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International Journal of Adolescent Medicine and Health

Editor-in-Chief: Merrick, Joav

Editorial Board: Birch, Diana ML / Blum, Robert W. / Greydanus, MD, Dr. HC (Athens), Donald E. / Hardoff, Daniel / Kerr, Mike / Levy, Howard B / Morad, Mohammed / Omar, Hatim A. / de Paul, Joaquin / Rydelius, Per-Anders / Shek, Daniel T.L. / Sher, Leo / Silber, Tomas J. / Towns, Susan / Urkin, Jacob / Verhofstadt-Deneve, Leni / Zeltzer, Lonnie / Tenenbaum, Ariel

CiteScore 2018: 0.79

SCImago Journal Rank (SJR) 2018: 0.350
Source Normalized Impact per Paper (SNIP) 2018: 0.476

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Menstrual irregularity and use of oral contraceptives in female adolescent athletes in Swedish National Sports High Schools

Philip von Rosen
  • Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Annette Heijne
  • Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Anna Frohm
  • Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
  • Swedish Sports Confederation Center, Bosön Sports Clinic, Lidingö, Sweden
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Cecilia Fridén
  • Corresponding author
  • Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, 23100, Karolinska Institutet, 141 86 Huddinge, Sweden, Phone: +46707415122
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-11-23 | DOI: https://doi.org/10.1515/ijamh-2017-0113



Female adolescent athletes seem to use oral contraceptives (OCs) in the same proportion as the general population. In athletes not using OCs, menstrual irregularity (MI) is reported to be common but there are few studies of MI in adolescent athletes. The aim of the study was to survey menarche, menstrual irregularity and use of OCs in adolescent athletes in the National Sports High Schools in Sweden. A further aim was to study the associations between current sport injury and menstrual irregularity as well as use of OCs.


Two hundred and ninety-eight female adolescent athletes at Swedish National Sports High Schools.


A web-based questionnaire containing questions related to menstrual status, contraception and current injury.


One third (32.6%) of the athletes used OCs and of the remaining athletes 31.8% had MI. The group of athletes with MI had a significantly (p = 0.038; Cohen’s d, 0.32) lower BMI and consisted of a significantly (p = 0.043) higher proportion of endurance athletes. OC users were less likely to participate in endurance sports compared to non-OC users (p = 0.024). Current injury was equally distributed in the OC and the non-OC group but athletes with MI had fewer sports injuries compared to eumenorrheic women.


OCs are frequently used among athletes at Swedish National Sports High Schools. OC users were less likely to participate in endurance sports compared to non-OC users. MI was common and athletes with MI had lower BMI compared to eumenorrheic athletes. Sports injuries were not associated with use of OC and eumenorrheic athletes had a higher proportion of current injury.

Keywords: female athlete triad; menstrual dysfunction; physical activity; sports injury


  • [1]

    Talma H, Schönbeck Y, van Dommelen P, Bakker B, van Buuren S, Hirasing RA. Trends in menarcheal age between 1955 and 2009 in the Netherlands. PLoS One. 2013;8(4):e60056.Web of ScienceCrossrefPubMedGoogle Scholar

  • [2]

    Cabanes A, Ascunce N, Vidal E, Ederra M, Barcos A, Erdozain N, et al. Decline in age at menarche among Spanish women born from 1925 to 1962. BMC Public Health. 2009;9:449.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [3]

    Wiksten-Almströmer M, Hirschberg AL, Hagenfeldt K. Menstrual disorders and associated factors among adolescent girls visiting a youth clinic. Acta Obstet Gynecol Scand. 2007;86(1):65–72.CrossrefWeb of SciencePubMedGoogle Scholar

  • [4]

    World Health Organization Task Force on Adolescent Reproductive Health. World Health Organization multicenter study on menstrual and ovulatory patterns in adolescent girls. II. Longitudinal study of menstrual patterns in the early postmenarcheal period, duration of bleeding episodes and menstrual cycles. J Adolesc Health Care. 1986;7(4):236–44.PubMedGoogle Scholar

  • [5]

    Greydanus DE, Omar H, Pratt HD. The adolescent female athlete: current concepts and conundrums. Pediatr Clin North Am. 2010;57(3):697–718.CrossrefWeb of SciencePubMedGoogle Scholar

  • [6]

    Medicine PCoASfR. Current evaluation of amenorrhea. Fertil Steril. 2008;90(5 Suppl):S219–25.Web of SciencePubMedGoogle Scholar

