Skip to main content
SpringerLink
Log in

The Prevalence of Menstrual Cycle Disorders and Menstrual Cycle-Related Symptoms in Female Athletes: A Systematic Literature Review

  • Systematic Review
  • Published:
Sports Medicine Aims and scope Submit manuscript

A Correction to this article was published on 17 July 2023

This article has been updated

Abstract

Background

Menstrual cycle (MC) disorders and MC-related symptoms can have debilitating effects on the health and performance of female athletes. As the participation of women in sports continues to increase, understanding the prevalence of a range of MC disorders and MC-related symptoms may guide preventive strategies to protect the health and optimise the performance of female athletes.

Objective

To examine the prevalence of MC disorders and MC-related symptoms among female athletes who are not using hormonal contraceptives and evaluate the assessment methods used to identify MC disorders and MC-related symptoms.

Methods

This systematic review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Six databases were searched until September 2022 for all original research that reported the prevalence of MC disorders and/or MC-related symptoms in athletes not using hormonal contraceptives, which included the definitions of the MC disorders examined, and the assessment methods used. MC disorders included amenorrhoea, anovulation, dysmenorrhoea, heavy menstrual bleeding (HMB), luteal phase deficiency (LPD), oligomenorrhoea, premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). MC-related symptoms included any affective and physical symptoms related to the MC that do not cause significant personal, interpersonal or functional impairment. The prevalence data across eligible studies were combined, and all studies were qualitatively synthesised to evaluate the assessment methods and tools used to identify MC disorders and MC-related symptoms. The methodological quality of studies was assessed using a modified Downs and Black checklist.

Results

Sixty studies involving 6380 athletes were included. A wide range of prevalence was observed for all types of MC disorders, with a dearth of data on anovulation and LPD. Based on pooled data, dysmenorrhoea (32.3%; range 7.8–85.6%) was the most prevalent MC disorder. Studies reporting MC-related symptoms mostly examined the premenstrual and menstruation phases, where affective symptoms appeared more prevalent than physical symptoms. A larger proportion of athletes reported symptoms during the initial days of menstruation compared with the premenstrual phase. MC disorders and MC-related symptoms were retrospectively assessed using self-report methods in 90.0% of studies. Most studies (76.7%) in this review were graded as moderate quality.

Discussion

MC disorders and MC-related symptoms are commonplace among female athletes, warranting further research examining their impact on performance and preventive/management strategies to optimise athlete health. To increase the quality of future studies, researchers should adopt standardised definitions of MC disorders and assessment methods such as a combination of calendar counting, urinary ovulation tests and a mid-luteal phase serum progesterone measurement when assessing menstrual function. Similarly, standardised diagnostic criteria should be used when examining MC disorders such as HMB, PMS and PMDD. Practically, implementing prospective cycle monitoring that includes ovulation testing, mid-luteal blood sampling (where feasible) and symptom logging throughout the MC could support athletes and practitioners to promptly identify and manage MC disorders and/or MC-related symptoms.

Trial Registration

This review has been registered in the PROSPERO database (CRD42021268757).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Change history

References

  1. American College of Obstetricians and Gynecologists. Practice Bulletin No. 128: Diagnosis of Abnormal Uterine Bleeding in Reproductive-Aged Women. 2012. https://journals.lww.com/greenjournal/Citation/2012/07000/Practice_Bulletin_No__128__Diagnosis_of_Abnormal.41.aspx. Accessed 1 Nov 2021.

  2. Broekmans FJ, Visser JA, Laven JSE, Broer SL, Themmen APN, Fauser BC. Anti-Müllerian hormone and ovarian dysfunction. Trends Endocrinol Metab. 2008;19:340–7.

    Article  CAS  PubMed  Google Scholar 

  3. Phillips NA, Bachmann G. Premenstrual syndrome and dysphoric disorder - Symptoms, diagnosis and treatment. BMJ Best Practice. 2022. https://bestpractice.bmj.com/topics/en-us/419. Accessed 10 Nov 2022.

  4. Goldman MB, Hatch MC. Women and Health. Berlin: Elsevier; 1999.

    Google Scholar 

  5. Ellison PT. Human ovarian function and reproductive ecology: new hypotheses. Am Anthropolog. 1990;92:933–52.

    Article  Google Scholar 

  6. Bernardi M, Lazzeri L, Perelli F, Reis FM, Petraglia F. Dysmenorrhea and related disorders. F1000Res. 2017;6:1645.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Biggs WS, Demuth RH. Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Phys. 2011;84:918–24.

    Google Scholar 

  8. Manore MM. Dietary recommendations and athletic menstrual dysfunction. Sports Med. 2002;32:887–901.

    Article  PubMed  Google Scholar 

  9. Otis CL, Drinkwater B, Johnson M, Loucks A, Wilmore J. American College of Sports Medicine position stand. The Female Athlete Triad. Med Sci Sports Exerc. 1997;29:i–ix.

    Article  CAS  PubMed  Google Scholar 

  10. Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP. American College of Sports Medicine position stand. The female athlete triad. Med Sci Sports Exerc. 2007;39:1867–82.

    PubMed  Google Scholar 

  11. Shufelt CL, Torbati T, Dutra E. Hypothalamic amenorrhea and the long-term health consequences. Semin Reprod Med. 2017;35:256–62.

