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Reproductive Disorders among Female Athletes: Causes, Pathomechanism, and Treatment Approaches – A Literature Review

Anastasiya Aleshchyk, Michał Adamczak, Marcel Majewski, Bogumił Libura, Martyna Lazar, Łukasz Szkaradowski et al. · Quality in Sport · 2026

This narrative review pulled together research and expert guidelines on reproductive problems in female athletes, from the older Female Athlete Triad idea to the broader RED-S (Relative Energy Deficiency in Sport) framework. It concludes that low energy availability is the main trigger, suppressing the hormonal signals that drive menstruation and harming bone, heart, metabolic, and mental health; treatment should focus on nutrition and psychological support, with hormone patches only as a last resort, while routinely prescribing oral contraceptives simply masks the underlying energy deficit.
Takeaway: Treat a missed or irregular period as a warning sign of under-fuelling and address energy intake rather than accepting it as normal for training.
Abstract (source)

Background: . Female sport participation has grown rapidly, outpacing sex-specific clinical guidelines and leaving reproductive disorders under-recognised and often normalised as a marker of training success. The conceptual model has shifted from the narrow Female Athlete Triad to the broader Relative Energy Deficiency in Sport (RED-S) framework, yet diagnostic delay remains common.

Aim: . To synthesise current literature on the spectrum of reproductive disorders in female athletes and provide a clinically actionable framework for aetiology, diagnosis, and management. Material and

Methods: . A narrative review of original studies, randomised controlled trials, systematic reviews, meta-analyses, and consensus statements from the International Olympic Committee, American College of Sports Medicine, Endocrine Society, and American Society for Reproductive Medicine.

Results: . Low energy availability (LEA) was identified as the primary trigger of GnRH suppression, with effects on skeletal, cardiovascular, metabolic, and psychological health. Diagnosis requires a systematic algorithm; management is based on nutritional and psychological intervention, with transdermal hormonal replacement as a last resort. Widespread oral contraceptive prescription is a counterproductive practice masking the underlying energy deficit.

Conclusions: . Reproductive dysfunction in female athletes reflects a systemic energy-conservation response, not an isolated gynaecological finding. Closing the diagnostic gap requires screening integration, education, and a cultural shift away from normalising amenorrhea in sport.

Systematic review / meta-analysisOpen accessRecovery & SleepWomen's & Youth Athletics
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