  • [7]

    Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP, et al. American College of Sports Medicine position stand. The female athlete triad. Med Sci Sports Exerc. 2007;39(10):1867–82.PubMedGoogle Scholar

  • [8]

    Dusek T. Influence of high intensity training on menstrual cycle disorders in athletes. Croat Med J. 2001;42(1):79–82.PubMedGoogle Scholar

  • [9]

    Maïmoun L, Georgopoulos NA, Sultan C. Endocrine disorders in adolescent and young female athletes: impact on growth, menstrual cycles, and bone mass acquisition. J Clin Endocrinol Metab. 2014;99(11):4037–50.CrossrefWeb of ScienceGoogle Scholar

  • [10]

    Gavela-Pérez T, Garcés C, Navarro-Sánchez P, López Villanueva L, Soriano-Guillén L. Earlier menarcheal age in Spanish girls is related with an increase in body mass index between pre-pubertal school age and adolescence. Pediatr Obes. 2015;10(6):410–5.Web of ScienceCrossrefPubMedGoogle Scholar

  • [11]

    Gavela-Pérez T, Navarro P, Soriano-Guillén L, Garcés C. High prepubertal leptin levels are associated with earlier menarcheal age. J Adolesc Health. 2016;59(2):177–81.Web of SciencePubMedCrossrefGoogle Scholar

  • [12]

    Georgopoulos NA, Markou KB, Theodoropoulou A, Vagenakis GA, Mylonas P, Vagenakis AG. Growth, pubertal development, skeletal maturation and bone mass acquisition in athletes. Hormones (Athens). 2004;3(4):233–43.PubMedCrossrefGoogle Scholar

  • [13]

    Valentino R, Savastano S, Tommaselli AP, D’Amore G, Dorato M, Lombardi G. The influence of intense ballet training on trabecular bone mass, hormone status, and gonadotropin structure in young women. J Clin Endocrinol Metab. 2001;86(10):4674–8.CrossrefPubMedGoogle Scholar

  • [14]

    Hoch AZ, Pajewski NM, Moraski L, Carrera GF, Wilson CR, Hoffmann RG, et al. Prevalence of the female athlete triad in high school athletes and sedentary students. Clin J Sport Med. 2009;19(5):421–8.CrossrefWeb of SciencePubMedGoogle Scholar

  • [15]

    Nichols JF, Rauh MJ, Lawson MJ, Ji M, Barkai HS. Prevalence of the female athlete triad syndrome among high school athletes. Arch Pediatr Adolesc Med. 2006;160(2):137–42.PubMedCrossrefGoogle Scholar

  • [16]

    Nichols JF, Rauh MJ, Barrack MT, Barkai HS, Pernick Y. Disordered eating and menstrual irregularity in high school athletes in lean-build and nonlean-build sports. Int J Sport Nutr Exerc Metab. 2007;17(4):364–77.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [17]

    Thein-Nissenbaum JM, Rauh MJ, Carr KE, Loud KJ, McGuine TA. Associations between disordered eating, menstrual dysfunction, and musculoskeletal injury among high school athletes. J Orthop Sports Phys Ther. 2011;41(2):60–9.CrossrefWeb of SciencePubMedGoogle Scholar

  • [18]

    Thein-Nissenbaum JM, Rauh MJ, Carr KE, Loud KJ, McGuine TA. Menstrual irregularity and musculoskeletal injury in female high school athletes. J Athl Train. 2012;47(1):74–82.PubMedCrossrefGoogle Scholar

  • [19]

    Austin TM, Reinking MF, Hayes AM. Menstrual function in female high school cross-country athletes. Int J Adolesc Med Health. 2009;21(4):555–65.PubMedGoogle Scholar

  • [20]

    Thein-Nissenbaum JM, Carr KE, Hetzel S, Dennison E. Disordered eating, menstrual irregularity, and musculoskeletal injury in high school athletes: a comparison of oral contraceptive pill users and nonusers. Sports Health. 2014;6(4):313–20.CrossrefPubMedGoogle Scholar

  • [21]

    Larsson M, Aneblom G, Odlind V, Tydén T. Reasons for pregnancy termination, contraceptive habits and contraceptive failure among Swedish women requesting an early pregnancy termination. Acta Obstet Gynecol Scand. 2002;81(1):64–71.PubMedCrossrefGoogle Scholar

  • [22]