    Article  PubMed  PubMed Central  Google Scholar 

  12. De Souza MJ, West SL, Jamal SA, Hawker GA, Gundberg CM, Williams NI. The presence of both an energy deficiency and estrogen deficiency exacerbate alterations of bone metabolism in exercising women. Bone. 2008;43:140–8.

    Article  PubMed  Google Scholar 

  13. O’Donnell E, Harvey PJ, Goodman JM, De Souza MJ. Long-term estrogen deficiency lowers regional blood flow, resting systolic blood pressure, and heart rate in exercising premenopausal women. Am J Physiol Endocrinol Metab. 2007;292:E1401-1409.

    Article  PubMed  Google Scholar 

  14. Rickenlund A, Eriksson MJ, Schenck-Gustafsson K, Hirschberg AL. Amenorrhea in female athletes is associated with endothelial dysfunction and unfavorable lipid profile. J Clin Endocrinol Metab. 2005;90:1354–9.

    Article  CAS  PubMed  Google Scholar 

  15. Elliott-Sale KJ, Minahan CL, de Jonge XAKJ, Ackerman KE, Sipilä S, Constantini NW, et al. Methodological considerations for studies in sport and exercise science with women as participants: a working guide for standards of practice for research on women. Sports Med [Internet]. 2021. https://doi.org/10.1007/s40279-021-01435-8.

    Article  PubMed  Google Scholar 

  16. Karlsson TS, Marions LB, Edlund MG. Heavy menstrual bleeding significantly affects quality of life. Acta Obstet Gynecol Scand. 2014;93:52–7.

    Article  PubMed  Google Scholar 

  17. Gao M, Zhang H, Gao Z, Cheng X, Sun Y, Qiao M, et al. Global and regional prevalence and burden for premenstrual syndrome and premenstrual dysphoric disorder. Medicine (Baltimore). 2022;101: e28528.

    Article  PubMed  Google Scholar 

  18. Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiol Rev. 2014;36:104–13.

    Article  PubMed  Google Scholar 

  19. Bruinvels G, Goldsmith E, Blagrove R, Simpkin A, Lewis N, Morton K, et al. Prevalence and frequency of menstrual cycle symptoms are associated with availability to train and compete: a study of 6812 exercising women recruited using the Strava exercise app. Br J Sports Med. 2021;55:438–43.

    Article  PubMed  Google Scholar 

  20. Armour M, Parry KA, Steel K, Smith CA. Australian female athlete perceptions of the challenges associated with training and competing when menstrual symptoms are present. Int J Sports Sci Coach. 2020;15:316–23.

    Article  Google Scholar 

  21. Warren MP, Perlroth NE. The effects of intense exercise on the female reproductive system. J Endocrinol. 2001;170:3–11.

    Article  CAS  PubMed  Google Scholar 

  22. De Souza MJ, Toombs RJ, Scheid JL, O’Donnell E, West SL, Williams NI. High prevalence of subtle and severe menstrual disturbances in exercising women: confirmation using daily hormone measures. Hum Reprod. 2010;25:491–503.

    Article  PubMed  Google Scholar 

  23. Torstveit MK, Sundgot-Borgen J. The female athlete triad exists in both elite athletes and controls. Med Sci Sports Exerc. 2005;37:1449–59.

    Article  PubMed  Google Scholar 

  24. McNulty KL, Elliott-Sale KJ, Dolan E, Swinton PA, Ansdell P, Goodall S, et al. The effects of menstrual cycle phase on exercise performance in eumenorrheic women: a systematic review and meta-analysis. Sports Med. 2020;50:1813–27.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Elliott-Sale KJ, McNulty KL, Ansdell P, Goodall S, Hicks KM, Thomas K, et al. The effects of oral contraceptives on exercise performance in women: a systematic review and meta-analysis. Sports Med. 2020;50:1785–812.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Elliott-Sale KJ, Ross E, Burden R, Hicks K. The BASES Expert Statement on conducting and implementing female athlete-based research. Sport Exerc Sci. 2020;65:6–7.

  27. Pitchers G, Elliott-sale K. Considerations for coaches training female athletes. Prof Strength Cond. 2019;55:19–30.

  28. Roupas ND, Georgopoulos NA. Menstrual function in sports. Hormones (Athens). 2011;10:104–16.

    Article  PubMed  Google Scholar 

  29. De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, et al. 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad: 1st International Conference held in San Francisco, CA, May 2012, and 2nd International Conference held in Indianapolis, IN, May 2013. Clin J Sport Med. United States; 2014;24:96–119.

  30. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10:89.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. McKay AKA, Stellingwerff T, Smith ES, Martin DT, Mujika I, Goosey-Tolfrey VL, et al. Defining Training and performance caliber: a participant classification framework. Int J Sports Physiol Perform. 2022;17:317–31.

    Article  PubMed  Google Scholar 

  33. Smith ES, McKay AKA, Ackerman KE, Harris R, Elliott-Sale KJ, Stellingwerff T, et al. Methodology review: a protocol to audit the representation of female athletes in sports science and sports medicine research. Int J Sport Nutr Exerc Metab. 2022;1:1–14.

