The Impact of Nutritional Intervention on Menstrual Dysfunction in Female Athletes: a Systematic Review

Abstract

Menstrual function is strongly affected by nutritional status and energy availability in female athletes, and impaired menstrual function can impact bone mineral density. Nutritional interventions have been proposed to mitigate menstrual dysfunction. The purpose of this systematic review was to assess the ability of nutritional interventions, directed at improving energy availability, to restore normal menstrual status in female athletes. PubMed, Cinahl, and SportDiscus databases were comprehensively searched. Included studies had to investigate the impact of increasing energy availability in female athletes through a nutritional intervention. The primary outcome measure of interest was menstrual status. Included studies were reviewed for methodological rigor using the American Academy of Dietetics Quality Criteria Checklist. Five studies met the inclusion criteria. Of the athletes who completed the interventions in the studies, 0-100% resumed normal menses. For those that improved, the mean length of time for return to menses ranged from 2.63 to 15.6 months. The length of the interventions (3-9 months), mean ages of the participants (17-1-22.6 years), and particular dietary intervention(s) (counseling, education, and nutritional supplementation) varied between the studies. Nutritional interventions may restore normal menses in some female athletes. Educational strategies targeted at improved eating and understanding the energy demands of sport, as well as weekly interaction with athletes should be considered.

Low energy availability: history, definition and evidence of its endocrine, metabolic and physiological effects in prospective studies in females and males

“…Findings revealed that this aggressive refeeding regimen failed to restore T 3 levels and only partially restored LH pulsatility . This study suggests that in humans, opposite to other mammalian species, restoration of the normal endocrine milieu after resuming adequate energy availability is a slow process, something that is supported by our (Areta et al 2020), and others' (Łagowska et al 2014;Mallinson et al 2013;Stickler et al 2019) observations of periods of weeks and months to resume normal menstrual cycle after prolonged periods of amenorrhea and oligomenorrhea.…”

Body Composition, Energy Availability, Training, and Menstrual Status in Female Runners

“…Previous interventions, in which EA has been increased, have shown that the restoration of menses may take 23 days to 16 months. 24,25,28 Altogether 5 and 6 ATH were able to enhance their PB and SB IAAF score, respectively. All of these ATH except for one were in the EUM group.…”

Case Study: Resumption of Eumenorrhea in Parallel With High Training Load After 4 Years of Menstrual Dysfunction: A 5-Year Follow-Up of an Elite Female Cyclist

“…The sequence of events and the time-scales (months) are strongly suggestive of an increase in EA being what drove the resumption of menses. Acutely, increasing EA in energetically disrupted women results in a slow readjustment of the reproductive hormone circadian rhythm , while chronically, interventions increasing EA have shown to have the capacity to restore menses in exercising women after 23 days to 16 months (Łagowska et al, 2014;Mallinson et al, 2013;Stickler et al, 2019).…”

“…Additionally, the recovery time-course for resumption of menses with changes in energy status is not well characterised. Evidence suggests that increased energy availability slowly restores the normal hormonal mileu of energy-disrupted women , but proofs for the effectiveness of increased energy on actual resumption of menses in amenorrhoeic athletes over prolonged periods is limited (Stickler et al, 2019). Moreover, the interaction between the energy status, menstrual function and the heavy training load of elite athletes has never been addressed longitudinally.…”