    Emans SJ, Grace E, Woods ER, Smith DE, Klein K, Merola J. Adolescents’ compliance with the use of oral contraceptives. J Am Med Assoc. 1987;257(24):3377–81.CrossrefGoogle Scholar

  • [23]

    Rechichi C, Dawson B, Goodman C. Athletic performance and the oral contraceptive. Int J Sports Physiol Perform. 2009;4(2):151–62.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [24]

    Hagmar M, Berglund B, Brismar K, Hirschberg AL. Hyperandrogenism may explain reproductive dysfunction in olympic athletes. Med Sci Sports Exerc. 2009;41(6):1241–8.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [25]

    Constantini NW, Dubnov G, Lebrun CM. The menstrual cycle and sport performance. Clin Sports Med. 2005;24(2):e51–82, xiii–xiv.CrossrefGoogle Scholar

  • [26]

    Bennell K, White S, Crossley K. The oral contraceptive pill: a revolution for sportswomen? Br J Sports Med. 1999;33(4):231–8.CrossrefPubMedGoogle Scholar

  • [27]

    Warren MP, Goodman LR. Exercise-induced endocrine pathologies. J Endocrinol Invest. 2003;26(9):873–8.PubMedCrossrefGoogle Scholar

  • [28]

    von Rosen P, Frohm A, Kottorp A, Fridén C, Heijne A. Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes. Scand J Med Sci Sports. 2016. DOI: .CrossrefPubMedWeb of ScienceGoogle Scholar

  • [29]

    Clarsen B, Myklebust G, Bahr R. Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology: the Oslo Sports Trauma Research Centre (OSTRC) overuse injury questionnaire. Br J Sports Med. 2013;47(8):495–502.Web of ScienceCrossrefPubMedGoogle Scholar

  • [30]

    Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, et al. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Clin J Sport Med. 2006;16(2):97–106.CrossrefPubMedGoogle Scholar

  • [31]

    Cohen J. Statisstical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum; 1988.Google Scholar

  • [32]

    Thein-Nissenbaum J. Long term consequences of the female athlete triad. Maturitas. 2013;75(2):107–12.Web of ScienceCrossrefPubMedGoogle Scholar

  • [33]

    Warren MP, Perlroth NE. The effects of intense exercise on the female reproductive system. J Endocrinol. 2001;170(1):3–11.PubMedCrossrefGoogle Scholar

  • [34]

    Rickenlund A, Carlström K, Ekblom B, Brismar TB, Von Schoultz B, Hirschberg AL. Effects of oral contraceptives on body composition and physical performance in female athletes. J Clin Endocrinol Metab. 2004;89(9):4364–70.CrossrefPubMedGoogle Scholar

  • [35]

    Möller-Nielsen J, Hammar M. Women’s soccer injuries in relation to the menstrual cycle and oral contraceptive use. Med Sci Sports Exerc. 1989;21(2):126–9.PubMedGoogle Scholar

  • [36]

    De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, et al. 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad: 1st International Conference held in San Francisco, CA, May 2012, and 2nd International Conference held in Indianapolis, IN, May 2013. Clin J Sport Med. 2014;24(2):96–119.Web of ScienceGoogle Scholar

  • [37]

    Miller SM, Kukuljan S, Turner AI, van der Pligt P, Ducher G. Energy deficiency, menstrual disturbances, and low bone mass: what do exercising Australian women know about the female athlete triad? Int J Sport Nutr Exerc Metab. 2012;22(2):131–8.CrossrefWeb of SciencePubMedGoogle Scholar

  • [38]

    Troy K, Hoch AZ, Stavrakos JE. Awareness and comfort in treating the Female Athlete Triad: are we failing our athletes? WMJ. 2006;105(7):21–4.PubMedGoogle Scholar

  • [39]

    Javed A, Tebben PJ, Fischer PR, Lteif AN. Female athlete triad and its components: toward improved screening and management. Mayo Clin Proc. 2013;88(9):996–1009.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [40]

    House S, Loud K, Shubkin C. Female athlete triad for the primary care pediatrician. Curr Opin Pediatr. 2013;25(6):755–61.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [41]

    De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, et al. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. Br J Sports Med. 2014;48(4):289.Web of ScienceGoogle Scholar

About the article

Received: 2017-06-30

Accepted: 2017-09-08

Published Online: 2017-11-23

Citation Information: International Journal of Adolescent Medicine and Health, 20170113, ISSN (Online) 2191-0278, DOI: https://doi.org/10.1515/ijamh-2017-0113.

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