Amenorrhea in Elite Female Climbers: What Every Athlete Should Know
A groundbreaking study of elite female competitive climbers registered with the International Federation of Sport Climbing (IFSC) reveals concerning rates of menstrual dysfunction. The findings highlight the need for greater awareness and medical supervision in competitive climbing.
Key Findings
Prevalence of Amenorrhea
Of the 114 female elite climbers surveyed, nearly 16% (18 athletes) presented with current amenorrhea - the absence of menstrual periods for three or more consecutive months.
Menstrual Status Breakdown
The 114 climbers were categorized as follows: 72% had normal menstrual function (eumenorrhea), 16% had amenorrhea (secondary), 1% had primary amenorrhea (never menstruated), and 12% had unclear status.
Body Weight and Menstrual Status
Average BMI comparisons revealed a pattern: climbers with normal cycles had an average BMI of 20.8, while climbers with amenorrhea had an average BMI of 20.0.
While the BMI difference seems small, the trend aligns with research showing that low energy availability affects menstrual function.
Why This Matters
Relative Energy Deficiency in Sport (RED-S)
Amenorrhea is a primary indicator of RED-S - a condition where energy intake is insufficient to support both training demands and normal body functions.
RED-S can lead to decreased performance over time, increased injury risk, bone stress fractures, hormonal disruption, and long-term health complications.
The Performance Paradox
Many climbers believe lighter equals better performance. The research challenges this assumption:
Short-term, acute weight loss may temporarily improve strength-to-weight ratio.
Long-term, chronic energy restriction leads to decreased power output, slower recovery, reduced training quality, and increased injuries.
Contributing Factors
Weight Loss Practices
The study found alarming patterns related to weight management. 45% of athletes attempt to change their competition weight. 23% consciously restrict food intake daily. 76% of those who lost weight used concerning methods.
Eating Behavior
When asked about their relationship with food, only 49% said they liked their relationship with food. 37% reported sometimes struggling with food. 14% said they disliked their relationship with food.
Additionally, 28% reported currently having or having had an eating disorder.
Training at Young Ages
Many climbers began intense training as adolescents. Previous research shows that high-intensity training during development can delay menarche and disrupt hormonal development.
Warning Signs to Watch
Physical Signs
These include loss of menstrual periods or irregular cycles, frequent illness or infection, recurrent injuries especially stress fractures, persistent fatigue, and difficulty recovering between sessions.
Behavioral Signs
Watch for excessive focus on weight or body composition, avoiding eating with others, rigid food rules or restrictions, excessive exercise beyond normal training, and anxiety around rest days.
Recommendations for Athletes
Track Your Cycle
Use an app or calendar to monitor menstrual regularity. Changes in cycle length or missed periods are important signals.
Fuel Your Training
Eating enough to support training volume is essential. Carbohydrates fuel performance. Protein supports recovery. Fat is necessary for hormone production.
Seek Professional Help
Work with a sports dietitian familiar with climbing. Address any disordered eating patterns early. Get regular health screenings including bone density if cycles are irregular.
Report Issues Early
Don't dismiss missed periods as "normal for athletes." Menstrual dysfunction is a warning sign, not a badge of dedication.
Recommendations for Coaches and Federations
Create Healthy Culture
Avoid comments about athlete body weight. Focus on performance metrics, not appearance. Model healthy eating behaviors.
Recognize Warning Signs
Watch for sudden weight changes, food avoidance behaviors, excessive exercise, and declining performance.
Provide Resources
Connect athletes with sports nutrition professionals. Educate on performance nutrition. Implement screening for eating disorders and RED-S.
The Bigger Picture
Climbing culture has historically emphasized leanness. With the sport now Olympic and athlete welfare under greater scrutiny, evidence-based approaches to nutrition and health are essential.
The goal is developing athletes who can climb for decades, not just perform in the next competition.
Limitations of the Study
Response Rate Unknown
The survey was emailed to 1,500 IFSC-registered athletes with 114 completing it. Those experiencing issues might be more or less likely to respond.
Self-Report
All data was self-reported, which may underestimate actual prevalence due to stigma or lack of awareness.
Hormonal Contraceptive Use
Some athletes on hormonal contraceptives may have masked menstrual dysfunction, making true prevalence potentially higher.
Resources
If you or someone you know is struggling with disordered eating or menstrual dysfunction, resources are available through sports medicine physicians, registered dietitians specializing in sports nutrition, and the IFSC Medical Commission.
Based on: Joubert L, Warme A, Larson A, Gronhaug G, Michael M, Schoffl V, Burtscher E and Meyer N (2022) Prevalence of amenorrhea in elite female competitive climbers. Frontiers in Sports and Active Living