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Stress fracture and premenstrual syndrome in Japanese adolescent athletes: a cross-sectional study
  1. Takashi Takeda,
  2. Yoko Imoto,
  3. Hiroyo Nagasawa,
  4. Atsuko Takeshita,
  5. Masami Shiina
  1. Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University School of Medicine, Osaka, Japan
  1. Correspondence to Dr Takashi Takeda; take{at}


Objectives To investigate the relationship between the occurrence of stress fracture and premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) in Japanese adolescent athletes.

Design Cross-sectional study.

Setting Osaka, Japan.

Participants A school-based survey on menstruation and school life was conducted using a sample of 1818 Japanese female students who belonged to two public high schools in Japan. Among them, we recruited 394 athletes who had regular menstrual cycles (25–38 days) and completed a questionnaire about their premenstrual symptoms and their competitive career.

Main outcome measure Premenstrual symptoms and the occurrence of stress fracture.

Results The prevalences of moderate-to-severe PMS and PMDD were 8.9% and 1.3%, respectively, which were the same as in collegiate athletes in a previous study. Premenstrual symptoms disturbed ‘Work efficiency or productivity, home responsibilities’, ‘Relationships with coworkers or family’ and ‘Athletic performance in training or competition’ more severely than menstrual pain (p=0.031, p=0.004 and p<0.001, respectively). 66 athletes (16.8%) reported having experienced a stress fracture. The severity of ‘Overeating or food cravings’, ‘Physical symptoms’ and ‘Performance in training or competition’ in athletes with previous stress fractures were much higher than in those without a history of stress fractures (p=0.015, p=0.008 and p=0.006, respectively). In terms of premenstrual symptoms, ‘Physical symptoms’ was associated with an increased risk of stress fractures in athletes (OR 1.66, 95% CI 1.06 to 2.62).

Conclusions The results from this study indicated that premenstrual symptoms may affect athletic performance and has the risk of stress fractures in adolescent athletes.


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  • Contributors TT contributed to the drafting of the manuscript. TT, YI, HN, AT and MS contributed to data collection and analysed the data. TT was the main contributor to the study design and conception. All authors agreed with the integrity of the study and gave their approval.

  • Funding This work was supported, in part, by grants from JSPS KAKENHI grant number 15K01636, Tokyo, Japan and Research Promotion and Practical Use for Women's Health, AMED grant number 15666492, 15665610, Tokyo, Japan.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board at Kindai University (approval number 26-193).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.