High prevalence of subtle and severe menstrual disturbances in exercising women: confirmation using daily hormone measures
High prevalence of subtle and severe menstrual disturbances in exercising women: confirmation using daily hormone measures
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DOI：
10.1093/humrep/dep411
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发表时间：
2010-02-01
影响因子：
6.1
通讯作者：
Williams, N. I.
中科院分区：
文献类型：
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作者：
De Souza, M. J.;Toombs, R. J.;Williams, N. I.
识别微妙的月经周期紊乱需要每天进行荷尔蒙评估。相反，严重的月经紊乱，如闭经和月经过少，可以通过临床观察来确定。这项研究的主要目的是确定从事各种娱乐和竞技运动的锻炼女性的月经周期为26-35天的轻微月经紊乱的频率，定义为黄体期缺陷(LPD)或无排卵。月经状况通过连续两到三个周期的每日测量雌酮、孕二醇葡糖醛酸苷和黄体生成素来记录，随后在久坐(SED)和锻炼(EX)的妇女中归类为排卵期(Ovul)、LPD、无排卵期(ANOV)、月经量少(Origo)和闭经期(AMen)。年龄(26.3±0.8岁)、体重(59.3±-1.8 kg)、体重指数(22.0±0.6 kg/m(2))、初潮年龄(12.8±0.3岁)和妇科成熟(13.4±0.9岁)。SED组运动量较少(P<；0.001)(96.7+/-39.1比457.1+/-30.5min/周)，峰值摄氧量(34.4+/-1.4比44.3+/-0.6ml/kg/min)比Ex组低。在SED组研究的月经周期中，轻度月经紊乱的发生率仅为4.2%(2/48)，95.8%(46/48)的月经周期为排卵期。这一发现与Ex组的观察结果形成了鲜明的对比，在Ex组中，只有50%(60/120)的观察到的月经周期是排卵的，多达50%(60/120)是异常的。在Ex组异常周期中，29.2%(35/120)为LPD(短、不充分或两者兼有)，20.8%(25/120)为ANOV。在有严重月经紊乱的前妇女中，3.5%(3/86)的周期为寡月经，33.7%(29/86)的周期为男性。这项研究表明，大约一半的锻炼女性经历了轻微的月经紊乱，即LPD和无排卵，三分之一的锻炼女性可能闭经。根据是否存在短周期或长周期来估计锻炼女性中轻微月经紊乱的患病率并不能确定这些紊乱。根据已知的月经紊乱的临床后果，这些发现强调了正常月经间隔和自我报告缺乏可靠性来推断月经状态。
The identification of subtle menstrual cycle disturbances requires daily hormone assessments. In contrast, the identification of severe menstrual disturbances, such as amenorrhea and oligomenorrhea, can be established by clinical observation. The primary purpose of this study was to determine the frequency of subtle menstrual disturbances, defined as luteal phase defects (LPD) or anovulation, in exercising women, with menstrual cycles of 26-35 days, who engage in a variety of sports, both recreational and competitive. Secondly, the prevalence of oligomenorrhea and amenorrhea was also determined via measurement of daily urinary ovarian steroids rather than self report alone.Menstrual status was documented by daily measurements of estrone and pregnanediol glucuronide and luteinizing hormone across two to three consecutive cycles and subsequently categorized as ovulatory (Ovul), LPD, anovulatory (Anov), oligomenorrheic (Oligo) and amenorrheic (Amen) in sedentary (Sed) and exercising (Ex) women.Sed (n = 20) and Ex women (n = 67) were of similar (P > 0.05) age (26.3 +/- 0.8 years), weight (59.3 +/- 1.8 kg), body mass index (22.0 +/- 0.6 kg/m(2)), age of menarche (12.8 +/- 0.3 years) and gynecological maturity (13.4 +/- 0.9 years). The Sed group exercised less (P < 0.001) (96.7 +/- 39.1 versus 457.1 +/- 30.5 min/week) and had a lower peak oxygen uptake (34.4 +/- 1.4 versus 44.3 +/- 0.6 ml/kg/min) than the Ex group. Among the menstrual cycles studied in the Sed group, the prevalence of subtle menstrual disturbances was only 4.2% (2/48); 95.8% (46/48) of the observed menstrual cycles were ovulatory. This finding stands in stark contrast to that observed in the Ex group where only 50% (60/120) of the observed menstrual cycles were ovulatory and as many as 50% (60/120) were abnormal. Of the abnormal cycles in the Ex group, 29.2% (35/120) were classified as LPD (short, inadequate or both) and 20.8% (25/120) were classified as Anov. Among the cycles of Ex women with severe menstrual disturbances, 3.5% (3/86) of the cycles were Oligo and 33.7% (29/86) were Amen. No cycles of Sed women (0/20) displayed either Oligo or Amen.This study suggests that approximately half of exercising women experience subtle menstrual disturbances, i.e. LPD and anovulation, and that one third of exercising women may be amenorrheic. Estimates of the prevalence of subtle menstrual disturbances in exercising women determined by the presence or absence of short or long cycles does not identify these disturbances. In light of known clinical consequences of menstrual disturbances, these findings underscore the lack of reliability of normal menstrual intervals and self report to infer menstrual status.