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      The Specificities of Elite Female Athletes: A Multidisciplinary Approach

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          Abstract

          Female athletes have garnered considerable attention in the last few years as more and more women participate in sports events. However, despite the well-known repercussions of female sex hormones, few studies have investigated the specificities of elite female athletes. In this review, we present the current but still limited data on how normal menstrual phases, altered menstrual phases, and hormonal contraception affect both physical and cognitive performances in these elite athletes. To examine the implicated mechanisms, as well as the potential performances and health risks in this population, we then take a broader multidisciplinary approach and report on the causal/reciprocal relationships between hormonal status and mental and physical health in young (18–40 years) healthy females, both trained and untrained. We thus cover the research on both physiological and psychological variables, as well as on the Athlete Biological Passport used for anti-doping purposes. We consider the fairly frequent discrepancies and summarize the current knowledge in this new field of interest. Last, we conclude with some practical guidelines for eliciting improvements in physical and cognitive performance while minimizing the health risks for female athletes.

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          The IOC consensus statement: beyond the Female Athlete Triad--Relative Energy Deficiency in Sport (RED-S).

          Protecting the health of the athlete is a goal of the International Olympic Committee (IOC). The IOC convened an expert panel to update the 2005 IOC Consensus Statement on the Female Athlete Triad. This Consensus Statement replaces the previous and provides guidelines to guide risk assessment, treatment and return-to-play decisions. The IOC expert working group introduces a broader, more comprehensive term for the condition previously known as 'Female Athlete Triad'. The term 'Relative Energy Deficiency in Sport' (RED-S), points to the complexity involved and the fact that male athletes are also affected. The syndrome of RED-S refers to impaired physiological function including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health caused by relative energy deficiency. The cause of this syndrome is energy deficiency relative to the balance between dietary energy intake and energy expenditure required for health and activities of daily living, growth and sporting activities. Psychological consequences can either precede RED-S or be the result of RED-S. The clinical phenomenon is not a 'triad' of the three entities of energy availability, menstrual function and bone health, but rather a syndrome that affects many aspects of physiological function, health and athletic performance. This Consensus Statement also recommends practical clinical models for the management of affected athletes. The 'Sport Risk Assessment and Return to Play Model' categorises the syndrome into three groups and translates these classifications into clinical recommendations.
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            The microbiome of professional athletes differs from that of more sedentary subjects in composition and particularly at the functional metabolic level

            It is evident that the gut microbiota and factors that influence its composition and activity effect human metabolic, immunological and developmental processes. We previously reported that extreme physical activity with associated dietary adaptations, such as that pursued by professional athletes, is associated with changes in faecal microbial diversity and composition relative to that of individuals with a more sedentary lifestyle. Here we address the impact of these factors on the functionality/metabolic activity of the microbiota which reveals even greater separation between exercise and a more sedentary state.
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              Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods

              Sex hormones have been implicated in neurite outgrowth, synaptogenesis, dendritic branching, myelination and other important mechanisms of neural plasticity. Here we review the evidence from animal experiments and human studies reporting interactions between sex hormones and the dominant neurotransmitters, such as serotonin, dopamine, GABA and glutamate. We provide an overview of accumulating data during physiological and pathological conditions and discuss currently conceptualized theories on how sex hormones potentially trigger neuroplasticity changes through these four neurochemical systems. Many brain regions have been demonstrated to express high densities for estrogen- and progesterone receptors, such as the amygdala, the hypothalamus, and the hippocampus. As the hippocampus is of particular relevance in the context of mediating structural plasticity in the adult brain, we put particular emphasis on what evidence could be gathered thus far that links differences in behavior, neurochemical patterns and hippocampal structure to a changing hormonal environment. Finally, we discuss how physiologically occurring hormonal transition periods in humans can be used to model how changes in sex hormones influence functional connectivity, neurotransmission and brain structure in vivo.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Life (Basel)
                Life (Basel)
                life
                Life
                MDPI
                2075-1729
                26 June 2021
                July 2021
                : 11
                : 7
                : 622
                Affiliations
                [1 ]CIAMS, Université Paris-Saclay, 91405 Orsay, France; carole.castanier@ 123456universite-paris-saclay.fr (C.C.); caroline.teulier@ 123456universite-paris-saclay.fr (C.T.); sandrine.schiano-lomoriello@ 123456univ-orleans.fr (S.S.-L.); nancy.rebot@ 123456univ-orleans.fr (N.V.-R.); aude.villemain@ 123456univ-orleans.fr (A.V.); nathalie.rieth@ 123456univ-orleans.fr (N.R.); christine.le-scanff@ 123456universite-paris-saclay.fr (C.L.-S.)
                [2 ]CIAMS, Université d’Orléans, 45067 Orléans, France
                [3 ]LAMHESS, Université Côte d’Azur, 06205 Nice, France; valerie.bougault@ 123456univ-cotedazur.fr
                [4 ]B3OA, Université de Paris, 75010 Paris, France; christelle.jaffre@ 123456u-picardie.fr
                [5 ]Département des Analyses, AFLD, 92290 Chatenay-Malabry, France; c.buisson@ 123456afld.fr
                Author notes
                [* ]Correspondence: katia.collomp@ 123456univ-orleans.fr ; Tel.: +33-238-417-178
                Author information
                https://orcid.org/0000-0002-8808-9366
                https://orcid.org/0000-0003-4400-783X
                https://orcid.org/0000-0001-5401-8431
                https://orcid.org/0000-0001-6004-7052
                Article
                life-11-00622
                10.3390/life11070622
                8303304
                34206866
                f7711ace-deaa-4996-9ca8-4c50eb9aa5d5
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 29 April 2021
                : 23 June 2021
                Categories
                Review

                menstrual phase,amenorrhea,hormonal contraception,performance,health,athlete biological passport

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