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Hyperandrogenism May Explain Reproductive Dysfunction in Olympic Athletes
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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“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]
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“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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Metadata
- Authors
- HAGMAR, M., BERGLUND, B., BRISMAR, K., & HIRSCHBERG, A. L.
- Affiliations
- Karolinska Institutet (SE)
- Venue
- Medicine & Science in Sports & Exercise
- Published
- 2009-06
- Volume
- 41
- Issue
- 6
- Pages
- 1241-1248
- ISSN
- 0195-9131 (ISSN-L)
- 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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