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Cabre HE, Gould LM, Redman LM, Smith-Ryan AE. Effects of the Menstrual Cycle and Hormonal Contraceptive Use on Metabolic Outcomes, Strength Performance, and Recovery: A Narrative Review. Metabolites 2024; 14:347. [PMID: 39057670 PMCID: PMC11278889 DOI: 10.3390/metabo14070347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/06/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
The effects of female sex hormones on optimal performance have been increasingly recognized as an important consideration in exercise and sport science research. This narrative review explores the findings of studies evaluating the effects of menstrual cycle phase in eumenorrheic women and the use of hormonal contraception (oral contraceptives and hormonal intrauterine devices) on metabolism, muscular strength, and recovery in active females. Ovarian hormones are known to influence metabolism because estrogen is a master regulator of bioenergetics. Importantly, the menstrual cycle may impact protein synthesis, impacting skeletal muscle quality and strength. Studies investigating muscular strength in eumenorrheic women report equivocal findings between the follicular phase and luteal phase with no differences compared to oral contraceptive users. Studies examining recovery measures (using biomarkers, blood lactate, and blood flow) do not report clear or consistent effects of the impact of the menstrual cycle or hormonal contraception use on recovery. Overall, the current literature may be limited by the evaluation of only one menstrual cycle and the use of group means for statistical significance. Hence, to optimize training and performance in females, regardless of hormonal contraception use, there is a need for future research to quantify the intra-individual impact of the menstrual cycle phases and hormonal contraceptive use in active females.
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Affiliation(s)
- Hannah E. Cabre
- Reproductive Endocrinology and Women’s Health Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA;
| | | | - Leanne M. Redman
- Reproductive Endocrinology and Women’s Health Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA;
| | - Abbie E. Smith-Ryan
- Human Movement Sciences Curriculum, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
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Seidman L, Seidman DS, Constantini NW. Hormonal contraception for female athletes presents special needs and concerns. EUR J CONTRACEP REPR 2024; 29:8-14. [PMID: 38108091 DOI: 10.1080/13625187.2023.2287960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Oral contraceptives (OCs) are commonly used by female athletes raising concerns regarding the possible adverse effects of OCs on physical performance, musculoskeletal injuries, and bone density. We aimed to review all current studies on the physiological effects of OCs in physically active women. MATERIALS AND METHODS A review of literature in electronic search in PubMed and Google Scholar databases from December 2002 to December 2022 using relevant keywords. The reference lists of the articles found eligible were also reviewed. RESULTS Out of 344 articles in the initial database, 54 clinical studies were eligible for inclusion in our literature review. OCs are used by about two-thirds of female athletes. Current research suggests that OCs' effects on endurance performance and muscle strength are mostly reassuring. OCs do not seem to have a major negative impact on bone health or sports injuries. In fact, new data suggests that they may even significantly reduce the risk of anterior cruciate ligament (ACL) injury. CONCLUSIONS OCs can be safely used by young female athletes, who may also benefit from better menstrual cycle control. OCs offer newly realised protection from ACL injuries. The use of OCs must be carefully individualised according to their preferences, expectations, and experience.
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Affiliation(s)
- Liron Seidman
- Soroka Medical School, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniel S Seidman
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama W Constantini
- Heidi Rothberg Sport Medicine Center, Shaare Zedek Medical Center, affiliated to the Hebrew University, Jerusalem, Israel
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Nolan D, McNulty KL, Manninen M, Egan B. The Effect of Hormonal Contraceptive Use on Skeletal Muscle Hypertrophy, Power and Strength Adaptations to Resistance Exercise Training: A Systematic Review and Multilevel Meta-analysis. Sports Med 2024; 54:105-125. [PMID: 37755666 PMCID: PMC10798924 DOI: 10.1007/s40279-023-01911-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Resistance exercise training is widely used by general and athletic populations to increase skeletal muscle hypertrophy, power and strength. Endogenous sex hormones influence various bodily functions, including possibly exercise performance, and may influence adaptive changes in response to exercise training. Hormonal contraceptive (HC) use modulates the profile of endogenous sex hormones, and therefore, there is increasing interest in the impact, if any, of HC use on adaptive responses to resistance exercise training. OBJECTIVE Our aim is to provide a quantitative synthesis of the effect of HC use on skeletal muscle hypertrophy, power and strength adaptations in response to resistance exercise training. METHODS A systematic review with meta-analysis was conducted on experimental studies which directly compared skeletal muscle hypertrophy, power and strength adaptations following resistance exercise training in hormonal contraceptive users and non-users conducted before July 2023. The search using the online databases PUBMED, SPORTDiscus, Web of Science, Embase and other supplementary search strategies yielded 4669 articles, with 8 articles (54 effects and 325 participants) meeting the inclusion criteria. The methodological quality of the included studies was assessed using the "Tool for the assessment of study quality and reporting in exercise". RESULTS All included studies investigated the influence of oral contraceptive pills (OCP), with no study including participants using other forms of HC. The articles were analysed using a meta-analytic multilevel maximum likelihood estimator model. The results indicate that OCP use does not have a significant effect on hypertrophy [0.01, 95% confidence interval (CI) [- 0.11, 0.13], t = 0.14, p = 0.90), power (- 0.04, 95% CI [- 0.93, 0.84], t = - 0.29, p = 0.80) or strength (0.10, 95% CI [- 0.08, 0.28], t = 1.48, p = 0.20). DISCUSSION Based on the present analysis, there is no evidence-based rationale to advocate for or against the use of OCPs in females partaking in resistance exercise training to increase hypertrophy, power and/or strength. Rather, an individualised approach considering an individual's response to OCPs, their reasons for use and menstrual cycle history may be more appropriate. REGISTRATION The review protocol was registered on PROSPERO (ID number and hyperlink: CRD42022365677).
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Affiliation(s)
- David Nolan
- School of Health and Human Performance, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Kelly L McNulty
- Sport, Health & Exercise (SHE) Research Group, Department of Sport and Health Sciences, Technological University of the Shannon, Athlone, Co. Westmeath, Ireland
- UPMC Sports Medicine and UPMC Institute for Health, UPMC, Pittsburgh, Ireland
| | - Mika Manninen
- School of Health and Human Performance, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Brendan Egan
- School of Health and Human Performance, Dublin City University, Glasnevin, Dublin 9, Ireland.
- Florida Institute of Human and Machine Cognition, Pensacola, FL, USA.
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Power CJ, Fox JL, Elliott-Sale KJ, Bender AM, Dalbo VJ, Scanlan AT. Waking Up to the Issue! Research Inattention and Sex-Related Differences Warrant More Sleep Studies in Female Athletes. Sports Med 2023:10.1007/s40279-023-01963-5. [PMID: 37989830 DOI: 10.1007/s40279-023-01963-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/23/2023]
Abstract
Understanding sleep patterns and behaviors of athletes is essential for developing targeted sleep-based interventions for implementation in practice. However, more than double the number of sleep studies have examined male athletes compared with female athletes, making the current understanding of sleep patterns, behaviors, and interventions among athletes disproportionately indicative of men. Consequently, this review demonstrates the need for more female-specific sleep data among athlete populations due to research inattention and sex-related differences. Specifically, this review identifies variations in sleep patterns and behaviors between male and female athletes, as well as physiological and lifestyle factors that potentially affect sleep patterns and behaviors across the lifespan, specifically in female athletes. In this regard, evidence suggests some female athletes experience longer sleep durations and better objective sleep quality, but similar or worse subjective sleep quality compared with male athletes. Additionally, scheduling training in the morning or throughout the day may benefit sleep in some female athletes. Considering sleep disorders, women may be at greater risk for insomnia and restless legs syndrome compared with men, which may be attributed to pregnancy, as well as a higher prevalence of anxiety and depressive symptoms, iron deficiency without anemia, and use of psychotropic medication among women. Finally, the menstrual cycle, menstrual disorders, oral contraceptive use, and the postpartum period have been shown to exert detrimental effects on sleep patterns and behaviors and should theoretically be considered when monitoring and managing sleep in female athletes.
