Polycystic ovary–like syndrome in adolescent competitive swimmers

ObjectiveTo investigate the potential effects of intensive swimming on clinical and hormonal pubertal development in adolescent girls and to determine whether hyperandrogenism contributes to menstrual disorders.DesignCross-sectional study.SettingEndocrinology and gynecology pediatric units of academic hospitals.Patient(s)Eighteen competitive swimmers and 18 age-matched control subjects with breast stages IV or V.Intervention(s)None.Main Outcome Measure(s)Clinical, biologic, and ultrasonographic investigations.Result(s)A high number of cases of hyperandrogenism was seen in swimmers compared with control subjects (n = 11 vs. n = 5 with T level >0.5 ng/mL), as well as a higher LH/FSH ratio (1.5 vs. 0.9) and SHBG level (58.4 vs. 39.5 nmol/L) and more oligomenorrhea (n = 9 vs. n = 4). Half of the swimmers with hyperandrogenism presented pauci- or multifollicular ovaries determined by pelvic ultrasound. Free T was not significantly different between the two groups.Conclusion(s)Hyperandrogenism and oligomenorrhea may be part of the spectrum of polycystic ovary syndrome in elite swimmers. Our findings suggest that hyperandrogenism may have preceded the intensive training of these swimmers and may have predisposed the choice of sport for these girls. Intensive swimming may in turn have attenuated the clinical expression of their hyperandrogenism. Follow-up after the cessation of intensive activity would be helpful to evaluate the endocrine and metabolic profiles of these swimmers.