Reproductive Consequences of Athletic Training in Women

  • Carol Grace Smith
  • Raymond A. Dombroski


Physical exercise and athletic training have become an important part of many women’s lifestyles. Thirty years ago, young women and girls were discouraged from participating in such activities. Although boys were expected to participate in athletic training, girls were encouraged not to be too physically active or competitive in sports. Underlying this attitude was the basic belief that female reproductive function might somehow be damaged by too much exercise, especially during menstruation. The beneficial effects of physical fitness on the cardiovascular, musculoskeletal, and metabolic systems are now well recognized for both men and women, and regular exercise has become an important component of a healthful lifestyle. However, the increasing participation of women in athletic training programs has again brought attention to the effects of exercise on reproductive function. The most important of the reproductive changes that frequently accompany intense physical training in women is called athletic amenorrhea or oligomenorrhea. Amenorrhea is a clinical term denoting disruption of the reproductive system with probable anovulation (cycles longer than 90 days duration). The term oligomenorrhea (or irregular cycles) refers to menstrual cycles with inconsistent intervals of 39 to 90 days duration. The terms eumenorrheic, regular, and cyclic are used interchangeably to refer to normal menstrual cycles which recur consistently at intervals of 25 to 39 days duration.


Luteinizing Hormone Obstet Gynecol Luteal Phase Corpus Luteum Fetal Heart Rate 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Loucks AB, Horvath SM: Athletic amenorrhea: a review. Med Sci Sports Exerc17: 56–72, 1985.PubMedGoogle Scholar
  2. 2.
    Carlberg KA, Buckman MT, Peake GT, et al: Body composition of olig/amenorrheic athletes. Med Sci Sports Exerc15: 215–217, 1983.PubMedGoogle Scholar
  3. 3.
    Sanborn CF, Martin BJ, Wagner WW: Is athletic amenorrhea specific to runners ? Am J Obstet Gynecol143: 859–861, 1982.PubMedGoogle Scholar
  4. 4.
    Warren MP: The effects of exercise on pubertal progression and reproductive function in girls. J Clin Endocrinol Metab51: 1150–1157, 1980.PubMedCrossRefGoogle Scholar
  5. 5.
    Speroff L, Redwine DB: Exercise and menstrual function. Phys Sports Med8: 42–52, 1980.Google Scholar
  6. 6.
    Deuster PA, Kyle SB, Moser PB, et al: Nutritional intake and status of highly-trained amenorrheic and eumenorrheic women runners. Fertil Steril46: 636–643, 1986.PubMedGoogle Scholar
  7. 7.
    Schwartz B, Cumming DC, Riordan M, et al: Exercise-associated amenorrhea: a distinct entity? Am J Obstet Gynecol141: 662–670, 1981.PubMedGoogle Scholar
  8. 8.
    Yen SSC: Chronic anovulation due to CNS—hypothalamic—pituitary dysfunction, in Yen SSC, Jaffe RB (eds): Reproductive Endocrinology and Clinical Management. Philadelphia, W.B. Saunders Co, 1986, p 500.Google Scholar
  9. 9.
    Shanegold M: Causes, evaluation and management of athletic oligo-/amenorrhea. Med Clin North Am69: 83–95, 1985.Google Scholar
  10. 10.
    Prior JC, Cameron K, HoYuen B, et al: Menstrual cycle changes with marathon training: anovulation and short luteal phase. Can J Appl Sport Sci7: 173–177, 1982.PubMedGoogle Scholar
  11. 11.
    MacConnie SE, Barkan A, Lampman RM, et al: Decreased hypothalamic gonadotropin-releasing hormone secretion in male marathon runners. N Engl J Med315: 411–417, 1986.PubMedCrossRefGoogle Scholar
  12. 12.
    Cumming DC, Brunsting LA, Strich G, et al: Reproductive hormone increases in responses to acute exercise in men. Med Sci Sports Exerc18: 369–373, 1986.PubMedGoogle Scholar
