Menstrual disorders in athletes

Conclusions No one should interpret warnings to physically active women about the hazards of undernutrition as discouraging them from participating in vigorous physical activity. The 1997 ACSM position stand on the female athlete triad opens by stating that "the majority of girls and women derive significant health benefits from regular physical activity without incurring health risks. They should be encouraged to be physically active at all phases of their lives." Nevertheless, the ACSM has a long history of warning against exercising in an unhealthful manner. The ACSM position stand on the female athlete triad is in that responsible tradition.     

Menstrual disorders in athletes

The various menstrual disorders in athletes may reflect different degrees of exposure to a disrupting factor or differences in the susceptibility of various women to disruption. The incidences of these disorders are not well documented, but they appear to be highest in aesthetic, endurance and weight-class sports, and at younger ages, higher training volumes and lower bodyweights. The morbid effects of these disorders include infertility, low bone mass, impaired endothelium-dependent vasodilation, and impaired skeletal muscle oxidative metabolism. The high incidences of menstrual disorders in athletes may derive in part from the self-selection of extraneously affected women into athletics, but many women acquire their menstrual disorders in athletics by failing to adequately increase dietary energy intake in compensation for exercise energy expenditure. Applied research is needed to develop effective dietary interventions that are acceptable to athletes.     

Menstrual dysfunction in athletes: an energetic challenge

Intense training programs that are insufficiently fueled by energy intake may lead to fatigue, impaired performance, and a broad spectrum of menstrual cycle disturbances. The effects of acute reduced energy availability and chronic energy deficiency on reproductive function, specifically luteinizing hormone secretion, will be examined, as well as possible recovery strategies.     

Preventing nutritional disorders in athletes: focus on the basics

The prevention of nutritional disorders in athletes is often a controversial topic. The answer centers on the practitioners ability to assess each participant’s individual needs, ensuring that basic nutrient requirements are met. The cornerstone to any athlete’s nutritional program is to ensure an adequate energy intake correctly proportioned with macronutrients. Inherent to this goal is the understanding that exposure to chronic stress alters energy depots: musculoskeletal structure and immune/ inflammatory responses that either facilitate or hinder training based on recovery. Essential to the athlete’s health is the understanding that each is a unique individual who will never fit neatly into a predefined, cookbook approach to nutrition. Failure to meet these objectives will only impair recovery. Although quality training and adequate rest is important to training, so too is adequate energy balance. This article focuses on better understanding the benefits of adequate energy balance, further enhanced by a better understanding of macronutrient use.     

Introduction to menstrual disturbances in athletes

The first symposium on this topic at an annual meeting of ACSM was presented 22 yr ago when the high prevalence of menstrual disorders in athletes was becoming increasingly apparent. The clinical consequences and need for treatment for menstrual disturbances in athletes have been recognized by ACSM through the publication of its 1997 Position Stand on the Female Athlete Triad. This mini-symposium presents an update on recent scientific advances on this topic. The first review in this symposium concentrates on a menstrual disturbance in which the length of the luteal phase is abbreviated and luteal function is suppressed. Such luteal suppression occurs in a large proportion of even the most regularly menstruating athletes. The next two papers summarize what has been learned about the mechanism of these disturbances from prospective experiments that have employed diet, exercise, cold exposure, and pharmacological blockers of metabolic pathways to disrupt menstrual cycles in monkeys and humans as well as estrous cycles and reproductive behavior in hamsters.     

