Trial reportPM & R : the journal of injury, function, and rehabilitation2026
Multiple eumenorrheic cycles are necessary to observe a significant increase in estrogen exposure and ovulation in exercising women with functional hypothalamic oligo/amenorrhea undergoing a nutritional intervention: Insights from the REFUEL study.
Trial report in PM & R : the journal of injury, function, and rehabilitation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- 2025 Update to the Female Athlete Triad Coalition Consensus Statement Part 2: Clinical Guidelines for Screening, Diagnosis, Treatment, and Return to Play for Adolescents and Adults.Sports medicine (Auckland, N.Z.) · 2026Guideline
- Multiple eumenorrheic cycles are necessary to observe a significant increase in estrogen exposure and ovulation in exercising women with functional hypothalamic oligo/amenorrhea undergoing a nutritional intervention: Insights from the REFUEL study.PM & R : the journal of injury, function, and rehabilitation · 2026Trial
- 2025 Update to the Female Athlete Triad Coalition Consensus Statement Part 1: State of the Science and Introduction of a New Adolescent Model.Sports medicine (Auckland, N.Z.) · 2026Review
- The Women's Tennis Association (WTA) Multidisciplinary Education and Treatment Protocol for the Female Athlete Triad (1996-2022).Sports (Basel, Switzerland) · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
backgroundDue to consequences of energy-related oligo-/amenorrhea (Oligo/Amen) among exercising females, recovery of menses (ROM) is a priority. ROM is inconsistently defined and rarely reported with reproductive hormone (estrogen, progesterone) data, making it difficult to know when females achieve adequate recovery.
objectiveThe purpose of this secondary analysis of the REFUEL randomized controlled trial was to explore the ovarian hormone environment and quality of menstrual recovery among varying ROM definitions.
methodsROM was assessed in exercising females with Oligo/Amen (n = 33) who participated in a 12-month intervention of increased energy intake. Four ROM definitions (onset of menses, 1 menstrual cycle <36 days, 2 cycles <36 days, or 3 cycles <36 days) demonstrating advancing degrees of recovery were evaluated. Urinary metabolites of estrogen (estrone-1-glucuronide) and progesterone (pregnanediol glucuronide) were measured daily in a baseline and recovery menstrual cycle; the change in ovarian hormone exposure from baseline to recovery menstrual cycle was analyzed for each ROM definition. The proportion of ovulatory versus anovulatory recovery cycles and the proportion of exercising females who experienced a relapse of Oligo/Amen post recovery were calculated.
resultsDuring the intervention, 58% (19/33) of females satisfied at least one ROM definition. There was no change in average ovarian hormone exposure from baseline to the recovery cycle until females experienced three consecutive cycles <36 days, when estrogen exposure significantly increased (+154.7 ng/mL*day, +32.5%, p < .04). As females achieved more consecutive cycles <36 days, the number of ovulatory cycles increased (ROM-1: 31% ovulatory vs. ROM-2 and ROM-3: 54% and 44% ovulatory, respectively) and the occurrence of relapse after recovery decreased (ROM-1 relapse: 53% vs. ROM-2 and ROM-3 relapse: 15% and 22%, respectively).
conclusionMultiple eumenorrheic cycles may be necessary to observe a significant increase in estrogen exposure, ovulation, and a decrease in relapse after recovery.
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