Multiple eumenorrheic cycles are necessary to observe a significant increase in estrogen exposure and ovulation in exercising women with functional hypothalamic oligo/amenorrhea undergoing a nutritional intervention: Insights from the REFUEL study.
Rebecca J Mallinson, Nancy I Williams, Emily A Ricker and 2 others
PMID 41099383WHAT IT FOUND
Increasing energy intake led to menstrual recovery in 58% of exercising females.
However, significant estrogen exposure increases and reduced relapse rates were only observed after three consecutive normal cycles. A single period was insufficient for hormonal recovery.
Key findings
01Nineteen of 33 exercising females (58%) recovered according to at least one definition of menstrual recovery.
02Estrogen exposure did not significantly increase for females who achieved one or two consecutive normal cycles, but did significantly increase for those who achieved three consecutive cycles.
03Immediate relapse to amenorrhea or oligomenorrhea decreased from 53% after one cycle to 22% after three consecutive cycles.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study had a high dropout rate, with only 48% of participants completing 12 months, which limited the sample size for the most rigorous recovery definitions. The participants were predominantly White (82%), limiting generalizability to other ethnic groups. The intervention required daily urine collection, which was burdensome and may have contributed to dropout.
Declared interests
Funded by the United States Department of Defense. Author Mary Jane De Souza reports consulting fees from California Prune Board, Regeneron Pharmaceutical, and Coca Cola Company.
The easy way to misread this
Do not assume that the return of a single menstrual period indicates full hormonal recovery or reduced relapse risk. The data shows that estrogen exposure did not significantly improve and relapse remained high until three consecutive normal cycles were achieved.
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