    Google Scholar 

  34. Master-Hunter T, Heiman DL. Amenorrhea: evaluation and treatment. Am Family Phys. 2006;73:1374–82.

    Google Scholar 

  35. Practice Committee of American Society for Reproductive Medicine. Current evaluation of amenorrhea. Fertil Steril. 2008;90:S219-225.

    Article  Google Scholar 

  36. Hackney AC, Smith-Ryan AE, Fink JE. Methodological considerations in exercise endocrinology. In: Hackney AC, Constantini NW, editors. Endocrinology of physical activity and sport [Internet]. Cham: Springer International Publishing; 2020. p. 1–17. https://doi.org/10.1007/978-3-030-33376-8_1.

    Chapter  Google Scholar 

  37. Klein DA, Poth MA. Amenorrhea: an approach to diagnosis and management. AFP. 2013;87:781–8.

    Google Scholar 

  38. Janse DE, Jonge X, Thompson B, Han A. Methodological recommendations for menstrual cycle research in sports and exercise. Med Sci Sports Exerc. 2019;51:2610–7.

    Article  Google Scholar 

  39. reVITALize: Gynecology Data Definitions. https://www.acog.org/en/practice-management/health-it-and-clinical-informatics/revitalize-gynecology-data-definitions. Accessed 1 Nov 2021.

  40. ACOG Committee Opinion No. 760: Dysmenorrhea and endometriosis in the adolescent. Obstet Gynecol. 2018;132:e249–58.

    Article  Google Scholar 

  41. Dawood MY. Primary dysmenorrhea: advances in pathogenesis and management. Obstet Gynecol. 2006;108:428–41.

    Article  PubMed  Google Scholar 

  42. Kadian S, O’Brien S. Classification of premenstrual disorders as proposed by the International Society for Premenstrual Disorders. Menopause Int. 2012;18:43–7.

    Article  PubMed  Google Scholar 

  43. Dickerson LM, Mazyck PJ, Hunter MH. Premenstrual syndrome. AFP. 2003;67:1743–52.

    Google Scholar 

  44. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Arlington: American Psychiatric Association; 2013.

    Book  Google Scholar 

  45. Lanhers C, Courteix D, Valente-Dos-Santos J, Ferry B, Gracia-Marco L, Pereira B, et al. Gonadal hormones may predict structural bone fragility in elite female soccer player. J Sports Sci. 2020;38:827–37.

    Article  PubMed  Google Scholar 

  46. Bacchi E, Spiazzi G, Zendrini G, Bonin C, Moghetti P. Low body weight and menstrual dysfunction are common findings in both elite and amateur ballet dancers. J Endocrinol Invest. 2013;36:343–6.

    CAS  PubMed  Google Scholar 

  47. Barrack MT, Van Loan MD, Rauh MJ, Nichols JF. Physiologic and behavioral indicators of energy deficiency in female adolescent runners with elevated bone turnover. Am J Clin Nutr. 2010;92:652–9.

    Article  CAS  PubMed  Google Scholar 

  48. Beals KA, Manore MM. Disorders of the female athlete triad among collegiate athletes. Int J Sport Nutr Exerc Metab. 2002;12:281–93.

    Article  PubMed  Google Scholar 

  49. Brooks-Gunn J, Warren MP, Hamilton LH. The relation of eating problems and amenorrhea in ballet dancers. Med Sci Sports Exerc. 1987;19:41–4.

    Article  CAS  PubMed  Google Scholar 

  50. Calabrese LH, Kirkendall DT, Floyd M, Rapoport S, Williams GW. Menstrual abnormalities, nutritional patterns, and body composition in female classical ballet dancers. Phys Sportsmed. 1983;11:86–90.

    Article  CAS  PubMed  Google Scholar 

  51. Cook SD, Harding AF, Thomas KA, Morgan EL, Schnurpfeil KM, Haddad RJ Jr. Trabecular bone density and menstrual function in women runners. Am J Sports Med. 1987;15:503–7.

    Article  CAS  PubMed  Google Scholar 

  52. Czajkowska M, Drosdzol-Cop A, Gałązka I, Naworska B, Skrzypulec-Plinta V. Menstrual cycle and the prevalence of premenstrual syndrome/premenstrual dysphoric disorder in adolescent athletes. J Pediatr Adolesc Gynecol. 2015;28:492–8.

    Article  PubMed  Google Scholar 

  53. Czajkowska M, Plinta R, Rutkowska M, Brzęk A, Skrzypulec-Plinta V, Drosdzol-Cop A. Menstrual cycle disorders in professional female rhythmic gymnasts. Int J Environ Res Public Health. 2019;16:1470.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Dusek T. Influence of high intensity training on menstrual cycle disorders in athletes. Croat Med J. 2001;42:79–82.

    CAS  PubMed  Google Scholar 

  55. Egan E, Reilly T, Whyte G, Giacomoni M, Cable NT. Disorders of the menstrual cycle in elite female ice hockey players and figure skaters. Biol Rhythm Res. 2003;34:251–64.

    Article  Google Scholar 

  56. Fogelholm M, Van Marken LW, Ottenheijm R, Westerterp K. Amenorrhea in ballet dancers in the Netherlands. Med Sci Sports Exerc. 1996;28:545–50.

