Background A healthy menstrual cycle affects the athletic performance in training and competition. However, the prevalence of menstrual cycle disorders among elite athletes is unclear.

Objective To assess the prevalence of menstrual disorders among German female elite athletes in 2019 and 2020.

Design Retrospective cohort study.

Setting German female youth and adult elite athletes.

Participants 532 female elite athletes (19.5 ± 5.0 years; 170.0 ± 7,3 cm; 62.1 ± 11.4 kg) were included in this study. All athletes were members of the German funding for high performance sports.

Assessment of Risk Factors Menstrual disorder, sport discipline, age, BMI, body fat, training volume.

Main Outcome Measurements All athletes completed a baseline gynaecological survey. The independent samples t-test and ANOVA were used for statistical analysis (p<.05).

Results 118 of all 532 of the female athletes (22.2%) had an irregular menstrual cycle. The most prevalent menstrual disorders are oligomenorrhea (41.9%), secondary amenorrhea (25.0%), primary amenorrhea (11.3%), dysmenorrhea (4.0%), metrorrhagia (2.4%), hypermenorrhea (1.6%), polymenorrhea (0.8%) and others (12.9%). There is a significant difference in the prevalence of menstrual disorders among sport disciplines (p=.000, f=.214). The highest prevalence of menstrual disorders occurs among endurance sport athletes (30.9%). Athletes with menstrual disorders have a significantly lower BMI (p=.014, d=.258) and lower percent body fat (p=.000, d=.392) compared to athletes with normal menstrual cycles. There is no significant difference in age (p=.101, d=.172) and training volume (p=.100, d=.172) between the groups.

Conclusions Our research showed a high prevalence of menstrual disorders among German female elite athletes. The results suggest that especially athletes with low BMI and low percent body fat are at a high risk for menstrual disorders. Further research is required to investigate the effects of menstrual disorders on athletic performance and long-term health.