Exercise-induced menstrual cycle changes. A functional, temporary adaptation to metabolic stress

Abstract

Chronic exercise is now known to alter the menstrual cycle. Yet, we do not yet know the true incidence of menstrual cycle alterations in athletes, because good normative data do not exist and the metabolic cost of training has not been considered in many studies. Secondary amenorrhoea is not easily induced by exercise training alone but seems to require additional metabolic stressors. Induction of secondary amenorrhoea in prospective exercise studies has not occurred, although the onset of short luteal or inadequate luteal phase cycles may occur in women even when running distances are not extensive. Such menstrual cycles may cause infertility, but this is only a temporary phenomenon since pregnancy, if desired, will usually occur upon cessation of training. Exercise-related changes in the menstrual cycle can be viewed as a functionally adaptive rather than a maladaptive dysfunction. A strong case can be made that the changes in the menstrual cycle as a result of exercise are an energy conserving strategy to protect more important biological processes. This hypothesis is consistent with the theory of metabolic arrest that has been identified in lower organisms and hibernating mammals.