    CAS  PubMed  Google Scholar 

  57. Foster R, Vaisberg M, Araújo MP, Martins MA, Capel T, Bachi ALL, et al. Relationship between Anxiety and Interleukin 10 in Female Soccer Players with and Without Premenstrual Syndrome (PMS). Rev Bras Ginecol Obstet. 2017;39:602–7.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Frisch RE, Albright T, Gotz-Welbergen AV, Witschi J, McArthur JW. Delayed menarche and amenorrhea of college athletes in relation to age of onset of training. J Am Med Assoc. 1981;246:1559–63.

    Article  CAS  Google Scholar 

  59. Goodwin Y, Monyeki MA, Boit MK, De Ridder JH, Toriola AL, Mwangi FM, et al. Association between energy availability and menstrual function in elite Kenyan runners. Afr J Phys Health Educ Recreat Dance. 2014;20:291–307.

    Google Scholar 

  60. Guler F, Hascelik Z. Menstrual dysfunction rate and delayed menarche in top athletes of team games. Sports Med Train Rehabil. 1993;4:99–106.

    Article  Google Scholar 

  61. Hagmar M, Berglund B, Brismar K, Hirschberg AL. Hyperandrogenism may explain reproductive dysfunction in olympic athletes. Med Sci Sports Exerc. 2009;41:1241–8.

    Article  PubMed  Google Scholar 

  62. Hammar ML, Hammar-Henriksson MB, Frisk J, Rickenlund A, Wyon YA. Few oligo-amenorrheic athletes have vasomotor symptoms. Maturitas. 2000;34:219–25.

    Article  CAS  PubMed  Google Scholar 

  63. Harber VJ, Webber CE, Sutton JR, MacDougall JD. The effect of amenorrhea on calcaneal bone density and total bone turnover in runners. Int J Sports Med. 1991;12:505–8.

    Article  CAS  PubMed  Google Scholar 

  64. Hoch AZ, Pajewski NM, Moraski L, Carrera GF, Wilson CR, Hoffmann RG, et al. Prevalence of the female athlete triad in high school athletes and sedentary students. Clin J Sport Med. 2009;19:421–8.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Ihalainen JK, Kettunen O, McGawley K, Solli GS, Hackney AC, Mero AA, et al. Body composition, energy availability, training, and menstrual status in female runners. Int J Sports Physiol Perform. 2021;16:1043–8.

    Article  PubMed  Google Scholar 

  66. Jenkins PJ, Ibanez-Santos X, Holly J, Cotterill A, Perry L, Wolman R, et al. IGFBP-1: a metabolic signal associated with exercise-induced amenorrhoea. Neuroendocrinology. 1993;57:600–4.

    Article  CAS  PubMed  Google Scholar 

  67. Kishali NF, Imamoglu O, Katkat D, Atan T, Akyol P. Effects of menstrual cycle on sports performance. Int J Neurosci. 2006;116:1549–63.

    Article  PubMed  Google Scholar 

  68. Maïmoun L, Coste O, Georgopoulos NA, Roupas ND, Mahadea KK, Tsouka A, et al. Despite a high prevalence of menstrual disorders, bone health is improved at a weight-bearing bone site in world-class female rhythmic gymnasts. J Clin Endocrinol Metab. 2013;98:4961–9.

    Article  PubMed  Google Scholar 

  69. Martin D, Sale C, Cooper SB, Elliott-Sale KJ. Period Prevalence and perceived side effects of hormonal contraceptive use and the menstrual cycle in elite athletes. Int J Sports Physiol Perform. 2018;13:926–32.

    Article  PubMed  Google Scholar 

  70. Melin A, Tornberg ÅB, Skouby S, Møller SS, Sundgot-Borgen J, Faber J, et al. Energy availability and the female athlete triad in elite endurance athletes. Scand J Med Sci Sports. 2015;25:610–22.

    Article  CAS  PubMed  Google Scholar 

  71. Möller-Nielsen J, Hammar M. Women’s soccer injuries in relation to the menstrual cycle and oral contraceptive use. Med Sci Sports Exerc. 1989;21:126–9.

    PubMed  Google Scholar 

  72. Molnár AH, Vidiczki-Dóczi A, Petrovszki Z, Győri F. Prevalence of eating disorders and menstrual irregularities among female football players. Arena J Phys Activ. 2016;5:16–27.

  73. Momma R, Nakata Y, Sawai A, Takeda M, Natsui H, Mukai N, et al. Comparisons of the prevalence, severity, and risk factors of dysmenorrhea between Japanese female athletes and non-athletes in universities. Int J Environ Res Public Health. 2021;19:52.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Mukherjee P, Mishra SK, Ray S. Menstrual characteristics of adolescent athletes: a study from West Bengal, India. Coll Antropol. 2014;38:917–23.

    PubMed  Google Scholar 

  75. Myburgh KH, Berman C, Novick I, Noakes TD, Lambert EV. Decreased Resting Metabolic Rate in Ballet Dancers With Menstrual Irregularity. Int J Sport Nutr. 1999;9:285.

    Article  CAS  PubMed  Google Scholar 

  76. Nichols JF, Rauh MJ, Lawson MJ, Ji M, Barkai HS. Prevalence of the female athlete triad syndrome among high school athletes. Arch Pediatr Adolesc Med. 2006;160:137–42.

