{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:03:23Z","timestamp":1790791403665,"version":"4.1.0"},"reference-count":34,"publisher":"Human Kinetics","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"\n Recent methodological recommendations suggest the use of the \u201c3-step method,\u201d consisting of calendar-based counting, urinary ovulation testing, and serum blood sampling, for the identification of subtle menstrual disturbances (SMDs). However, the use of the 3-step method is not always feasible, so a less demanding combination of calendar-based counting and urinary ovulation testing, that is, the 2-step method, may be a viable alternative.\n \n Purpose<\/jats:bold>\n :\n <\/jats:italic>\n To investigate the agreement between the 2- and 3-step methods for the detection of SMDs.\n \n Methods<\/jats:bold>\n :\n <\/jats:italic>\n Menstrual cycles (MCs, 98) of 59 athletes were assessed using the 2- and 3-step methods. Regular-length MCs (ie,\u00a0\u226521 and \u226435\u00a0d) were classified as either having no SMD (luteal phase length \u226510\u00a0d, midluteal progesterone concentration \u226516\u00a0nmol\u00b7L\n \u22121<\/jats:sup>\n , and being ovulatory) or having an SMD (eg,\u00a0short luteal phase [<10\u00a0d], inadequate luteal phase [midluteal progesterone concentration <16\u00a0nmol\u00b7L\n \u22121<\/jats:sup>\n ], or being anovulatory). Method agreement was assessed using the\u00a0McNemar test and Cohen kappa (\n \u03ba<\/jats:italic>\n ).\n \n Results<\/jats:bold>\n :\n <\/jats:italic>\n Substantial agreement was observed between methods (\n \u03ba<\/jats:italic>\n \u2009=\u2009.72; 95% CI, .53\u2013.91), but the 2-step method did not detect all MCs with an SMD, resulting in evidence of systematic bias (\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20095.14;\n P<\/jats:italic>\n \u2009=\u2009.023). The 2-step method detected 61.1% of MCs that had an SMD ([51.4, 70.8]), as verified using the 3-step method, and correctly identified 100% of MCs without an SMD.\n \n Conclusions<\/jats:bold>\n :\n <\/jats:italic>\n MCs classified as being disturbed using the 2-step method could be considered valid evidence of SMDs. However, MCs classified without SMDs do not definitively confirm their absence, due to the proven underdetection via the 2-step method.\n <\/jats:p>","DOI":"10.1123\/ijspp.2024-0057","type":"journal-article","created":{"date-parts":[[2024,7,23]],"date-time":"2024-07-23T19:01:18Z","timestamp":1721761278000},"page":"953-957","source":"Crossref","is-referenced-by-count":20,"title":["Agreement Between the 2- and 3-Step Methods for Identifying Subtle Menstrual Disturbances"],"prefix":"10.1123","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1630-4696","authenticated-orcid":true,"given":"Dionne A.","family":"Noordhof","sequence":"first","affiliation":[{"name":"Department of Neuromedicine and Movement Science, Center for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4241-3004","authenticated-orcid":true,"given":"Madison Y.","family":"Taylor","sequence":"additional","affiliation":[{"name":"School of Sport Sciences, UiT the Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8123-0841","authenticated-orcid":true,"given":"Virginia","family":"De Martin Topranin","sequence":"additional","affiliation":[{"name":"Department of Neuromedicine and Movement Science, Center for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway"},{"name":"Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1823-7087","authenticated-orcid":true,"given":"Tina P.","family":"Engseth","sequence":"additional","affiliation":[{"name":"School of Sport Sciences, UiT the Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9014-5152","authenticated-orcid":true,"given":"\u00d8yvind","family":"Sandbakk","sequence":"additional","affiliation":[{"name":"Department of Neuromedicine and Movement Science, Center for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway"},{"name":"School of Sport Sciences, UiT the Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8681-8521","authenticated-orcid":true,"given":"John O.","family":"Osborne","sequence":"additional","affiliation":[{"name":"School of Sport Sciences, UiT the Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"100","reference":[{"issue":"5","key":"r1","series-title":"Sports Med","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1007\/s40279-021-01435-8","article-title":"Methodological considerations for studies in sport and exercise science with women as participants: a working guide for standards of practice for research on women","volume":"51","author":"Elliott-Sale KJ","year":"2021","unstructured":"Elliott-Sale KJ, Minahan CL, de Jonge XAKJ, et\u00a0al. 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