Summary
Chronic exercise is now known to alter the menstrual cycle. Yet, we do not yet know the true incidence of menstrual cycle alterations in athletes, because good normative data do not exist and the metabolic cost of training has not been considered in many studies. Secondary amenorrhoea is not easily induced by exercise training alone but seems to require additional metabolic stressors. Induction of secondary amenorrhoea in prospective exercise studies has not occurred, although the onset of short luteal or inadequate luteal phase cycles may occur in women even when running distances are not extensive. Such menstrual cycles may cause infertility, but this is only a temporary phenomenon since pregnancy, if desired, will usually occur upon cessation of training.
Exercise-related changes in the menstrual cycle can be viewed as a functionally adaptive rather than a maladaptive dysfunction. A strong case can be made that the changes in the menstrual cycle as a result of exercise are an energy conserving strategy to protect more important biological processes. This hypothesis is consistent with the theory of metabolic arrest that has been identified in lower organisms and hibernating mammals.
Similar content being viewed by others
References
Anderson JL. Women’s sport and fitness programs at the US military academy. Physician and Sportsmedicine 7: 72–80, 1979
Bates GW, Bates SR, Whitworth NS. Reproductive failure in women who practice weight control. Fertility and Sterility 37: 3373–3378, 1982
Beitins IZ, McArthur JW, Turnbull BA, Skrinar GS, Bullen BA. Exercise induces two types of human luteal dysfunction: confirmation by urinary free progesterone. Journal of Endocrinology and Metabolism 72: 1350–1358, 1991
Bonen A. Exercise-related disturbances in the menstrual cycle. In Borer et al. (Eds) Frontiers of exercise biology, pp. 214–237, Human Kinetics Publishers, Champaign, 1983
Bonen A. Alterations in menstrual cycles: effects of exercise. Modern Medicine Canada 41: 331–342, 1986a
Bonen A. Endocrine alterations with exercise training. In Puhl & Brown (Eds) The menstrual cycle and physical activity, pp. 81–100, Human Kinetics Publishers, Champaign, 1986b
Bonen A. Recreational exercise does not impair menstrual cycles: a prospective study. International Journal of Sports Medicine 13: 100–120, 1992
Bonen A, Beicastro, W, Ling Y, Simpson AA. Profiles of selected hormones during menstrual cycles of teenage athletes. Journal of Applied Physiology 50: 545–551, 1981
Bonen A, Haynes FJ, Watson-Wright W, Sopper MM, Pierce GN, et al. Effects of menstrual cycle on metabolic responses to exercise. Journal of Applied Physiology 55: 1506–1513, 1983
Bonen A, Keizer HA. Athletic menstrual cycle irregularity: endocrine response to exercise and training. Physician and Sports-medicine 12: 78–93, 1984
Bonen A, Keizer HA. Pituitary, ovarian, and adrenal hormone responses to marathon running. International Journal of Sports Medicine 8 (Suppl.): 161–167, 1987
Bonen A, Ling WY, Maclntyre KP, Neil R, McGrail JC, et al. Effects of exercise on the serum concentrations of FSH, LH, progesterone, and estradiol. European Journal of Applied Physiology and Occupational Physiology 42: 15–23, 1979
Boyden TW, Pamenter RW, Stanforth P, Rotkis T, Wilmore JH. Sex steroids and endurance running in women. Fertility and Sterility 39: 629–632, 1983
Broocks A, Pirke K, Schweiger U, Tuschi R, Laessle R, et al. Cyclic ovarian function in recreational athletes. Journal of Applied Physiology 68: 2003–2086, 1990
Bronson FH. Efect of food amnipulation on the GnRH-LH-estradiol axis of young female rats. American Journal of Physiology 254: R616–R621, 1988
Bullen BA, Beitins IZ, Carr DB, Skrinar GS, Orsulak PJ, et al. Athletic stress and menstrual dysfunction In Cantu & Gillespie (Eds) Sports medicine, sports science, bridging the gap, pp. 82–97, Collamore Press, DC Heath & Co., Lexington, 1982
