Abstract
Exercise-related menstrual dysfunction (ExMD) is associated with low energy availability (EA), decreased bone mineral density (BMD), and increased risk of musculoskeletal injury. We investigated whether a 6-month carbohydrate-protein (CHO-PRO) supplement (360 kcal/day, 54 g CHO/day, 20 g PRO/day) intervention would improve energy status and musculoskeletal health and restore menses in female athletes (n = 8) with ExMD. At pre/post-intervention, reproductive and thyroid hormones, bone health (BMD, bone mineral content, bone markers), muscle strength/power and protein metabolism markers, profile of mood state (POMS), and energy intake (EI)/energy expenditure (7 day food/activity records) were measured. Eumenorrheic athlete controls with normal menses (Eumen); n = 10) were measured at baseline. Multiple linear regressions were used to evaluate differences between groups and pre/post-intervention blocking on participants. Improvements in EI (+382 kcal/day; p = 0.12), EA (+417 kcal/day; p = 0.17) and energy balance (EB; +466 kcal/day; p = 0.14) were observed with the intervention but were not statistically significant. ExMD resumed menses (2.6 ± 2.2-months to first menses; 3.5 ± 1.9 cycles); one remaining anovulatory with menses. Female athletes with ExMD for >8 months took longer to resume menses/ovulation and had lower BMD (low spine (ExMD = 3; Eumen = 1); low hip (ExMD = 2)) than those with ExMD for <8 months; for 2 ExMD the intervention improved spinal BMD. POMS fatigue scores were 15% lower in ExMD vs. Eumen (p = 0.17); POMS depression scores improved by 8% in ExMD (p = 0.12). EI, EA, and EB were similar between groups, but the intervention (+360 kcal/day) improved energy status enough to reverse ExMD despite no statistically significant changes in EI. Similar baseline EA and EB between groups suggests that some ExMD athletes are more sensitive to EA and EB fluctuations.
Highlights
Optimal energy intake (EI) and nutrition can improve exercise performance and maintain overall health in physically active individuals [1]
Weight gain was observed in 75% (6/8) of the exercise-related menstrual dysfunction (ExMD) women
6-months in ExMD group, blocking on participant and controlling for baseline age and weight and false discovery rate (FDR) of 5%. This is the first study to demonstrate that when ExMD athletes maintain exercise training and consistently consume an extra 360 kcal/day for 6-months, menses and ovulation are restored. These findings are consistent with results reported by Mallinson et al [32] where menstrual status was restored in two amenorrheic athletes with increased EI and Kopp-Woodroffe et al [18] where menses and ovulation was restored in three amenorrheic athletes during a 20–24 week diet (360 kcal/day) and exercise intervention [18]
Summary
Optimal energy intake (EI) and nutrition can improve exercise performance and maintain overall health in physically active individuals [1]. Can find it difficult to meet energy and nutrient needs while maintaining a low fat or body weight considered optimal for sports performance. They often restrict EI to make weight goals [1]. Low EI, combined with high levels of exercise, increases the risk of developing exercise-related menstrual dysfunction (ExMD) and poor bone health [2,3]. Low energy availability (EA) (i.e., energy remaining for body functions after exercise training) may lead to menstrual dysfunction through a leptin-controlled pathway [2]. The ovaries decrease production of estrogen and progesterone, the hormones responsible for triggering the lining and egg of the uterus to be shed (menstruation) resulting in abnormal menses [5]
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