  13. 13.
    Vogel RB, Books CA, Ketchum C, et al: Increase of free and total testosterone during submaximal exercise in normal males. Med Sci Sports Exerc17: 119–123, 1985.PubMedGoogle Scholar
  14. 14.
    Farrel PA: Exercise and endorphins—male responses. Med Sci Sports Exerc17: 89–93, 1985.Google Scholar
  15. 15.
    McArthur JW: Endorphins and exercise in females possible connection with reproductive dysfunction. Med Sci Sports Exerc17: 82–88, 1985.PubMedGoogle Scholar
  16. 16.
    Robert JF, Quigley ME, Yen SSC: Endogenous opiates modulate pulsatile luteinizing hormone release in humans. J Clin Endocrinol Metab52: 583–585, 1981.CrossRefGoogle Scholar
  17. 17.
    Cumming DC, Rebar RW: Hormonal changes with acute exercise and with training in women. Sem Reprod Endocrinol3: 55–64, 1985.CrossRefGoogle Scholar
  18. 18.
    Shanegold MM, Gatz ML, Thysen B: Acute effects of exercise on plasma concentrations of prolactin and testosterone in recreational women runners. Fertil Steril35: 699–702, 1981.Google Scholar
  19. 19.
    Baker ER, Mathur RS, Kirk RF: Plasma gonadotropins, prolactin, and steroid hormone concentrations in female runners immediately after a long distance run. Fertil Steril38: 38–41, 1982.PubMedGoogle Scholar
  20. 20.
    Cumming DC, Belcastro AN: The reproductive effects of exertion. Curr Prob Obstet Gynecol5: 1–42, 1982.Google Scholar
  21. 21.
    Bonen AW, Ling K, Maclntyre R, et al: Effects of exercise on the serum concentrations of FSH, LH. progesterone and estradiol. Eur J Appl Physiol42: 15–23, 1979.CrossRefGoogle Scholar
  22. 22.
    Cumming DC, Rebar RW: Exercise and reproductive function in women. Am J Indust Med4: 113–125, 1983.CrossRefGoogle Scholar
  23. 23.
    Jurkowski JE, Jones WC, Walker EV, et al: Ovarian hormonal responses to exercise. J Appl Physiol44: 109–114, 1978.PubMedGoogle Scholar
  24. 24.
    Keizer HA, Poortman J, Bunnik GSJ: Influence of physical exercise on sex-hormone metabolism. J Appl Physiol48: 765–769, 1980.PubMedGoogle Scholar
  25. 25.
    Baker ER, Mathur RS, Kirk RF, et al: Female runners and secondary amenorrhea: correlation with age, parity mileage, and plasma hormonal and sex-hormone-binding-globulin concentrations. Fertil Steril36: 183–187, 1981.PubMedGoogle Scholar
  26. 26.
    McArthur JW, Bullen BA, Beitins IZ, et al: Hypothalamic amenorrhea in runners of normal body composition. Endocrinol Res Commun7: 13–25, 1980.CrossRefGoogle Scholar
  27. 27.
    Wakat DK, Sweeney KA, Rogol AD: Reproductive system function in women cross-country runners. Med Sci Sports Exerc14: 263–269, 1982.PubMedCrossRefGoogle Scholar
  28. 28.
    Bonen A, Belcastro AN, Ling WY, et al: Profiles of selected hormones during menstrual cycles of teenage athletes. J Appl Physiol50: 545–551, 1981.PubMedGoogle Scholar
  29. 29.
    Shanegold MR, Freeman R, Thysen B, et al: The relationship between long-distance running, plasma progesterone and luteal phase length. Fertil Steril31: 130–133, 1979.Google Scholar
  30. 30.
    Lloyd T, Triantafyllou SJ, Baker ER, et al: Women athletes with menstrual irregularity have increased musculoskeletal injuries. Med Sci Sports Exerc18: 374–379, 1986.PubMedGoogle Scholar
  31. 31.
    Lotgering FK, Gilbert RD, Longo LD: The interactions of exercise and pregnancy: a review. Am J Obstet Gynecol149: 560–568, 1984.PubMedGoogle Scholar
  32. 32.
    Ueland K, Novy MJ, Peterson EN, et al: Maternal cardiovascular dynamics. IV. The influence of gestational age on the maternal cardiovascular response to posture and exercise. Am J Obstet Gynecol104: 856–864, 1969.PubMedGoogle Scholar
  33. 33.
