ReviewSports medicine (Auckland, N.Z.)2024
Beyond Menstrual Dysfunction: Does Altered Endocrine Function Caused by Problematic Low Energy Availability Impair Health and Sports Performance in Female Athletes?
Review in Sports medicine (Auckland, N.Z.), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Resting metabolic rate fluctuations across the menstrual cycle: a systematic review.Frontiers in physiology · 2026Pooled it
- Menstrual Cycle-Related Symptoms and Disorders and Their Impact on Physical, Psychosocial, and Environmental Determinants of Exercise Performance: A Scoping Review.Sports medicine (Auckland, N.Z.) · 2026Article
- Risk of Menstrual Dysfunction, Low Energy Availability, Eating Disorders and Injury in the First All-Female UK Military Team Rowing 3000 Miles Across the Atlantic.Sports (Basel, Switzerland) · 2026Article
- Menstrual status and bone health in athletes from different sports - a retrospective analysis.BMC sports science, medicine & rehabilitation · 2026Article
- Fueling Women's Football: Evidence-Informed Practical Nutrition Strategies for Performance and Health.Sports medicine (Auckland, N.Z.) · 2026Review
- Monitoring Menstrual Health in Footballers: Considerations for Tracking Menstrual and Hormonal Contraceptive Cycles in the Field to Support Performance.Sports medicine (Auckland, N.Z.) · 2026Review
- Sex-Specific Responses to Intermittent Fasting: A Narrative Review Across Physiological, Clinical, and Psychosocial Contexts.Nutrients · 2026Review
- An Overarching Conceptual Framework for Menstrual Health in Sport Research: Theory, Causality and Validation.Sports medicine (Auckland, N.Z.) · 2026Review
- Role of Lifestyle and Nutrition in Menstrual Cycle Regularity: Associations with Body Composition and Dietary Habits.Journal of clinical medicine · 2026Article
- An Overview of the Impact of the Menstrual Cycle on Nutrient Metabolism: An Integrative Perspective.Nutrients · 2026Review
- Elite and Sub-elite Athletes and Pregnancy: Training, Performance, Health and Psychological Aspects Across the Pre-, Peri-, and Postnatal Stages: A Scoping Review.Sports medicine - open · 2026Review
- The Immune System as a Biosensor of Health and Athletic Performance.Scandinavian journal of medicine & science in sports · 2026Review
- Rethinking Energy Availability from Conceptual Models to Applied Practice: A Narrative Review.Nutrients · 2026Review
- Menstrual Health in Servicewomen: The Menstrual Cycle, Menstrual Disturbances, and Occupational Consequences.Sports medicine - open · 2026Review
- The interplay between sexual activity, athletic performance, and recovery in athletes: a narrative review.Frontiers in physiology · 2026Review
- Associations of academic performance, sports participation, disordered eating and menstrual cycle irregularities in adolescents: a population-based study.BMJ open sport & exercise medicine · 2026Article
- Endocrine markers of energy deficiency and within-day energy balance metrics in elite athletes.Frontiers in sports and active living · 2026Article
- Low energy availability, the gut microbiome, and bone health in athletes: a mechanistic narrative review based on athlete evidence and clinical analogues.Frontiers in nutrition · 2026Review
- Hormone Profiles After Planned Low Energy Availability Exposure in Naturally Menstruating and Hormonal Contraceptive Using Physique Athletes.European journal of sport science · 2025Observational
- The harder the prep, the harder the recovery: a qualitative exploration of physique athlete perspectives on competition weight loss and restoration.Journal of the International Society of Sports Nutrition · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Low energy availability, particularly when problematic (i.e., prolonged and/or severe), has numerous negative consequences for health and sports performance as characterized in relative energy deficiency in sport. These consequences may be driven by disturbances in endocrine function, although scientific evidence clearly linking endocrine dysfunction to decreased sports performance and blunted or diminished training adaptations is limited. We describe how low energy availability-induced changes in sex hormones manifest as menstrual dysfunction and accompanying hormonal dysfunction in other endocrine axes that lead to adverse health outcomes, including negative bone health, impaired metabolic activity, undesired outcomes for body composition, altered immune response, problematic cardiovascular outcomes, iron deficiency, as well as impaired endurance performance and force production, all of which ultimately may influence athlete health and performance. Where identifiable menstrual dysfunction indicates hypothalamic-pituitary-ovarian axis dysfunction, concomitant disturbances in other hormonal axes and their impact on the athlete's health and sports performance must be recognized as well. Given that the margin between podium positions and "losing" in competitive sports can be very small, several important questions regarding low energy availability, endocrinology, and the mechanisms behind impaired training adaptations and sports performance have yet to be explored.
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Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.