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Sports Medicine

, Volume 2, Issue 4, pp 287–295 | Cite as

Gonadal Steroids in Athletic Women

Contraception, Complications and Performance
  • Jerilynn C. Prior
  • Yvette Vigna
Research Review

Summary

Gonadal steroids are altered by the reproductive system’s adaptation to conditioning exercise. Contraceptive options for the athletic woman include all measures appropriate for the sedentary woman. Barrier methods (always with spermicidal jelly) are the preferred choice. The cardiovascular risks, decreased aerobic performance, and shorter lime to muscular exhaustion related to oral contraceptives make this a less desirable option.

Potential complications from the steroid changes of intense exercise include: low oestrogen and progesterone with risk of loss of trabecular bone and early osteoporosis, and absent progesterone with low normal oestrogen levels associated with risk of endometrial or breast cancer. Therapeutic options for the amenorrhoeic or young athlete include supplemental oral calcium, cyclic oral progesterone, or possibly cyclic physiological oestrogen and progesterone. The anovulatory (usually older) athlete with regular menses needs cyclic progesterone. Medroxyprogesterone 10mg on days 16 to 25 of the cycle or for 10 days monthly can potentially prevent endometrial and breast cancer, give predictable cycles, improve trabecular bone balance and stimulate the return of ovulatory cycles.

A practical approach to anovulatory infertility in the athlete includes a 10% reduction in exercise intensity and/or an increase in percentage body fat to 18 to 20%. Cyclic vaginal progesterone (25mg bid) can then treat short luteal phase cycles.

With improved understanding of the hormonal adaptations to conditioning exercise, we will be better able to outline contraceptive and therapeutic options in the future.

