Amenorrhea and Stress Fractures in Female New Jersey Division III Collegiate Runners: An Opportunity for Increased Health Education

Authors

  • Emily Forester, BS Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, U.S.A.
  • Tara Pellegrino, DO Department of Family Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, U.S.A.

DOI:

https://doi.org/10.53646/g7c3xk08

Keywords:

female athlete, amenorrhea, stress fracture, prevention

Abstract

BACKGROUND: In the National Collegiate Athletic Association (NCAA), 9.1% of the injuries reported by women’s cross-country athletes between 2014-2019 were fractures. Both history of amenorrhea and prior stress fractures have been found to predict incidence of subsequent bone stress injuries among female athletes. Although excessive exercise is a major contributor to the development of amenorrhea, there are currently no studies on the association between amenorrhea and stress fractures in New Jersey (NJ) National NCAA Division III Women’s cross country or track athletes. This study aims to determine if there is an association between incidence of amenorrhea and subsequent occurrence of stress fractures among this population, and to identify a possible area for increased reproductive health education.

METHODS: This is a survey-based study. Participants were female athletes over the age of 18 who currently participate in collegiate cross country or track running at a NJ Division III school. Coaches of the Division III cross country and track teams in NJ distributed a survey to their female athletes to gain participants for this study. Survey data included information on participant menstrual history, stress fracture history, and athletic involvement. Participants also indicated if their school’s staff had ever educated them on the importance of menstrual regularity and athletics. Descriptive statistics and comparison between groups were analyzed.

RESULTS: In total, 68 survey responses were collected. Survey respondents included female NJ cross country and track athletes ages 18-23, from a total of eight institutions. During training or competition, 58.8% of the study participants missed at least one menstrual cycle and 45.6% experienced a stress fracture. There is a significant association between having missed at least one menstrual cycle during training or competition and the number of stress fractures experienced by the athlete (p = 0.044). Only 30.9% of respondents indicated that someone from their school’s staff spoke to them about the importance of maintaining regular menstruation during training.

CONCLUSION: This study confirms that both amenorrhea and stress fractures are commonly seen among NJ NCAA Division III female cross country and track athletes. Our data also highlights a need for increased education of NJ Division III female athletes regarding the importance of maintaining regular menstruation as a means of stress fracture prevention. Further investigation of the role of amenorrhea on the incidence of stress fractures may shine light on an important area for prevention and increased health education.

References

Bratsman A, Wassef A, Wassef CR, Jayaram P, Mosely JB, Shybut TB. Epidemiology of NCAA Bone Stress Injuries: A Comparison of Athletes in Divisions I, II, and III. Orthop J Sports Med. Jul 2021;9(7):23259671211014496.

Huhmann K. Menses Requires Energy: A Review of How Disordered Eating, Excessive Exercise, and High Stress Lead to Menstrual Irregularities. Clin Ther. Mar 2020;42(3):401-407. doi:10.1016/j.clinthera.2020.01.016

Ackerman KE, Cano Sokoloff N, De Nardo Maffazioli G, Clarke HM, Lee H, Misra M. Fractures in Relation to Menstrual Status and Bone Parameters in Young Athletes. Medicine & Science in Sports & Exercise. 2015;47(8):1577-1586. doi:10.1249/mss.0000000000000574

Hutson MJ, O'Donnell E, Petherick E, Brooke-Wavell K, Blagrove RC. Incidence of bone stress injury is greater in competitive female distance runners with menstrual disturbances independent of participation in plyometric training. J Sports Sci. Nov 2021;39(22):2558-2566. doi:10.1080/02640414.2021.1945184

Tenforde AS, Carlson JL, Chang A, et al. Association of the Female Athlete Triad Risk Assessment Stratification to the Development of Bone Stress Injuries in Collegiate Athletes. Am J Sports Med. Feb 2017;45(2):302-310. doi:10.1177/0363546516676262

Barrack MT, Gibbs JC, De Souza MJ, et al. Higher incidence of bone stress injuries with increasing female athlete triad-related risk factors: a prospective multisite study of exercising girls and women. Am J Sports Med. Apr 2014;42(4):949-58. doi:10.1177/0363546513520295

Chandran A, Morris SN, Boltz AJ, Robison HJ, Collins CL. Epidemiology of Injuries in National Collegiate Athletic Association Women's Cross-Country: 2014-2015 Through 2018-2019. J Athl Train. Jul 1 2021;56(7):622-628. doi:10.4085/1062-6050-395-20

Beaudry A, Rizzone, K, Davis, S, Harvey, T, Gordon, P, & Chetlin, R. Female Athlete Triad Recognition and Knowledge of Collegiate Cross-Country Coaches. Journal of Women’s Sports Medicine, Dec 2022;2(3), 112–124. https://doi.org/10.53646/jwsm.v2i2.31

Lodge MT, Ackerman KE, Garay J. Knowledge of the Female Athlete Triad and Relative Energy Deficiency in Sport Among Female Cross-Country Athletes and Support Staff. Journal of Athletic Training. 2021;57(4):385-392. doi:10.4085/1062-6050-0175.21

Armento A, VanBaak K, Seehusen CN, Sweeney EA, Wilson JC, Howell DR. Presence and Perceptions of Menstrual Dysfunction and Associated Quality of Life Measures Among High School Female Athletes. J Athl Train. Oct 1 2021;56(10):1094-1099. doi:10.4085/624-20

Kroshus E, DeFreese JD, Kerr ZY. Collegiate Athletic Trainers' Knowledge of the Female Athlete Triad and Relative Energy Deficiency in Sport. J Athl Train. Jan 2018;53(1):51-59. doi:10.4085/1062-6050-52.11.29

Downloads

Published

2023-12-18

Issue

Section

Articles

How to Cite

Amenorrhea and Stress Fractures in Female New Jersey Division III Collegiate Runners: An Opportunity for Increased Health Education. (2023). Journal of Women’s Sports Medicine, 3(3), 14-21. https://doi.org/10.53646/g7c3xk08

Similar Articles

1-10 of 38

You may also start an advanced similarity search for this article.