Sports gynaecology

Abstract

While the physiological, psychosocial and obstetric health benefits of exercise are well established, there is less awareness of the health implications of long-term intense exercise. Relative Energy Deficiency in Sport (RED-S) represents a complex inter-relationship of health consequences that arise as a result of low energy availability. The common presentations of elite sportswomen to gynaecologists include menstrual abnormalities, delayed menarche, subfertility and urinary incontinence. Gynaecology input, including screening, recognition and management, can minimise the risk of consequences and optimise health, fertility and performance. Learning objectivesTo understand the short-term and long-term impacts of elite sport on gynaecological health.To describe the gynaecologist's role in the screening, investigation and management of elite sportswomen. Ethical issuesElite sportswomen should be fully informed about the potential health implications of long-term vigorous exercise to enable autonomous decision making. While it is the role of the coach to optimise performance, it is the physician's responsibility to prioritise the health of sportswomen, even if this is at the expense of performance level, ability to train or competition rules. To reach an elite level, training is often necessary from childhood; however, many girls will not have capacity, and the health consequences of RED-S can cause them irreversible problems.

Menstrual cycles and the impact upon performance in elite British track and field athletes: a longitudinal study

“…The physiological mechanisms controlling menstruation, with different levels of oestrogen and progesterone throughout the cycle, have previously been described by this group ( 4 ). Importantly, there is a growing body of evidence demonstrating menstrual cycle disorders in competitive female athletes ( 4 , 5 ).…”

Sports Obstetrics: Implications of Pregnancy in Elite Sportswomen, a Narrative Review

“…Around 15–30% of women experience urinary incontinence (UI) in the first year postpartum, irrespective of MOD [ 65 ]. Female athletes have a theoretically increased risk of UI, anal incontinence (AI), and pelvic organ prolapse because of large increases in intra-abdominal pressure during strength training, which causes additional strain on pelvic floor musculature [ 13 , 66 , 67 ]. However, a study on elite athletes ( n = 40) did not find any significant difference in AI or UI prevalence compared to controls, both during pregnancy and at 6 weeks postpartum [ 42 ].…”

“…Another important consideration is the risk of pelvic organ prolapse, particularly in those participating in high-impact sports such as Cross-Fit, weightlifting, and running, especially as prolapse symptoms can be a deterrent to returning to training postpartum [ 68 , 69 ]. Whilst there is limited evidence on the impact of pregnancy on pelvic floor dysfunction and UI, given the increased prevalence of UI in athletes out-with pregnancy, most notably in higher impact sports [ 66 , 67 , 68 , 69 ], they remain a high-risk group, and as such warrant pro-active screening and pelvic floor exercise advice from a women’s health physiotherapist.…”

“… Guidance for obstetricians managing athletes during the preconception, antenatal and postnatal periods: ANC; antenatal care, BP; blood pressure CI; contraindication, FBC; full blood count, Fe; iron, GWG; gestational weight gain, hrs/wk; hours per week, MOD; mode of delivery; PND; postnatal depression, RED-S; relative energy deficiency in sport, RTT; return to training; USS; ultrasound scan, VO2 max; maximum oxygen consumption [ 11 , 13 , 65 , 66 , 83 ]. a Booking bloods; FBC, Group and save, Syphilis, Hepatitis B, HIV, urea & electrolytes, glucose, iron studies, B12, folate b Combined screening; Nuchal Translucency (NT)/Pregnancy Associated Plasma Protein A (PAPP-A)/hCG c Warning symptoms [ 42 ] : Vaginal bleeding, regular painful contractions, leakage of amniotic fluid, dyspnoea before exercise, pre-syncopal symptoms or syncope, headache, chest pain, muscle weakness, calf pain/swelling.…”

How to balance the treatment of stress urinary incontinence among female athletes?

“…In dysfunction the bladder neck descends or does not move, and this could be enhanced by intra-abdominal pressure [ 25 , 26 ]. The caudal vector of the PFM excludes the proper closure of the urethra and is more frequently seen in athletes [ 27 , 28 ]. Interestingly, submaximal contraction of the TrA and PFM enables the elevation of the bladder neck, but additional activation of internal oblique muscles makes it impossible [ 24 ].…”