Aim To describe the rate of occurrence of subtle menstrual disturbances (MD) in female endurance athletes and the prevalence of MDs across different performance levels. Methods Forty-eight normally menstruating endurance athletes (mean age 26 (8) years) were classified based on their training and performance level: tier 2 (developmental, n=18), tier 3 (national, n=24), tier 4 (elite, n=6)1. Menstrual cycle (MC) status was monitored using the calendar-based counting method and an at-home urinary ovulation kit across 1 to 4 MCs. MCs were categorized as normal or as presenting with a MD, i.e., abnormal cycle length (<21 or >35 days), anovulatory, or luteal phase deficient (LPD, luteal phase <10 days) 2,3. Data were analyzed using logistic mixed model analysis. Results A total of 176 MCs were recorded during the study, of which 59.1% were normal, 20.5% were anovulatory, 11.9% were LPD and 8.5% had an abnormal cycle length. The prevalence of MDs was significantly higher in tier 3 compared to tier 2 (odds ratio=5.67, p=0.009), without significant differences between the other tiers. Practical applications Endurance athletes have an increased risk for presenting with subtle MDs 2, and increased train ing and performance level appears to result in a higher incidence of subtle MDs. As a normal MC is a vital sign of health, and the presence of MDs might have negative long-term consequences on performance, the support staff of national and elite athletes should monitor the MCs of their athletes closely to identify MDs.
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