    Morton MJ, Paul MS, Campos GR, et al: Exercise dynamics in late gestation: Effects of physical training. Am J Obstet Gynecol152: 91–97, 1985.PubMedGoogle Scholar
  34. 34.
    Chesley LC: Plasma and red cell volumes during pregnancy. Am J Obstet Gynecol112: 440–450, 1972.PubMedGoogle Scholar
  35. 35.
    Clapp JF: Maternal heart rate in pregnancy. Am J Obstet Gynecol152: 659–66, 1985.PubMedGoogle Scholar
  36. 36.
    Metcalfe J, McAnulty JH, Ueland K: Cardiovascular physiology. Clin Obstet Gynecol24: 693–710, 1981.PubMedCrossRefGoogle Scholar
  37. 37.
    Pernoll ML, Metcalfe J, Schlenker TL, et al: Oxygen consumption at rest and during exercise in pregnancy. Respir Physiol25: 285–293, 1975.PubMedCrossRefGoogle Scholar
  38. 38.
    Edwards MJ, Metcalfe T, Dunham MJ, et al: Accelerated respiratory response to moderate exercise in late pregnancy. Respir Phys45: 229–241. 1981.CrossRefGoogle Scholar
  39. 39.
    Ueland J, Novy MJ, Metcalfe J: Cardiorespiratory responses to pregnancy and exercise in normal women and patients with heart disease. Am J Obstet Gynecol115: 4–10, 1973.PubMedGoogle Scholar
  40. 40.
    Clapp JF: Cardiac output and uterine blood flow in the pregnant ewe. Am J Obstet Gynecol130: 419423, 1978.Google Scholar
  41. 41.
    Nagy LE, King JC: Energy expenditure of pregnant women at rest or walking self-paced. Am J Clin Nutr38: 369–376, 1983.PubMedGoogle Scholar
  42. 42.
    Pernoll ML, Metcalfe J, Kovach PA, et al: Ventilation during rest and exercise in pregnancy and post partum. Respir Physiol25: 295–310, 1975.PubMedCrossRefGoogle Scholar
  43. 43.
    Knuttgen HG, Emerson K: Physiological response to pregnancy at rest and during exercise. J Appl Physiol36: 549–553, 1974.PubMedGoogle Scholar
  44. 44.
    Artal R, Wiswell R, Romem Y, et al: Pulmonary responses to exercise in pregnancy. Am J Obstet Gynecol154: 378–383, 1986.PubMedGoogle Scholar
  45. 45.
    Pauerstein CJ: Physiology of the pregnant woman in Pauerstein, CJ (ed): Clinical Obstetrics. New York, Wiley Medical, 1987, pp 65–82.Google Scholar
  46. 46.
    Wasserman K, Whipp BJ, Castagna J: Cardiodynamic hyperpnea: hyperpnea secondary to cardiac output increase. J Appl Physiol36: 457–464, 1974.PubMedGoogle Scholar
  47. 47.
    Wasserman K: Breathing during exercise. N Engl J Med298: 780–785, 1978.PubMedCrossRefGoogle Scholar
  48. 48.
    Seitchik J: Body composition and energy expenditure during rest and work in pregnancy. Am J Obstet Gynecol97: 701–713, 1967.PubMedGoogle Scholar
  49. 49.
    Guzman Ca, Caplan R: Cardiorespiratory response to exercise during pregnancy. Am J Obstet Gynecol108: 600–605, 1970.Google Scholar
  50. 50.
    Clapp JF, Dickstein S: Endurance exercise and pregnancy outcome. Med Sci Sports Exerc16: 556–562, 1984.PubMedGoogle Scholar
  51. 51.
    Hutchinson PL, Coreton KJ, Sparling PB: Metabolic and circulatory responses to running during pregnancy. Phys Sports Med9 (8): 55–61, 1981.Google Scholar
  52. 52.
    Zaharieva E: Olympic participation by women. JAMA221: 992–995, 1972.PubMedCrossRefGoogle Scholar
  53. 53.
    Jarrett JC, Spellacy WN: Jogging during pregnancy: an improved outcome? Obstet Gynecol61: 705–709, 1983.PubMedGoogle Scholar
  54. 54.
    Bader RA, Bader ME, Rose DJ: Hemodynamics at rest and during exercise in normal pregnancy as studied by cardiac catheterization. J Clin Invest34: 1524–1536, 1955.PubMedCrossRefGoogle Scholar
  55. 55.
    Botti JJ, Jones RL: Aerobic conditioning, nutrition and pregnancy. Clin Nutr4: 14–17, 1985.CrossRefGoogle Scholar
  56. 56.
    Hohimer AR, Bissonnette JM, Metcalfe J, et al: Effect of exercise on uterine blood flow in the pregnant Pygmy goat. Am J Physiol246: 207–212, 1984.Google Scholar
  57. 57.
