Where do you go when your periods go?: a case-study examining secondary amenorrhea in a professional internationally-capped female soccer player through the lens of the sport nutritionist

Parker, Lloyd JF, Elliott-Sale, Kirsty J, Hannon, Marcus, Morton, James P and Close, Graeme L (2022) Where do you go when your periods go?: a case-study examining secondary amenorrhea in a professional internationally-capped female soccer player through the lens of the sport nutritionist. Science and Medicine in Football, 6 (5). pp. 643-649. ISSN 2473-3938

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Abstract

This case study follows a professional internationally capped female soccer player's two-year journey from eumenorrhea, through injury, to amenorrhea, and the challenges faced by the player and nutritionist. The two years are split into three sections: (1) longitudinal profiling of the player, (2) nutrition to support her return from injury, and (3) investigation into the observed secondary amenorrhea. The cause of amenorrhea was investigated through the assessment of energy availability via doubly labelled water, remote food photography, blood biomarkers and resting metabolic rate. Despite having secondary amenorrhea and anovulatory cycles, the player did not have low energy availability. This study shows the importance for practitioner's, particularly nutritionists, to not assume that all menstrual irregularities are caused by low energy availability and could be caused by a combination of factors (e.g. clinical, physiological, and psychological), which requires a multi-disciplinary investigation and intervention team. This study also showed that education needs to be provided about menstrual health to elite female soccer players as the player (i) believed that not having a period was beneficial for performance and unsure of possible health implications; (ii) was convinced that a one-day bleed indicated a regular menstrual cycle; and (iii) was reluctant to waste the practitioners time discussing menstrual issues and was nervous of finding out if she had an actual health issue. It is therefore crucial that players feel comfortable in discussing their menstrual status with practitioners to support their performance and long-term health.