The relation between athletic sports and prevalence of amenorrhea and oligomenorrhea in Iranian female athletes

Association between Physical Activity and Menstrual Cycle Disorders in Young Athletes

Our study aims to evaluate clinical predictors of menstrual cycle disorders in female athletes who compete in running disciplines. This is a prospective observational study. Women were recruited between January and May 2022. Fifty-three patients were enrolled and completed a questionnaire about menstrual cycle, physical activity, and food habit characteristics. Of the women in our population, 39.6% had menstrual irregularities and reported a significantly higher number of kilometers run per week (67 vs. 35, p:0.02). The number of kilometers run per week was associated with menstrual irregularities (for 10 km, OR 1.35; IC95% 1.05-1.73; p: 0.02) after adjusting for BMI, age, level of sport and caloric intake. The variable of "km run per week" appeared as a diagnostic indicator of irregular menstrual cycle with statistical significance (AUC ROC curve 0.71, IC95% 0.54-0.86, p-value=0.01) and the cut-off of 65 km run per week is a good indicator of the presence of irregular menstrual cycle (sensitivity (SE) and specificity (SP) of 55% and 81.48%). Menstrual cycle disorders are very frequent in female athletes, and the variable of km run per week may play a role in screening endurance athletes at high risk for these disorders.

Effects of physical activity and sleep duration on fertility: A systematic review and meta-analysis based on prospective cohort studies

Objective

Subfertility is a common problem for couples in modern society. Many studies have confirmed that lifestyle factors can affect fertility although there are conflicting conclusions relating to the effects of physical activity and sleep duration on fertility. In this study, we aimed to summarize and analyze the available evidence.

Methods

PubMed, Web of Science, Cochrane, and Embase databases (as of October 14, 2022) were systematically searched for eligible prospective cohort studies. Data were extracted and effect values were combined. We also performed methodological quality and bias risk assessments for all the included studies.

Results

A total of 10 eligible articles were included in our analysis; seven investigated the relationship between physical activity and fertility, and three investigated the effect of sleep duration on fertility. Compared with the lowest level of physical activity, high intensity physical activity (the highest levels of physical activity) was negatively correlated with fertility [odds ratio (OR) = 0.84; 95% confidence interval (CI): 0.70, 1.00, I ² = 64%]. However, we did not find an association between moderate intensity physical activity and fertility (OR = 1.09; 95% CI: 0.98, 1.22, I ² = 60%). We observed an inverse association between limited sleep duration (≤ 7 h) and fertility (OR = 0.92; 95% CI: 0.84, 1.00, I ² = 0%) compared with 8 h of sleep. The relationship between long sleep duration (≥9 h) and fertility was not statistically significant (OR = 0.85; 95% CI: 0.60, 1.21, I ² = 83%). According to the Newcastle-Ottawa Scale score, the overall quality of the research articles included was ranked as medium to high (6-9). Through GRADE system, the quality of evidence for the impact of high intensity physical activity and limited sleep duration on fertility was moderate, while the quality of evidence for the impact of moderate intensity physical activity and long sleep duration on fertility was low.

Conclusion

The current evidence shows that high intensity physical activity and limited sleep time are negatively related to fertility. But there was great heterogeneity among studies, and the quality of research evidence was low to median. Thus, further high-quality research is needed to confirm this conclusion.

PROSPERO registration number

CRD42022298137.

The female athlete triad: review of current literature

PURPOSE OF REVIEW

Adolescence and young adulthood are a critical period in the life of women for optimizing long-term bone health. Young athletes lead a demanding lifestyle with increased dietary requirements to meet the robust demands of energy expenditure to maintain a state of energy balance. During a time of fast paced changes and unpredictable societal demands on young athletes, it is important to review the severe consequences of energy deficiency and options for adequate management.

RECENT FINDINGS

This review focuses on hormonal adaptations that occur in energy deficient female athletes that lead to menstrual irregularities and impaired bone health, increasing the risk for stress and other fractures. We also describe management strategies to mitigate the consequences of limited energy availability on bone and other outcomes.

SUMMARY

These strategies should help guide the management of young female athletes to prevent irreversible changes to their bone health. Identifying current knowledge should help increase awareness among medical providers, which can then be communicated to the sports community, parents, and athletes.

