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Factors associated with menstrual dysfunction and self-reported bone stress injuries in female runners in the ultra- and half-marathons of the Two Oceans
  1. L K Micklesfield,
  2. J Hugo,
  3. C Johnson,
  4. T D Noakes,
  5. E V Lambert
  1. UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, UCT School of Health Sciences, University of Cape Town, South Africa
  1. Dr L Micklesfield, UCT/MRC Research Unit for Exercise Science and Sports Medicine, PO Box 115, Newlands, Cape Town, South Africa 7700; lisam{at}


Objective: To investigate factors associated with menstrual dysfunction, self-reported bone stress injuries and energy balance in women runners.

Methods: 613 runners were randomly sampled during the registration period for an endurance event. Demographic information, including self-reported height and weight, training and injury history and menstrual history, was collected by questionnaire.

Results: Ultra-marathon (ULTRA) participants (n = 276) were significantly older (mean (SD) 39 (8.2) vs 34 (10.5) years; p<0.001), lighter (58.2 (6.6) vs 59.6 (8.3) kg; p<0.05) and reported a higher training volume (p<0.001) than half-marathon (HALF) participants (n = 337). Significantly more ULTRA subjects than HALF subjects reported a previous bone stress injury (21% vs 14%; p<0.05). There was no difference between the groups for menstrual status, but age at menarche was later (p<0.01) in the ULTRA group. Data were combined according to the absence (REG; n = 368/602 (61%)) or presence (IRREG; n = 234/602 (39%)) of a history of menstrual irregularity. Subject morphology was similar between groups, but the IRREG group had a higher self-reported measure on the self-loathing subscale (SLSS; p<0.01). The whole group was then classified according to current menstrual status, with 165 women being classified as currently irregular. (OLIGO/AMEN; 11.6%) and 445 women as currently regular (EUMEN; 88.4%). There were no morphological differences between the groups, however the OLIGO/AMEN group had a later age of menarche (p<0.01) than the EUMEN group. Further, women who reported a previous bone stress injury had higher SLSS scores than those who did not (2.91 (0.98) vs 2.68 (0.84); p<0.05).

Conclusions: There may be two independent mechanisms associated with energy balance, which are related to bone stress injuries, but may not necessarily be related to menstrual dysfunction.

  • female
  • athlete
  • menstrual dysfunction
  • bone
  • energy balance

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  • Conflict of interest: None declared.

  • Abbreviations:
    bone mineral density
    body mass index
    presence of a history of menstrual irregularity
    absence of a history of menstrual irregularity
    self-loathing subscale