ABSTRACT
Background: Functional hypothalamic menstrual disorder (FHMD) has a destructive effect on the athlete's bone mineral density and cardiovascular system. Utilizing hormone replacement therapy to treat FHMD in athletes is controversial. This study was conducted to examine the effect of hormone therapy on bone density and the cardiovascular system of professional female athletes with FHMD. Methods: In this study, 18 female athletes with at least a 2- year history of FHMD were recruited in a 9-month single blind randomized clinical intervention (RCT) and randomly classified into 2 groups: the oral contraceptive pills (OCP) group, who received a lowdose combined oral contraceptive (OC) containing 30 µg ethinyl estradiol and 150 µg levonorgestrel (n= 10), and the control group (n= 8). Bone mineral densitometry (BMD) and certain cardiovascular risk factors were measured before and after the 9-month trial. The Chi square test was used to compare the quantitative and qualitative results. Results: Bone mineral density did not change significantly in either group. Very low density lipoprotein (VLDL) (p= 0.035) and Apolipoprotein B (Apo B) (p= 0.04) reduced significantly in the OCP group. An increase was observed in the serum levels of Apolipoprotein A (Apo A) (p= 0.01) in the control group. Changes in the Apo B to Apo A ratio was significant in both groups (OCP group: p= 0.018, control group: p= 0.040). No significant changes were observed in the other measured factors. Conclusion: Although the administration of estrogen did not significantly increase bone mineral density, it had positive effects on the cardiovascular system and lipid profile.
ABSTRACT
PURPOSE: Oligo/amenorrhea, as a part of the Female Athlete Triad has adverse effects on the athlete's bone mineral density (BMD) and cardiovascular system. Hypoestrogenism, due to suppression of hypothalamus-pituitary axis (HPA) as a result of energy imbalance, is the possible cause of the Triad. This study was designed based on following up and reassessment of elite female athletes who were diagnosed as menstrual dysfunction about two years ago. METHODS: THIS STUDY WAS CONDUCTED IN THREE PHASE SECTIONS: 1) Reassess the pattern of menstrual cycle among athletes who reported menstrual dysfunction about two years ago; 2) Bone mineral density was measured twice in the same machine and same center with a two-year interval; 3) The laboratory data including blood glucose, lipid profile and inflammatory markers was assessed in phase 3. RESULTS: BMD of athletes did not change significantly after 25.5 months of oligomenorrhea P (spine) = 0.2, P (femur)=0.9. Mean of all cardiovascular factors was in the normal range except for high density lipoprotein (HDL) which was 49.28 (SD=9.18), however, most of the athletes had abnormalities in their lipid profile. Inverse relationship between the increase in the BMD of spine and total cholesterol (r =-0.49, P=0.04), Apolipoprotein A (r = -0.51 P=0.04), and very low density lipoprotein (VLDL) (r =-0.66, P=0.009). Also correlation between BMD of spine and HbA1C (r =-0.70, P=0.003) were significant. CONCLUSION: Findings of this study show that negative changes in BMD and cardiovascular biomarkers of female athletes with functional hypothalamic menstrual dysfunction could occur if proper therapeutic intervention (including increase in calorie intake, decrease in exercise load or hormonal replacement) will not consider.
ABSTRACT
PURPOSE: The study's purpose was to evaluate clinical manifestations of the female athlete triad among some elite Iranian athletes. METHODS: This cross-sectional study was conducted in three phases: 1) screening for menstrual irregularity (oligomenorrhea/amenorrhea) and/or stress fracture and weight-reducing drugs, 2) measurement of bone mineral density by dual-energy x-ray absorptiometry, and 3) a clinical interview to diagnose eating disorders. Phases 2 and 3 were conducted in athletes who reported menstrual irregularity and/or stress fracture and weight-reducing drugs. RESULTS: We evaluated a total of 786 athletes (94%) with a mean age of 21.1 ± 4.5 yr old. Seventy-two (9.2%) athletes reported menstrual irregularity, 11 (1.4%) of whom had polycystic ovary syndrome. Only three athletes (0.4%) had all three common clinical manifestations of the Triad (eating disorders, menstrual irregularity, and low bone mineral density). There was no association between these disorders and body mass index or type of sport. A total of 17 (2%) reported stress fracture, 14 of whom also reported a history of stress fracture without any menstrual irregularity. The athletes who competed in high-risk sports (endurance sports, weight class sports, and sports requiring a lean build) had significantly more stress fractures than those participating in other types (odds ratio = 3.35, 95% confidence interval = 1.22-9.15). CONCLUSIONS: Although the prevalences of clinical functional hypothalamic menstrual disorders and stress fracture were less than those reported in some other countries, athletes in the high-risk group had significantly more stress fractures than those in the low-risk group. Future studies should focus on screening, diagnosing, preventing, and treating all components of the newly defined Triad, especially in high-risk sports in Iran.
