Menstrual Status and Pregnancy in Former Elite Long-Distance Runners With Menstrual Disorders

Abstract

Objective: To estimate the ratio of menstrual abnormalities, infertility, and other problems related to pregnancy and childbirth in former long-distance runners. We hypothesized that the female athlete triad during an athletic career affects future fertility and childbearing in former athletes. Design: Cross-sectional study. Setting: Participants of the All Japan University Women's Ekiden. Participants: Female former athletes who competed at national level were asked to complete the questionnaire; 137 valid responses were obtained. Independent Variables: Age at menarche and at the onset of pregnancy, history of amenorrhea and gynecological disorders, and lowest body mass index (BMI) during their athletic career. Main Outcome Measures: Menstrual status, history of pregnancy and childbirth, any related infertility treatment and problems, and history of stress fractures. Results: The mean age at menarche was 13.3 ± 2.2 (range, 10-25) years. Five athletes (3.6%) had primary amenorrhea. Eleven of the 137 participants (8.0%) required treatment for infertility. Sixty participants had 121 pregnancies, of which 5 were yet to deliver during the survey. Fifteen of 116 pregnancies (12.9%) ended in miscarriage, induced abortion, or stillbirth. Logistic regression analysis showed that the factors related to “infertility treatment” were age at the onset of pregnancy (P = 0.047) and higher BMI during their athletic career (P = 0.032; odds ratio, 2.19). Conclusions: The main factor influencing infertility was an older age at the time of pregnancy, similar to that observed in the general population. Amenorrhea or being underweight during their athletic career was not associated with problems related to conception and childbirth.