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Sports Med Arthrosc Rehabil Ther Technol. 2009 Jul 30;1(1):16. doi: 10.1186/1758-2555-1-16.

The relation between athletic sports and prevalence of amenorrhea and oligomenorrhea in Iranian female athletes.

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Sport Medicine Department of Iran Medical University. Rassole Akram Hospital., Iran University, Tehran, Iran.
Orthopaedic and Sport Medicine Department of Iran Medical University. Rassole Akram Hospital., Iran University, Tehran, Iran.
Gynaecologic and Obstetrics Department of Tehran Medical University. Shariati Hospital. Tehran University, Tehran, Iran.
Sport Medicine Federation, Islamic Republic of Iran. Tehran. Iran.
Rheumatology Research Center, Shariati Hospital, Tehran University, Tehran, Iran.
Contributed equally



In 1992, the concept of female athlete triad was introduced to describe the interrelated problems of amenorrhea, eating disorders and osteoporosis seen in female athletes. To gain a clearer picture of amenorrhea/oligomenorrhea in Iran, one of the main components of the female athlete triad, we therefore established this study on the prevalence of amenorrhea/oligomenorrhea in elite Iranian female athletes, also evaluating the risk factors of these disorders in the same population.


This study performed as a cross-sectional study. All elite Iranian female athletes of 34 sports federation, including female athletes in national teams and medalists of Tehran were invited to participate. A total of 788 (95% response rate) returned the questionnaires and were examined. Younger athletes under the age of menarche were excluded. Each athlete completed a self-administered questionnaire, which covered the following questions about participant's demographic information, athletic history, history of injuries and menstrual pattern. In order to diagnose the causes of amenorrhea/Oligomenorrhea including polycystic ovary syndrome(PCOS), participants with amenorrhea/Oligomenorrhea underwent further investigation. They were evaluated by following Para clinic investigation, and an ultrasonographic study of ovary.


The age ranged from 13-37 (mean = 21.1, SD = 4.5). Seventy one (9.0%) individuals had amenorrhea/oligomenorrhea, among those, 11 (15.5%) had PCOS.There was also a positive association between amenorrhea/oligomenorrhea and the following: age under 20 OR; 2.67, 95%CI(1.47 - 4.85), weight class sports OR; 2.09, 95%CI(1.15 - 3.82), endurance sports OR; 2.89, 95%CI(1.22 - 6.84), late onset of menarche OR; 3.32 95%CI(1.04-10.51), and use of oral contraceptive pills OR; 6.17, 95%CI(3.00 - 12.69). Intensity of training sport or BMI were not risk factors.


These findings support the previous findings in the literature that the prevalence of amenorrhea/oligomenorrhea is high in athletes. Furthermore, we provided the first report on the prevalence of PCOS in female athletes with amenorrhea/oligomenorrhea. Athletes would be greatly benefited by greater general awareness about the complications of amenorrhea/oligomenorrhea.To increase awareness of exercise-associated menstrual cycle irregularities, it is necessary to design complete and comprehensive education programs for female athletes, their parents, their coaches, and the relevant authorities.

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