    Clapp JF: Acute exercise stress in the pregnant ewe. Am J Obstet Gynecol136: 489–494, 1980.PubMedGoogle Scholar
  58. 58.
    Lotgering FK, Gilbert RD, Longo LD: Exercise responses in pregnant sheep: oxygen consumption, uterine blood flow and blood volume. J Appl Physiol55: 834–841, 1983.PubMedGoogle Scholar
  59. 59.
    Lotgering FK, Gilbert RD, Lawrence LD: Exercise responses in pregnant sheep: blood gases, temperatures and fetal cardiovascular system. J Appl Physiol55: 842–850, 1983.PubMedGoogle Scholar
  60. 60.
    Collings CA, Curet LB, Mullin JP: Maternal and fetal responses to a maternal aerobic exercise program. Am J Obstet Gynecol145: 702–707, 1983.PubMedGoogle Scholar
  61. 61.
    Clapp JF: Fetal heart rate response to running in midpregnancy and late pregnancy. Am J Obstet Gynecol153: 251–252, 1985.PubMedGoogle Scholar
  62. 62.
    Hauth JC, Gilstrap LC, Widmer K: Fetal heart rate reactivity before and after maternal jogging during the third trimester. Am J Obstet Gynecol142: 545–547, 1982.PubMedGoogle Scholar
  63. 63.
    Collings C, Curet LB: Fetal heart rate response to maternal exercise. Am J Obstet Gynecol151: 498–501. 1985.PubMedGoogle Scholar
  64. 64.
    Platt LD. Artal R, Semel J, et al: Exercise in pregnancy: II. Fetal responses. Am J Obstet Gymecol 147: 487-491, 1983.Google Scholar
  65. 65.
    Sorensen KE, Borlum K: Fetal heart function in response to short-term maternal exercise. Br J Obstet Gynaecol93: 301–313, 1986.Google Scholar
  66. 66.
    Pijpers L, Wladiiniroff JW, McGhie J: Effect of short-term maternal exercise on maternal and fetal cardiovascular dynamics. Br J Obstet Gynaecol91: 1081–1086, 1984.PubMedCrossRefGoogle Scholar
  67. 67.
    Jovanovic L, Kessler A, Peterson CM: Human maternal and fetal response to graded exercise. J Appl Physiol58: 1719–1722, 1985.PubMedCrossRefGoogle Scholar
  68. 68.
    Artal R, Paul RH, Romem Y, et al: Fetal bradycardia induced by maternal exercise. Lancet2: 258–260, 1984.PubMedCrossRefGoogle Scholar
  69. 69.
    Veille J, Hohimer R, Burry K, et al: The effect of exercise on uterine activity in the last weeks of pregnancy. Am J Obstet Gynecol151: 727–730, 1985.PubMedGoogle Scholar
  70. 70.
    Jones RL, Botti JJ, Anderson WM, et al: Thermoregulation during aerobic exercise in pregnancy. Obstet Gynecol65: 340–345, 1985.PubMedGoogle Scholar
  71. 71.
    Naeye RL, Peters EC: Working during pregnancy: effects in the fetus. Pediatrics69: 724–727, 1982.PubMedGoogle Scholar
  72. 72.
    Tafari N, Naeye RL, Gobezie A: Effects of maternal undernutrition and heavy physical work during pregnancy on birth weight. Br J Obstet Gynaecol87: 222–226, 1980.PubMedCrossRefGoogle Scholar
  73. 73.
    Mamelle N, Laumon B, Lazar P: Prematurity and occupational activity during pregnancy. Am J Epidemiol119: 309–322, 1984.PubMedGoogle Scholar
  74. 74.
    Pomerance JJ, Gluck L, Lynch VA: Physical fitness in pregnancy: its effect on pregnancy outcome. Am J Obstet Gynecol119: 867–875, 1974.PubMedGoogle Scholar
  75. 75.
    Erkkola R, Rauramo L: Correlation of maternal physical fitness during pregnancy with maternal and fetal pH and lactic acid at delivery. Acta Obstet Gynecol Scand55: 441–446, 2976.CrossRefGoogle Scholar
  76. 76.
    Clapp JF, Wesley M: Selective aspects of pregnancy outcome in recreational runners. Abstract No. 129. Society for Gynecological Investigation, 34th Annual Meeting, Atlanta, Mar 18–21, 1987.Google Scholar

Copyright information

© Plenum Publishing Corporation 1988

Authors and Affiliations

  • Carol Grace Smith
    • 1
  • Raymond A. Dombroski
    • 1
  1. 1.Department of Obstetrics and GynecologyThe University of Texas Health Science Center at San AntonioSan AntonioUSA

Personalised recommendations