Heavy Training and Menstrual Dysfunction: A Risk in Female Athletes

Abstract

Background: Menstrual health is an important indicator of physiological adaptation and overall wellbeing in female athletes, and menstrual dysfunction is frequently linked to high training load and low energy availability. Objective: To determine the occurrence of menstrual dysfunction in competitive female athletes and test its association with heavy training load. Methods: A cross-sectional survey was conducted among 151 competitive female athletes aged 18–35 years at the University of Lahore. Menstrual function and symptoms were assessed using the Menstrual Symptom Questionnaire (MSQ); training exposure was characterized using weekly training hours and the International Physical Activity Questionnaire–Short Form (IPAQ-SF); and low energy availability risk features were screened using the LEAF-Q. Associations between training exposure group (low, moderate, high) and menstrual function category (regular, irregular, amenorrhea) were evaluated using chi-square testing, with effect size and odds ratios (ORs) with 95% confidence intervals (CIs). Results: Overall, 58.3% (88/151) reported menstrual dysfunction, including amenorrhea in 25.8% (39/151) and irregular cycles in 32.5% (49/151), while 41.7% (63/151) reported regular cycles. Menstrual function differed significantly by training exposure (χ² = 67.693, df = 4, p = 0.001; Cramér’s V = 0.473). High training athletes had substantially higher odds of menstrual dysfunction versus low training athletes (OR 37.00, 95% CI 10.87–125.96). Conclusion: Heavy training load was strongly associated with menstrual dysfunction and multidimensional symptom burden in competitive female athletes, supporting routine menstrual health monitoring, education, nutritional support, and multidisciplinary care