Reversing menstrual dysfunction (REMEDY) : the impact of menstrual status on musculoskeletal and hormonal health Public Deposited

http://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/np193d150

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  • Menstrual dysfunction (MD), possibly due to lower energy availability (EA), is prevalent in active women and associated with unfavorable heath consequences. PURPOSE: To determine if EA improvements in endurance-trained women, using a daily Carbohydrate-Protein supplement (CHO-PRO), will restore menstrual function and improve musculoskeletal health. METHODS: Athletes with MD (ExMD; n=8; age=23±3y, VO₂max=49±6ml·kg⁻¹·min⁻¹, body fat=22±5%) completed a 6-mo intervention; a CHO-PRO drink was consumed (360kcal·d⁻¹) and assessments were made pre/post-intervention: 1) reproductive and thyroid hormones, bone markers; 2) energy intake and expenditure using 7-d weighed food and physical activity records, accelerometry; 3) body composition, bone mineral density (BMD), lower muscle strength and power; and 5) phosphorylated FoXO1a, p70S6K, and AMPK as indicators of muscle net protein balance. For comparison, eumenorrheic athletes (Eumen, n=10, age=23±4y, VO₂max=51±5ml·kg⁻¹·min⁻¹, body fat=23±4%) were assessed. Multiple linear regression was used to assess differences between groups and pre/postintervention blocking on participants. RESULTS: All women resumed menses (2.6±2.2mo to first menses, 3.5±1.9cycles). Women with longer ExMD duration took longer to resume menses and had lower BMD. EA was similar between groups and pre/post-intervention. Excluding one ExMD outlier, EA increased by 589 kcal·d⁻¹ (12.2kcal·kgFFM⁻¹·d⁻¹) with the intervention (p=0.03). Mean hormonal or BMD were similar pre/post-intervention and between groups (p>0.05). Spinal BMD status improved in two ExMD women (osteoporosis to low BMD in one; low to normal BMD in the other). Knee extension/flexion and ankle flexion power in ExMD was greater at post-intervention (p<0.05). Compared to Eumen, ExMD had lesser knee extension power (p=0.04) at baseline but was similar at postintervention (p=0.36). No other differences in strength, power, and phosphorylation of FoXO1a, p70S6K, and AMPK occurred. CONCLUSION: An increased daily energy intake (360kcal·d⁻¹) and EA were associated with reversal of ExMD. Longer time to resume menses is required if ExMD>1y; these individuals may be at greater risk for adverse health consequences. Power improvements were observed with resumption of menses, but net muscle protein balance indicators did not change. An energy status measurement would aid in identifying women at risk for ExMD; more research is required to determine such a measure.
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