The Impact of Menstrual Cycle Phase on Athletes' Performance: A Narrative Review

The effect of the menstrual cycle on physical performance is being increasingly recognised as a key consideration for women's sport and a critical field for further research. This narrative review explores the findings of studies investigating the effects of menstrual cycle phase on perceived and objectively measured performance in an athletic population. Studies examining perceived performance consistently report that female athletes identify their performance to be relatively worse during the early follicular and late luteal phases. Studies examining objective performance (using anaerobic, aerobic or strength-related tests) do not report clear, consistent effects of the impact of menstrual cycle phase on physical performance. Overall sport performance can be influenced by both perceived and physical factors. Hence, to optimise performance and management of eumenorrheic female athletes, there is a need for further research to quantify the impact of menstrual cycle phase on perceived and physical performance outcomes and to identify factors affecting variability in objective performance outcomes between studies.

Female hyperandrogenism and elite sport

Emerging evidence indicates that testosterone, which can increase muscle mass and strength, stimulates erythropoiesis, promotes competitive behaviour, and enhances the physical performance of women. Indeed, the levels of testosterone within the normal female range are related to muscle mass and athletic performance in female athletes. Furthermore, among these athletes, the prevalence of hyperandrogenic conditions, including both polycystic ovary syndrome and rare differences/disorders of sex development (DSD), which may greatly increase testosterone production, are elevated. Thus, if the androgen receptors of an individual with XY DSD are functional, her muscle mass will develop like that of a man. These findings have led to the proposal that essential hyperandrogenism is beneficial for athletic performance and plays a role in the choice by women to compete in athletic activities. Moreover, a recent randomized controlled trial demonstrated a significant increase in the lean mass and aerobic performance by young exercising women when their testosterone levels were enhanced moderately. Circulating testosterone is considered the strongest factor to explain the male advantage in sport performance, ranging between 10 and 20%. It appears to be unfair to allow female athletes with endogenous testosterone levels in the male range (i.e. 10-20 times higher than normal) to compete against those with normal female androgen levels. In 2012, this consideration led international organizations to establish eligibility regulations for the female classification in order to ensure fair and meaningful competition, but the regulations are controversial and have been challenged in court.

The effect of hormone therapy on bone mineral density and cardiovascular factors among Iranian female athletes with amenorrhea/oligomenorrhea: A randomized clinical trial

Background: Functional hypothalamic menstrual disorder (FHMD) has a destructive effect on the athlete's bone mineral density and cardiovascular system. Utilizing hormone replacement therapy to treat FHMD in athletes is controversial. This study was conducted to examine the effect of hormone therapy on bone density and the cardiovascular system of professional female athletes with FHMD. Methods: In this study, 18 female athletes with at least a 2- year history of FHMD were recruited in a 9-month single blind randomized clinical intervention (RCT) and randomly classified into 2 groups: the oral contraceptive pills (OCP) group, who received a lowdose combined oral contraceptive (OC) containing 30 µg ethinyl estradiol and 150 µg levonorgestrel (n= 10), and the control group (n= 8). Bone mineral densitometry (BMD) and certain cardiovascular risk factors were measured before and after the 9-month trial. The Chi square test was used to compare the quantitative and qualitative results. Results: Bone mineral density did not change significantly in either group. Very low density lipoprotein (VLDL) (p= 0.035) and Apolipoprotein B (Apo B) (p= 0.04) reduced significantly in the OCP group. An increase was observed in the serum levels of Apolipoprotein A (Apo A) (p= 0.01) in the control group. Changes in the Apo B to Apo A ratio was significant in both groups (OCP group: p= 0.018, control group: p= 0.040). No significant changes were observed in the other measured factors. Conclusion: Although the administration of estrogen did not significantly increase bone mineral density, it had positive effects on the cardiovascular system and lipid profile.

Do anabolic-androgenic steroids have performance-enhancing effects in female athletes?

Doping with anabolic-androgenic steroids (AAS) is common among both male and female athletes and is a growing public health problem. Review of historical data of systematic state-sponsored doping programs implemented by the German Democratic Republic in elite female athletes and from clinical trials of testosterone administration in non-athlete women suggests that AAS have ergogenic effects in women. The use of AAS in female athletes has been associated with adverse effects that include acne, hirsutism, deepening of the voice and menstrual disturbances; life-threatening adverse effects such as cardiac arrhythmias and sudden death have also been reported. Therefore, detection of AAS abuse in female athletes is important to ensure fairness in competition; at the same time, the athletes should be educated regarding the adverse consequences of AAS use. Although administration of exogenous androgens have been associated with ergogenic effects, it remains unclear whether endogenous hyperandrogenism seen in some medical conditions such as disorders of sexual development (DSD), congenital adrenal hyperplasia and polycystic ovary syndrome, confers any competitive advantage. Well-designed studies are needed to determine the effects of endogenous hyperandrogenism on athletic performance in female athletes.

