delayed menarche and amenorrhea of college athletes in relation to age of onset of training. JAMA. 1981 Oct 2;246(14):1559–1563. [PubMed] [Google Scholar]
  14. Garner D. M., Garfinkel P. E., Rockert W., Olmsted M. P. A prospective study of eating disturbances in the ballet. Psychother Psychosom. 1987;48(1-4):170–175. doi: 10.1159/000288049. [DOI] [PubMed] [Google Scholar]
  15. Hata E., Aoki K. Age at menarche and selected menstrual characteristics in young Japanese athletes. Res Q Exerc Sport. 1990 Jun;61(2):178–183. doi: 10.1080/02701367.1990.10608672. [DOI] [PubMed] [Google Scholar]
  16. Khan K. M., Liu-Ambrose T., Sran M. M., Ashe M. C., Donaldson M. G., Wark J. D. New criteria for female athlete triad syndrome? As osteoporosis is rare, should osteopenia be among the criteria for defining the female athlete triad syndrome? Br J Sports Med. 2002 Feb;36(1):10–13. doi: 10.1136/bjsm.36.1.10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. 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 Dec;37(6):490–494. doi: 10.1136/bjsm.37.6.490. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Loucks A. B., Horvath S. M. Athletic amenorrhea: a review. Med Sci Sports Exerc. 1985 Feb;17(1):56–72. [PubMed] [Google Scholar]
  19. Loucks A. B., Verdun M., Heath E. M. Low energy availability, not stress of exercise, alters LH pulsatility in exercising women. J Appl Physiol (1985) 1998 Jan;84(1):37–46. doi: 10.1152/jappl.1998.84.1.37. [DOI] [PubMed] [Google Scholar]
  20. Loucks Anne B. Energy availability, not body fatness, regulates reproductive function in women. Exerc Sport Sci Rev. 2003 Jul;31(3):144–148. doi: 10.1097/00003677-200307000-00008. [DOI] [PubMed] [Google Scholar]
  21. Malina R. M., Katzmarzyk P. T., Bonci C. M., Ryan R. C., Wellens R. E. Family size and age at menarche in athletes. Med Sci Sports Exerc. 1997 Jan;29(1):99–106. doi: 10.1097/00005768-199701000-00014. [DOI] [PubMed] [Google Scholar]
  22. Malina R. M. Menarche in athletes: a synthesis and hypothesis. Ann Hum Biol. 1983 Jan-Feb;10(1):1–24. doi: 10.1080/03014468300006141. [DOI] [PubMed] [Google Scholar]
  23. Malina R. M., Ryan R. C., Bonci C. M. Age at menarche in athletes and their mothers and sisters. Ann Hum Biol. 1994 Sep-Oct;21(5):417–422. doi: 10.1080/03014469400003432. [DOI] [PubMed] [Google Scholar]
  24. Malina R. M., Spirduso W. W., Tate C., Baylor A. M. Age at menarche and selected menstrual characteristics in athletes at different competitive levels and in different sports. Med Sci Sports. 1978 Fall;10(3):218–222. [PubMed] [Google Scholar]
  25. Otis C. L., Drinkwater B., Johnson M., Loucks A., Wilmore J. American College of Sports Medicine position stand. The Female Athlete Triad. Med Sci Sports Exerc. 1997 May;29(5):i–ix. doi: 10.1097/00005768-199705000-00037. [DOI] [PubMed] [Google Scholar]
  26. Otis C. L. Exercise-associated amenorrhea. Clin Sports Med. 1992 Apr;11(2):351–362. [PubMed] [Google Scholar]
  27. Robinson T. L., Snow-Harter C., Taaffe D. R., Gillis D., Shaw J., Marcus R. Gymnasts exhibit higher bone mass than runners despite similar prevalence of amenorrhea and oligomenorrhea. J Bone Miner Res. 1995 Jan;10(1):26–35. doi: 10.1002/jbmr.5650100107. [DOI] [PubMed] [Google Scholar]
  28. Sundgot-Borgen J. Eating disorders, energy intake, training volume, and menstrual function in high-level modern rhythmic gymnasts. Int J Sport Nutr. 1996 Jun;6(2):100–109. doi: 10.1123/ijsn.6.2.100. [DOI] [PubMed] [Google Scholar]
  29. Sundgot-Borgen J. Prevalence of eating disorders in elite female athletes. Int J Sport Nutr. 1993 Mar;3(1):29–40. doi: 10.1123/ijsn.3.1.29. [DOI] [PubMed] [Google Scholar]
  30. Sundgot-Borgen Jorunn, Torstveit Monica Klungland. Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med. 2004 Jan;14(1):25–32. doi: 10.1097/00042752-200401000-00005. [DOI] [PubMed] [Google Scholar]
  31. Timmreck Lorna S., Reindollar Richard H. Contemporary issues in primary amenorrhea. Obstet Gynecol Clin North Am. 2003 Jun;30(2):287–302. doi: 10.1016/s0889-8545(03)00027-5. [DOI] [PubMed] [Google Scholar]
  32. Toriola A. L. Survey of menstrual function in young Nigerian athletes. Int J Sports Med. 1988 Feb;9(1):29–34. doi: 10.1055/s-2007-1024974. [DOI] [PubMed] [Google Scholar]
  33. Warren M. P., Brooks-Gunn J., Hamilton L. H., Warren L. F., Hamilton W. G. Scoliosis and fractures in young ballet dancers. Relation to delayed menarche and secondary amenorrhea. N Engl J Med. 1986 May 22;314(21):1348–1353. doi: 10.1056/NEJM198605223142104. [DOI] [PubMed] [Google Scholar]
  34. Warren M. P., Perlroth N. E. The effects of intense exercise on the female reproductive system. J Endocrinol. 2001 Jul;170(1):3–11. doi: 10.1677/joe.0.1700003. [DOI] [PubMed] [Google Scholar]
  35. Weaver C. M., Teegarden D., Lyle R. M., McCabe G. P., McCabe L. D., Proulx W., Kern M., Sedlock D., Anderson D. D., Hillberry B. M. Impact of exercise on bone health and contraindication of oral contraceptive use in young women. Med Sci Sports Exerc. 2001 Jun;33(6):873–880. doi: 10.1097/00005768-200106000-00004. [DOI] [PubMed] [Google Scholar]
  36. Williams N. I., Helmreich D. L., Parfitt D. B., Caston-Balderrama A., Cameron J. L. 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 Nov;86(11):5184–5193. doi: 10.1210/jcem.86.11.8024. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Sports Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES