| Summary: | Menstruation is the leading cause of iron deficiency anaemia in pre-menopausal women. When combined with regular exercise, iron deficiency (ID) risk in menstruating women is increased. This may be exacerbated in those with heavy menstrual bleeding (HMB), which despite no validated diagnosis, is thought common in the general population but is under-investigated in exercisers. Accordingly, the potential relationship between menstruation, ID and performance remains unknown. The aims of this research were to: a) identify HMB prevalence (utilising a diagnostic series) and association with fatigue and perceived disruption to exercise training/performance in exercising women; b) evaluate the impact and existing diagnosis of ID. A ‘Female Health Questionnaire’ was developed to identify HMB amongst other factors in an exercising population (n=789), elite athletes (n=90) and London Marathon runners (n=1073). The relationships between iron status, HMB and fatigue or the perception that the menstrual cycle disrupts exercise training/performance was then investigated in exercising women (n=271). Finally, a clinical trial assessed the impact of intravenous iron repletion (single dose of 20 mg·kg-1) on exercise and aerobic capacity, haematological markers, fatigue and mood disturbance in non-elite, iron deficient (serum ferritin ≤30μg·L-1), exercising women (n=32). HMB was identified to be common (37% elite athletes, 36% marathon runners), and associated with perceived disruption to exercise training/performance and fatigue, but these relationships were independent of iron status. Iron repletion improved exercise and aerobic capacity, but only in those more severely iron deficient (serum ferritin < 15μg·L-1), with wide individual variation, unrelated to baseline serum ferritin. In conclusion, HMB is a risk factor for ID, physiological and psychological function decrements in exercising women. Intravenous iron repletion effectively restores iron status and improves functional exercise capacity when true ID exists. Serum ferritin as a biomarker for ID and its associated normative data should be re-evaluated to avoid false positive ID diagnosis.
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