The menstrual cycle and the exercising female: Implications for health and performance

While the health benefits of physical activity are widely known, there are serious clinical sequelae associated with sustained exercise-related menstrual disruption i.e., amenorrhoea. There is no suppressive effect of exercise per se on the menstrual cycle in women apart from its impact on the amount of energy available for vital bodily processes. The propensity for exercising women to consciously restrict food intake has contributed to a high prevalence of menstrual disturbances. More recently, work in this area is focused on male athletes, athletes with disabilities, and those with varied racial backgrounds. Other research considers the role of psychogenic stress and gynaecological age as contributors to one’s susceptibility to exercise-related menstrual disturbances. While it is critical to understand how menstrual disruption impacts health, it is also important to understand how the menstrual cycle may affect the physiological systems responsible for athletic performance and human functioning. It is still common for coaches to consider amenorrhoea as a sign of optimal training, presumably because performance gains in some sports are coincident with menstrual suppression. Whether or not athletic performance, injury risk, and/or physiological systems change across the menstrual cycle is a topic of great interest to athletes and coaches. This chapter examines the impact of exercise on the menstrual cycle and the associated impact on health. It also examines the role of the menstrual cycle and reproductive hormones in exercise performance. The chapter considers these unique perspectives in order to increase one's understanding of the complexities of the underlying research and of where knowledge gaps exist. In the general population, clinical disorders of menstruation per se are marked by irregularities in menstrual bleeding accompanied by a variety of endocrine abnormalities. These disorders range from dysmenorrhoea to hypothalamic amenorrhoea and can impact a significant proportion of adolescent and premenopausal women. It should not be assumed that menstrual abnormalities in an exercising female are associated with exercise until other physiological and/or psychological causes can be ruled out. Two case studies of exercising women with amenorrhoea of short (3 months') and long (11 months') duration were reported by R. J. Mallinson and colleagues.