Skeletal effects of menstrual disturbances in athletes

This article reviews the skeletal effects and clinical implications of menstrual disturbances in active women. At the lumbar spine, menstrual disturbances are associated with premature bone loss or failure to reach peak bone mass, while appendicular sites are less affected. This suggests that trabecular bone is more sensitive to hormonal stimuli and less responsive to mechanical loading than cortical bone. Although the mechanisms responsible for the detrimental effects of menstrual disturbances are likely to be multifactorial, low circulating levels of oestrogen are thought to be the main cause. The clinical significance of menstrual disturbances depends upon a number of factors, including type of sport, genetic back-ground, body composition and calcium intake. Not all athletes who present with menstrual disturbances will develop osteopenia. Nevertheless, the risk of stress fracture does seem to be increased in athletes with menstrual disturbances and with lower bone density. Whether athletes with menstrual disturbances are at a greater risk for osteoporosis in later life is not yet known. Bone loss can be at least partially reversed, especially with the spontaneous resumption of menses. This may serve to offset any previous increased risk of osteoporsis. Furthermore, other factors, apart from low bone mass, act to determine the likelihood of osteoporotic fractures. Therefore, the clinical significance of menstrual disturbances associated with exercise participation needs to be established for each individual athlete. Bone densitometry may guide the clinician in this respect and assist in the formulation of appropriat management strategies.     

Surgical management of cartilage defects in athletes

The synovial joints provide a unique environment in which to carry out their critical mechanical function. The complex architecture of the articular cartilage normally provides painless motion throughout a variety of activities. Fluids secreted by cells in the superficial layers of the articular cartilage as well as in the synovium provide an almost frictionless articulation. The synovium also helps to maintain the aseptic environment found within the joint. The cartilage and fluid provide critical protection to the underlying bone. If any of these structures are damaged, or lose their efficiency, the ensuing cascade of damage inflicted on the joint can lead to catastrophic failure.     

Menstrual cycle stage and oral contraceptive effects on anterior tibial displacement in collegiate female athletes

AIM: The aim of this study was to establish if differences in anterior tibial displacement exists in collegiate female student-athletes at different stages of the menstrual cycle. METHODS: Design and setting: a 2 x 3 factorial design with repeated measures on the second factor guided this study. The first independent variable was group with 2 levels (control and oral contraceptive) and the second independent variable was menstrual cycle phase with 3 levels (follicular, ovulation, luteal). The single dependent variable was anterior tibial displacement. All data were collected in a research laboratory. Subjects: 53 female student athletes (control: n=28; oral contraceptive: n=25) with no previous history of knee injury or anomalies with a normal 28-30 day menstrual cycle participated. Measurements: anterior tibial displacement (mm) measurements were taken on days 1 (follicular phase), 13 (ovulation phase), and 23 (luteal phase) of each subject's menstrual cycle using a KT1000 knee arthrometer. RESULTS: For the entire group, statistically significant increases in anterior tibial laxity were found (F=4.49; df=52.1; P<0.05) between the follicular cycle (0+/-SD =5.14 mm) and ovulation cycle (0+/-SD=5.81 mm); and follicular cycle (0+/-SD=5.14 mm) and luteal cycle (0+/-SD=5.79 mm). A separate analysis of the non-birth control group revealed no significant difference in anterior tibial laxity throughout the stages of the menstrual cycle. CONCLUSION: The results of this study suggest that: 1) the menstrual cycle does have an influence on laxity of the anterior displacement of the knee; 2) significant increases in anterior displacement are shown during the ovulation and luteal phases of the menstrual cycle; and 3) birth control subjects tend to have increased laxity when compared to those subjects who are not on hormone therapy.     

Failure to induce ovulation with clomiphene citrate and bromocriptine in luteal deficient women athletes