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Affiliation(s)
- Cody J Power
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, QLD, Australia.
| | - Jordan L Fox
- Rural Clinical School, The University of Queensland, Rockhampton, QLD, Australia
| | - Kirsty J Elliott-Sale
- Department of Sport and Exercise Sciences, Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | - Amy M Bender
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Absolute Rest, Austin, TX, USA
| | - Vincent J Dalbo
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, QLD, Australia
| | - Aaron T Scanlan
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, QLD, Australia
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Sacral stress fractures in athletes. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:1-9. [PMID: 34727235 DOI: 10.1007/s00586-021-07043-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Fatigue stress fractures are a common overuse injury, frequently associated with high load-bearing endurance activities such as running, military training and aerobic exercise. While these fractures can arise at any site, sacral stress fractures are poorly studied with evidence consisting mainly of case reports and limited case series. This review aims to analyze and summarize all reports published to date describing cases of sacral stress fracture in athletes. METHODS PubMed, Embase, Web of Science and the Cochrane Database were systematically searched for studies reporting on Stress Fractures of the Sacrum. Insufficiency fractures of the elderly were excluded. RESULTS The literature review revealed 49 studies reporting on 124 cases of sacral stress fractures. Seventy-six patients (61%) were professional or collegiate level athletes, and 37 (30%) were military recruits or police officers in training. Seventeen female athletes were identified as suffering from low bone mineral density (25%), 9 of which reported menstrual irregularities. Thirteen female patients (19%) had a history of eating disorders. CONCLUSION While most sacral stress fractures occur in normal bones exposed to abnormal repetitive loads, the high percentage of lower bone mineral density can blur the lines between fatigue fractures and insufficiency fractures. The causes of these fractures are multifactorial. High endurance sports and the features of the female athlete triad were found in high percentage of the cases. Conservative treatment is the mainstay of treatment, consisting of ceasing of training and a period of rehabilitation and gradual return to training and competition.
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Nakamura M, Nose-Ogura S. Effect of administration of monophasic oral contraceptive on the body composition and aerobic and anaerobic capacities of female athletes. J Obstet Gynaecol Res 2020; 47:792-799. [PMID: 33336549 DOI: 10.1111/jog.14613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/05/2020] [Accepted: 12/05/2020] [Indexed: 12/18/2022]
Abstract
AIM To examine the effects of administration of monophasic oral contraceptive (OC) on the body composition and aerobic and anaerobic capacities of female athletes. METHODS Ten female athletes (23.0 ± 4.1 years old) participated in this study. All the subjects were examined during the menstrual cycle (early follicular [EF], middle luteal [ML]) and OC cycle (inactive OC, and active OC phases). After the menstrual cycle measurements, all the subjects began taking OC. The athletes tested using a body composition, circumferences, the lactate curve test, the maximal oxygen consumption test, and the Wingate test during all phases. RESULTS Waist circumference was lower during the OC cycle than menstrual cycle (P < 0.05), and the other circumferences of parts were not different during the menstrual or OC cycles. However, there were no differences in body composition before and after taking OC. The phase of the menstrual or OC cycle did not affect maximal oxygen consumption, heart rate max or power output at a blood lactate concentration of 2 and 4 mmol/L between the menstrual and OC cycle phases. Although, the peak blood lactate level after the Wingate test was higher during the OC cycle (inactive OC phase, 13.0 ± 2.4 mmol/L; active OC phase, 12.4 ± 3.0 mmol/L) than during the menstrual cycle (EF phase, 11.9 ± 2.1 mmol/L; ML phase, 11.4 ± 2.1 mmol/L; P < 0.05), the peak and average power in the Wingate test did not change during the menstrual and OC cycle phases. CONCLUSION Administration of monophasic OC did not affect the body composition or aerobic and anaerobic capacities of female athletes.
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Affiliation(s)
- Mariko Nakamura
- Department of Sports Sciences, Japan Institute of Sports Sciences, Tokyo, Japan
| | - Sayaka Nose-Ogura
- Department of Sports Medical Center, Japan Institute of Sports Sciences, Tokyo, Japan.,Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
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Elliott-Sale KJ, McNulty KL, Ansdell P, Goodall S, Hicks KM, Thomas K, Swinton PA, Dolan E. The Effects of Oral Contraceptives on Exercise Performance in Women: A Systematic Review and Meta-analysis. Sports Med 2020; 50:1785-1812. [PMID: 32666247 PMCID: PMC7497464 DOI: 10.1007/s40279-020-01317-5] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND Oral contraceptive pills (OCPs) are double agents, which downregulate endogenous concentrations of oestradiol and progesterone whilst simultaneously providing daily supplementation of exogenous oestrogen and progestin during the OCP-taking days. This altered hormonal milieu differs significantly from that of eumenorrheic women and might impact exercise performance, due to changes in ovarian hormone-mediated physiological processes. OBJECTIVE To explore the effects of OCPs on exercise performance in women and to provide evidence-based performance recommendations to users. METHODS This review complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A between-group analysis was performed, wherein performance of OCP users was compared with naturally menstruating women, and a within-group analysis was conducted, wherein performance during OCP consumption was compared with OCP withdrawal. For the between-group analysis, women were phase matched in two ways: (1) OCP withdrawal versus the early follicular phase of the menstrual cycle and (2) OCP consumption versus all phases of the menstrual cycle except for the early follicular phase. Study quality was assessed using a modified Downs and Black Checklist and a strategy based on the recommendations of the Grading of Recommendations Assessment Development and Evaluation working group. All meta-analyses were conducted within a Bayesian framework to facilitate probabilistic interpretations. RESULTS 42 studies and 590 participants were included. Most studies (83%) were graded as moderate, low or very low quality, with 17% achieving high quality. For the between-group meta-analysis comparing OCP users with naturally menstruating women, posterior estimates of the pooled effect were used to calculate the probability of at least a small effect (d ≥ 0.2). Across the two between-group comparison methods, the probability of a small effect on performance favouring habitual OCP users was effectually zero (p < 0.001). In contrast, the probability of a small effect on performance favouring naturally menstruating women was moderate under comparison method (1) (d ≥ 0.2; p = 0.40) and small under comparison method (2) (d ≥ 0.2; p = 0.19). Relatively large between-study variance was identified for both between-group comparisons ([Formula: see text]0.5 = 0.16 [95% credible interval (CrI) 0.01-0.44] and [Formula: see text]0.5 = 0.22 [95% CrI 0.06-0.45]). For the within-group analysis comparing OCP consumption with withdrawal, posterior estimates of the pooled effect size identified almost zero probability of a small effect on performance in either direction (d ≥ 0.2; p ≤ 0.001). CONCLUSIONS OCP use might result in slightly inferior exercise performance on average when compared to naturally menstruating women, although any group-level effect is most likely to be trivial. Practically, as effects tended to be trivial and variable across studies, the current evidence does not warrant general guidance on OCP use compared with non-use. Therefore, when exercise performance is a priority, an individualised approach might be more appropriate. The analysis also indicated that exercise performance was consistent across the OCP cycle.
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Affiliation(s)
- Kirsty J Elliott-Sale
- Department of Sport Science, Sport Health and Performance Enhancement (SHAPE) Research Centre, Nottingham Trent University, Nottingham, UK.
| | - Kelly L McNulty
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - Paul Ansdell
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - Stuart Goodall
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - Kirsty M Hicks
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - Kevin Thomas
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - Paul A Swinton
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Eimear Dolan
- Applied Physiology and Nutrition Research Group, Escola de Educação Física e Esporte, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
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Statham G. Understanding the effects of the menstrual cycle on training and performance in elite athletes: A preliminary study. PROGRESS IN BRAIN RESEARCH 2020; 253:25-58. [PMID: 32771127 DOI: 10.1016/bs.pbr.2020.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Success at an Olympic level can come down to the smallest of margins. However little research has been conducted into how the menstrual cycle affects elite athletes' performance and decision making. This study uses a combination of quantitative and qualitative research methods to explore this question. Physiological performance data was collected from eight elite athletes for 7 months and analyzed as a function of menstrual phase. The Cambridge Gambling Task (CGT) was used to test decision making and testing occurred twice in one cycle, during the early follicular phase and during the mid-luteal phase. Menstrual cycle phase was determined using menstrual cycle mapping and urine ovulation tests. In the qualitative part of this project, two elite athletes, two Olympic level athletes, and two coaches participated in semi-structured interviews. The study found that physiological performance was significantly better during the menses phase (MP) compared to the proliferative and secretory phases (PSP). There was variation in how elite athletes were individually affected however. Oral contraceptive users showed a greater performance change from MP to PSP suggesting that oral contraceptives may be detrimental to performance in some athletes. The results of the CGT showed that impulsivity is significantly affected by menstrual cycle phase. Risk taking, error rates and response times were not affected. The qualitative interviews revealed that elite athletes and their coaches understand little of the menstrual cycle. Despite this, there are preconceptions that it negatively effects performance during the menses phase. The findings suggest that the menstrual cycle can have a significant effect on an elite athlete's performance and this paper discusses how individuals can possibly improve aspects of physiological and psychological performance by understanding and monitoring their menstrual patterns.
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Affiliation(s)
- Georgia Statham
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom.