    Article  PubMed  Google Scholar 

  77. Nose-Ogura S, Yoshino O, Dohi M, Kigawa M, Harada M, Kawahara T, et al. Low bone mineral density in elite female athletes with a history of secondary amenorrhea in their teens. Clin J Sport Med. 2020;30:245–50.

    PubMed  Google Scholar 

  78. Oxfeldt M, Dalgaard LB, Jørgensen AA, Hansen M. Hormonal contraceptive use, menstrual dysfunctions, and self-reported side effects in elite athletes in Denmark. Int J Sports Physiol Perform. 2020;15:1377–84.

    Article  PubMed  Google Scholar 

  79. Parker LJ, Elliott-Sale KJ, Hannon MP, Morton JP, Close GL. An audit of hormonal contraceptive use in Women’s Super League soccer players; implications on symptomology. Sci Med Footb. 2022;6:153–8.

    Article  PubMed  Google Scholar 

  80. Pollock N, Grogan C, Perry M, Pedlar C, Cooke K, Morrissey D, et al. Bone-mineral density and other features of the female athlete triad in elite endurance runners: a longitudinal and cross-sectional observational study. Int J Sport Nutr Exerc Metab. 2010;20:418–26.

    Article  PubMed  Google Scholar 

  81. Quah YVMS, Poh BKP, Ng LODP, Noor MIP. The female athlete triad among elite Malaysian athletes: prevalence and associated factors. Asia Pac J Clin Nutr. 2009;18:200–8.

    PubMed  Google Scholar 

  82. Roberts TA, Glen J, Kreipe RE. Disordered eating and menstrual dysfunction in adolescent female athletes participating in school-sponsored sports. Clin Pediatr. 2003;42:561–4.

    Article  Google Scholar 

  83. Robinson TL. Bone mineral and menstrual cycle status in competitive female athletes: a longitudinal study. Oregon State University; 1996. https://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/gh93h161c. Accessed 6 Aug 2021.

  84. Rutherford OM. Spine and total body bone mineral density in amenorrheic endurance athletes. J Appl Physiol. 1993;74:2904–8.

    Article  CAS  PubMed  Google Scholar 

  85. Schtscherbyna A, Soares EA, de Oliveira FP, Ribeiro BG. Female athlete triad in elite swimmers of the city of Rio de Janeiro, Brazil. Nutrition. 2009;25:634–9.

    Article  PubMed  Google Scholar 

  86. Stefani L, Galanti G, Lorini S, Beni G, Dei M, Maffulli N. Female athletes and menstrual disorders: a pilot study. Muscles Ligaments Tendons J (MLTJ). 2016;6:183–7.

    Article  PubMed  Google Scholar 

  87. Stokic E, Srdic B, Barak O. Body mass index, body fat mass and the occurrence of amenorrhea in ballet dancers. Gynecol Endocrinol. 2005;20:195–9.

    Article  PubMed  Google Scholar 

  88. Sygo J, Coates AM, Sesbreno E, Mountjoy ML, Burr JF. Prevalence of indicators of low energy availability in elite female sprinters. Int J Sport Nutr Exerc Metab. 2018;28:490–6.

    Article  CAS  PubMed  Google Scholar 

  89. Takeda T, Imoto Y, Nagasawa H, Muroya M, Shiina M. Premenstrual SYNDROME AND PREMENSTRUAL DYSPHORIC DISORDER in Japanese Collegiate Athletes. J Pediatr Adolesc Gynecol. 2015;28:215–8.

    Article  PubMed  Google Scholar 

  90. Takeda T, Imoto Y, Nagasawa H, Takeshita A, Shiina M. Stress fracture and premenstrual syndrome in Japanese adolescent athletes: a cross-sectional study. BMJ Open. 2016;6: e013103.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Takeda T, Ueno T, Uchiyama S, Shiina M. Premenstrual symptoms interference and equal production status in Japanese collegiate athletes: a cross-sectional study. J Obstet Gynaecol Res. 2018;44:488–94.

    Article  CAS  PubMed  Google Scholar 

  92. Thompson SHEC. Characteristics of the Female Athlete Triad in Collegiate Cross-Country Runners. J Am Coll Health. 2007;56:129–36.

    Article  PubMed  Google Scholar 

  93. Toriola AL. Survey of menstrual function in young Nigerian athletes. Int J Sports Med. 1988;9:29–34.

    Article  CAS  PubMed  Google Scholar 

  94. Toriola AL, Mathur DN. Menstrual dysfunction in Nigerian athletes. Br J Obstet Gynaecol. 1986;93:979–85.

    Article  CAS  PubMed  Google Scholar 

  95. Tsukahara Y, Torii S, Yamasawa F, Iwamoto J, Otsuka T, Goto H, et al. Bone parameters of elite athletes with oligomenorrhea and prevalence seeking medical attention: a cross-sectional study. J Bone Miner Metab. 2021;39:1009–18.

    Article  CAS  PubMed  Google Scholar 

  96. Wakat DK, Sweeney KA, Rogol AD. Reproductive system function in women cross-country runners. Med Sci Sports Exerc. 1982;14:263–9.