This study was designed with a three-fold aim: to assess ovarian function of women athletes with menstrual irregularities (AMI); to evaluate the potentiality of clomiphene citrate and bromocriptine for the induction of ovulation in these women; and to show that ultrasound scanning offers a suitable technique for ovarian screening in healthy and high-performance athletes. Our small test group consisted of 11 women, mainly track athletes, with AMI. There was no significant difference in age at menarche (13.2 yrs +/- 0.2), percent of ideal body weight (92% +/- 4), or percent of body fat (12.3% +/- 2.8) among the subjects. Plasma estradiol values were low (mean: 22 pg/ml +/- 0.8), as those of plasma progesterone (2.85 ng/ml +/- 2.10), LH (5.6 mIU/ml +/- 0.8), and prolactin (10.89 ng/ml +/- 5.56). The mean distance run per week (35 km +/- 15) was relatively high considering the presence of 4 non-runners. All menstrual irregularities were attributed to exercise. A short luteal phase (7 days +/- 1.5 for a cycle with a mean duration of 25 days +/- 1.8) was found in all subjects. We failed to observe the presence of a corpus luteum in 9 out of 11 women. A two-month administration of clomiphene citrate (150 mg/d for 5 days) or bromocriptine (2.5 mg/d) did not succeed in provoking ovulation in any of these women. Ultrasonographic observations showed a continuously hypo-estrogenic endometrium with a consecutively developing and regressive follicle. Our data emphasize the difficulties inherent in the restoration of menstrual function in women athletes with AMI. In addition, the usefulness of ultrasound in screening ovarian function was confirmed.     

Dynamic stability control during volitional stepping: a focus on the restabilisation phase at movement termination

This work sought to advance the understanding of dynamic stability control during stepping. The specific intention was to better understand the control of the centre of mass during voluntary stepping, by characterizing its trajectory and intertrial variability. Young participants (n=10) performed five different stepping tasks to vary the challenge to COM control: (1) preferred step, (2) long step, (3) wide step, (4) long and wide step and (5) rapid step. The trajectory of the total body COM during the restabilisation phase was assessed by quantifying the magnitude of incongruity between the peak and final COM position. The intertrial variability of incongruity and the extent to which incongruity was reduced with trial repetition were also evaluated. Interestingly, incongruity was typical during preferred stepping, with a strong bias toward overshoot. In the frontal plane, the magnitude of incongruity and the incidence of overshoot were greater in trials with increased step width. The variability of incongruity did not vary by condition nor was there evidence of adaptive changes. Together, these results suggest that overshoots may represent a strategy linked to gait initiation or to the simplification of reactive control during the restabilisation phase. Further insight into these mechanisms will be gained by examining the kinetic determinants of dynamic stability control.     

Overuse injuries in athletes: a perspective

Injuries secondary to sporting activities have increased significantly in the past decade. Traditional treatment programs for these maladies have frequently failed to meet the physiological expectations of the athlete. Forced rest or immobilization result in predictable musculoskeletal atrophy with impaired function. Furthermore, the rehabilitation process has commonly focused on the management of the acute problem with minor attention to the etiology and pathomechanics of the injury (preventive medicine). Many sports injuries, as a result of overuse, can be avoided by scientific coaching and contemporary sports medicine.     

aPL-RM妇女黄体中期子宫内膜血流特点分析

目的：对比分析抗磷脂抗体相关性习惯性流产（ aPL-RM）妇女与正常妇女黄体中期子宫内膜血流特点。方法从本院2011年11月-2013年11月收治的抗磷脂抗体相关性习惯性流产患者中,随机选择100例进行研究,设为观察组,另随机选择100例正常妇女作为对照组。比较分析两组的黄体中期子宫内膜血流特点。结果两组在子宫内膜厚度、子宫动脉搏动指数（ PI）及阻力指数（ RI）和内膜容积等方面的差异均不显著（ P﹥0.05）;观察组在内膜血管指数（ VI）、血流指数（ FI）及血管血流指数（VFI）,以及内膜下区域各血流指数等方面,均显著低于对照组（P﹤0.05或P﹤0.01）。结论通过对抗磷脂抗体相关性习惯性流产妇女黄体中期的子宫内膜血流特点进行分析研究,可以为临床治疗提供较好的参考依据。     

