Menstrual Cycle and Sports Performance
Menarche possibly occurs later in the well-trained athlete.
Menstruation is not a contraindication to physical activity. Females who exercise generally report fewer premenstrual symptoms – may be due to exercise ‘dampening down’ reproductive hormones or due to lessened perception of symptoms due to exercise related improvements in mood. Surveys do suggest that women feel as though their athletic performance is decreased during the menses, but anecdotal suggestions are that world records have been broken when the athlete was menstruating. Some female athletes may manipulate their menstrual cycle to avoid menstruating at a major competition by the use of oral contraceptives.
Premenopausal female athletes who have absent menses or irregular menses while engaged in a vigorous exercise program have been shown to be at increased risk for musculoskeletal injury .
Exercise Associated Amenorrhoea (EAA):
Amenorrhoea has been reported in some studies to be present in up to 50% of elite runners and ballet dancers (up to 5% in normal populations). Pathology is related to weight loss, reduced body fat, inadequate nutrition, physical and emotional stress. May also be related to a reduction in the gonadotropin-releasing hormone. Usually reversible when exercise levels decreased. Consequences of exercise induced amenorrhoea fertility (may have long term effect); bone mineral density decreases (increased risk for stress fractures); greater injury incidence (increase in both acute and chronic injuries).
Management – rule out other causes; discussion of short and long term consequences; counselling athlete to decrease training load; may use hormonal replacement therapy to protect bone health (especially if unwilling to comply with reduction in training).
Other menstrual cycle disorders (eg oligomenorrhoea, short luteal phase, anovulation) are also more common in female athletes.
Paula Radcliffe on periods and elite performance: http://www.bbc.com/sport/0/athletics/30927245
http://bjsm.bmj.com/content/early/2016/05/17/bjsports-2016-096279.short
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