Vol 91, No 9 (2020)
Research paper
Published online: 2020-09-30

open access

Page views 2747
Article views/downloads 3031
Get Citation

Connect on Social Media

Connect on Social Media

The impact of competitive sports on menstrual cycle and menstrual disorders, including premenstrual syndrome, premenstrual dysphoric disorder and hormonal imbalances

Mariola Czajkowska1, Agnieszka Drosdzol-Cop1, Beata Naworska1, Iwona Galazka1, Celina Gogola1, Magdalena Rutkowska1, Violetta Skrzypulec-Plinta1
Pubmed: 33030729
Ginekol Pol 2020;91(9):503-512.


Objectives: With the considerable increase of female participation in youth sports, it has become crucial for medical professionals, coaches and parents to improve their competitiveness by understanding the conditions for which these females are at elevated risk and mitigating possible health consequences. The aim of this study was to evaluate the effect competitive sports have on the disorders of the menstrual cycle, to investigate the frequency of PMS (premenstrual syndrome)/PMDD (premenstrual dysphoric order) in professional female athletes and to identify risk factors predisposing for PMS and PMDD. Additionally, the levels of selected hormones such as serum estradiol, FSH, LH and prolactin were investigated to identify any hormonal perturbances that might have influence or be the risk factors for menstrual dysfunctions. Material and methods: The study group consisted of 75 professional athletes (girls and young women at the age of 16–22) who lived on the territory of Silesia. The control group consisted of 50 girls and young women at the same age, who did not practice any sport. The research tools included daily diary of PMS symptoms created in line with The American College of Obstetricians and Gynecologists (ACOG) recommendations and ICD-10 diagnostic criteria, daily diary of PMDD symptoms created according to DSM-V diagnostic criteria of the American Psychiatric Association (APA) and premenstrual symptoms screening tool (PSST). Results: The analysis of menstrual cycle disorders showed statistical significance for heavy menstrual bleeding (p = 0.01) and longer breaks between menstrual bleeds (p = 0.01). PMDD was diagnosed in 8% and PMS in more than 42% of respondents. The incidence of PMDD was not at significant variance between the groups (9.33% in contrast to 6.0%), while incidence of PMS was statistically different in both groups (p = 0.045) (49.33% vs 32.0%). A significant correlation between PMS, average age (p = 0.00001) and menarche age (p = 0.03) in young active athletes has been shown. The risk of PMS increased with age (by 1.71 with each year) (p = 0.0007). Conclusions: A number of other risk factors predisposing for PMS and PMDD has also been identified. The findings of these researches will enable the athletic care network to provide better care for young female athletes.