Bullen BA, Skrinar GS, Beitins IZ, von Mering G, Turnbull BA, et al. Induction of menstrual disorders by strenuous exercise in untrained women. New England Journal of Medicine 1349–1353, 1985
Carlberg KA, Buckman MT, Peake GT, Riedesel ML. A survey of menstrual function in athletes. European Journal of Applied Physiology and Occupational Physiology 51: 211–222, 1983
Casper RC, Schoeller DA, Kushner R, Hnilicka J, Trainer Gold S. Total daily energy expenditure and activity level in anorexia nervosa. American Journal of Clinical Nutrition 53: 1143–1150, 1991
Collett ME, Wertenberger GE, Fiske Vm. The effect of age upon the pattern of the menstrual cycle. Fertility and Sterility 5: 437–448, 1954
Cumming DC, Rebar RW. Lack of consistency in the indirect methods of estimating percent body fat. Fertility and Sterility 41: 739–742, 1984
Cumming DC, Vikovic MM, Wall SR, Fluker MR. Defects in pulsatile release in normally menstruating runners. Journal of Clinical Endocrinology and Metabolism 60: 810–812, 1985
Dalvitt SR The effect of the menstrual cycle on patterns of food intake. American Journal of Clinical Nutrition 34: 1811–1815, 1981
De Souza MJ, Arce JC, Nulsen JC. Effects of exercise training on sex steroids. Endocrine profiles and clinical implications. Sex Steroids 3: 129–148, 1992
De Souza MJ, Metzger DA. Reproductive dysfunction in amenor-rheic athletes and anorexic patients: a review. Medicine and Science in Sports and Exercise 23: 995–1007, 1991
Döring GK. The incidence of anovular cycles in women. Journal of Reproduction and Fertility (Suppl. 6): 77–81, 1969
Frisch RE, Gotz-Welbergen AV, McArthur JW, Albright T, Witschi J, et al. Delayed menarche and amenorrhea of college athletes in relation to age of onset of training. Journal of the American Medical Association 246: 1559–1563, 1981
Frisch RE, McArthur JW. Menstrual cycles: fatness as a determinant of minimum weight for height necessary for their maintenance or onset. Science 185: 949–951, 1974
Frisch RE, Wyshak G, Vincent L. Delayed menarche and amenorrhea in ballet dancers. New England Journal of Medicine 303: 17–19, 1980
Gong EJ, Garrel D, Howes Calloway D. Menstrual cycle and voluntary food intake. American Journal of Clinical Nutrition 49: 252–258, 1989
Graham TE, Viswanathan M, Van Dijk P, Bonen A, George JC. Thermal and metabolic responses to cold by men and by eumenorrheic and amenorrheic women. Journal of Applied Physiology 67: 282–290, 1989
Gray DP, Dale E. Variables associated with secondary amenorrhea in women runners. Journal of Sports Science 1: 55–67, 1983
Hochachka PW, Guppy M. Metabolic arrest and the control of biological time, Harvard University Press, Cambridge, 1987
Kaiserauer S, Snyder AC, Sleeper M, Zierath J. Nutritional, physiological, and menstrual status of distance runners. Medicine and Science in Sports and Exercise 21: 120–125, 1989
Karsch FJ. Central actions of ovarian steroids in the feedback and regulation of pulsatile secretion of luteinizing hormone. Annual Reviews of Physiology 49: 365–382, 1987
Keizer HA, Rogol AD. Physical exercise and menstrual cycle alterations. What are the mechanisms? Sports Medicine 10: 218–235, 1990
Lloyd T, Buchanan JR, Bitzer S, Waldman CJ, Myers C, et al. Interrelationships of diet, athletic activity, menstrual status, and bone density in collegiate women. American Journal of Clinical Nutrition 46: 681–684, 1987
Loucks AB. Does exercise training affect reproductive hormones in women? Clinics in Sports Medicine 5: 535–557, 1986
Loucks AB. Effects of exercise training on the menstrual cycle: existence and mechanisms. Medicine and Science in Sports and Exercise 22: 275–280, 1990
Loucks AB, Horvath SM. Athletic amenorrhea: a review. Medicine and Science in Sports and Exercise 17: 56–72, 1985
Loucks AB, Horvath SM, Freedson PS. Menstrual status and validation of body fat prediction in athletes. Human Biology 56: 383–392, 1984
Marcus R, Cann C, Madvig P, Minkoff J, Goddard M et al. Menstrual function and bone mass in elite women distance runners. Endocrine and metabolic features. Annals of Internal Medicine 102: 158–163, 1985