Morphological and molecular variations induce mitochondrial dysfunction as a possible underlying mechanism of athletic amenorrhea

Female athletes may experience difficulties in achieving pregnancy due to athletic amenorrhea (AA); however, the underlying mechanisms of AA remain unknown. The present study focuses on the mitochondrial alteration and its function in detecting the possible mechanism of AA. An AA rat model was established by excessive swimming. Hematoxylin and eosin staining, and transmission electron microscopic methods were performed to evaluate the morphological changes of the ovary, immunohistochemical examinations and radioimmunoassays were used to detect the reproductive hormones and corresponding receptors. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used to test the mtDNA copy number. PCR and western blot analysis were used to test the expression of ND2. The change of morphological features of the rat ovaries revealed evident abnormalities. Particularly, the features of the mitochondria were markedly altered. In addition, reproductive hormones in the serum and tissues of AA rats were also detected to evaluate the function of the ovaries, and the levels of these hormones were significantly decreased. Furthermore, the mitochondrial DNA copy number (mtDNA) and expression of NADH dehydrogenase subunit 2 (ND2) were quantitated by qPCR or western blot analysis. Accordingly, the mtDNA copy number and expression of ND2 expression were markedly reduced in the AA rats. In conclusion, mitochondrial dysfunction in AA may affect the cellular energy supply and, therefore, result in dysfunction of the ovary. Thus, mitochondrial dysfunction may be considered as a possible underlying mechanism for the occurrence of AA.

Female athletes and menstrual disorders: a pilot study

BACKGROUND

There is a greater incidence of menstrual disorders in female athletes than in their sedentary counterparts. The menstrual disorder is reported in female athletes suffering from athletic triad syndrome, while few data in those free of this syndrome are available. The study aims to ascertain the presence of menstrual disorders and the eventual relationship with myocardial performance in female athletes practicing different sports.

METHODS

A sample of 64 subjects aged 18.5±2 was selected and divided into 3 groups (37 subjects practicing rhythmic gymnastics, 11 swimmers, and 16 volleyball players). All underwent echocardiography, biompendance analysis, and answered a questionnaire.

RESULTS

All anthropometrics parameters were normal. Few athletes reported menstrual disorders. No association between the presence of menstrual disorders and BMI. All echo results were within the normal range. Cardiac Mass Index (CMI) was normal for all athletes despite in swimmers significantly higher values (90.64±14.9 g/m2) compared to the volleyball players (78.25±14.0 g/m2; p<.04) and rhythmic gymnasts (77.89±13.4 g/m2; p<.009) were found.

CONCLUSIONS

Despite menstrual disorders are represented among female athletes, the eventual relationship with the sport practiced is not so evident. Questionnaire should be used to identify menstrual disorders in non-elite athletically active females.

Prevalence of polycystic ovary syndrome and its associated complications in Iranian women: A meta-analysis

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and is the most common cause of infertility due to anovulation. There is no single criterion for the diagnosis of this syndrome.

OBJECTIVE

The purpose of this study was to investigate the prevalence of PCOS and its associated complications in Iranian women using meta-analysis method.

MATERIALS AND METHODS

Prevalence of PCOS was investigated from the SID, Goggle scholar, PubMed, Magiran, Irandoc, and Iranmedex, and weighting of each study was calculated according to sample size and prevalence of the binomial distribution. Data were analyzed using a random-effects model meta-analysis (Random effects model) and the software R and Stata Version 11.2.

RESULTS

30 studies conducted between the years 2006 to 2011 were entered into meta-analysis. The total sample size was 19, 226 women aged between 10-45 years. The prevalence of PCOS based on National institute of child health and human disease of the U.S was, 6.8% (95 % CI: 4.11-8.5), based on Rotterdam was 19.5% (95 % CI: 2.24-8.14), and based on ultrasound was 4.41% (95% CI: 5.68-4.14). Also, the prevalence of hirsutism was estimated to be 13%, acne 26%, androgenic alopecia 9%, menstrual disorders 28%, overweight 21%, obesity 19%, and infertility 8%.

CONCLUSION

The prevalence of PCOS in Iran is not high. However, given the risk of complications such as heart disease - cardiovascular and infertility, prevention of PCOS is important; we suggest that health officials must submit plans for the community in this respect.

Bone Mineral Changes and Cardiovascular Effects among Female Athletes with Chronic Menstrual Dysfunction

Purpose

Oligo/amenorrhea, as a part of the Female Athlete Triad has adverse effects on the athlete's bone mineral density (BMD) and cardiovascular system. Hypoestrogenism, due to suppression of hypothalamus-pituitary axis (HPA) as a result of energy imbalance, is the possible cause of the Triad. This study was designed based on following up and reassessment of elite female athletes who were diagnosed as menstrual dysfunction about two years ago.

