Severity of energy-related menstrual disturbances increases in proportion to indices of energy conservation in exercising women

Souza, Mary Jane De; Lee, Daniel K.; VanHeest, Jaci L.; Scheid, Jennifer L.; West, Sarah; Williams, Nancy I.

doi:10.1016/j.fertnstert.2006.11.171

Cited by 113 publications

(79 citation statements)

References 19 publications

(25 reference statements)

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“…De Souza et al 45 also noted that as the magnitude of negative energy balance increases, alterations in the reproductive system become more severe. 45 The results of these studies 4345 and others 39 ,40,4648 indicate that alterations in reproductive function appear to be related to acute energy availability, not body mass or exercise intensity.…”

Section: Resultsmentioning

confidence: 75%

Menstrual Irregularity and Musculoskeletal Injury in Female High School Athletes

Thein-Nissenbaum

Rauh

Carr

et al. 2012

Journal of Athletic Training

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Context:The female athlete triad describes the interrelatedness of energy availability, menstrual function, and bone density. Although associations between triad components and musculoskeletal injury (INJ) have been reported in collegiate athletes, limited information exists about menstrual irregularity (MI) and INJ in the high school population.Objective: To determine the prevalence of and relationship between MI and INJ in high school athletes.Design: Cross-sectional study. Setting: High schools. Patients or Other Participants:The sample consisted of 249 female athletes from 3 high schools who competed in 33 interscholastic, school-sponsored sport teams, dance teams, and cheerleading or pom-pon squad during the 2006-2007 school year. Each athlete remained on the roster throughout the season.Main Outcome Measure(s): Participants completed a survey regarding injury type, number of days of sport participation missed, and menstrual history in the past year.Results: The prevalences of M I and INJ were 19.7% and 63.1 %, respectively. Athletes who reported MI sustained a higher percentage of severe injuries (missing ;:>:22 days of practice or competition) than did athletes who reported normal menses. Although the trend was not significant, athletes with MI were almost 3 times more likely to sustain an injury resulting in 7 or more days of time lost from sport (odds ratio=2.7, 95% confidence interval = 0.8, 8.8) than those who sustained an injury resulting in 7 or fewer days of time lost.Conclusions: The incidences of MI and INJ in this high school population during the study period were high. Athletes who reported MI sustained a higher percentage of severe injuries than did athletes who reported normal menses. Education programs to increase knowledge and improve management of MI and its potential effects on injury in female high school athletes are warranted.

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Section: Resultsmentioning

confidence: 75%

Menstrual Irregularity and Musculoskeletal Injury in Female High School Athletes

Thein-Nissenbaum

Rauh

Carr

et al. 2012

Journal of Athletic Training

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“…Chronic energy deficiency can result in the suppression of dispensable metabolic processes, such as growth and reproduction, to conserve energy for vital functions (Wade, Schneider, & Li, 1996). These metabolic alterations are associated with unfavorable health outcomes, such as impaired reproductive, bone and cardiovascular health (De Souza et al, 2007De Souza & Williams, 2004, 2005Ducher et al, 2011;O'Donnell, Harvey, & De Souza, 2009). These health effects have been reported primarily in exercising women and have been captured under the term female athlete triad (De Souza et al, 2014;Nattiv et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Low energy availability in exercising men is associated with reduced leptin and insulin but not with changes in other metabolic hormones

Koehler

Hoerner

Gibbs

et al. 2016

Journal of Sports Sciences

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161

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“…Likewise, lower than expected RMRs have also been reported in women with exercise-associated menstrual disturbances (EAMD) (10,15,21), a condition caused by insufficient dietary energy intake relative to the energy expenditure of exercise (13). Because women with EAMD frequently display disrupted profiles of leptin, triiodothyronine, insulin, and other peptides involved in energy homeostasis, their lower than expected RMRs are understood as evidence of energy conservation (10,12,42).…”

mentioning

confidence: 99%

“…Previous investigators have addressed this issue by normalizing RMR for lean mass (10,15,21,32) or by comparing measured RMR with predicted RMR, which is derived from prediction equations that utilize anthropometric characteristics (10,15,21,29,38,40). However, these approaches may not be adequately sensitive to reflect the true magnitude of RMR suppression (42).…”

mentioning

confidence: 99%

Low resting metabolic rate in exercise-associated amenorrhea is not due to a reduced proportion of highly active metabolic tissue compartments

Koehler

Williams

Mallinson

et al. 2016

American Journal of Physiology-Endocrinology and Metabolism

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Exercising women with menstrual disturbances frequently display a low resting metabolic rate (RMR) when RMR is expressed relative to body size or lean mass. However, normalizing RMR for body size or lean mass does not account for potential differences in the size of tissue compartments with varying metabolic activities. To explore whether the apparent RMR suppression in women with exercise-associated amenorrhea is a consequence of a lower proportion of highly active metabolic tissue compartments or the result of metabolic adaptations related to energy conservation at the tissue level, RMR and metabolic tissue compartments were compared among exercising women with amenorrhea (AMEN; n = 42) and exercising women with eumenorrheic, ovulatory menstrual cycles (OV; n = 37). RMR was measured using indirect calorimetry and predicted from the size of metabolic tissue compartments as measured by dual-energy X-ray absorptiometry (DEXA). Measured RMR was lower than DEXA-predicted RMR in AMEN (1,215 ± 31 vs. 1,327 ± 18 kcal/day, P < 0.001) but not in OV (1,284 ± 24 vs. 1,252 ± 17, P = 0.16), resulting in a lower ratio of measured to DEXA-predicted RMR in AMEN (91 ± 2%) vs. OV (103 ± 2%, P < 0.001). AMEN displayed proportionally more residual mass ( P < 0.001) and less adipose tissue ( P = 0.003) compared with OV. A lower ratio of measured to DXA-predicted RMR was associated with lower serum total triiodothyronine ( ρ = 0.38, P < 0.001) and leptin ( ρ = 0.32, P = 0.004). Our findings suggest that RMR suppression in this population is not the result of a reduced size of highly active metabolic tissue compartments but is due to metabolic and endocrine adaptations at the tissue level that are indicative of energy conservation.

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Severity of energy-related menstrual disturbances increases in proportion to indices of energy conservation in exercising women

Cited by 113 publications

References 19 publications

Menstrual Irregularity and Musculoskeletal Injury in Female High School Athletes

Menstrual Irregularity and Musculoskeletal Injury in Female High School Athletes

Low energy availability in exercising men is associated with reduced leptin and insulin but not with changes in other metabolic hormones

Low resting metabolic rate in exercise-associated amenorrhea is not due to a reduced proportion of highly active metabolic tissue compartments

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