Journal of Clinical Endocrinology & Metabolism, Vol 80, 2740-2744, Copyright © 1995 by Endocrine Society

ARTICLES

Menstrual dysfunction in swimmers: a distinct entity

NW Constantini and MP Warren
Ribstein Center for Research and Sport Medicine Sciences, Wingate Institute, Netanya, Israel.

Menstrual dysfunction is common among athletes with very low body mass, such as long distance runners and dancers, and is usually associated with hypothalamic dysfunction. The purpose of this study was to investigate the menstrual status of swimmers, in whom exercise is nonweight bearing and thinness is, thus, not essential. Questionnaires recording the menstrual history of 69 young competitive swimmers (aged 16.4 +/- 0.5) were compared to those of 279 age-matched controls. Age of menarche (M) was significantly (P < 0.005) delayed among swimmers (13.8 +/- 0.2 yr) compared to controls (13.0 +/- 0.1 yr). Eighty-two percent of swimmers had menstrual irregularities after M compared to 40% of control, with longer duration of these irregularities (16 vs. 4 months; P < 0.005). A subset of 24 swimmers was studied further for body composition, pubertal stage, and reproductive hormone levels. Estradiol levels were normal in all post-M swimmers (273 +/- 20 pmol/L) and higher than average in pre-M (383 +/- 44 pmol/L). FSH levels were normal in all subjects (10.7 +/- 1.6 IU/L), LH was mildly elevated (17.1 +/- 1.2 IU/L), and the LH/FSH ratio was 1.7. Levels of dehydroepiandrostenedione sulfate and androstenedione, but not testosterone, were higher than average in all groups of swimmers. The results of this study indicate that female competitive swimmers are vulnerable to delayed puberty and menstrual irregularities, but the associated hormonal profile is very different from the hypothalamic amenorrhea described in dancers and runners. We, therefore, suggest a different mechanism for reproductive dysfunction in swimmers that is associated not with hypoestrogenism, but, rather, with mild hyperandrogenism. A distinction among the various types of athletic amenorrhea should be made based on hormonal profiles with attention to their weight and somatotype.

This article has been cited by other articles:

				N. H. GOLDEN and J. L. CARLSON The Pathophysiology of Amenorrhea in the Adolescent Ann. N.Y. Acad. Sci., June 1, 2008; 1135(1): 163 - 178. [Abstract] [Full Text] [PDF]

				M K Torstveit and J Sundgot-Borgen 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., March 1, 2005; 39(3): 141 - 147. [Abstract] [Full Text] [PDF]

				A. Rickenlund, M. Thoren, K. Carlstrom, B. von Schoultz, and A. L. Hirschberg Diurnal Profiles of Testosterone and Pituitary Hormones Suggest Different Mechanisms for Menstrual Disturbances in Endurance Athletes J. Clin. Endocrinol. Metab., February 1, 2004; 89(2): 702 - 707. [Abstract] [Full Text] [PDF]

				P Klentrou and M Plyley Onset of puberty, menstrual frequency, and body fat in elite rhythmic gymnasts compared with normal controls Br. J. Sports Med., December 1, 2003; 37(6): 490 - 494. [Abstract] [Full Text] [PDF]

				R. B. Perkins, J. E. Hall, and K. A. Martin Aetiology, previous menstrual function and patterns of neuro-endocrine disturbance as prognostic indicators in hypothalamic amenorrhoea Hum. Reprod., October 1, 2001; 16(10): 2198 - 2205. [Abstract] [Full Text] [PDF]

				R Ramsay and R Wolman Are synchronised swimmers at risk of amenorrhoea? Br. J. Sports Med., August 1, 2001; 35(4): 242 - 244. [Abstract] [Full Text] [PDF]

				A. D Rogol, P. A Clark, and J. N Roemmich Growth and pubertal development in children and adolescents: effects of diet and physical activity Am. J. Clinical Nutrition, August 1, 2000; 72(2): 521S - 528. [Abstract] [Full Text] [PDF]

				Author's Response J. Clin. Endocrinol. Metab., December 1, 1999; 84(12): 4751 - 4751. [Full Text]

				M. P. Warren Health Issues for Women Athletes: Exercise- Induced Amenorrhea J. Clin. Endocrinol. Metab., June 1, 1999; 84(6): 1892 - 1896. [Full Text]