Keywords

Progesterone Oral Contraceptive Luteal Phase Medroxyprogesterone Oral Contraceptive Pill 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Aloia, J.; Cohn, S.H.; Dstuni, J.A.; Cane, R. and Ellis, K.: Prevention of involutional bone loss by exercise. American Journal of Medicine 89: 356–358 (1978).Google Scholar
  2. Bonen, A.; Belcastro, A.N. and Simpson, A.A.: Profiles of menstrual cycle hormones in teenage athletes. Journal of Applied Physiology 50: 545–551 (1981).PubMedGoogle Scholar
  3. Bonen, A.; Haynes, F.J.; Watson-Wright, W.; Sopper, M.M.; Pierce, G.N. et al.: Effects of menstrual cycle on metabolic responses to exercise. Journal of Applied Physiology 55: 1506–1513 (1983).PubMedGoogle Scholar
  4. Boyden, T.W.; Parmenter, R.W.; Stanforth, P.; Rotkis, T. and Wilmore, J.: Sex steroids and endurance running in women. Fertility and Sterility 39: 629–632 (1983).PubMedGoogle Scholar
  5. Cann, C.E.; Martin, M.C.; Genant, H.K. and Jaffe, R.B.: Decreased spinal mineral content in amenorrheic women. Journal of the American Medical Association 215: 626–629 (1984).CrossRefGoogle Scholar
  6. Chang, R.J. and Jaffe, R.B.: Progesterone effects on gonadotrophin release in women pretreated with estradiol. Journal of Clinical Endocrinology and Metabolism 44: 119–125 (1978).CrossRefGoogle Scholar
  7. Cowan, L.D.; Gordis, L.; Tonascia, J.A. and Seegar-Jones, G.: Breast cancer incidence in women with a history of progesterone deficiency. American Journal of Epidemiology 114: 209–216 (1981).PubMedGoogle Scholar
  8. Daggett, A.; Davies, B. and Boobis, L.: Physiological and bio-mechanical responses to exercise following oral contraceptive use. Medicine and Science in Sports and Exercise 15: 174 (1983).CrossRefGoogle Scholar
  9. Drinkwater, B.L.; Nilson, K.; Chestnut, C.H.; Bremner, W.J.; Shainholtz, S. and Southworth, M.B.: Bone mineral content of amenorrheic and eumenorrheic athletes. New England Journal of Medicine 311: 277–281 (1984).PubMedCrossRefGoogle Scholar
  10. Eston, R.G.: The regular menstrual cycle and athlete performance. Sports Medicine 1: 431–445 (1984).PubMedCrossRefGoogle Scholar
  11. Feicht, C.B.; Johnson, T.S.; Martin, B.J.; Sparkes, K.E. and Wagner, W.W.: Secondary amenorrhea in athletes. Lancet 2: 1145–1146 (1978).PubMedCrossRefGoogle Scholar
  12. Frisch, R.E.; Golz-Welbergen, A.J.; McArthur, J.W.; Albright, T.; Witschi, J. et al.: Delayed menarche and amenorrhea of college athletes in relation to age of onset of training. Journal American Medical Association 246: 1559–1563 (1981).CrossRefGoogle Scholar
  13. Jarrett, J.C. and Spellacy, W.N.: Contraceptive practices of female runners. Fertility and Sterility 39: 374–375 (1983).PubMedGoogle Scholar
  14. Hall-Jurkowski, J.E.; Jones, N.L.; Toews, C.J. and Sutton, J.R.: Effects of menstrual cycle on blood lactate, O2 delivery and performance during exercise. Journal of Applied Physiology 51: 1493–1499 (1981).Google Scholar
  15. Heany, R.P.; Recker, R.R. and Seville, P.O.: Menopausal changes in calcium balance performance. Journal of Laboratory and Clinical Medicine 6: 953–963 (1978).Google Scholar
  16. Huisveld, I.A.; Hospers, J.H.; Bernink, J.E.; Biersteker, M.W.A.; Erich, W.B.M. and Bouma, B.N.: Oral contraceptives and fibrinolysis among female cyclists before and after exercise. Journal of Applied Physiology 53: 330–334 (1982).PubMedGoogle Scholar
  17. Huisveld, I.A.; Hospers, J.E.H.; Bernink, M.J.E.; Erich, W.B.M. and Bouma, B.N.: The effect of oral contraceptives and exercise on hemostatic and fibrinolytic mechanisms in trained women. International Journal of Sports Medicine 4: 97–103 (1983).PubMedCrossRefGoogle Scholar
  18. Jurkowski, J.E.; Sutton, J.R. and Klare, P.: Effect of the menstrual cycle on the plasma catecholamine response to exercise in normal females. Canadian Journal of Applied Sport Sciences 3: 194 (1978).Google Scholar
  19. Kaufman, D.W.; Shapiro, S.; Rosenberg, I.; Monson, R.R.; Miettinen, O.S. et al.: Intrauterine contraceptive device use and pelvic inflammatory disease. American Journal of Obstetrics and Gynecology 136: 159–168 (1980).PubMedGoogle Scholar
  20. Lindsay, R.; Hart, D.M.; Purdee, D.; Ferguson, H.M.; Clark, A.S. and Kraszewski, A.: Comparative effects of estrogen and a progesterone on bone loss in post menopausal women. Clinical Science of Molecular Medicine 54: 193–195 (1978).Google Scholar
  21. Loucks, A.B. and Horvath, S.M.: Exercise-induced stress responses in amenorrheic and eumenorrheic runners. Journal of Clinical Endocrinology and Metabolism 59: 1109–1120 (1984).PubMedCrossRefGoogle Scholar
