Recall validity of the Health and Reproductive Survey (HeRS) and findings of menstrual health of young active females

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Hanna M. Gardner (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site:
Laurie Wideman

Abstract: The female menstrual cycle is inherently complex and there is great diversity in the hormonal profiles that maintain and govern the seemingly normal female reproductive cycle. Female sex hormones are linked to a breadth of physiological and psychological health mechanisms, yet timing, exposure, and flux of these hormones have been linked to both positive and negative health outcomes (Charkoudian, 2017; Dubey and Jackson, 2001; Henderson and Paganini-Hill, 1994; Karapanou & Papadimitriou, 2010; McEwen, 2017; Parazzini, 1993; Seifert-Klauss, 2010; Solomon, 2002; Terry, 2005; Yoo, 2016). Physical activity can have a large influence on menstrual function (Ackerman et al., 2020; Burch, 2000; Loucks, 1998; Mena, 2019; Redman, 2005; Reed, 2018; Sharma, 2013), and further exploration is needed to consider the balance between positive health benefits that come with exercise, and negative ones that may be associated with menstrual irregularities and infertility. The Health and Reproductive Survey (HeRS) was designed to investigate the impacts of physical activity and sport history participation on reproductive health from menarche to current (Ackerman, in press). The purpose of this study was to (1) investigate the reliability of (test-retest) recall data regarding menstrual health (menarche to menopause), (2) explore correlations between activity level, BMI, and self-identified athlete type associated with age at menarche, (3) investigate activity profiles of women experiencing menstrual irregularities (prevalence of secondary amenorrhea in athletes vs. non), (4) investigate changes in physical activity level and menstrual cycle characteristics (i.e. frequency, duration, and intensity) and (5) explore the prevalence of women using birth control in various age ranges and by self-identified athlete type. Within this study, 144 respondents took part in a test-retest procedure of the HeRS at timepoint one (T1) and four months later (T4mo). The average age of respondents was 32.73 +/- 11.919. The majority of participants (76.4% of respondents) reported reaching menarche at a normal age (between the ages of 12-15). Average BMI at the age of menarche was 20.15 +/- 2.884 (n=97), with a minimum of 12.86 and a maximum of 36.56. At the time of menarche, 82.6% of respondents reported being physically active. The majority of respondents reported being physically active 5-10 hours per week (30.6%), with the next largest group reporting 11-15 hours of physical activity per week (20.1%). The reliability of recall for menarche related questions showed no distinct difference based on the current age of the respondent, but the lack of medical records to validate the accuracy of respondents’ answers suggests that while older age groups showed high recall reliability, there is no way of knowing if their answers are more or less accurate. There was no significant relation between hours of physical activity at menarche and age at menarche. Over 40% of women in each age range reported irregular cycles (> 12 cycles or <10 cycles per year), a much greater value than currently reported in the literature (1.8-5%) (Peterson et al., 1973; Singh, 1981). Physician diagnosis of disordered menstrual cycles was lower (18.1%-36.1%), but still much higher than values from existing research. A number of HeRS questions were dropped from recall reliability testing due to poor survey design causing skewed and unreliable respondent answers (i.e., height in high school, physical activity change). It is suggested that these questions, as well as altering overlapping age ranges (i.e., 13-18; 18-24) be adjusted before the next administration of the HeRS. Finally, since the objective of the HeRS is to track female reproductive health with a focus on the influence of physical activity and sport participation, questions should be added to each age section to better clarify the number of hours of physical activity performed per week as well as the intensity level of that activity (Beals, 2002; Dusek, 2001; Freedman, 2002; Lagowska & Kapczuk, 2016; Mountjoy, 2018). The length and repetitive nature of questions within each section of the HeRS should be acknowledged, and questions that provide less crucial information should be considered for exclusion from future HeRS to reduce potential survey fatigue (Sinickas, 2007).

Additional Information

Language: English
Date: 2021
Amenorrhea, Female athlete, Menstrual disorders, Oligomenorrhea
Women athletes $x Physiology
Exercise $x Physiological aspects
Menstruation disorders
Recollection (Psychology)

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