McArthur JM. Endorphins and exercise in females: possible connection with reproductive dysfunction. Medicine and Science in Sports and Exercise 17: 82–88, 1985
Mulligan K, Butterfield GE. Discrepancies between energy intake and expenditure in physically active women. British Journal of Nutrition 64: 23–36, 1990
Nelson ME, Fisher EC, Catsos PD, Meredith CN, Nuran Turksoy R, et al. Diet and bone status in amenorrheic runners. American Journal of Clinical Nutrtition 43: 910–916, 1986
Pirke KM, Schweiger, U, Iemmel W, Krieg JC, Berger M. The influence of dieting on the menstrual cycle of healthy young women. Journal of Endocrinology and Metabolism 60: 1174–1179, 1985
Pliner P, Fleming AS. Food intake, body weight, and sweetness preferences over the menstrual cycle in humans. Physiology and Behavior 30: 663–666, 1983
Prior JC, Cameron K, Ho Yuen B, Thomas J. Menstrual cycle changes with marathon training: anovulation and short luteal phase. Canadian Journal of Applied Sport Sciences 7: 173–177, 1982
Prior JC, Ho Yuen B, Clement P, Bowie L, Thomas J. Reversible luteal phase changes and infertility associated with marathon training. Lancet 1: 269–270, 1982
Prior JC, Vigna YM, McKay DW. Reproduction for the athletic woman. Sports Medicine 14: 190–199, 1992
Prior JC, Vigna YM, Schechter MT, Burgess AE. Spinal bone loss and ovulatory disturbances. New England Journal of Medicine 323: 1221–1227, 1990
Prior JC, Vigna YM, Schulzer M, Hall JE, Bonen A. Determination of luteal phase lengths by quantitative basal temperature methods: validation against the midcycle LH peak. Clinical and Investigative Medicine 13: 123–131, 1990
Ruffin MT, Hunter RE, Arendt EA. Exercise and secondary amenorrhoea linked through endogenous opioids. Sports Medicine 10: 65–71, 1990
Shangold M, Freeman R, Thysen B, Gatz M. The relationship between long distance running, plasma progesterone, and luteal phase length. Fertility and Sterility 31: 130–133, 1979
Snell AM, Ford F, Rowntree LG. Studies in basal metabolism. Journal of the American Medical Association 75: 515–523, 1920
Solomon SJ, Kurzer MS, Howes-Calloway D. Menstrual cycle and basal metabolic rate in women. American Journal of Clinical Nutrition 36: 611–616, 1982
Todoroff EC, Wilkinson M, Bonen A. Endurance exercise potentiates the stimulatory influence of oestrogen-progesterone on LH and FSH release in the rat. Journal of Reproduction and Fertility 80: 75–80, 1987
Trussel J. Statistical flaws in evidence for the Frisch hypothesis that fatness triggers menarche. Human Biology 52: 711–720, 1980
Veldhuis JD, Evans WS, Demers LM, Thorner MO, Wakat D, et al. Altered neuroendocrine regulation of gonadotrophin secretion in women distance runners. Journal of Clinical Endocrinology and Metabolism 61: 557–563, 1985
Vollman RF. The menstrual cycle. In Friedman (Ed.) Major problems in obstetrics and gynecology, vol. 7, WB Saunders Co., Toronto, 1977
Wakeham G. Basal metabolism and the menstrual cycle. Journal of Biological Chemistry 67: 69–87, 1923
Wakat DK, Sweeney KA, Rogol AD. Reproductive system function in women cross country runners. Medicine and Science in Sports and Exercise 14: 263–269, 1982
Warren MP. The effects of pubertal progression and reproductive function in girls. Journal of Clinical Endocrinology and Metabolism 51: 1150–1157, 1980
Warren MP. Effect of exercise and physical training on menarche. Seminars in Reproductive Endocrinology 3: 17–26, 1985
Warren MP, Jewelewicz R, Dyrenfurth I, Ans R, Khalaf S, et al. The significance of weight loss in the evaluation of pituitary response to LH-RH in women with secondary amenorrhea. Journal of Clinical Endocrinology and Metabolism 40: 601–611, 1975
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bonen, A. Exercise-Induced Menstrual Cycle Changes. Sports Medicine 17, 373–392 (1994). https://doi.org/10.2165/00007256-199417060-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00007256-199417060-00004