  22. Lutter, J.M.: Contraceptive practices of female runners. (Correspondence.) Fertility and Sterility 40: 551 (1983).PubMedGoogle Scholar
  23. Malina, R.M.; Harper, A.B.; Arenet, H.H. and Campbell, D.E.: Age at menarche in athletes and non-athletes. Medicine and Science in Sport 5: 11–13 (1973).Google Scholar
  24. McArthur, J.W.; Beitins, I.Z. and Bullen, B.A.: Motility, nutrition and reproduction: Recent clues to an ancient relationship; in J.R. Givens (Ed.) The Hypothalamus (Year Book Medical Publishers, Chicago 1984).Google Scholar
  25. National Research Council: Recommended Dietary Allowances. Food and Nutrition Board, 9th edition (National Academy of Sciences, Washington, D.C. 1980).Google Scholar
  26. Prior, J.C.: Endocrine ‘conditioning’ with endurance training: A preliminary review. Canadian Journal of Applied Sport Sciences 7: 148–157 (1982).Google Scholar
  27. Prior, J.C.: Luteal phase defects and anovulation: adaptive alterations occurring with conditioning exercise; in R.W. Rebar (Ed.) Exercise and Reproduction. Seminars in Reproductive Endocrinology 3: 27–33 (1985).Google Scholar
  28. Prior, J.C.; Cameron, K.; Ho Yuen, B. and Thomas, J.: Menstrual cycle changes with marathon training: anovulation and short luteal phase. Canadian Journal of Applied Sport Sciences 7: 173–177 (1982a).Google Scholar
  29. Prior, J.C.; Ho Yuen, B.; Clement, P.; Bowie, L. and Thomas, J.: Reversible luteal phase changes and infertility associated with marathon training. Lancet 1: 269–270 (1982b).CrossRefGoogle Scholar
  30. Prior, J.C.; Pride, S.; Vigna, Y. and Ho Yuen, B.: The marathon and reversible luteal phase shortening: A controlled prospective study. Medicine and Science in Sports and Exercise 15: 174 (1983).CrossRefGoogle Scholar
  31. Prior, J.C. and Vigna, Y.: Conditioning exercise decreases premenstrual symptoms — a controlled trial; in J. Puhl and H. Brown (Eds) The Menstrual Cycle and Physical Activity (Human Kinetics Publisher, Champaign 1985).Google Scholar
  32. Royal College of General Practitioners: Oral contraception study: Mortality among oral contraceptive users. Lancet 2: 727–730 (1977).Google Scholar
  33. Schwartz, B.; Cumming, D.C.; Riordan, E.; Selye, H.; Yen, S.S.C. and Rebar, R.W.: Exercise-associated amenorrhea: A distant entity? American Journal of Obstetrics and Gynecology 141: 662–670 (1981).PubMedGoogle Scholar
  34. Shangold, M.; Freeman, R.; Thysen, B. and Gatz, M.: The relationship between long-distance running, plasma progesterone, and luteal phase length. Fertility and Sterility 31: 130–133 (1979).PubMedGoogle Scholar
  35. Shangold, M.M. and Levine, H.S.: The effect of marathon training on menstrual function. American Journal of Obstetrics and Gynecology 143: 862–869 (1982).PubMedGoogle Scholar
  36. Sinning, W.E. and Wilson, J.R.: Validity of ‘generalized’ equations for body composition analysis in women athletes. Research Quarterly for Exercise and Sport 53: 153–160 (1984).Google Scholar
  37. Smith, E.L.: Exercise for prevention of osteoporosis: A review. Physician and Sportsmedicine 70: 72–83 (1982).Google Scholar
  38. Sturdee, D.W.; Wade-Evans, T.; Patterson, M.E.L.; Thom, M. and Studd, J.W.W.: Relations between bleeding pattern, endometrial histology and estrogen treatment in menopausal women. British Medical Journal 1: 1575–1577 (1978).PubMedCrossRefGoogle Scholar
  39. Vessey, M.P.; McPherson, R. and Johnson, B.: Mortality among women participating in the Oxford Family Planning Association Contraceptive Study. Lancet 2: 731–734 (1977).PubMedCrossRefGoogle Scholar
  40. Warren, M.P.: The effects of exercise on pubertal progression and reproductive function in girls. Journal of Clinical Endocrinology and Metabolism 51: 1150–1157 (1980).PubMedCrossRefGoogle Scholar
  41. Wilson, E.A.: Steroid contraception; in J.R. Givens (Ed.) Clinical Use of Sex Steroids, pp. 103–132 (Year Book Medical Publishers, Chicago 1979).Google Scholar
  42. Wirth, J.C. and Lohman, T.G.: The relationship of static muscle function to use of oral contraceptives. Medicine and Science in Sports and Exercise 14: 16–20 (1982).PubMedCrossRefGoogle Scholar

Copyright information

© ADIS Press Limited 1985

Authors and Affiliations

  • Jerilynn C. Prior
    • 1
  • Yvette Vigna
    • 1
  1. 1.Department of Medicine, Endocrinology and Metabolism, Vancouver General HospitalUniversity of British ColumbiaVancouverCanada

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