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1 Fertility and Bone Mass in Prior Female Athletes with a History Of Fertility and bone mass in prior female athletes with a history of amenorrhea Thesis Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Megan Rose Stanley, B.S. Graduate Program in Allied Medicine The Ohio State University 2019 Master’s Examination Committee: Adviser: Jackie Buell, PhD, RDN, CSSD, ATC Julie Kennel, PhD, RDN, LD Holly Estes, MS, RDN, LD, CNSC 1 Copyrighted by Megan Stanley 2019 2 Abstract Background: The spectrum of menstrual dysfunction includes a wide domain from normal cycles to interrupted cycles of 3 months or more classified as amenorrhea. The disruption of hormones in amenorrhea can cause a cascade of issues such as low bone density, lowered resting metabolic rate, and potentially issues with fertility. Objective/Hypothesis: 1. Identify the prevalence of fertility issues in prior Ohio State female athlete athletes who experienced amenorrhea. 2. Compare the prevalence of low bone density and low resting metabolic rate in prior athletes with a history of amenorrhea to those without a history of amenorrhea. Methods: Past female athletes received a survey via an email through alumni services. The survey took about 30 minutes to complete and queried on sport participation, menstrual history, and fertility history. Local respondents could sign up for a lab visit to have an iDXA scan for bone density and a resting metabolic rate test. Results: The survey was completed by 298 alumnae. Of those, 158 reported trying to conceive, 44 with a history of amenorrhea and 114 eumenorrheic. For respective menstrual groups, 5 (11.36%) and 11 (9.65%) were unable to conceive, suggesting no likely influence of a history of amenorrhea on fertility in this cohort. A total of 44 participants completed the lab visit. There were no significant differences in bone density or resting metabolic rate between amenorrheic and eumenorrheic groups. Conclusions: These findings suggested that a history of amenorrhea does not lead to higher risk of infertility. When alumni who had experienced amenorrhea were compared with those who ii reported only eumenorrhea, there was no statistical difference in bone density or resting metabolic rate in the lab visit volunteers. iii Acknowledgements I would like to thank my advisor, Dr. Jackie Buell, for the opportunity to work with her and develop this project. I have enjoyed learning from you and being able to share my thoughts and concerns with you comfortably. You always answered my questions, no matter how ridiculous, with such knowledge and acceptance. I would also like to thank my thesis committee members Dr. Julie Kennel and Professor Holly Estes, for their encouragement and support. Additionally, I would like to thank Nancy Clark and Dr. Nicola Rinaldi for helping develop this project and sticking with me through the acceptance of this research. I do not know where I would be without the support from my fellow MS/DI program members. They were always there to help answer any question I had, to spend weekends working on our papers, and pick me up with words of wisdom when I needed it. I would finally like to acknowledge my family and friends for the many phone calls and pep talks over the last two years. Thank you all for encouraging me and letting me rant when I needed to. You all inspire me with your hard work and dedication and I truly would not have made it here without you. iv Vita March 14, 1995 .................................................................................... Born – Christiana, Delaware May 2017 ............................................ B.S. Nutrition, Dietetics, The Pennsylvania State University Field of Study Major Field: Allied Medicine Specialization: Medical Dietetics v Table of Contents Abstract ............................................................................................................................................ ii Acknowledgements......................................................................................................................... iv Vita ................................................................................................................................................... v List of Tables ................................................................................................................................. viii List of Figures .................................................................................................................................. ix List of Definitions ............................................................................................................................. x List of Abbreviations ....................................................................................................................... xi Chapter 1: Introduction ...................................................................................................................1 Introduction .........................................................................................................................1 Objectives.............................................................................................................................2 Chapter 2: Review of Literature .......................................................................................................3 Menstrual Classifications and Causes ..................................................................................3 Causes of Secondary Amenorrhea .......................................................................................7 Hypothalamic Amenorrhea ............................................................................................... 10 Risks Associated with Amenorrhea................................................................................... 16 Measurement Tools .......................................................................................................... 23 Predicted Prevalence of Amenorrhea in Athletes ............................................................ 24 Diagnosis of Amenorrhea ................................................................................................. 24 Treatment for Amenorrhea .............................................................................................. 26 What We Don’t Know ....................................................................................................... 27 Chapter 3: Methodology ............................................................................................................... 29 Research Design ................................................................................................................ 29 Recruitment and Description of Human Subjects ............................................................ 29 Exclusion Criteria............................................................................................................... 30 Study Questionnaire ......................................................................................................... 30 Face Validity ...................................................................................................................... 31 Laboratory Visit ................................................................................................................. 31 Anthropometrics and Bone Density ................................................................................. 31 Resting Metabolic Rate ..................................................................................................... 32 vi Lean versus Non-Lean Sports ............................................................................................ 32 Statistical Analysis ............................................................................................................. 33 Chapter 4: Results and Discussion ................................................................................................ 35 Results ............................................................................................................................... 35 Amenorrhea and Fertility .................................................................................................. 36 Lab Visit ............................................................................................................................. 36 Bone Density ..................................................................................................................... 37 Resting Metabolic Rate ..................................................................................................... 39 Sport Frequency ................................................................................................................ 40 Discussion.......................................................................................................................... 43 Limitations......................................................................................................................... 46 Conclusion ......................................................................................................................... 48 Implications for Practice ................................................................................................... 48 Chapter 5: Bone Density and Resting Metabolic Rate in Prior Female Athletes with a History of Amenorrhea .................................................................................................................................
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