Context: Menstrual dysfunction among adolescent female athletes is associated with both an increased musculoskeletal injury risk and poor psychological health.

Objective: To examine if adolescent flag football athletes with menstrual dysfunction report different levels of energy, mood, sleep, and stress during the season compared to those without menstrual dysfunction.

Design: Prospective cohort study

Setting: A series of questionnaires pre-season, in-season weekly, and post-season to athletes in Denver Metro Area

Patients or Other Participants: Female athletes with and without self-reported menstrual dysfunction who participated in a high school flag football season.

Main Outcome Measure(s): Quality of life measures (energy, mood, sleep, and stress) rated weekly from 0 (low energy, poor mood, poor sleep, low stress) to 10 (high energy, best mood, great sleep, and high stress).

Results: Of the 60 adolescent female flag football athletes enrolled, 15 (25%) reported menstrual dysfunction. The groups were not significantly different in mean ratings for energy (5.3±1.1 vs.5.1±1.4; p=0.70) or mood (5.6±1.1 vs. 6.0±1.5; p=0.32). However, the menstrual dysfunction group reported significantly worse sleep (4.2±1.3 vs. 5.2±1.4; p=0.02) and more stress (7.0±1.0 vs. 5.9±1.3; p=0.005) than those without menstrual dysfunction. When adjusting for school year, BMI, and injuries sustained during the season, menstrual dysfunction was significantly associated with worse sleep (β= -0.98; 95% CI= -1.82, -0.13; p=0.03) and more stress (β=1.11; 95% CI=0.35, 1.87; p=0.005).

Conclusion: Flag football athletes with menstrual dysfunction reported worse sleep and more stress compared to those without menstrual dysfunction. These findings contribute to the importance of monitoring and addressing menstrual dysfunction and its association with quality of life factors in female adolescent athletes.

menstrual dysfunction, adolescence, mental health
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Competing Interests

Conflicts of Interest: Unrelated to this study, Dr. Howell has received research support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (R03HD094560,), the National Institute of Neurological Disorders And Stroke (R01NS100952, R43NS108823), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (1R13AR080451), 59th Medical Wing Department of the Air Force, MINDSOURCE Brain Injury Network, and the Tai Foundation, and the Colorado Clinical and Translational Sciences Institute (UL1 TR002535‐05). Dr. Armento has received funding from the National Center for Advancing Translational Sciences/Clinical and Translational Science Awards Program/Colorado Clinical and Translational Sciences Institute (K12 TR004412, UM1 TR004399).