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Jenna C. Gibbs, Nancy I. Williams, Jennifer L. Scheid, Rebecca J. Toombs and Mary Jane De Souza

A high drive-for-thinness (DT) score obtained from the Eating Disorder Inventory-2 is associated with surrogate markers of energy deficiency in exercising women. The purposes of this study were to confirm the association between DT and energy deficiency in a larger population of exercising women that was previously published and to compare the distribution of menstrual status in exercising women when categorized as high vs. normal DT. A high DT was defined as a score ≥7, corresponding to the 75th percentile for college-age women. Exercising women age 22.9 ± 4.3 yr with a BMI of 21.2±2.2 kg/m2 were retrospectively grouped as high DT (n = 27) or normal DT (n = 90) to compare psychometric, energetic, and reproductive characteristics. Chi-square analyses were performed to compare the distribution of menstrual disturbances between groups. Measures of resting energy expenditure (REE) (4,949 ± 494 kJ/day vs. 5,406 ± 560 kJ/day, p < .001) and adjusted REE (123 ± 16 kJ/LBM vs. 130 ± 9 kJ/LBM, p = .027) were suppressed in exercising women with high DT vs. normal DT, respectively. Ratio of measured REE to predicted REE (pREE) in the high-DT group was 0.85 ± 0.10, meeting the authors’ operational definition for an energy deficiency (REE:pREE <0.90). A greater prevalence of severe menstrual disturbances such as amenorrhea and oligomenorrhea was observed in the high-DT group (χ2 = 9.3, p = .003) than in the normal-DT group. The current study confirms the association between a high DT score and energy deficiency in exercising women and demonstrates a greater prevalence of severe menstrual disturbances in exercising women with high DT.

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Karen Myrick, Richard Feinn and Meaghan Harkins

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José L. Areta

figure specifies period of no menses (amenorrhea), irregular menses (oligomenorrhea), and the period in which regular menses resumed (eumenorrhea). The insert in the figure reports the body mass (average ±  SD ) for the period prior to a body mass gain episode in November 2017 to February 2018 versus the

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Nura Alwan, Samantha L. Moss, Kirsty J. Elliott-Sale, Ian G. Davies and Kevin Enright

↓ (↑) ↓ ↑ ↓ (↑) ↓ ↑ – – – – ↓ ↑ ↓ ↑ – – Serum and self-report 11.5% precompetition and 28% postcompetition ↓CP; ↑RC Trexler al. ( 2017 ) 8 ♀ 7 ♂ – +3.9 kg (12.5–14.9%) 4–6 RC – ↑   –   –   –   ↑↓   ↑   ↓ – – – ↑ Saliva – – Petrizzo et al. ( 2017 ) 1 ♀ −7.7 kg (24.4–11.3%) – 24 CP – – – – – – – – – – – – – – – – – – Self-report Oligomenorrhea

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Sharon H. Thompson, Presley Smith and Rita DiGioacchino

A serious commitment to sport and exercise may predispose female athletes to the development of eating disorders. The energy restriction and accompanying menstrual disorders that are often associated with eating disorders may increase female athletes’ injury risks. The purpose of this study was to assess NCAA Division I, II, and III female collegiate cross country athletes’ weekly exercise time, rates of injury, menstrual dysfunction, and subclinical eating disorder risks. A paper-pencil survey was completed by athletes (mean age = 19.64 years) from NCAA Division I (n = 82), Division II (n = 103) and Division III (n = 115) colleges across the United States. Division I athletes spent significantly more weekly exercise time (M = 687.97 minutes) than Division II (M = 512.38 minutes, p = .0007) or Division III (M = 501.32 minutes, p = .0003) athletes. When examining rates of menstrual dysfunction, 23 percent reported amenorrhea or oligomenorrhea. Over 60 percent (64.3%) of the athletes reported a performance-related injury, with the knee being the most commonly injured site. 24 percent (23.7%) of the athletes reported having stress fractures. Scores for subclinical eating disorders for Division I athletes were significantly higher (M = 87.11) than Division III athletes (M = 82.94, p = .0042). Division I female athletes may be at an increased risk of developing subclinical eating disorders compared to those competing in Division II or III. Because early identification of those with subclinical eating disorders prevents the progression to eating disorders, further study is warranted.

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Eric C. Haakonssen, David T. Martin, David G. Jenkins and Louise M. Burke


This study investigated the satisfaction of elite female cyclists with their body weight (BW) in the context of race performance, the magnitude of BW manipulation, and the association of these variables with menstrual function.


Female competitors in the Australian National Road Cycling Championships (n = 32) and the Oceania Championships (n = 5) completed a questionnaire to identify current BW, BW fluctuations, perceived ideal BW for performance, frequency of weight consciousness, weight-loss techniques used, and menstrual regularity.


All but 1 cyclist reported that female cyclists are “a weight-conscious population,” and 54% reported having a desire to change BW at least once weekly; 62% reported that their current BW was not ideal for performance. Their perceived ideal BW was (mean ± SD) 1.6 ± 1.6 kg (2.5% ± 2.5%) less than their current weight (P < .01), and 73% reported that their career-lowest BW was either “beneficial” or “extremely beneficial” for performance. 65% reported successfully reducing BW in the previous 12 months with a mean loss of 2.4 ± 1.0 kg (4.1% ± 1.9%). The most common weight-loss technique was reduced energy intake (76%). Five cyclists (14%) had been previously diagnosed as having an eating disorder by a physician. Of the 18 athletes not using a hormonal contraceptive, 11 reported menstrual dysfunction (oligomenorrhea or amenorrhea).


Elite Australian female cyclists are a weight-conscious population who may not be satisfied with their BW leading into a major competition and in some cases are frequently weight conscious.

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Sarah Staal, Anders Sjödin, Ida Fahrenholtz, Karen Bonnesen and Anna Katarina Melin

Females Questionnaire (LEAF-Q; Melin et al., 2014 ), validated for detecting female athletes at risk for energy deficiency by assessing injury history, gastrointestinal, and menstrual function, was used. MD was defined as oligomenorrhea (<9 menstrual cycles the past year) or amenorrhea (an absence of

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Nicole C.A. Strock, Kristen J. Koltun, Emily A. Southmayd, Nancy I. Williams and Mary Jane De Souza

) including oligomenorrhea, anovulation, and luteal phase defects ( n  = 68). Menstrual Characteristics Menstrual status was based on self-reported menstrual history and confirmed by measurements of daily urinary reproductive hormone metabolites (estrone-1-glucuronide [E1G] and pregnanediol glucuronide [PdG

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Travis Anderson, Sandra J. Shultz, Nancy I. Williams, Ellen Casey, Zachary Kincaid, Jay L. Lieberman and Laurie Wideman

or due to menstrual disturbances such as amenorrhea and oligomenorrhea) or if the chosen sampling days limited detectable concentrations. It is also not known if the threshold would be similar for non-collegiate female athletes, since it is unclear if the magnitude of change in relaxin varies based

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Bryan Holtzman, Adam S. Tenforde, Allyson L. Parziale and Kathryn E. Ackerman

.7 (927) 5.3 (5.3) 2.0 (20) Delayed menarche 86.3 (863) 7.5 (7.5) 6.2 (62) Oligomenorrhea and/or amenorrhea 59.8 (598) 13.7 (137) 26.5 (265) Low BMD 92.3 (923) 5.0 (50) 2.7 (27) Stress reaction/fracture 60.9 (609) 16.2 (162) 22.9 (229) Note . Triad CRA = Female Athlete Triad Cumulative Risk Assessment