6 minute read
Personalising Female Footballer Hormone Health
FEATURE / DR NICOLA KEAY
Dr. Nicky Keay
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BA, MA, MB, BChir (Cantab),MRCP Sports and Dance Endocrinologist Honorary Clinical Lecturer Medicine, University College London Honorary Fellow Dept Sport and Exercise Sciences, Durham University CMO Forth Edge
1. Introduction
Relative energy deficiency in sport (RED-S) was first described in the 2014 International Olympic Committee consensus statement . RED-S compromises the interrelated adverse clinical outcomes of low energy availability on both health and performance. Therefore, early identification of athletes at risk of RED-S is a priority as a prevention strategy .
In female athletes, disruption of female hormone networks is an early indicator of the risk of developing RED-S. Although RED-S may be perceived as a situation only occurring in aesthetic or weight dependent sports, evidence is emerging that this syndrome can arise in other sports, including football.
2. Early identification of female players at risk of RED-S
• Modelling of female hormones over the menstrual cycle Healthy hormone network function is key to athletic performance. Hormones are impacted by athlete behaviours around training load, nutrition, and recovery. Imbalances in behaviours, whether intentional or unintentional, influence hormone networks. For example, low energy availability resulting because of a mismatch between energy intake and energy expenditure, can cause a subtle subclinical hormone dysfunction. In the case of female athletes this can be due to subclinical anovulatory cycles . This means that although an athlete reports regular having a regular menstrual cycle, her hormones may not be fluctuating in a way to support optimal health and performance. However, as every woman has individual timing, concentrations and biological response to female hormones, a personalised approach is required. Nevertheless, taking daily blood samples to assess female menstrual hormones is neither practical nor financially feasible.
Artificial intelligence techniques are used in many areas of medicine to personalise healthcare . These techniques allow clinicians to gain the maximal value from the minimum amount of data. Capillary blood sampling at two key time points during the menstrual cycle, allow hormone fluctuations to be modelled and compared to data from ovulating women with the same cycle length. In this way any disturbance of menstrual cycle hormones for an individual athlete can be identified. When combined with reported well-being metrics, this provides a personalised hormone health report .
• Female football specific energy availability questionnaire (FFEAQ) In terms of screening questionnaires for RED-S, there is a low energy availability female athlete questionnaire (LEAFQ) . However, this questionnaire is not sports specific and does not provide psychological indicators of athletes potentially at risk of developing RED-S. Published sport specific questionnaires for cyclists and dancers, with a scoring system have proved useful clinical tools . A similar approach was used to develop the female football specific energy availability questionnaire (FFEAQ) . To ensure female football players attain optimal health and performance and avoid developing the adverse outcomes of RED-S, the following monitoring strategies of personal player health are suggested:
• Modelling of female hormones over the menstrual cycle • Female football specific energy availability questionnaire (FFEAQ)
3. Practical solutions for personalising female hormone health
• Modelling female hormones Capillary sampling at 2 points during the menstrual cycle is not too onerous for athletes and can be sent in the post for analysis at a UK accredited laboratory. Once the results are available and have been entered into the model, personalised reports can be generated before the next menstrual cycle starts thus providing rapid feedback to the female athlete. Although the study population number was small (in view of the challenges of a pandemic on research), there was evidence of subclinical anovulatory cycles, which may have otherwise been undetected. In a larger longitudinal study of professional dancers, evidence for this type of subtle effect of low energy availability on female hormone function was found using this methodology . This is of clinical significance for all female athletes as there is increasing evidence that subclinical anovulatory cycles have adverse effects of health and consequently performance .
Personalising Female Athlete Hormone Health
Menstrual and Hormone Status
Eumenorrhea Healthy hormones
Amenorrhoea Hormone down regulation
Dr Nicky Keay nickykeayfitness.com
• Female football specific energy availability questionnaire (FFEAQ) The FFEAQ is a practical, low-cost tool to identify players with indicators of low energy availability and at risk of progression to RED-S. Although the 22 football players in our study recorded more positive scores and lower risk of RED-S than professional dancers, nonetheless 5 players reported previous secondary amenorrhoea. Early identification of subtle warnings signs in athletes is far better than waiting until presentation with a clinically significant adverse outcome of RED-S. This facilitates an effective prevention method when combined with personalised hormone monitoring and the opportunity to be proactive in supporting individual player health and performance. Healthy individual players mean a stronger, more successful team.
4. Conclusions
Key points for the football medicine and performance community • Early identification of female players at risk of relative energy deficiency in sports (RED-S) is key in prevention before the development of overt adverse impacts on health and performance • The female football low availability questionnaire (FFEAQ) and close monitoring of female hormone networks are effective strategies in picking up the early warning signs of risk of RED-S • Reliable information sources such as www.health4performance.co.uk from British Association of Sport and Exercise Medicine is a useful resource for players, coaching and healthcare staff • Online courses for female athletes and their coaches endorsed by British Association of Sport and Exercise Medicine are another resource https://www.
sportreadyacademy.com/p/trainingas-a-high-performing-femaleathlete1/?preview=logged_out
Key take home messages • Healthy hormone networks are essential for athlete health and performance • Imbalances in athlete behaviours can have adverse effects on hormone networks and lead to RED-S • Close monitoring of female hormone networks is key in personalising strategies for optimal health and performance in female footballers
5. Acknowledgements
We would like to thank the athletes, staff, and the club for their participation in this research.
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