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Resistance Training and Skeletal Muscle Protein Metabolism in Eumenorrheic Females: Implications for Researchers and Practitioners. Sports Med 2020; 49:1637-1650. [PMID: 31190324 DOI: 10.1007/s40279-019-01132-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Resistance training is essential for health and performance and confers many benefits such as increasing skeletal muscle mass, increasing strength and power output, and improving metabolic health. Resistance training is a major component of the physical activity guidelines, yet research in female populations is limited. Recent increases in the promotion of, and the participation by, females in sport and exercise, highlight the need for an increase in understanding of evidence-based best practice exercise prescription for females. The aim of this review is to provide an overview of the current research regarding resistance training performance and skeletal muscle adaptation in females, with a focus on the hormonal variables that may influence resistance training outcomes. Findings suggest that the menstrual cycle phase may impact strength, but not skeletal muscle protein metabolism. In comparison, oral contraception use in females may reduce skeletal muscle protein synthesis, but not strength outcomes, when compared to non-users. Future research should investigate the role of resistance training in the maintenance of skeletal muscle protein metabolism during pregnancy, menopause and in athletes experiencing relative energy deficiency in sport. The review concludes with recommendations for researchers to assist them in the inclusion of female participants in resistance training research specifically, with commentary on the most appropriate methods of controlling for, or understanding the implications of, hormonal fluctuations. For practitioners, the current evidence suggests possible resistance training practices that could optimise performance outcomes in females, although further research is warranted.
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Barba-Moreno L, Cupeiro R, Romero-Parra N, Janse de Jonge XAK, Peinado AB. Cardiorespiratory Responses to Endurance Exercise Over the Menstrual Cycle and With Oral Contraceptive Use. J Strength Cond Res 2019; 36:392-399. [PMID: 31855928 DOI: 10.1519/jsc.0000000000003447] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Barba-Moreno, L, Cupeiro, R, Romero-Parra, N, Janse de Jonge, XA, and Peinado, AB. Cardiorespiratory Responses to Endurance Exercise Over the Menstrual Cycle and With Oral Contraceptive Use. J Strength Cond Res XX(X): 000-000, 2019-Female steroid hormone fluctuations during the menstrual cycle and exogenous hormones from oral contraceptives may have potential effects on exercise performance. The aim of this study was to investigate the effects of these fluctuations on cardiorespiratory responses during steady-state exercise in women. Twenty-three healthy endurance-trained women performed 40 minutes of running at 75% of their maximal aerobic speed during different phases of the menstrual cycle (n = 15; early follicular phase, midfollicular phase, and luteal phase) or oral contraceptive cycle (n = 8; hormonal phase and nonhormonal phase). Ventilatory parameters and heart rate (HR) were measured. Data were analyzed using a mixed linear model. For the eumenorrheic group, significantly higher oxygen uptake (p = 0.049) and percentage of maximum oxygen uptake (p = 0.035) were observed during the midfollicular phase compared with the early follicular. Heart rate (p = 0.004), oxygen ventilatory equivalent (p = 0.042), carbon dioxide ventilatory equivalent (p = 0.017), and tidal volume (p = 0.024) increased during luteal phase in comparison with midfollicular. In oral contraceptive users, ventilation (p = 0.030), breathing frequency (p = 0.018), oxygen ventilatory equivalent (p = 0.032), and carbon dioxide ventilatory equivalent (p = 0.001) increased during the hormonal phase. No significant differences were found for the rest of the parameters or phases. Both the eumenorrheic group and oral contraceptive group showed a significant increase in some ventilatory parameters during luteal and hormonal phases, respectively, suggesting lower cardiorespiratory efficiency. However, the lack of clinical meaningfulness of these differences and the nondifferences of other physiological variables, indicate that the menstrual cycle had a small impact on submaximal exercise in the current study.
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Affiliation(s)
- Laura Barba-Moreno
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science, Polytechnic University of Madrid, Madrid, Spain
| | - Rocío Cupeiro
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science, Polytechnic University of Madrid, Madrid, Spain
| | - Nuria Romero-Parra
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science, Polytechnic University of Madrid, Madrid, Spain
| | - Xanne A K Janse de Jonge
- School of Environmental and Life Sciences, Faculty of Science, The University of Newcastle, Callaghan, Australia
| | - Ana B Peinado
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science, Polytechnic University of Madrid, Madrid, Spain
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Foster R, Vaisberg M, Bachi ALL, Dos Santos JDMB, de Paula Vieira R, Luna-Junior LA, Araújo MP, Parmigiano TR, Borges F, Di-Bella ZIKJ. Premenstrual Syndrome, Inflammatory Status, and Mood States in Soccer Players. Neuroimmunomodulation 2019; 26:1-6. [PMID: 30654383 DOI: 10.1159/000494559] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/13/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between the inflammatory profile and mood states in the different phases of the menstrual cycle in soccer players with and without premenstrual syndrome (PMS). METHODS Data on the menstrual cycle and mood states were collected using the Daily Symptom Report and the Brunel Mood Scale. Cytokine and stress hormone concentrations were measured in urine by flow cytometry before and after a game in the luteal phase and in the follicular phase of one menstrual cycle. RESULTS In all, 59.6% of the athletes had PMS. The PMS group showed higher concentrations of interleukin (IL)-1β, IL-6, and IL-8 than the athletes without PMS. After the game, IL-6 decreased in the follicular phase and the luteal phase. The tumor necrosis factor-α levels were higher in the group without PMS during the post-game follicular phase than before the game. In the PMS group, tension was higher in the follicular phase before the game and depression was higher in the pre-game luteal phase than in the group without PMS. The PMS group also presented a negative correlation between depression and IL-10 levels in the pre-game follicular phase. Finally, in the pre-game luteal phase were found positive correlations between growth hormone and IL-10. CONCLUSION PMS influences the inflammatory condition related to mood states and stress hormones in female soccer players.
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Affiliation(s)
- Roberta Foster
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
| | - Mauro Vaisberg
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, São Paulo, Brazil,
| | - André Luis Lacerda Bachi
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São José dos Campos, Brazil
| | | | - Rodolfo de Paula Vieira
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São José dos Campos, Brazil
- Postgraduate Program in Sciences of Human Movement and Rehabilitation, Federal University of São Paulo, Campus Baixada Santista, Santos, Brazil
| | - Luiz Antonio Luna-Junior
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, São Paulo, Brazil
| | - Maita Poli Araújo
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Fernanda Borges
- Nephrology Division of the Medicine Department, Federal University of São Paulo, São Paulo, Brazil
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Use of Oral Contraceptives to Manipulate Menstruation in Young, Physically Active Women. Int J Sports Physiol Perform 2018; 13:82-87. [PMID: 28459358 DOI: 10.1123/ijspp.2016-0689] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE Menstruation and menstrual symptoms are commonly cited barriers to physical activity in women. The delay or avoidance of menstruation through extended oral-contraceptive (OC) regimens may mitigate these barriers, yet information on menstrual-manipulation practices in young physically active women is sparse. The objective of this study was to investigate prevalence of, and reasons for, menstrual manipulation with OCs in recreationally and competitively active women. METHODS One hundred ninety-one recreationally active (self-reported moderate to vigorous physical activity 150-300 min/wk) women (age 23 ± 5 y), 160 subelite recreationally active (self-reported moderate to vigorous physical activity >300 min/wk) women (age 23 ± 5 y), and 108 competitive (state-, national- or international-level) female athletes (age 23 ± 4 y) completed a self-administered questionnaire assessing OC-regimen habits and reasons for manipulation of menstruation. RESULTS The majority (74%) of OC users reported having deliberately manipulated menstruation at least once during the previous year, with 29% reporting having done so at least 4 times. Prevalence of menstrual manipulation (at least once in the previous year) was not different between competitive athletes, subelite recreationally active women, and recreationally active women (77% vs 74% vs 72%; P > .05). The most cited reasons for manipulating menstruation were special events or holidays (rated by 75% as important/very important), convenience (54%), and sport competition (54%). CONCLUSIONS Menstrual manipulation through extended OC regimens is common practice in recreationally and competitively active young women, for a range of reasons relating to convenience that are not limited to physical activity. This strategy may help reduce hormone-related barriers to exercise participation, thereby positively affecting participation and performance.
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von Rosen P, Heijne A, Frohm A, Fridén C. Menstrual irregularity and use of oral contraceptives in female adolescent athletes in Swedish National Sports High Schools. Int J Adolesc Med Health 2017; 32:/j/ijamh.ahead-of-print/ijamh-2017-0113/ijamh-2017-0113.xml. [PMID: 29168967 DOI: 10.1515/ijamh-2017-0113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/08/2017] [Indexed: 11/15/2022]
Abstract
Objective Female adolescent athletes seem to use oral contraceptives (OCs) in the same proportion as the general population. In athletes not using OCs, menstrual irregularity (MI) is reported to be common but there are few studies of MI in adolescent athletes. The aim of the study was to survey menarche, menstrual irregularity and use of OCs in adolescent athletes in the National Sports High Schools in Sweden. A further aim was to study the associations between current sport injury and menstrual irregularity as well as use of OCs. Subjects Two hundred and ninety-eight female adolescent athletes at Swedish National Sports High Schools. Methods A web-based questionnaire containing questions related to menstrual status, contraception and current injury. Results One third (32.6%) of the athletes used OCs and of the remaining athletes 31.8% had MI. The group of athletes with MI had a significantly (p = 0.038; Cohen's d, 0.32) lower BMI and consisted of a significantly (p = 0.043) higher proportion of endurance athletes. OC users were less likely to participate in endurance sports compared to non-OC users (p = 0.024). Current injury was equally distributed in the OC and the non-OC group but athletes with MI had fewer sports injuries compared to eumenorrheic women. Conclusion OCs are frequently used among athletes at Swedish National Sports High Schools. OC users were less likely to participate in endurance sports compared to non-OC users. MI was common and athletes with MI had lower BMI compared to eumenorrheic athletes. Sports injuries were not associated with use of OC and eumenorrheic athletes had a higher proportion of current injury.