Methods

This study was conducted in three phase sections: 1) Reassess the pattern of menstrual cycle among athletes who reported menstrual dysfunction about two years ago; 2) Bone mineral density was measured twice in the same machine and same center with a two-year interval; 3) The laboratory data including blood glucose, lipid profile and inflammatory markers was assessed in phase 3.

Results

BMD of athletes did not change significantly after 25.5 months of oligomenorrhea P (spine) = 0.2, P (femur)=0.9. Mean of all cardiovascular factors was in the normal range except for high density lipoprotein (HDL) which was 49.28 (SD=9.18), however, most of the athletes had abnormalities in their lipid profile. Inverse relationship between the increase in the BMD of spine and total cholesterol (r =−0.49, P=0.04), Apolipoprotein A (r = −0.51 P=0.04), and very low density lipoprotein (VLDL) (r =−0.66, P=0.009). Also correlation between BMD of spine and HbA1C (r =−0.70, P=0.003) were significant.

Conclusion

Findings of this study show that negative changes in BMD and cardiovascular biomarkers of female athletes with functional hypothalamic menstrual dysfunction could occur if proper therapeutic intervention (including increase in calorie intake, decrease in exercise load or hormonal replacement) will not consider.

A prospective cohort study of physical activity and time to pregnancy

OBJECTIVE

To investigate the association between leisure-time physical activity (PA) and fecundability.

DESIGN

Prospective cohort study.

SETTING

Internet-based observational study of Danish women who were planning a pregnancy (2007-2009).

PATIENT(S)

A total of 3,628 women aged 18-40 years at baseline.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Time to pregnancy (TTP). Fecundability ratios (FRs) and 95% confidence intervals (CIs) were derived from discrete-time Cox models, with adjustment for potential confounders, such as body mass index (BMI).

RESULT(S)

We observed an inverse monotonic association between vigorous PA and fecundability (≥ 5 h/wk vs. none: FR 0.68, 95% CI 0.54-0.85) and a weak positive association between moderate PA and fecundability (≥ 5 vs. <1 h/wk: FR 1.18, 95% CI 0.98-1.43) after mutual adjustment for both PA types. Inverse associations between high vigorous PA and fecundability were observed within subgroups of age, parity status, and cycle regularity, but not among overweight or obese women (BMI ≥ 25 kg/m(2)).

CONCLUSION(S)

There was evidence for a dose-response relationship between increasing vigorous PA and delayed TTP in all subgroups of women with the exception of overweight and obese women. Moderate PA was associated with a small increase in fecundability regardless of BMI. These findings indicate that PA of any type might improve fertility among overweight and obese women, a subgroup at higher risk of infertility. Lean women who substitute vigorous PA with moderate PA may also improve their fertility.

Endogenous hyperandrogenism and exercise capacity lessons from the exercise-congenital adrenal hyperplasia model

Athletic excellence requires a combination of genetic endowment, continuous training, appropriate equipment, and proper nutrition. However, the specific genetic and/or intrinsic hormonal milieus that contribute to athletic performance are not clearly understood. Androgens are thought to play an important role in exercise-induced target tissue response. In adults, the use of exogenous anabolic steroids was found to improve athletic performance, decrease fatigue, increase muscle mass, and increase aggressiveness. However, the benefit of these substances in adolescents remains questionable. Moreover, the role of endogenous androgen secretion for competitive performance success is far less studied. The present review will summarize aspects related to the effect of endogenous hyperandrogenism on exercise performance, as seen in polycystic ovary syndrome (PCOS), and will concentrate on important lessons learned from the unique model of exercise in congenital adrenal hyperplasia, a disease associated with endogenous hyperandrogenism.

Sudden cardiac death athletes: a systematic review

Previous events evidence that sudden cardiac death (SCD) in athletes is still a reality and it keeps challenging cardiologists. Considering the importance of SCD in athletes and the requisite for an update of this matter, we endeavored to describe SCD in athletes. The Medline (via PubMed) and SciELO databases were searched using the subject keywords "sudden death, athletes and mortality". The incidence of SCD is expected at one case for each 200,000 young athletes per year. Overall it is resulted of complex dealings of factors such as arrhythmogenic substrate, regulator and triggers factors. In great part of deaths caused by heart disease in athletes younger than 35 years old investigations evidence cardiac congenital abnormalities. Athletes above 35 years old possibly die due to impairments of coronary heart disease, frequently caused by atherosclerosis. Myocardial ischemia and myocardial infarction are responsible for the most cases of SCD above this age (80%). Pre-participatory athletes' evaluation helps to recognize situations that may put the athlete's life in risk including cardiovascular diseases. In summary, cardiologic examinations of athletes' pre-competition routine is an important way to minimize the risk of SCD.