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New findings on menstrual disorders in elite athletes

17.04.2008
It has long been assumed that menstrual disorders amongst elite female athletes are related to tough training regimes combined with insufficient energy intake.

However, a new doctoral thesis from the Swedish medical university Karolinska Institutet overturns old ideas that elite sport can damage the health. Many elite female athletes can have a congenital condition, that gives them higher levels of testosterone and that might even contribute to their sporting successes.

“What we’re dealing with is just a tiny increase in levels, which can make it easier for the women to build muscle mass and absorb oxygen,” says Magnus Hagmar, postgraduate at the Department of Woman and Child Health. “This means that they might have got quicker results from their training and therefore been encouraged to train harder and more often.”

Polycystic ovary syndrome (PCOS) is a common and congenital cause of menstrual disorder that, amongst other things, can lead to a slight increase in testosterone production. Magnus Hagmar now shows in his thesis not only that PCOS is often behind menstrual disorders in elite Olympic athletes, but also that polycystic ovaries – part of PCOS – were more common amongst elite Olympic athletes (37 per cent) than amongst women on average (20 per cent).

“It’s particularly interesting that the percentage of women with polycystic ovaries was higher in power sports like ice hockey and wrestling than in technical sports like archery and curling,” says Dr Hagmar.

Dr Hagmar stresses that the results have nothing to do with doping. The 90 elite athletes that took part in the study have taken regular drug tests, all of them negative. He believes that the studies overturn old notions that female sporting performance can damage the health.

A central issue in elite-level women’s sport in recent years has been the ‘female athlete triad’, whereby tough training combined with low energy intake has been thought to contribute to menstrual disorder and subsequent low bone density (osteopenia) caused by low levels of oestrogen. However, this new study now shows that elite female athletes, despite menstrual disorders, have very strong bones. In sports where low body-weight is an advantage, women also generally have a healthier way of controlling their weight than their male counterparts.

“We cannot completely rule out low energy intake as a cause of menstrual disorder in elite athletes, there were one case in these studies too, but it is far from the most common cause,” says Mr Hagmar. “The fact that not a single woman had low bone density takes away one of the factors of the female athlete triad.”

Magnus Hagmar is assistant senior physician at the women’s clinic at Karolinska University Hospital, in Stockholm, and carried out his studies in association with the Swedish Olympic Committee (SOC). One of the studies involved 223 men and women who had competed in the 2002 and 2004 Olympic Games. Another involved 90 women, all of whom are in training for the 2008 Olympics.

Doctoral thesis: ‘Menstrual status and long-term cardiovascular effects of intense exercise in top elite athlete women’, Magnus Hagmar, Department of Woman and Child Health. The public defence will take place in Stockholm on Friday 18 April 2008.

Katarina Sternudd | alfa
Further information:
http://diss.kib.ki.se/2008/978-91-7357-549-2/

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