    Article  CAS  PubMed  Google Scholar 

  97. Yamada K, Takeda T. Low Proportion of Dietary Plant Protein among Athletes with Premenstrual Syndrome-Related Performance Impairment. Tohoku J Exp Med. 2018;244:119–22.

    Article  CAS  PubMed  Google Scholar 

  98. Feldmann JM, Belsha JP, Eissa MA, Middleman AB. Female adolescent athletes’ awareness of the connection between menstrual status and bone health. J Pediatr Adolesc Gynecol. 2011;24:311–4.

    Article  PubMed  Google Scholar 

  99. Muia EN, Wright HH, Onywera VO, Kuria EN. Adolescent elite Kenyan runners are at risk for energy deficiency, menstrual dysfunction and disordered eating. J Sports Sci. 2016;34:598–606.

    Article  PubMed  Google Scholar 

  100. Pavlak MJS. The inter-relatedness of nutrition, menstrual status, lean body mass, and injury among high school female varsity basketball players. Grand Valley State University; 1998. https://scholarworks.gvsu.edu/cgi/viewcontent.cgi?article=1388&context=theses. Accessed 6 Aug 2021.

  101. Snyder AC, Wenderoth MP, Johnston CC, Hui SL. Bone mineral content of elite lightweight amenorrheic oarswomen. Hum Biol. 1986;58:863–9.

    CAS  PubMed  Google Scholar 

  102. Takeda T, Imoto Y, Nagasawa H, Takeshita A, Shiina M. Fish consumption and premenstrual syndrome and dysphoric disorder in Japanese Collegiate Athletes. J Pediatr Adolesc Gynecol. 2016;29:386–9.

    Article  PubMed  Google Scholar 

  103. Takeda T, Yoshimi K, Imoto Y, Shiina M. Associations between sleep habits and interference of premenstrual symptoms in athletic performance in Japanese adolescent athletes: a cohort study over a 2-year period. Gynecol Endocrinol. 2020;36:885–9.

    Article  PubMed  Google Scholar 

  104. Vannuccini S, Fondelli F, Clemenza S, Galanti G, Petraglia F. Dysmenorrhea and heavy menstrual bleeding in elite female athletes: quality of life and perceived stress. Reprod Sci. 2020;27:888–94.

    Article  PubMed  Google Scholar 

  105. de Oliveira FP, Bosi MLM, dos Vigário PS, Vieira da RS. Comportamento alimentar e imagem corporal em atletas. Rev Bras Med Esporte. 2003;9:348–56.

    Article  Google Scholar 

  106. O’Brien PMS, Bäckström T, Brown C, Dennerstein L, Endicott J, Epperson CN, et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health. 2011;14:13–21.

    Article  PubMed  PubMed Central  Google Scholar 

  107. Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. 2006;332:1134–8.

    Article  PubMed  PubMed Central  Google Scholar 

  108. Armour M, Ee CC, Naidoo D, Ayati Z, Chalmers KJ, Steel KA, et al. Exercise for dysmenorrhoea. Cochrane Database oSyste Rev [Internet]. 2019. https://doi.org/10.1002/14651858.CD004142.pub4/full.

    Article  Google Scholar 

  109. Casey ML, MacDonald PC, Mitchell MD. Despite a massive increase in cortisol secretion in women during parturition, there is an equally massive increase in prostaglandin synthesis. A paradox? J Clin Invest. 1985;75:1852–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  110. Pascoe MC, Thompson DR, Ski CF. Yoga, mindfulness-based stress reduction and stress-related physiological measures: a meta-analysis. Psychoneuroendocrinology. 2017;86:152–68.

    Article  PubMed  Google Scholar 

  111. Bhatia SC, Bhatia SK. Diagnosis and treatment of premenstrual dysphoric disorder. AFP. 2002;66:1239.

    Google Scholar 

  112. McNamara A, Harris R, Minahan C. ‘That time of the month’… for the biggest event of your career! Perception of menstrual cycle on performance of Australian athletes training for the 2020 Olympic and Paralympic Games. BMJ Open Sport Exerc Med. 2022;8: e001300.

    Article  PubMed  PubMed Central  Google Scholar 

  113. Findlay R, Macrae E, Whyte I, Easton C, Forrest (née Whyte) L. How the menstrual cycle and menstruation affect sporting performance: experiences and perceptions of elite female rugby players. Br J Sports Med. 2020;54:1108–13.

  114. Logue CM, Moos RH. Positive perimenstrual changes: Toward a new perspective on the menstrual cycle. J Psychosom Res. 1988;32:31–40.

    Article  CAS  PubMed  Google Scholar 

  115. Riaz Y, Parekh U. Oligomenorrhea [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Mar 15]. http://www.ncbi.nlm.nih.gov/books/NBK560575/.

  116. Nazem TG, Ackerman KE. The female athlete triad. sports. Health. 2012;4:302–11.

    Google Scholar 

  117. Mallinson R, Souza MJD. Current perspectives on the etiology and manifestation of the “silent” component of the Female Athlete Triad. Int J Women’s Health. 2014;6:451–67.

  118. De Souza MJ. Menstrual disturbances in athletes: a focus on luteal phase defects. Med Sci Sports Exerc. 2003;35:1553–63.