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Affiliation(s)
- Philip von Rosen
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Annette Heijne
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Anna Frohm
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Swedish Sports Confederation Center, Bosön Sports Clinic, Lidingö, Sweden
| | - Cecilia Fridén
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, 23100, Karolinska Institutet, 141 86 Huddinge, Sweden, Phone: +46707415122
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14
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Samuelson K, Balk EM, Sevetson EL, Fleming BC. Limited Evidence Suggests a Protective Association Between Oral Contraceptive Pill Use and Anterior Cruciate Ligament Injuries in Females: A Systematic Review. Sports Health 2017; 9:498-510. [PMID: 29016234 PMCID: PMC5665118 DOI: 10.1177/1941738117734164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Context: Female athletes aged 14 to 18 years are at particular risk for anterior cruciate ligament (ACL) injuries. Hormonal factors are thought to predispose them to this injury. Oral contraceptive pills (OCPs) might reduce ACL injury risk, although the literature appears controversial. Objective: To evaluate the association between OCP use and ACL injuries in women. The secondary objective was to determine the rates of ACL injuries in the pre- and postovulatory phases of the menstrual cycle in OCP and non-OCP (NOCP) users. Data Sources: Searches were performed across 4 reference databases (PubMed, CINAHL, Embase, Cochrane), abstracts from 6 specialty societies, ClinicalTrials.gov, and reference lists of relevant papers. Study Selection: We included studies investigating the association between OCP use and ACL injuries in females of any age or the distribution of ACL injuries across the menstrual cycle in OCP and NOCP users. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: Data regarding study design, population characteristics, OCP details, outcome definitions, analytic methods, and results were extracted from the included studies. The methodological quality of each study was assessed using the Newcastle-Ottawa scale. Results: The search yielded 1305 citations, of which 7 retrospective observational studies met the inclusion criteria. Two large case-control studies with higher methodological quality suggested that OCP use may reduce the risk of sustaining an ACL injury. Five comparative studies examining injury distribution across the menstrual cycle in OCP and NOCP users had conflicting findings, were heterogeneous, and were limited by low methodological quality. Conclusion: The evidence suggests OCP use may reduce the risk of ACL injury; however, no conclusions can be drawn regarding differences in risk of ACL injuries between OCP and NOCP users across the menstrual cycle. Studies were limited by small sample sizes, heterogeneity, and methodological concerns.
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Affiliation(s)
- Kathleen Samuelson
- Department of Molecular Pharmacology, Physiology, and Biotechnology, Brown University, Providence, Rhode Island
| | - Ethan M Balk
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
| | - Erika L Sevetson
- Health and Information Services, Brown University Library, Brown University, Providence, Rhode Island
| | - Braden C Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island.,School of Engineering, Brown University, Providence, Rhode Island
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15
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Gordon D, Scruton A, Barnes R, Baker J, Prado L, Merzbach V. The effects of menstrual cycle phase on the incidence of plateau at V˙O2max and associated cardiorespiratory dynamics. Clin Physiol Funct Imaging 2017; 38:689-698. [PMID: 28906053 DOI: 10.1111/cpf.12469] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/12/2017] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to examine the effect of menstrual cycle phase on maximal oxygen uptake (V˙O2max) and associated cardiodynamic responses. A total of 16 active females volunteered of which n = 10 formed the non-oral contraceptive pill group (n-OCP), displaying a regular menstrual cycle of 28·4 ± 2·2 days (age 20·6 ± 1·6 years, height 169·9 ± 6·4 cm, mass 68·7 ± 7·9 kg) and n = 6 formed the oral contraceptive pill group (OCP) (monophasic pill) (age 21·7 years ± 2·16, height 168·1 cm ± 6·8 cm, mass 61·6 ± 6·8 kg). Each completed four incremental exercise tests for determination of V˙O2max, cardiac output, stroke volume and heart rate. Each test was completed according to the phases of the menstrual cycle as determined through salivary analysis of 17-β oestrodiol and progesterone. Non-significant differences were observed for V˙O2max across phases and between groups (P>0·05) with additional non-significant differences for Q˙max, HRmax and SVmax between groups. For ∆ V˙O2 during the final 60 s of the V˙O2max trial, significant differences were observed between OCP and n-OCP (P<0·05) with OCP showing zero V˙O2 plateaus in three pseudo-phases. Significant difference observed for a-vO2dif n-OCP between premenstruation and menstruation at 30-100% V˙O2max (P<0·05). Data suggest that the V˙O2 -plateau is effected by monophasic oral contraceptive pill, furthermore these data imply that V˙O2max test outcome is independent of menstrual cycle phase but caution should be applied when evaluating maximal oxygen uptake in females who are administered a monophasic oral contraceptive pill.
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Affiliation(s)
- Dan Gordon
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Adrian Scruton
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Richard Barnes
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - James Baker
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Luciano Prado
- School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Viviane Merzbach
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
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16
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Abstract
The female athlete triad is a medical condition observed in physically active females involving three components: 1) low energy availability with or without disordered eating, 2) menstrual dysfunction, and 3) low bone density. An individual does not need to show clinical manifestations of all three components of the female athlete triad simultaneously to be affected by the condition. Consequences of these clinical conditions may not be completely reversible, so prevention, early diagnosis, and intervention are critical. All athletes are at risk of the female athlete triad, regardless of body build or sport. All active females should be assessed for components of the triad and further evaluation should be performed if one or more components are identified. The obstetrician-gynecologist has the opportunity to screen athletes for components of the female athlete triad at comprehensive visits for preventive care. Using the menstrual cycle as a vital sign is a useful tool for identifying athletes at risk of female athlete triad and should be an integral part of the preparticipatory sports physical. The goal of treatment for those diagnosed with female athlete triad is restoration of regular menses as a clinical marker of reestablishment of energy balance and enhancement of bone mineral density. The female athlete triad is a result of energy imbalance; thus, adjusting the energy expenditure and energy availability is the main intervention. Pharmacologic treat-ment may be considered when nonpharmacologic treatment has failed. A team approach involving the patient, obstetrician-gynecologist, sports nutritionist, coaches, parents, and mental health care provider, if indicated, is optimal.
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17
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Lei T, Stannard SR, Perry BG, Schlader ZJ, Cotter JD, Mündel T. Influence of menstrual phase and arid vs. humid heat stress on autonomic and behavioural thermoregulation during exercise in trained but unacclimated women. J Physiol 2017; 595:2823-2837. [PMID: 27900769 PMCID: PMC5407968 DOI: 10.1113/jp273176] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/10/2016] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Despite an attenuated fluctuation in ovarian hormone concentrations in well-trained women, one in two of such women believe their menstrual cycle negatively impacts training and performance. Forthcoming large international events will expose female athletes to hot environments, and studies evaluating aerobic exercise performance in such environments across the menstrual cycle are sparse, with mixed findings. We have identified that autonomic heat loss responses at rest and during fixed-intensity exercise in well-trained women are not affected by menstrual cycle phase, but differ between dry and humid heat. Furthermore, exercise performance is not different across the menstrual cycle, yet is lower in humid heat, in conjunction with reduced evaporative cooling. Menstrual cycle phase does not appear to affect exercise performance in the heat in well-trained women, but humidity impairs performance, probably due to reduced evaporative power. ABSTRACT We studied thermoregulatory responses of ten well-trained [V̇O2 max , 57 (7) ml min-1 kg-1 ] eumenorrheic women exercising in dry and humid heat, across their menstrual cycle. They completed four trials, each of resting and cycling at fixed intensities (125 and 150 W), to assess autonomic regulation, then self-paced intensity (30 min work trial), to assess behavioural regulation. Trials were in early-follicular (EF) and mid-luteal (ML) phases in dry (DRY) and humid (HUM) heat matched for wet bulb globe temperature (WBGT, 27°C). During rest and fixed-intensity exercise, rectal temperature was ∼0.2°C higher in ML than EF (P < 0.01) independent of environment (P = 0.66). Mean skin temperature did not differ between menstrual phases (P ≥ 0.13) but was higher in DRY than HUM (P < 0.01). Local sweat rate and/or forearm blood flow differed as a function of menstrual phase and environment (interaction: P ≤ 0.01). Exercise performance did not differ between phases [EF: 257 (37), ML: 255 (43) kJ, P = 0.62], but was 7 (9)% higher in DRY than HUM [263 (39), 248 (40) kJ; P < 0.01] in conjunction with equivalent autonomic regulation and thermal strain but higher evaporative cooling [16 (6) W m2 ; P < 0.01]. In well-trained women exercising in the heat: (1) menstrual phase did not affect performance, (2) humidity impaired performance due to reduced evaporative cooling despite matched WBGT and (3) behavioural responses nullified thermodynamic and autonomic differences associated with menstrual phase and dry vs. humid heat.
