Preoccupation with weight and menstrual function in female elite athletes

Abstract

To determine the self‐reported prevalence of menstrual dysfunction in athletes and controls found to be at risk of developing eating disorders (ED) and the factors characterizing and classifying athletes suffering from menstrual dysfunction, the Eating Disorder Inventory (EDI) and a self‐developed questionnaire were administered to the total population of Norwegian female elite athletes (n=603) and age‐ and home community‐matched controls (n=522). The response rate in both athletes and controls was 86%. Subjects younger than 16 years who had not attained menarche (29 athletes and 14 controls) and subjects taking contraceptive medication (145 athletes and 131 controls) were excluded. Thus, a total of 348 athletes (19.4±4.3 years) and 303 controls (20.6±4.4 years) were analyzed. A high prevalence of athletes (42%) reported menstrual dysfunction; the prevalence of menstrual dysfunction was significantly different between subjects classified as at risk of developing ED (54% and 36%, for athletes and controls, respectively) and subjects found not to be at risk (41% and 23%, respectively). Furthermore, the prevalence of menstrual dysfunction was significantly higher among athletes competing in sports in which leanness and/or a specific weight are considered important (endurance: 62%, aesthetics: 60% and weight‐dependent: 50%) than among athletes competing in sports in which these factors are considered less important (technical: 37%, ballgames: 28% and power sports: 22%). Menarchal age, training volume, body mass index (BMI) and EDI score contributed significantly to explaining menstrual dysfunction in athletes (37%). The authors suggest that athletes reporting menstrual dysfunction could be characterized and classified into 2 main groups: first, the athletes who have a predisposed genetically lean body build (low BMI) and a delayed menarche and undertake hard physical training that does not allow them to achieve the “critical” weight for height found necessary for regular cycles. Secondly, the athletes who have normal BMI, experience menarche at the expected time and who become preoccupied with weight and dieting and/or use of pathogenic weight control methods which then, at least in part, may explain the menstrual dysfunction.