Screening and management of menstrual cycle disorders in women athletes by sports physicians: The HYPOFIT Study

The number of women of all ages engaging in physical activity is steadily increasing. While exercise is generally beneficial to health, when practiced under condition of negative energy balance, it can disrupt menstrual cycles. This study aimed to evaluate the practices of sports physicians in screening for and managing menstrual cycle disorders in female athletes.

We conducted a national observational study among sports physicians. Participants completed an online questionnaire designed to assess their approaches to screening and managing menstrual disorders.

Among the 129 physicians surveyed, only 72 (55.8%) systematically assessed current menstrual status, and just 44 (34.1%) consistently evaluated menstrual regularity. Furthermore, 43 (33.6%) explored menstrual regularity only in athletes participating in specific sports (e.g., long-distance running, gymnastics) or those with low body mass index. In cases of amenorrhea, 93 (72.1%) performed β-hCG testing, 68 (52.7%) conducted hormonal assessments, and 43 of 126 (34.1%) never requested bone densitometry. Hormonal treatment was rarely prescribed, while 53 (41.7%) routinely referred patients to a gynecologist or endocrinologist. Most physicians reported difficulties in managing menstrual disorders and expressed interest in standardized screening tools, although the perceived difficulty of referring patients to a specialist varied among respondents.

Sports physicians require additional training and structured support to improve the identification and management of menstrual cycle disorders in athletes. Strengthening clinical guidance and providing systematic tools could help prevent the long-term health consequences of FHA (functional hypothalamic amenorrhea).