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Affiliation(s)
- Tze‐Huan Lei
- School of Sport and ExerciseMassey UniversityPalmerston NorthNew Zealand
| | | | - Blake G. Perry
- School of Sport and ExerciseMassey UniversityPalmerston NorthNew Zealand
| | - Zachary J. Schlader
- Department of Exercise and Nutrition SciencesUniversity at BuffaloBuffaloNYUSA
| | - James D. Cotter
- School of Physical EducationSport and Exercise SciencesUniversity of OtagoDunedinNew Zealand
| | - Toby Mündel
- School of Sport and ExerciseMassey UniversityPalmerston NorthNew Zealand
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18
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Nappi RE, Fiala C, Chabbert-Buffet N, Häusler G, Jamin C, Lete I, Lukasiewic M, Pintiaux A, Lobo P. Women’s preferences for menstrual bleeding frequency: results of the Inconvenience Due to Women’s Monthly Bleeding (ISY) survey. EUR J CONTRACEP REPR 2016; 21:242-50. [DOI: 10.3109/13625187.2016.1154144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rossella E. Nappi
- Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Christian Fiala
- Gynmed Ambulatorium, Vienna, Austria
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Nathalie Chabbert-Buffet
- Department of Obstetrics and Gynaecology, APHP Tenon Hospital, Pierre and Marie Curie University, Paris, France
| | - Günther Häusler
- Department of Gynaecology and Gynaecological Oncology, AKH-Wien, Vienna, Austria
| | | | - Iñaki Lete
- Department of Obstetrics and Gynaecology, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Monika Lukasiewic
- Department of Obstetrics and Gynaecology, Bielanski Hospital, Warsaw, Poland
| | - Axelle Pintiaux
- Department of Obstetrics and Gynaecology, Citadelle Hospital, Liège University, Liège, Belgium
| | - Paloma Lobo
- Department of Obstetrics and Gynaecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
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19
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Hayashida H, Dolan NJ, Hounsome C, Alajmi N, Bishop NC. Salivary SIgA responses to acute moderate-vigorous exercise in monophasic oral contraceptive users. Appl Physiol Nutr Metab 2015; 40:863-7. [PMID: 26300012 DOI: 10.1139/apnm-2014-0468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to examine the effect of oral contraceptive (OC) use on salivary secretory immunoglobulin A (SIgA) levels at rest and in response to an acute bout of moderate-vigorous exercise during 2 phases of the 4-week OC cycle corresponding to different phases of the synthetic menstrual cycle. Ten healthy active females completed a cycling at 70% peak oxygen uptake for 45 min at 2 time points of an OC cycle: during the equivalent in time to the mid-follicular phase (day 8 ± 2) and the mid-luteal phase (day 20 ± 2). Timed unstimulated saliva samples were obtained before, immediately postexercise, and 1 h postexercise and analyzed for salivary SIgA. Salivary SIgA secretion rate was 26% (95% confidence limits (CI) 6-46) lower at postexercise compared with pre-exercise during the synthetic follicular phase (p = 0.019) but no differences were observed during the synthetic luteal trial. Saliva flow rate was 11% (95% CI, 8-30) lower at postexercise compared with pre-exercise (main effect for time; p = 0.025). In conclusion, the pattern of salivary SIgA secretion rate response to moderate-vigorous exercise varies across the early and late phases of a monophasic OC cycle, with a transient reduction in salivary SIgA responses during the synthetic follicular phase. These findings indicate that monophasic OC use should be considered when assessing mucosal immune responses to acute exercise.
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Affiliation(s)
- Harumi Hayashida
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Nicola J Dolan
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Charlotte Hounsome
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Nawal Alajmi
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Nicolette C Bishop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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20
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Impact of progesterone administration on doping test of endogenous steroids. Anal Bioanal Chem 2014; 406:6061-7. [DOI: 10.1007/s00216-014-8027-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 06/15/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
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22
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Differences in anterior cruciate ligament elasticity and force for knee flexion in women: oral contraceptive users versus non-oral contraceptive users. Eur J Appl Physiol 2013; 114:285-94. [PMID: 24240566 DOI: 10.1007/s00421-013-2771-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 10/30/2013] [Indexed: 10/26/2022]
Abstract
Eighty-two percent of sexually active women aged 15-44 have used oral contraceptive pills (OCP) in the United States. The OCP, an exogenous source of synthetic forms of steroid hormones, prevents ovulation. Hormone changes during the menstrual cycle (MC) are believed to have an impact on anterior cruciate ligament (ACL) laxity due to estrogen. Because the estrogen receptor β resides on human connective tissue, OCP may have potential impact on tendon and ligament synthesis, structure, and biomechanical properties. Temperature has also been known to have an effect on tissue elasticity. Therefore, the purpose of this study was to investigate the differences in ACL elasticity, force to flex the knee (FFK), and knee flexion-extension hysteresis (KFEH) between OCP users and non-OCP users. To investigate these changes, two different knee temperatures were measured. Nineteen young females were divided into two groups: OCP users and non-OCP users. Blood for estradiol serum concentration (E2) was taken before beginning the tests. ACL elasticity, FFK, and KFEH were assessed both at ambient temperature (22 °C) and after 38 °C warming of the leg to stabilize tissue temperature. Assessments were performed four times during the MC. Throughout the MC, ACL elasticity, FFK, and KFEH fluctuated in non-OCP users, but not in OCP users. At ambient temperature, ACL elasticity was significantly lower and FFK and KFEH were significantly higher in OCP users than non-OCP users (p < 0.05). But, no significant differences in FFK and KFEH between the two groups were found after warming to 38 °C.
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23
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Joyce S, Sabapathy S, Bulmer A, Minahan C. Effect of Long-Term Oral Contraceptive Use on Determinants of Endurance Performance. J Strength Cond Res 2013; 27:1891-6. [DOI: 10.1519/jsc.0b013e3182736935] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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24
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Isacco L, Duché P, Boisseau N. Influence of hormonal status on substrate utilization at rest and during exercise in the female population. Sports Med 2012; 42:327-42. [PMID: 22380007 DOI: 10.2165/11598900-000000000-00000] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
During exercise, substrate utilization plays a major role in performance and disease prevention. The contribution of fat and carbohydrates to energy expenditure during exercise is modulated by several factors, including intensity and duration of exercise, age, training and diet, but also gender. Because sex hormone levels change throughout a woman's lifetime (in connection with puberty, the menstrual cycle, use of oral contraceptives and menopause), the female population has to be considered specifically in terms of substrate utilization, and metabolic and hormonal responses to exercise. Before puberty, there is no difference between males and females when it comes to substrate oxidation during exercise. This is not the case during adulthood, since women are known to rely more on fat than men for the same relative intensity of exercise. Among adult women, the menstrual cycle and use of oral contraceptives may influence substrate oxidation. While some authors have noted that the luteal phase of the menstrual cycle is connected with greater lipid oxidation, compared with the follicular stage, other authors have found no difference. Among oral contraceptive users, fat oxidation is sometimes increased during prolonged exercise with a concomitant rise in lipolytic hormones, as well as growth hormone. If this result is not always observed, the type of oral contraceptive (monophasic vs triphasic) and hormone doses may be implicated. Menopause represents a hormonal transition in a woman's life, leading to a decline in ovarian hormone production. A decrease in fat oxidation is consequently observed, and some studies have demonstrated a similar respiratory exchange ratio during prolonged exercise in postmenopausal women and in men. As is the case during puberty, no sex difference should thus appear after menopause in the absence of hormonal replacement therapy (HRT). Results concerning women who take HRT remain conflicting. HRT may act on fat loss by increasing lipid metabolism, but this depends on how the treatment is administered (orally vs transdermally). To better understand the role of ovarian hormones in substrate oxidation, studies have made use of animal protocols to investigate cellular mechanisms. Estradiol and progesterone seem to have opposite effects, with greater lipid oxidation when estradiol is used alone. However, the concentrations used (physiological levels or pharmacological doses) may considerably modify fuel selection. In cases where conflicting data are observed in studies of substrate utilization and prolonged exercise in women, methodological reasons must be called into question. Too many parameters, which oftentimes are not specified, may modulate substrate utilization and metabolic and hormonal responses to prolonged exercise. Although information is generally provided about the type of exercise, its duration and the subjects' training level, detailed information is not always given about the subjects' nutritional state and, more specifically, the hormonal status of female subjects. The primary purpose of this review was to identify the impact of hormonal status on substrate oxidation among female subjects at rest and during exercise. A second aim was to describe gender differences in substrate utilization during exercise.
