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This version published online on November 30, 2004
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2004-1286
A more recent version of this article appeared on March 1, 2005
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Submitted on July 2, 2004
Accepted on November 22, 2004

Amenorrhea in Female Athletes is Associated with Endothelial Dysfunction and Unfavorable Lipid Profile

Anette Rickenlund MD*, Maria J. Eriksson MD, PhD, Karin Schenck-Gustafsson MD, PhD, and Angelica Lindén Hirschberg MD, PhD

Departments of Obstetrics and Gynecology, Clinical Physiologyand Cardiology, Karolinska University Hospital, Stockholm, Sweden

* To whom correspondence should be addressed.
Anette Rickenlund, E-mail: anette.rickenlund{at}ks.se

The aim of this study was to evaluate endothelial function measured as flow-mediated dilatation (FMD) of the brachial artery and blood markers of cardiovascular disease in young female endurance athletes with menstrual disturbance. Age- and body mass index-matched groups of young endurance athletes with amenorrhea (n = 14), oligomenorrhea (n = 9) and regularly cycling athletes (n = 12) and sedentary controls (n = 12) were compared with respect to endothelial function, lipid profile, markers of inflammation and endocrine status. We found a significantly decreased FMD in the amenorrheic athletes compared with all other groups. Amenorrheic athletes also had the most unfavorable lipid profile with significantly higher total cholesterol and LDL compared with the other athlete groups. The oligomenorrheic athletes had the lowest levels of total cholesterol, LDL and Apo B of all groups and significantly lower in comparison with the amenorrheic group. However, with respect to FMD the oligomenorrheic group represented an intermediate between amenorrheic and regularly cycling subjects. There was a gradual impairment of FMD and the lipid profile to the degree of menstrual disturbance supporting an association with estrogen status. We conclude that amenorrhea in young endurance athletes is associated with endothelial dysfunction and unfavorable lipid profile. Further studies are needed to elucidate the clinical implications of these results with regard to long-term risk for cardiovascular disease.
Key words: female athletes • menstruation disturbance • endothelial function • flow-mediated vasodilatation • endothelial cell markers • lipid profile




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