Key Points There is insufficient scientific evidence in the sports science literature to directly link endocrine dysfunction (e.g., menstrual dysfunction) to decreased performance and blunted or decreased training adaptations. We can, however, derive the possible mechanistic links between low energy availability-induced hormonal dysfunction and negative health and sports performance outcomes in female athletes from established physiology. Monitoring/tracking menstrual bleeding, ovulation (luteinizing hormone surge), and/or peak progesterone during the luteal phase may help to identify menstrual dysfunction associated with low energy availability (e.g., anovulation, luteal phase defect) before more severe menstrual dysfunction (amenorrhea) or marked health or performance decrements occur. The endocrine consequences of low energy availability may negatively impact optimal training, recovery, and performance before or after menstrual dysfunction is evident. Concomitant disturbances in other hormonal axes and their impact on an athlete`s health and sports performance must be recognized.
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