    Article  PubMed  Google Scholar 

  119. Russell M, Misra M. Influence of ghrelin and adipocytokines on bone mineral density in adolescent female athletes with amenorrhea and eumenorrheic athletes. Med Sport Sci. 2010;55:103–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  120. Barrack MT, Gibbs JC, De Souza MJ, Williams NI, Nichols JF, Rauh MJ, et al. Higher incidence of bone stress injuries with increasing female athlete triad-related risk factors: a prospective multisite study of exercising girls and women. Am J Sports Med. 2014;42:949–58.

    Article  PubMed  Google Scholar 

  121. Vanheest JL, Rodgers CD, Mahoney CE, De Souza MJ. Ovarian suppression impairs sport performance in junior elite female swimmers. Med Sci Sports Exerc. 2014;46:156–66.

    Article  PubMed  Google Scholar 

  122. Mansour D, Hofmann A, Gemzell-Danielsson K. A Review of clinical guidelines on the management of iron deficiency and iron-deficiency anemia in women with heavy menstrual bleeding. Adv Ther. 2021;38:201–25.

    Article  CAS  PubMed  Google Scholar 

  123. Hinton PS. Iron and the endurance athlete. Appl Physiol Nutr Metab. 2014;39:1012–8.

    Article  CAS  PubMed  Google Scholar 

  124. Davies J, Kadir RA. Heavy menstrual bleeding: An update on management. Thromb Res. 2017;151:S70–7.

    Article  CAS  PubMed  Google Scholar 

  125. Franchini E, Brito CJ, Artioli GG. Weight loss in combat sports: physiological, psychological and performance effects. J Int Soc Sports Nutr. 2012;9:52.

    Article  PubMed  PubMed Central  Google Scholar 

  126. Thomas S, Gonzalez A, Ghigiarelli J. The Relationship between weight cutting and the female athlete triad in combat sport athletes. Int J Kinesiol Sports Sci. 2021;9:9.

    Article  Google Scholar 

  127. Gordon CM, Ackerman KE, Berga SL, Kaplan JR, Mastorakos G, Misra M, et al. Functional hypothalamic amenorrhea: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017;102:1413–39.

    Article  PubMed  Google Scholar 

  128. Sharps FRJ, Wilson LJ, Graham CA-M, Curtis C. Prevalence of disordered eating, eating disorders and risk of low energy availability in professional, competitive and recreational female athletes based in the United Kingdom. Eur J Sport Sci. 2022;22:1445–51.

    Article  PubMed  Google Scholar 

  129. Meng K, Qiu J, Benardot D, Carr A, Yi L, Wang J, et al. The risk of low energy availability in Chinese elite and recreational female aesthetic sports athletes. J Int Soc Sports Nutr. 2020;17:13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  130. Loucks AB, Kiens B, Wright HH. Energy availability in athletes. J Sports Sci. 2011;29:S7-15.

    Article  PubMed  Google Scholar 

  131. Kuikman MA, Mountjoy M, Burr JF. Examining the relationship between exercise dependence, disordered eating, and low energy availability. Nutrients. 2021;13:2601.

    Article  PubMed  PubMed Central  Google Scholar 

  132. Hagmar M, Berglund B, Brismar K, Hirschberg AL. Hyperandrogenism may explain reproductive dysfunction in olympic athletes. Med Sci Sports Exerc United States. 2009;41:1241–8.

    Article  Google Scholar 

  133. Althubaiti A. Information bias in health research: definition, pitfalls, and adjustment methods. J Multidiscip Healthc. 2016;9:211–7.

    Article  PubMed  PubMed Central  Google Scholar 

  134. Small CM, Manatunga AK, Marcus M. Validity of self-reported menstrual cycle length. Ann Epidemiol. 2007;17:163–70.

    Article  PubMed  Google Scholar 

  135. Taffe J, Dennerstein L. Retrospective self-report compared with menstrual diary data prospectively kept during the menopausal transition. Climacteric. 2000;3:183–91.

    Article  CAS  PubMed  Google Scholar 

  136. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. 2018. https://www.nice.org.uk/guidance/ng88. Accessed 22 Mar 2022.

  137. Zakherah MS, Sayed GH, El-Nashar SA, Shaaban MM. Pictorial blood loss assessment chart in the evaluation of heavy menstrual bleeding: diagnostic accuracy compared to alkaline hematin. GOI Karger Publishers. 2011;71:281–4.

    Google Scholar 

  138. Higham JM, O’Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol. 1990;97:734–9.

    Article  CAS  PubMed  Google Scholar 

  139. Hald K, Lieng M. Assessment of Periodic Blood Loss: Interindividual and Intraindividual Variations of Pictorial Blood Loss Assessment Chart Registrations. J Minim Invasive Gynecol. 2014;21:662–8.

    Article  PubMed  Google Scholar 

  140. Herman MC, Mol BW, Bongers MY. Diagnosis of heavy menstrual bleeding. Womens Health (Lond Engl). 2016;12:15–20.

    Article  CAS  PubMed  Google Scholar 

  141. Magnay JL, O’Brien S, Gerlinger C, Seitz C. Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: a systematic literature review. BMC Womens Health. 2020;20:24.

