Hyperandrogenism may explain reproductive dysfunction in Olympic athletes

HAGMAR, MAGNUS; BERGLUND, BO; BRISMAR, KERSTIN; HIRSCHBERG, ANGELICA LINDÉN

doi:10.1249/mss.0b013e318195a21a

Cited by 114Ovarian function and disordersHypothalamic control of reproductive hormonesMenstrual Health and Disorders

Hyperandrogenism may explain reproductive dysfunction in Olympic athletes

HAGMAR, MAGNUS, BERGLUND, BO, BRISMAR, KERSTIN, HIRSCHBERG, ANGELICA LINDÉN·2009·Medicine & Science in Sports & Exercise

DOI 10.1249/mss.0b013e318195a21a

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Abstract

PURPOSE: Female athletes are known to be at risk for reproductive dysfunction and osteopenia because of energy deficiency. Although endocrine balance and an optimal body composition are essential for top elite performance, these parameters have not yet been explored fully in Olympic sportswomen. The objective of this study, therefore, was to characterize the menstrual status, body composition, and endocrine balance in female Olympic athletes participating in different disciplines. METHODS: Ninety Swedish female Olympic athletes underwent a gynecologic examination that included vaginal examination by ultrasound and determination of body composition. In addition, blood samples were collected for the analysis of reproductive hormones and biomarkers of energy availability. RESULTS: Of all the athletes, 47% were using hormonal contraception (HC). Menstrual dysfunction (MD) was common (27%) among those not using HC and, particularly, in endurance athletes. However, the proportion of body fat and biomarkers of energy availability were within the normal ranges and none exhibited osteopenia. On the contrary, bone mineral density was generally high, particularly in the power athletes. The most common diagnosis associated with MD was polycystic ovary syndrome (PCOS) and not hypothalamic inhibition because of energy deficiency. CONCLUSIONS: Female Olympic athletes participating in different sports were found to have an anabolic body composition and biomarkers of energy availability within the normal ranges. Most cases of menstrual disturbances observed were due to PCOS. These findings challenge the contemporary concept that reproductive dysfunction in sportswomen is typically a consequence of chronic energy deficiency.

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PCOS has higher than expected prevalence among elite female athletes.
“has higher than expected prevalence among elite female athletes (36, 45–47)”
From Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance (2018) · cites this paper as [45]
It is unlikely that mild nonclassical congenital adrenal hyperplasia is a major contributor to the mild hyperandrogenism prevalent among elite female athletes.
“It is unlikely that mild nonclassical congenital adrenal hyperplasia is a major contributor to the mild hyperandrogenism prevalent among elite female athletes.”
From Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance (2018) · cites this paper as [45]

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Authors: HAGMAR, M., BERGLUND, B., BRISMAR, K., & HIRSCHBERG, A. L.
Affiliations: Karolinska Institutet (SE)
ORCID: BERGLUND, BO
BRISMAR, KERSTIN
HIRSCHBERG, ANGELICA LINDÉN
Venue: Medicine & Science in Sports & Exercise
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2009-06
Volume: 41
Issue: 6
Pages: 1241-1248
ISSN: 0195-9131 (ISSN-L)
DOI: 10.1249/mss.0b013e318195a21a
OpenAlex: W2003398233
Cited by: 114
References: 43
Citations by year: 2026: 4 · 2025: 8 · 2024: 5 · 2023: 11 · 2022: 8 · 2021: 10 · 2020: 7 · 2019: 7 · 2018: 8 · 2017: 9 · 2016: 4 · 2015: 3 · 2014: 7 · 2013: 4 · 2012: 7
FWCI: 7.46
Type: journal article
Language: en
Open access: closed
Locations: Medicine & Science in Sports & Exercise (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
Keywords: hyperandrogenism, reproductive disorders, menstrual disorders, polycystic ovary syndrome, energy availability, body composition, bone mineral density, hormonal contraception, endurance athletes, power athletes, hypothalamic inhibition, energy deficiency
MeSH terms: Adult, Body Composition, Female, Humans, Polycystic Ovary Syndrome, Regression Analysis, Sports, Ultrasonography, Vagina, Biomarkers, Bone Density, Exercise Tolerance, Female Athlete Triad Syndrome

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Hyperandrogenism may explain reproductive dysfunction in Olympic athletes

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