Exercise-induced arterial hypoxaemia in athletes: a review

During exercise, healthy individuals are able to maintain arterial oxygenation, whereas highly-trained endurance athletes may exhibit an exercise-induced arterial hypoxaemia (EIAH) that seems to reflect a gas exchange abnormality. The effects of EIAH are currently debated, and different hypotheses have been proposed to explain its pathophysiology. For moderate exercise, it appears that a relative hypoventilation induced by endurance training is involved. For high-intensity exercise, ventilation/perfusion (V(A)/Q) mismatching and/or diffusion limitation are thought to occur. The causes of this diffusion limitation are still under debate, with hypotheses being capillary blood volume changes and interstitial pulmonary oedema. Moreover, histamine is released during exercise in individuals exhibiting EIAH, and questions persist as to its relationship with EIAH and its contribution to interstitial pulmonary oedema. Further investigations are needed to better understand the mechanisms involved and to determine the long term consequences of repetitive hypoxaemia in highly trained endurance athletes.     

Suicide in athletes: a review and commentary

Not only are athletes at risk for psychiatric illness, but they are at risk of suicide. In an effort to learn more about suicide in athletes and those connected to the sports arena, a review of the medical literature from 1960 to 2000 was conducted through Medline, and a review of the periodical literature from 1980 to 2000 was conducted through Infotrac. These reviews revealed 71 cases of athletes who have either contemplated, attempted, or completed suicide. In this article, these cases are analyzed by sport, gender, and age. Through inference, an attempt to establish the etiologic basis for these behaviors is undertaken. Intervention and prevention strategies are discussed, based on the available data.     

Menstrual Irregularity in Athletes: The Unanswered Question

Rose Frisch, PhD, has a simple explanation: It is related to their lean-fat ratio. But she doesn't claim to have all the answers.     

Elbow injuries in throwing athletes: a current concepts review

Repetitive overhead throwing imparts high valgus and extension loads to the athlete's elbow, often leading to either acute or chronic injury or progressive structural change. Tensile force is applied to the medial stabilizing structures with compression on the lateral compartment and shear stress posteriorly. Common injuries encountered in the throwing elbow include ulnar collateral ligament tears, ulnar neuritis, flexor-pronator muscle strain or tendinitis, medial epicondyle apophysitis or avulsion, valgus extension overload syndrome with olecranon osteophytes, olecranon stress fractures, osteochondritis dissecans of the capitellum, and loose bodies. Knowledge of the anatomy and function of the elbow complex, along with an understanding of throwing biomechanics, is imperative to properly diagnose and treat the throwing athlete. Recent advantages in arthroscopic surgical techniques and ligament reconstruction in the elbow have improved the prognosis for return to competition for the highly motivated athlete. However, continued overhead throwing often results in subsequent injury and symptom recurrence in the competitive athlete.     

Left ventricular morphology and function in female athletes: a meta-analysis

The purpose of the present study was to examine the impact of physical training upon cardiac structure and function, and identify physiologic upper limits in female athletes. Meta-analytical techniques were applied to 13 published echocardiographic studies examining cardiac structure and function in female athletes. The study group included 890 athletes and 333 controls. For comparison of sporting discipline, studies were partitioned into 3 categories (endurance, strength/sprint, team). Significant (p < 0.05) effect sizes were observed for all structural measures between athletes and controls. Significant effect size differences existed between sporting groups for LVIDd and LVM only, with endurance and team game athletes demonstrating the largest effect sizes compared to strength trained athletes. No significant effect of training was observed for left ventricular diastolic or systolic function, with the exception of stroke volume where a significant effect size difference was observed between athletes and controls with no observed difference between sporting groups. Maximum reported upper limits for LV wall thickness and LVIDd in female athletes were 12 mm and 66 mm respectively. Chronic exercise training results in cardiac enlargement in female athletes. The nature of physiologic adaptation is similar to that observed in male athletes. LV wall thickness values greater than 12 mm in female athletes should be viewed with caution and indicate a more comprehensive evaluation to establish a physiological or pathological basis for the observed left ventricular enlargement.