    Article  PubMed  PubMed Central  Google Scholar 

  142. Sokol ER, Casele H, Haney EI. Ultrasound examination of the postpartum uterus: what is normal? J Matern Fetal Neonatal Med. 2004;15:95–9.

    Article  CAS  PubMed  Google Scholar 

  143. Hofmeister S, Bodden S. Premenstrual syndrome and premenstrual dysphoric disorder. AFP. 2016;94:236–40.

    Google Scholar 

  144. Diaz A, Laufer MR, Breech LL, American College of Obstetricians and Gynecologists Committee on Adolescent Health Care. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics. 2006;118:2245–50.

    Article  PubMed  Google Scholar 

  145. Jamieson MA. Disorders of Menstruation in Adolescent Girls. Pediatr Clin N Am. 2015;62:943–61.

    Article  Google Scholar 

  146. American College of Obstetricians and Gynecologists. Practice Bulletin No. 136: Management of Abnormal Uterine Bleeding Associated With Ovulatory Dysfunction. 2013. https://journals.lww.com/greenjournal/Citation/2013/07000/Practice_Bulletin_No__136__Management_of_Abnormal.38.aspx. Accessed 1 Nov 2021.

  147. Armour M, Dahlen HG, Smith CA. More than needles: the importance of explanations and self-care advice in treating primary dysmenorrhea with acupuncture. Evid Based Complement Altern Med. 2016;2016:3467067.

    Article  Google Scholar 

  148. As-Sanie S, Black R, Giudice LC, Gray Valbrun T, Gupta J, Jones B, et al. Assessing research gaps and unmet needs in endometriosis. Am J Obstet Gynecol. 2019;221:86–94.

    Article  PubMed  Google Scholar 

  149. Hudelist G, Fritzer N, Thomas A, Niehues C, Oppelt P, Haas D, et al. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod. 2012;27:3412–6.

    Article  CAS  PubMed  Google Scholar 

  150. Ramos-Pichardo JD, Ortega-Galán ÁM, Iglesias-López MT, Abreu-Sánchez A, Fernández-Martínez E. Why do some spanish nursing students with menstrual pain fail to consult healthcare professionals? Int J Environ Res Public Health. 2020;17:8173.

    Article  PubMed  PubMed Central  Google Scholar 

  151. Frankovich RJ, Lebrun CM. Menstrual cycle, contraception, and performance. Clin Sports Med. 2000;19:251–71.

    Article  CAS  PubMed  Google Scholar 

  152. Lethaby A, Wise MR, Weterings MA, Rodriguez MB, Brown J. Combined hormonal contraceptives for heavy menstrual bleeding. Cochrane Database Syst Rev [Internet]. 2019. https://doi.org/10.1002/14651858.CD000154.pub3/full.

    Article  PubMed  Google Scholar 

  153. Davis AR, Westhoff C, O’Connell K, Gallagher N. Oral contraceptives for dysmenorrhea in adolescent girls: a randomized trial. Obstet Gynecol. 2005;106:97–104.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Sport and Health Sciences, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland

    Bernadette Cherianne Taim, Ciarán Ó Catháin, Michèle Renard & Niamh Ní Chéilleachair

  2. SHE Research Group, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland

    Bernadette Cherianne Taim, Ciarán Ó Catháin, Michèle Renard & Niamh Ní Chéilleachair

  3. Department of Sport and Exercise Sciences, Institute of Sport, Manchester Metropolitan University, 99 Oxford Road, M1 7EL, Manchester, UK

    Kirsty Jayne Elliott-Sale

  4. Sport Ireland Institute, Dublin, Ireland

    Sharon Madigan

  5. Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland

    Sharon Madigan

Authors
  1. Bernadette Cherianne Taim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ciarán Ó Catháin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michèle Renard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kirsty Jayne Elliott-Sale
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sharon Madigan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Niamh Ní Chéilleachair
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bernadette Cherianne Taim.

Ethics declarations

Funding

This work was funded by the Technological University of the Shannon: Midlands Midwest and the Irish Research Council under grant number GOIPG/2022/2230 awarded to Bernadette Cherianne Taim.

Conflicts of Interest

Bernadette Cherianne Taim, Ciarán Ó Catháin, Michèle Renard, Kirsty Jayne Elliot-Sale, Sharon Madigan and Niamh Ní Chéilleachair declare that they have no conflict of interest.

Availability of Data and Material

The data analysed during the current study are available from the corresponding author upon reasonable request.

Ethics Approval

Not applicable.

Consent to Participate

Not applicable.

Consent for Publication

Not applicable.

Code Availability

Not applicable.

Author Contributions

BCT, MR and COC conceptualised the design of this study. BCT and MR conducted the literature search, screening and data extraction. BCT conducted the formal analysis. BCT, COC and NNC interpreted the data analysis. BCT wrote the manuscript with critical input from COC, KES, SM, NNC and MR. All authors read and approved the final manuscript.

Additional information

The original article has been updated: Due to co-author name update.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taim, B.C., Ó Catháin, C., Renard, M. et al. The Prevalence of Menstrual Cycle Disorders and Menstrual Cycle-Related Symptoms in Female Athletes: A Systematic Literature Review. Sports Med 53, 1963–1984 (2023). https://doi.org/10.1007/s40279-023-01871-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40279-023-01871-8

Search

Navigation