Georgie Bruinvels

The Prevalence and Impact of Heavy Menstrual Bleeding (Menorrhagia) in Elite and Non-Elite Athletes

To identify the prevalence and impact of heavy menstrual bleeding (HMB) in exercising females where anemia may have a significant effect on training and performance a ‘Female Health Questionnaire’ was designed incorporating a validated diagnostic HMB series, demographics, exercise ability data, training status, anemia, iron supplementation and whether the menstrual cycle had affected training and performance. The survey was conducted in two stages; initially online, advertised via social media, and then repeated via face-to-face interviews with runners registered for the 2015 London Marathon. 789 participants responded to the online survey, and 1073 completed the survey at the marathon. HMB was reported by half of those online (54%), and by more than a third of the marathon runners (36%). Surprisingly, HMB was also prevalent amongst elite athletes (37%). Overall, 32% of exercising females reported a history of anemia, and 50% had previously supplemented with iron. Only a minority (22%) had sought medical advice. HMB is highly prevalent in exercising females, associated with self-reported anemia, increased use of iron supplementation and a perceived negative impact on performance. Further research is needed to investigate the impact of HMB, iron deficiency and anemia in exercising females.

Sport, exercise and the menstrual cycle: where is the research?

Despite a decreasing gender gap in exercise participation, there still remains a significant under-representation of women included in sport and exercise medicine research studies.1 A review of 1382 sport and exercise research studies involving over 6 million participants, from 2011 to 2013, found the representation of women to be 39%.1 The complexities of the menstrual cycle are considered major barriers to the inclusion of women in clinical trials. Historically, partially due to concerns of potentially damaging unborn fetuses, medical trials—including drug trials—were conducted solely in men. Further, women were perceived …

Low energy availability surrogates correlate with health and performance consequences of Relative Energy Deficiency in Sport

Low energy availability (EA) is suspected to be the underlying cause of both the Female Athlete Triad and the more recently defined syndrome, Relative Energy Deficiency in Sport (RED-S). The International Olympic Committee (IOC) defined RED-S as a syndrome of health and performance impairments resulting from an energy deficit. While the importance of adequate EA is generally accepted, few studies have attempted to understand whether low EA is associated with the health and performance consequences posited by the IOC. Objective The purpose of this cross-sectional study was to examine the association of low EA with RED-S health and performance consequences in a large clinical population of female athletes. Methods One thousand female athletes (15–30 years) completed an online questionnaire and were classified as having low or adequate EA. The associations between low EA and the health and performance factors listed in the RED-S models were evaluated using chi-squared test and the odds ratios were evaluated using binomial logistic regression (p<0.05). Results Athletes with low EA were more likely to be classified as having increased risk of menstrual dysfunction, poor bone health, metabolic issues, haematological detriments, psychological disorders, cardiovascular impairment and gastrointestinal dysfunction than those with adequate EA. Performance variables associated with low EA included decreased training response, impaired judgement, decreased coordination, decreased concentration, irritability, depression and decreased endurance performance. Conclusion These findings demonstrate that low EA measured using self-report questionnaires is strongly associated with many health and performance consequences proposed by the RED-S models.

The prevalence and impact of heavy menstrual bleeding among athletes and mass start runners of the 2015 London Marathon

The single most common cause of iron deficiency anaemia in the developed world in premenopausal females is the menstrual cycle.1 It is well recognised and reported that amenorrhoea and oligomenorrhoea are common in elite athletes typically as a result of relative energy deficiency;2 however, little is known about the prevalence of other menstrual abnormalities. Heavy menstrual bleeding (HMB or menorrhagia ) affects a quarter of the general population,3 yet no data exist for athletes or exercising women. It is possible that HMB might impact significantly on womens participation in sport. HMB can lead to fatigue, anxiety, reduced mood and energy levels with a negative impact on quality of life and productivity.4 Furthermore, iron turnover in exercising females …

Iron balance and iron supplementation for the female athlete: A practical approach

ABSTRACT Maintaining a positive iron balance is essential for female athletes to avoid the effects of iron deficiency and anaemia and to maintain or improve performance. A major function of iron is in the production of the oxygen and carbon dioxide carrying molecule, haemoglobin, via erythropoiesis. Iron balance is under the control of a number of factors including the peptide hormone hepcidin, dietary iron intake and absorption, environmental stressors (e.g. altitude), exercise, menstrual blood loss and genetics. Menstruating females, particularly those with heavy menstrual bleeding are at an elevated risk of iron deficiency. Haemoglobin concentration [Hb] and serum ferritin (sFer) are traditionally used to identify iron deficiency, however, in isolation these may have limited value in athletes due to: (1) the effects of fluctuations in plasma volume in response to training or the environment on [Hb], (2) the influence of inflammation on sFer and (3) the absence of sport, gender and individually specific normative data. A more detailed and longitudinal examination of haematology, menstrual cycle pattern, biochemistry, exercise physiology, environmental factors and training load can offer a superior characterisation of iron status and help to direct appropriate interventions that will avoid iron deficiency or iron overload. Supplementation is often required in iron deficiency; however, nutritional strategies to increase iron intake, rest and descent from altitude can also be effective and will help to prevent future iron deficient episodes. In severe cases or where there is a time-critical need, such as major championships, iron injections may be appropriate.

The Impact Of Heavy Menstrual Bleeding (menorrhagia) And Iron Status In Exercising Females

Background The effects of the menstrual cycle on exercise participation and performance are poorly researched. Menstrual blood loss is a leading cause of iron deficiency (ID) and ultimately iron deficiency anaemia (IDA). Furthermore, iron losses are increased in those who exercise. The menstrual cycle, ID and IDA may affect the ability to exercise, mood state, productivity and quality of life while also increasing fatigue and anxiety. Objective To determine the impact of heavy menstrual bleeding (HMB) on iron status; to identify the association between HMB, ID and IDA with self-reported exercise training and performance. Design A cross-sectional study design was used. Setting Routine healthcare assessments in Singapore. Participants Healthy females (n=271; mean age 36.3±9.6 years, body mass 58.3±12.5 kg, height 1.59±0.12 m). Inclusion criteria: regularly menstruating and reporting >60 minutes exercise participation per week or ‘taking part in races, in a relatively non-competitive manner’. Interventions No interventions were applied. Main Outcome Measurements Participants completed a ‘Female Health Questionnaire’ capturing: a 4-part diagnostic criteria for HMB; aspects of exercise training habits and performance; exercise volume; and competition level. Haemoglobin concentration ([Hb]) and serum ferritin were measured in all participants. Results 22.4% reported HMB, 18.8% had IDA ([Hb]<12 g/dL), 30.0% severe ID (ferritin<16 ug/L), and 48.0% had moderate ID (ferritin <30 ug/L). Those with HMB were twice as likely to suffer IDA or have moderate ID, while they were nearly three times as likely to have severe ID (p<0.05). When controlling for IDA those with HMB were 3.9 times more likely to cite negative impacts on training and performance as a result of the menstrual cycle (p<0.05). Conclusions Heavy menstrual bleeding is common in exercising women. Regular screening should be encouraged to check iron status as this has potential to cause IDA in addition to compromising exercise training behaviours and performance.