Sport consequences in female fertility

Many women in reproductive age do some kind of exercise.

In most cases, this is beneficial:

increased physical endurance,
body weight control,
bone mass increase and
reduced cardiovascular risk.

However, in some cases excessive exercise can lead to infertility due to luteal insufficiency or in severe cases amenorrhoea (absence of menstrual cycles).

Índice

1 Kind of exercise and its effect on fertility
2 Relative caloric deficiency
3 Excessive exercise consequences
- 3.1 Amenorrhoea
- 3.2 Luteal failure
4 Treatment
- 4.1 Infertility
- 4.2 Luteal Insuficiency

Kind of exercise and its effect on fertility

The likelihood of missing menstrual cycles depends on the type and amount and the rate of increase in exercise. Sports activities which are often associated with low body weight (e.g. ballet) and sports in which scoring is subjective (e.g. figure skating or rhythmic gymnastics) are associated with a higher incidence of amenorrhoea than other sports activities.

Gradual increase in exercise is less associated with amenorrhoea than more rapid increases. Such as that performed quickly and intensively by women when training for a competition.

Relative caloric deficiency

In many cases, fertility problems or amenorrhoea are attributed to low body weight, but low body weight alone is not enough to explain the absence of periods because women with similar Body Mass Index (BMI) have different patterns of menstrual cycles in response to exercise. It appears that the absence of periods occurs only when there’s also a relative calorie deficiency due to an inadequate or insufficient intake for the amount of energy consumed in exercise.

Excessive exercise consequences

Amenorrhoea

In the most severe cases, sportswomen lose their menstrual cycles and do not become pregnant due to lack of ovulation.

Luteal failure

Many sportswomen maintain their menstrual cycles and ovulatory capacity, but show a decrease in progesterone secretion during the second phase of the menstrual cycle. This is important because fertility can be compromised by this deficiency of progesterone, which is the hormone responsible for good embryo implantation. Thus, we can find sportswomen with implantation failures or early miscarriages.

Treatment

If we think that the cause of the absence of menstrual cycles and/or infertility is due to excessive exercise, the importance of an adequate nutritional intake in terms of calories, in accordance with the caloric expenditure involved in her sporting activity should be explained. In general, the caloric intake of the diet should be increased and physical exercise should be reduced. If the weight is low, a minimal but necessary weight gain should also be recommended. This approach is healthier than simply introducing hormonal treatment, which masks the real underlying problem.

Infertility

We can always effectively induce ovulation with drugs. However, this would not be the first-line recommendation; increasing caloric intake is highly effective and “healthier”. If a woman does not eat enough to have normal menstrual cycles and fertility, her nutrient intake during a pregnancy obtained with pharmacological ovulation induction is likely to be inadequate for normal foetal growth and development. In addition, the possibility of miscarriage is common. Ovulation induction treatment should be considered when a minimum healthy weight has been achieved and above all when we are sure of a good caloric intake throughout gestation.

Luteal Insuficiency

If the athletic woman presents only luteal insufficiency, the best way to treat it will be to increase caloric intake and/or decrease exercise, and if the weight is correct, we can treat it with progesterone.

Dr Pino Navarro, Endocrinology and Nutrition director of Instituto Bernabeu

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