Female football specific energy availability questionnaire and menstrual cycle hormone monitoring
Authors: Keay Nicola , Craghill Eddie , Francis Gavin 
Published: October 2021

Objectives

The purpose of this study was to assess the energy availability status of professional female football players with an online Female Football Energy Availability Questionnaire (FFEAQ), combined with the clinical tool to model menstrual cycle hormones using artificial intelligence (AI) techniques.

Methods

The Female Football Energy Availability (FFEAQ) was developed based on published questionnaires, with a weighted scoring system to assess risk of Relative Energy Deficiency in Sport (RED-S). For menstrual cycle hormones AI techniques modelled hormone variation over a cycle, using the results from capillary blood samples taken at two time points.

Results

21 female footballers of professional club level participated in this study, with mean age 22 years [range 16 to 30]. 20 athletes recorded positive scores on the FFEAQ, suggesting a low risk of Relative Energy Deficiency in Sport (RED-S). No players had experienced primary amenorrhoea. 5 athletes reported previous history of secondary amenorrhoea. Amongst the 15 players not taking hormonal contraception, 2 reported current oligomenorrhoea.

The application of AI techniques to model menstrual cycle hormones found that in 1 of the 3 players, subclinical hormone disruption was occurring with this player reporting variable flow of menstruation. Although the other 2 players showed expected menstrual hormone variation, 1 player reported variable flow according to training load, suggestive of subclinical anovulation. At the time of testing training load was low due to pandemic lock down.

Conclusions

The professional female football athletes in this study were found to be at low risk of RED-S from the FFEAQ. Modelling menstrual cycle hormones using AI techniques indicated that this has the potential to be an effective clinical tool in identifying subtle hormone dysfunction such as subclinical anovulatory cycles in female athletes.

What are the new findings?

Female football players can be at risk of low energy availability and development of the adverse health and performance consequences of Relative Energy Deficiency in Sport (RED-S)

Sport specific screening questionnaires are a valuable clinical screening tool to identify those at risk of RED-S, to direct swift and personalised support to prevent progression from low energy availability to the clinical syndrome of RED-S

Modelling menstrual cycle hormones with artificial intelligence (AI) techniques is an effective clinical tool to provide finer detail of hormone networks to identify subclinical hormone dysfunction in female athletes

How might this study impact on clinical practice in the future?

Female Football Energy Availability Questionnaire (FFEAQ) is a useful clinical screening tool to identify athletes at risk of RED-S

Application of artificial intelligence to menstrual cycle hormones can provide a complete picture of hormone function. This clinical tool has the ability to detect subclinical hormone dysfunction as a precursor to developing functional hypothalamic amenorrhoea (FHA) in RED-S

This AI clinical tool can also be helpful for athletes recovering from FHA to guide the appropriate return to full training once full hormone function is restored

This AI hormone clinical tool can be used in distinguishing hypothalamic issues found in low energy availability; from reduced ovarian responsiveness found in perimenopause.