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Affiliation(s)
- Laurie Isacco
- Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions, Clermont University, Blaise Pascal University, Aubière, France
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25
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Isacco L, Thivel D, Pelle AM, Zouhal H, Duclos M, Duche P, Boisseau N. Oral contraception and energy intake in women: impact on substrate oxidation during exercise. Appl Physiol Nutr Metab 2012; 37:646-56. [PMID: 22607658 DOI: 10.1139/h2012-031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Oral contraception (OC) and energy intake may play a role in fuel selection during exercise. The aim of this study was to investigate the effect of OCs (OC+ vs. OC-) in fed and fasting conditions on substrate oxidation and metabolic and hormonal responses in women during exercise. Substrate oxidation (respiratory exchange ratio and lipid and carbohydrates oxidation rates), metabolic (glycerol, free fatty acids (FFA), and glucose), and hormonal (insulin, adrenaline, and noradrenaline) responses were determined in 21 women: 10 regularly menstruating women (OC-) and 11 women using OCs (OC+: low-dose monophasic pill; ethinyl estradiol ≤ 30 µg) during 45 min at 65% of maximal oxygen consumption in fasting and postprandial states. At rest, OC+ presented higher low-density lipoprotein cholesterol, total cholesterol, and triglyceride plasma concentrations as compared with OC-. OC status had no influence on substrate oxidation and metabolic and hormonal responses during exercise. In the fasting state, whatever the OC status, women exhibited greater reliance on fat than in postprandial condition. This occurred in the presence of lower plasma insulin concentrations and higher plasma FFA and glycerol levels. The results indicated that the use of low-dose monophasic combined with OCs did not modify fuel selection and metabolic and hormonal responses during exercise in women. The fasting condition, compared with the fed condition, decreased carbohydrate oxidation during exercise, leading to a greater lipid mobilization and utilization whatever the OC status. Thus, in women, the realization of an exercise in either the fed or fasting conditions had a greater impact on substrate oxidation than OC status.
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Affiliation(s)
- Laurie Isacco
- Clermont Université, Université Blaise Pascal, Clermont-Ferrand, France
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26
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Ducher G, Turner AI, Kukuljan S, Pantano KJ, Carlson JL, Williams NI, De Souza MJ. Obstacles in the optimization of bone health outcomes in the female athlete triad. Sports Med 2011; 41:587-607. [PMID: 21688870 DOI: 10.2165/11588770-000000000-00000] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Maintaining low body weight for the sake of performance and aesthetic purposes is a common feature among young girls and women who exercise on a regular basis, including elite, college and high-school athletes, members of fitness centres, and recreational exercisers. High energy expenditure without adequate compensation in energy intake leads to an energy deficiency, which may ultimately affect reproductive function and bone health. The combination of low energy availability, menstrual disturbances and low bone mineral density is referred to as the 'female athlete triad'. Not all athletes seek medical assistance in response to the absence of menstruation for 3 or more months as some believe that long-term amenorrhoea is not harmful. Indeed, many women may not seek medical attention until they sustain a stress fracture. This review investigates current issues, controversies and strategies in the clinical management of bone health concerns related to the female athlete triad. Current recommendations focus on either increasing energy intake or decreasing energy expenditure, as this approach remains the most efficient strategy to prevent further bone health complications. However, convincing the athlete to increase energy availability can be extremely challenging. Oral contraceptive therapy seems to be a common strategy chosen by many physicians to address bone health issues in young women with amenorrhoea, although there is little evidence that this strategy improves bone mineral density in this population. Assessment of bone health itself is difficult due to the limitations of dual-energy X-ray absorptiometry (DXA) to estimate bone strength. Understanding how bone strength is affected by low energy availability, weight gain and resumption of menses requires further investigations using 3-dimensional bone imaging techniques in order to improve the clinical management of the female athlete triad.
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Affiliation(s)
- Gaele Ducher
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia.
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27
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Kontrazeption bei Sportlerinnen. GYNAKOLOGISCHE ENDOKRINOLOGIE 2010. [DOI: 10.1007/s10304-010-0374-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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28
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Ruedl G, Ploner P, Linortner I, Schranz A, Fink C, Sommersacher R, Pocecco E, Nachbauer W, Burtscher M. Are oral contraceptive use and menstrual cycle phase related to anterior cruciate ligament injury risk in female recreational skiers? Knee Surg Sports Traumatol Arthrosc 2009; 17:1065-9. [PMID: 19333573 DOI: 10.1007/s00167-009-0786-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 03/12/2009] [Indexed: 11/24/2022]
Abstract
Oral contraceptive use and menstrual cycle phase are suggested to influence the risk of anterior cruciate ligament (ACL) injuries in female athletes. However, only few data are available for recreational sports. Therefore, female recreational skiers with a non-contact ACL injury and age-matched controls completed a self-reported questionnaire relating to menstrual history, oral contraceptive use and previous knee injuries. Menstrual history data were used to group subjects into either preovulatory or postovulatory phases of menstrual cycle. Our findings suggest that oral contraceptive use did not show any protective effect against ACL injuries nor did self-reported previous knee injuries show any association with ACL injury rate in recreational alpine skiing. Analysis of menstrual history data revealed that recreational skiers in the preovulatory phase were significantly more likely to sustain an ACL injury than were skiers in the postovulatory phase.
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Affiliation(s)
- Gerhard Ruedl
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria.
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Hansen M, Miller BF, Holm L, Doessing S, Petersen SG, Skovgaard D, Frystyk J, Flyvbjerg A, Koskinen S, Pingel J, Kjaer M, Langberg H. Effect of administration of oral contraceptives in vivo on collagen synthesis in tendon and muscle connective tissue in young women. J Appl Physiol (1985) 2008; 106:1435-43. [PMID: 18845777 DOI: 10.1152/japplphysiol.90933.2008] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Women are at greater risk than men for certain kinds of diseases and injuries, which may at least partly be caused by sex hormonal differences. We aimed to test the influence of estradiol in vivo on collagen synthesis in tendon, bone, and muscle. Two groups of young, healthy women similar in age, body composition, and exercise-training status were included. The two groups were either habitual users of oral contraceptives exposed to a high concentration of synthetic estradiol and progestogens (OC, n = 11), or non-OC-users tested in the follicular phase of the menstrual cycle characterized by low concentrations of estradiol and progesterone (control, n = 12). Subjects performed 1 h of one-legged kicking exercise. The next day collagen fractional synthesis rates (FSR) in tendon and muscle connective tissue were measured after a flooding dose of [(13)C]proline followed by biopsies from the patellar tendon and vastus lateralis in both legs. Simultaneously, microdialysis catheters were inserted in vastus lateralis and in front of the patellar tendon for measurement of insulin-like growth factor I (IGF-I) and its binding proteins. Serum NH(2)-terminal propeptide of type I collagen (PINP) and urine COOH-terminal telopeptides of type-I collagen (CTX-I) were measured as markers for bone synthesis and breakdown, respectively. Tendon FSR and PINP were lower in OC compared with control. An increase in muscle collagen FSR postexercise was only observed in control (P < 0.05). Furthermore, the results indicate a lower bioavailability of IGF-I in OC. In conclusion, synthetic female sex hormones administered as OC had an inhibiting effect on collagen synthesis in tendon, bone, and muscle connective tissue, which may be related to a lower bioavailability of IGF-I.
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Affiliation(s)
- M Hansen
- Institute of Sports Medicine, Bispebjerg Hospital and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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Abstract
A plethora of medical literature has been published discussing the demographics, risk factors, anatomic distribution, diagnostic evaluation, and treatment of stress fractures. However, the literature contains a void regarding the rehabilitation and preventive aspects of this frequent injury. This article briefly reviews the risk factors, common sites, and sport-specific and gender-specific stress fractures. In addition, the common clinical presentation, physical examination findings, and diagnostic evaluation are discussed, including high-risk stress fractures. An in-depth review of the treatment and prevention of stress fractures in women is also provided.
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Affiliation(s)
- Sheila A Dugan
- Rush Medical College, Rush University Medical Center, 1725 West Harrison Street, #970, Chicago, IL 60612, USA.