Article available in PDF format

View PDF Download PDF file


  1. Wheatley S, Khan S, Székely A, et al. Expanding the female athlete triad concept to address a public health issue. Performance Enhancement & Health. 2012; 1(1): 10–27.
  2. Brook Ch. (ed). Endokrynologia pediatryczna. Elsevier Ubran&Partner, Wrocław 2013: 37–95, 139–162.
  3. Lebrun C. The female athlete triad. Women's Health Medicine. 2006; 3(3): 119–123.
  4. Brown K, Dewoolkar A, Baker N, et al. The female athlete triad: special considerations for adolescent female athletes. Translational Pediatrics. 2017; 6(3): 144–149.
  5. Skrzypulec-Plinta V., Drosdzol-Cop A. (ed). Ginekologia dziecięca i dziewczęca. PZWL, Warszawa 2017: 49–76, 107–145, 183–203.
  6. Gordon C, Ackerman K, Berga S, et al. Functional hypothalamic amenorrhea: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017; 102(5): 1413–1439.
  7. American College of Obstericians and Gynecologists. ACOG practice bulletin: management of anowvulatory bleeding. ACOG Committee on Practice Bulletins — Gynecology. Int J Gynaecol Obstet. 2001; 72(3): 263–271.
  8. Halbreich U, Backstrom T, Eriksson E, et al. Clinical diagnostic criteria for premenstrual syndrome and guidelines for their quantification for research studies. Gynecological Endocrinology. 2009; 23(3): 123–130.
  9. Gehlert S, Song IH, Chang CH, et al. The prevalence of premenstrual dysphoric disorder in a randomly selected group of urban and rural women. Psychological Medicine. 2008; 39(1): 129–136.
  10. Adewuya AO, Loto OM, Adewumi TA. Premenstrual dysphoric disorder amongst Nigerian university students: prevalence, comorbid conditions, and correlates. Archives of Women's Mental Health. 2008; 11(1): 13–18.
  11. Czajkowska M, Drosdzol-Cop A, Gałązka I, et al. Menstrual cycle and the prevalence of premenstrual syndrome/premenstrual dysphoric disorder in adolescent athletes. J Pediatr Adolesc Gynecol. 2015; 28(6): 492–498.
  12. Gałecki P, Święcicki Ł. (ed.) Kryteria diagnostyczne z DSM-5. Edra Urban & Partner, Wrocław 2015.
  13. American College of Obstericians and Gynecologists. ACOG practice bulletin: management of anowulatory bleeding. ACOG Committee on Practice Bulletins — Gynecology. Int J Gynaecol Obstet. 2001; 72(3): 263–271.
  14. American Psychiatric Association. Premenstrual dysphoric disorder. In: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. American Psychiatric Association, Washington 2000: 771–774.
  15. Sowińska-Przepiera E, Andrysiak-Mamos E, Jarząbek-Bielecka G, et al. Functional hypothalamic amenorrhoea — diagnostic challenges, monitoring and treatment. Endokrynol Pol. 2015; 66(3): 252–260.
  16. Ducher G, Eser P, Hill B, et al. History of amenorrhoea compromises some of the exercise-induced benefits in cortical and trabecular bone in the peripheral and axial skeleton: A study in retired elite gymnasts. Bone. 2009; 45(4): 760–767.
  17. Drosdzol-Cop A, Skrzypulec-Plinta V. Komentarz do aktykułu pt. Co jest normą? Dokładna i efektywna ocena miesiączkowania. Med Prakt Pediatr. 2016; 2: 88–89.
  18. Yermachenko A, Dvornyk V. Nongenetic determinants of age at menarche: a systematic review. Biomed Res Int. 2014; 2014: 1–14.
  19. Williams C, Creighton S. Menstrual disorders in adolescents: review of current practice. Horm Res Pediatr. 2012; 78(3): 135–143.
  20. Pantano K. Knowledge, attitude, and skill of high school coaches with regard to the female athlete triad. J Pediatr Adolesc Gynecol. 2017; 30(5): 540–545.
  21. Nattiv A, Loucks AB, Manore MM, et al. American College of Sports Medicine position stand. The female athlete triad. Med Sci Sports Exerc. 2007; 39(10): 1867–1882.
  22. Loveless M, Hewitt G. Committee Opinion No. 702: Female Athlete Triad. Obstetrics and Gynecology. 2017; 129(6): 160–167.
  23. Yermachenko A, Dvornyk V. Nongenetic determinants of age at menarche: a systematic review. Biomed Res Int. 2014; 2014: 1–14.
  24. Caronia L, Martin C, Welt C, et al. A genetic basis for functional hypothalamic amenorrhea. N Engl J Med. 2011; 364(3): 215–225.
  25. Gelson E, Prakash A. Investigation and treatment of primary amenorrhoea. Obster Ginecol and Reproduct Med. 2016; 26(4): 108–113.
  26. Zgliszczyński W. red. Endokrynologia 2. Wielka Interna, Warszawa 2012: 533–593.
  27. Haamid F, Sass A, Dietrich J. Heavy menstrual bleeding in adolescents. J Pediatr Adolesc Gynecol. 2017; 30(3): 335–340.
  28. Mallison RJ. De Suoza M.J. Current perspectives on the etiology and manifestation of the “silent” component of the Female Athlete Triad. International Journal of Women’s Health. 2014; 6: 451–467.
  29. Thein-Nissenbaum J. Long term consequences of the female athlete triad. Maturitas. 2013; 75(2): 107–112.
  30. Guebels C, Kam L, Maddalozzo G, et al. Active women before/after an intervention designed to restore menstrual function: resting metabolic rate and comparison of four methods to quantify energy expenditure and energy availability. Int J Sport Nutr Exerc Metab. 2014; 24(1): 37–46.
  31. Fideleff HL, Boquete HR, Suárez MG, et al. Prolactinoma in children and adolescents. Horm Res. 2009; 72(4): 197–205.
  32. Brunet M. Female athlete triad. Clin Sports Med. 2005; 24(3): 623–636.
  33. Ciocca M. Medication and supplement use by athletes. Clin Sports Med. 2005; 24(3): 719–738.
  34. Bielecka-Jarząbek G, Radomski D, Nowaczyk A, et al. Analiza stężeń prolaktyny u dziewcząt bez cech endokrynopatii z zaburzeniami miesiączkowania i stresem w wywiadzie. Ginekol Prakt. 2010; 18(1): 46–53.
  35. Męczekalski B, Katulski K, Kostrzak A. Metabolicaspects of hyperprolactinaemia. Arch. Perinat. Med. 2012 Vol. Arch Perinat Med. 2012; 18(3): 153–156.