Exercise-Induced Menstrual Disorders

Ellison, Peter T.; Lager, Catherine; Frisch, Rose E.; Albright, Tenley E.; Veldhuis, Johannes D.; Rogol, Alan D.; Metcalf, Mary G.; Bullen, Beverly A.; Skrinar, Gary S.; Beitins, Inese Z.; Mering, Gregory Von; Turnbull, Barry A.; McArthur, Janet W.

doi:10.1056/nejm198509263131314

Cited by 17 publications

(3 citation statements)

References 13 publications

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“…Furthermore, a 2002 questionnaire-based prospective cohort study, originally designed to examine the association between lifestyle (smoking/exercise) and diet with breast cancer and other major diseases, found that each hour of vigorous activity undertaken per week was associated with a 7% lower relative risk of ovulatory infertility (5% on adjustment of BMI) ( Rich-Edwards et al 2002 ). This is in contrast to other studies examining ovulatory infertility and exercise ( Bullen et al 1985 , Ellison & Lager 1985 , De Souza et al 1998 ) and should perhaps be interpreted with caution as the outcomes do not relate to the original question asked within the study.…”

Section: Discussionmentioning

confidence: 59%

“…Evidence is available from large prospective observational studies informing that vigorous PA could be detrimental to fecundability in a population of women, with a normal BMI, not seeking fertility treatment ( Wise et al 2012 , McKinnon et al 2016 ), and change in menstrual cycle is also seen in women participating in vigorous exercise ( Bullen et al 1985 , Ellison & Lager 1985 , De Souza et al 1998 ). Despite this, there is a lack of robust evidence and guidelines relating to women seeking fertility treatment to advise on how best to incorporate PA into their daily routine.…”

Section: Discussionmentioning

confidence: 99%

“…A study looking at sedentary behaviour and idiopathic infertility showed that sedentary behaviour (OR: 3.61; 95% CI, 1.58, 8.24) was shown to be associated with infertility, but PA was not associated with fertility ( Foucaut et al 2019 ). Conversely, evidence is also available demonstrating that high-intensity exercise is detrimental to fertility, causing a decreased length of the luteal phase, anovulatory cycles, and eventually, amenorrhoea ( Bullen et al 1985 , Ellison & Lager 1985 , Green et al 1986 , De Souza et al 1998 , Hakimi & Cameron 2017 , Huhmann 2020 , Sophie Gibson et al 2020 ). A large population-based health survey reported that increased frequency, duration, and intensity of PA were associated with increased subfertility.…”

Section: Discussionmentioning

confidence: 99%

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Habitual physical activity levels in women attending the one-stop infertility clinic: a prospective cross-sectional observational study

Tempest

France-Ratcliffe

Al-Lamee

et al. 2022

Reproduction and Fertility

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Optimisation of lifestyle factors such as smoking and alcohol are encouraged to improve fecundability rates in the fertility setting. Currently, routine fertility consultations do not involve counselling or imparting advice regarding habitual physical activity (PA) and/or structured exercise, despite data showing that vigorous PA can be associated with delayed time to pregnancy. Therefore, this study aimed to determine habitual PA in a sample of women attending the one stop infertility (OSI) clinic. 250 women attending a large tertiary level NHS fertility unit prospectively anonymously completed a questionnaire over a period of 9 months. Participant’s (mean age 34±5years, mean BMI 29±7kg/m2) habitual PA levels varied from vigorous exercise on ≥5 days/week (8%, n=17), to no moderate or high intensity activities across the whole week (66%, n=29). The majority of women reported no structured exercise (72%, n=179). No association was identified between any domain of PA and BMI, age, alcohol units, regular periods, or time spent trying to conceive (P > 0.05). Participant’s habitual PA levels varied widely and no association between any domain of PA and background of the women was identified. No existing evidence and/or guidelines to explicitly inform women attempting to conceive regarding recommended PA levels are available, despite PA being a modifiable, affordable, and feasible lifestyle choice with the possible potential to improve fertility. A large-scale, clinical trial assessing effects of PA on fecundability is warranted to gain insights into the potential of this lifestyle factor to improve fertility outcomes and to explore the underlying biological mechanisms involved.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Habitual physical activity levels in women attending the one-stop infertility clinic: a prospective cross-sectional observational study

Tempest

France-Ratcliffe

Al-Lamee

et al. 2022

Reproduction and Fertility

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Demography Part 2: Population Growth and Fertility Regulation

Ellison

Bogin

O'Rourke³

2012

Human Biology

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Effect of moderate weight loss on ovarian function assessed by salivary progesterone measurements

Lager

Ellison

1990

American J Hum Biol

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The effects of moderate, voluntary weight loss on ovarian function are studied by monitoring the daily levels of salivary progesterone in 8 dieting women (18 cycles) and 9 age-matched controls (19 cycles). Both groups of women were within normal standards of weight for height, though the dieters were significantly heavier than the controls. Dieters lost weight at an average rate of 1.9 ± 0.3 kg/mo during the study. Dieters' cycles during periods of weight loss (weight loss cycles) have significantly lower peak levels of luteal progesterone (controls 655 ± 46 pmol/L, weight loss 461 ± 67 pmol/L; P < 0.005) and lower average levels of luteal progesterone (controls 287 ± 30 pmol/L, weight loss 214 ± 23 pmol/L; P < 0.005) than do controls. All control cycles were classified as ovulatory by virtue of at least one salivary progesterone reading ≥ 300 pmol/L. Only 62% of the weight loss cycles were classified as ovulatory by this criterion. Where longitudinal weight data are available both the magnitude and duration of progesterone elevation correlates significantly with net weight change during the preceding cycle and show no significant correlation with net weight change during the current cycle. Examination of individual profiles confirms that the most profound suppression of luteal activity usually occurs during post-loss rather than weight loss cycles, even if weight is stable or increasing during the post-loss cycle itself. These results, together with field studies of African horticultural populations, suggest that human ovarian function may be adapted to modulate waiting time to conception in response to trends in energetic balance.

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Exercise-Induced Menstrual Disorders

Cited by 17 publications

References 13 publications

Habitual physical activity levels in women attending the one-stop infertility clinic: a prospective cross-sectional observational study

Habitual physical activity levels in women attending the one-stop infertility clinic: a prospective cross-sectional observational study

Demography Part 2: Population Growth and Fertility Regulation

Effect of moderate weight loss on ovarian function assessed by salivary progesterone measurements

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