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Lin K, Barnhart K. The Clinical Rationale for Menses-Free Contraception. J Womens Health (Larchmt) 2007; 16:1171-80. [DOI: 10.1089/jwh.2007.0332] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kat Lin
- Reproductive Research Unit, Center for Reproductive Medicine and Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kurt Barnhart
- Reproductive Research Unit, Center for Reproductive Medicine and Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
It is now estimated that the prevalence of oral contraceptive use in athletic women matches that of women in the general population. The oral contraceptive pill (OCP) reduces cycle-length variability and provides a consistent 28-day cycle by controlling concentrations of endogenous sex hormones. The OCP is administered in three different forms that differ widely in chemical constitution and concomitant effects on the human body. As fluctuation in sex steroids are believed to be a possible causal factor in performance and exercise capacity, it is imperative to understand the effect of administering the various types of OCP on women. However, the research into oral contraceptives and exercise performance is not consistent. The type of OCP administered (monophasic, biphasic or triphasic), as well as the type and dose of estrogen and progestogen within, will have varying effects on exercise. To date, research in the area of oral contraceptives and exercise capacity is sparse and much has been plagued by poor research design, methodology and small sample size. It is clear from the research to date that more randomised clinical trials are urgently required to assess the array of OCP formulations currently available to women and their concomitant effect on health and exercise capacity. Therefore, the purpose of this article is to critically appraise the literature to date and to provide a current review of the physiological scientific knowledge base in relation to the OCP and exercise performance. In addition, methodological control, design and conduct will be considered with future areas of research highlighted.
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Peters C, Burrows M. Androgenicity of the progestin in oral contraceptives does not affect maximal leg strength. Contraception 2006; 74:487-91. [PMID: 17157107 DOI: 10.1016/j.contraception.2006.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Revised: 06/30/2006] [Accepted: 08/01/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE This study was conducted to examine androgenicity of the progestin in oral contraceptive pills and its effect on maximal leg strength in females. METHODS Twelve participants who were using a monophasic pill containing 30 microg ethinylestradiol plus either 150 microg levonorgestrel (LEV) or 250 microg norgestimate (NOR) for at least the last 6 months were recruited (mean+/-SEM; LEV: age, 19.8+/-0.3 years; stature, 1.67+/-0.17 m; mass, 65.9+/-1.9 kg; NOR: age, 20.6+/-0.2 years; stature, 1.65+/-0.17 m; mass, 64.6+/-2.4 kg). Three maximal isokinetic extension and flexion tests were performed on three occasions (Days 3-6, 11-14 and 18-21 of the pill cycle) to assess peak extension and peak flexion torque (in Newton meters). RESULTS No significant (p>.05) differences were found in the LEV and NOR groups in peak extension torque (F=0.719; p=.416) or peak flexion torque (F=0.291, p=.601) throughout the pill cycle and between groups. CONCLUSION In this small study, the androgenicity of the progestin in the contraceptive pill had no significant association with maximal strength in these female athletes.
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Affiliation(s)
- Charlotte Peters
- School of Sport and Health Sciences, The University of Exeter, Heavitree Road, Exeter, Devon EX1 2LU, UK.
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Archer DF. Menstrual-cycle-related symptoms: a review of the rationale for continuous use of oral contraceptives. Contraception 2006; 74:359-66. [PMID: 17046376 DOI: 10.1016/j.contraception.2006.06.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Revised: 05/26/2006] [Accepted: 06/06/2006] [Indexed: 11/22/2022]
Abstract
As many as 80% of reproductive-aged women experience physical changes associated with menstruation, and 20% to 40% experience menstrual-cycle-related symptoms. Decades of research in women with menstrual disorders, such as dysmenorrhea and menorrhagia, have shown that continuous use of oral contraceptives (OCs), without the hormone-free interval, is a safe and effective method to relieve these symptoms and ultimately induce amenorrhea in many women. If given the opportunity, a majority of women would opt for extended-cycle or continuous regimens, and numerous clinical trials have shown that continuous OC regimens induce amenorrhea in 80% to 100% of women by 10 to 12 months of use. For women who do not wish to become pregnant, a continuous OC regimen should be an available option.
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Affiliation(s)
- David F Archer
- Contraceptive Research and Development Program, Clinical Research Center, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
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Abstract
The female sex steroid hormones estrogen and progesterone have potential effects on exercise capacity and performance through numerous mechanisms, such as substrate metabolism, cardiorespiratory function, thermoregulation, psychologic factors, and injuries. Consequently, hormone level changes may theoretically lead to either improved or decreased performance at various times throughout the menstrual cycle. Numerous methodological issues and a paucity of studies have precluded evidence-based conclusions in almost every area of research in this field. In addition, there appears to be a great degree of inter- and intraindividual variability in these hormonal responses. Using oral contraceptives may be advantageous for female athletes who are negatively affected by their menstrual cycle, as they may provide a stable yet controllable hormonal milieu for training and competition.
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Affiliation(s)
- Naama W Constantini
- Department of Physiology, Tel-Aviv University-Sackler Faculty of Medicine, 4 Haarazim Street, Tel-Aviv, Israel.
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Ferrero S, Abbamonte LH, Giordano M, Alessandri F, Anserini P, Remorgida V, Ragni N. What is the desired menstrual frequency of women without menstruation-related symptoms? Contraception 2006; 73:537-41. [PMID: 16627042 DOI: 10.1016/j.contraception.2006.01.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Revised: 12/12/2005] [Accepted: 01/06/2006] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study aimed to investigate the desired menstrual frequency of subjects without menstruation-related symptoms. MATERIALS AND METHODS The study included 270 women of reproductive age. Women with menstrual headache, dysmenorrhea, hypermenorrhea and/or premenstrual syndrome were excluded. The study subjects completed a standardized questionnaire. RESULTS Of the women, 75.6% declared that menstrual periods interfere with their sexual life, 28.8% preferred not having their menstrual period when at work and 48.4% reported that menstrual periods interfere with practicing sports. Given the choice, 28.5% of the women would desire amenorrhea and 27.8% would prefer a reduction in the frequency of menstrual periods. Of the 152 women desiring to reduce menstrual frequency, 73.0% declared that they would accept to use a drug to reduce menstrual frequency. CONCLUSIONS Over 50% of women without menstruation-related symptoms would like to lessen the frequency of menstrual periods and about 50% of them would desire amenorrhea.
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Affiliation(s)
- Simone Ferrero
- Department of Obstetrics and Gynecology, San Martino Hospital and University of Genoa, 16132 Genoa, Italy.
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Liu SL, Lebrun CM. Effect of oral contraceptives and hormone replacement therapy on bone mineral density in premenopausal and perimenopausal women: a systematic review. Br J Sports Med 2006; 40:11-24. [PMID: 16371485 PMCID: PMC2491937 DOI: 10.1136/bjsm.2005.020065] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Seventy five articles on the effect of oral contraceptives and other hormone replacement on bone density in premenopausal and perimenopausal women were reviewed. The evidence was appraised using the Oxford Centre for Evidence-Based Medicine levels of evidence. There is good evidence for a positive effect of oral contraceptives on bone density in perimenopausal women, and fair evidence for a positive effect in "hypothalamic" oligo/amenorrhoeic premenopausal women. There is limited evidence for a positive effect in healthy and anorexic premenopausal women. In hypothalamic oligo/amenorrhoeic women, baseline bone density has been shown to be significantly lower than that in healthy controls, therefore the decision to treat is clinically more important. The ideal formulation(s) and duration of treatment remain to be determined by further longitudinal and prospective randomised controlled trials in larger subject populations.
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Affiliation(s)
- S L Liu
- Queen's University, Kingston, Ontario, Canada
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38
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Participation in leanness sports but not training volume is associated with menstrual dysfunction: a national survey of 1276 elite athletes and controls. Br J Sports Med 2005; 39:141-7. [PMID: 15728691 DOI: 10.1136/bjsm.2003.011338] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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.
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Affiliation(s)
- Jolie C Holschen
- University of Michigan, Department of Orthopaedic Surgery, Ann Arbor, MI, USA
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40
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Redman LM, Weatherby RP. Measuring Performance during the Menstrual Cycle: A Model Using Oral Contraceptives. Med Sci Sports Exerc 2004; 36:130-6. [PMID: 14707778 DOI: 10.1249/01.mss.0000106181.52102.99] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of the study was to use a low-dose oral contraceptive (OC) pill to generate consistent estrogen and progestogen concentrations and investigate the relationship between steroid hormone concentrations during the OC cycle and anaerobic performance. METHODS Five female rowers taking a low-dose OC performed tests of anaerobic power (10-s all-out effort) and capacity (1000-m row) on the Concept IIC rowing ergometer at two time points in each of three OC cycles. These time points corresponded to high estrogen and high progestogen (pill day 16-18; TDH) and low estrogen and low progestogen (pill day 26-28; TDL). Blood samples were collected at rest and postexercise for the quantification of 17beta-estradiol (E2), progesterone (P4), glucose, triglyceride, and lactate concentrations. RESULTS Endogenous E2 and P4 concentrations were not significantly different between testing days or OC cycles (P > 0.05). Peak power output was higher (P < 0.05) and 1000-m rowing ergometer time faster (P < 0.05) at TDL. Pre- and postexercise glucose concentrations were increased (P < 0.05) at TDL, whereas rest and postexercise plasma triglyceride concentrations were significantly (P < 0.05) lower during this time. CONCLUSIONS This study found that alterations in anaerobic performance throughout the OC cycle occurred with improved performances corresponding to low estrogen and progestogen concentrations. The OC provided a consistent hormonal milieu reducing inter- and intra-individual variations in sex steroids and standardized all performance and metabolic variables across each OC cycle tested. Given that OC use has a high prevalence among female athletes and provides a controlled hormonal environment, it serves as a good model in which the acute effects of female sex steroids on exercise performance can be studied.
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Affiliation(s)
- Leanne M Redman
- Exercise Physiology Laboratory, Department of Physiology, University of Adelaide, Adelaide, SA, Australia.
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Zanker CL, Cooke CB, Truscott JG, Oldroyd B, Jacobs HS. Annual Changes of Bone Density over 12 Years in an Amenorrheic Athlete. Med Sci Sports Exerc 2004; 36:137-42. [PMID: 14707779 DOI: 10.1249/01.mss.0000106186.68674.2c] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To link annual changes of bone mineral density (BMD) over 12 consecutive years to pharmacological intervention and to fluctuations of body mass and body composition in an amenorrheic athlete. METHODS BMD of the lumbar spine (LS) and total proximal femur (PF) were measured using dual energy x-ray absorptiometry (DXA), every 11-13 months between ages 24.8 and 36.9 yr. Body composition was assessed every 3-4 yr from a whole body DXA scan. Body mass was recorded every 3 months. For the first 5 yr of study, the subject used oral contraceptives (OC). For the subsequent 7 yr, she used estradiol skin patches (EP) with oral norethisterone. RESULTS The first DXA scan (age 24.8 yr) revealed a low BMD at both LS and PF, with T-scores of -1.4 and -2.8, respectively. During the next 5 yr, while adhering to OC, the BMD of her LS and PF declined by 9.8% and 12.1%, respectively. Concomitantly, her body mass fell from 45.1 to 41.4 kg, her body mass index (BMI) from 16.4 to 15.0 kg.m-2, and her percent body fat from 8.3 to <4.0%. While treated with EP and norethisterone (age 29.8-33.5 yr), her LS BMD gradually increased by 9.4%, despite a further 0.8 kg decline of body mass. From age 33.8 to 36.9 yr, voluntary weight gain (2-3 kg.yr-1; total: 8.1 kg) was accompanied by an increase of her PF BMD (16.9%), with no further increase at the LS. CONCLUSION Changes of BMD at the total proximal femur reflected changes of body mass in this subject. At the lumbar spine, BMD declined with weight loss but increased in association with transdermal estradiol treatment in the absence of weight gain.
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Affiliation(s)
- Cathy L Zanker
- School of Leisure and Sport Studies, Leeds Metropolitan University, UK.
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42
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Quereux C, Gabriel R. [Non contraceptive benefits of oral contraception]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2003; 31:1047-51. [PMID: 14680788 DOI: 10.1016/j.gyobfe.2003.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Both women and the medical profession underrate the non-contraceptive benefits of oral contraception, imbued as they are with its sole deleterious effects, such as thromboembolic ones, in particular. However, the pill is quite an efficient means of preventing against troubles of the menstrual cycle, with a betterment of cycle regularity, a diminishing of menstrual flux and a lowering of the frequency and the severity of primary dismenorrhoea. A review of the literature also demonstrates that oral contraception reduce by 40-50% the incidence of endometrial and ovarian cancer, inclusive of women with a previous history, or genetic predispositions. This effect is correlated with time of use and continues until 10 years or more after stopping taking the pill. Also, the positive part of the pill may well be considered as far as colorectal cancer is concerned, with a 40% or so reduction in risk, by means of decreasing bile acids in the colon. Other benefits of oral contraception have been documented, such as prevention of postmenopausal osteopenia when used during perimenopause, decrease in the incidence of adenofibromas, uterine fibromyomas, fibrocystic mastosis and uterine adnexial infections, and, finally, a favourable effect on acne. Preventive action of the pill on rheumatoid arthritis is debatable, the current feeling being that it diminishes severity as well as symptomatology more than risk of occurrence.
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Affiliation(s)
- C Quereux
- Service de gynécologie-obstétrique, maternité Alix-de-Champagne, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
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Brooker EJ, Barnes RJ, Walton EK, Wickramasinghe AH. Changes in saccadic latencies over the human menstrual cycle. Percept Mot Skills 2003; 96:1197-214. [PMID: 12929774 DOI: 10.2466/pms.2003.96.3c.1197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The study assessed differences in sensorimotor processing as reflected in measurements of saccadic latencies at 3 different stages in the menstrual cycle (menstruation, early luteal, and premenstruation) in naturally cycling women (n = 13), and at the same time intervals in women taking an oral contraceptive (n = 6), and male controls (n = 8). Subjects (M age = 22.0 yr., SD = 2.2 yr.) were recruited by questionnaire from the student population of the University of Cambridge. Latencies were measured using a portable infrared scleral oculometer. Changes in latency across the menstrual cycle occurred only in the naturally cycling women (F(2.11) = 5.95, p < .05). Premenstrual latencies were greater (199.3 +/- 12.7 msec., M +/- SD) compared to those during menstruation (191.9 +/- 11.1 msec.) or midcycle (196.9 +/- 12.7 msec.). These findings could account for the loss of musculoskeletal coordination reported by some women prior to menstruation and suggests that administration of an oral contraceptive may alleviate this effect.
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Abstract
OBJECTIVE To describe the components of female athlete triad, the proposed mechanisms that may relate to its causation, and some screening and treatment options that may be used by the clinician who encounters this clinical entity in patients. DATA SOURCES A qualitative review of the literature was performed. RESULTS This article provides the clinician with current information relevant to understanding and recognizing female athlete triad in at-risk patients. The components of the triad-amenorrhea, disordered eating, and osteoporosis-are interrelated in multifactorial etiology, pathogenesis, and consequences. Proposed causal factors include inadequate nutrition, menstrual status, training intensity and frequency, body size and composition, and psychological and physiological stress. There should be a high index of suspicion in all females athletes for the presence of and/or increased risk for female athlete triad. An increased awareness of the existence of the problem and its presenting signs and symptoms is the key to screening for this syndrome. The most efficacious treatment lies in its prevention. CONCLUSIONS Female athlete triad is an interrelated, multifactorial syndrome comprised of disordered eating, amenorrhea, and osteoporosis. It is a common entity among female athletes. Prevention, early detection, and early treatment are absolutely essential to maintain the athletes health into maturity and to prevent the serious consequences of this triad. The long-term effects of some triad components are still unknown.
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Couture CJ, Karlson KA. Tibial stress injuries: decisive diagnosis and treatment of 'shin splints'. PHYSICIAN SPORTSMED 2002; 30:29-36. [PMID: 20086529 DOI: 10.3810/psm.2002.06.337] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tibial stress injuries, commonly called 'shin splints,' often result when bone remodeling processes adapt inadequately to repetitive stress. Physicians who care for athletic patients need a thorough understanding of this continuum of injuries, including medial tibial stress syndrome and tibial stress fractures, because there are implications for appropriate diagnosis, management, and prevention.
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Affiliation(s)
- Christopher J Couture
- Family Medicine Residency, Ehrling Berquist Hospital, Offutt AFB, NB, 68113-2160, USA.
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47
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Abstract
For many women in the United States, menstruation is a major health concern because menstrual disorders and other conditions that may be aggravated during menses (e.g., migraine headaches, epilepsy) carry substantial morbidity. Women today menstruate nearly 3 times as often as in primitive societies, and evidence suggests that frequent, repetitive menstrual cycles may increase health risks. Because the conventional 21/7 combination oral contraceptive (OC) regimen provides only limited relief for women with menstrual disorders, alternative OC regimens that reduce menstrual frequency have been proposed. A new OC formulation specifically designed to decrease menstrual bleeding to 4 times per year is currently under investigation. Most women welcome less frequent menses or even amenorrhea. Women who may derive particular benefit from reduced menstrual frequency include not only those with medical conditions directly caused or aggravated by menses, but also those serving in the military, female athletes, mentally-retarded women with menstrual hygiene problems, young teens, and perimenopausal women.
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MESH Headings
- Adolescent
- Adult
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/pharmacology
- Contraceptive Agents, Female/therapeutic use
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/therapeutic use
- Contraceptives, Oral, Hormonal/administration & dosage
- Contraceptives, Oral, Hormonal/therapeutic use
- Female
- Humans
- Menstruation/drug effects
- Menstruation/physiology
- Menstruation Disturbances/prevention & control
- Middle Aged
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Affiliation(s)
- A M Kaunitz
- University of Florida Health Science Center, Jacksonville, FL 32557, USA.
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