{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T22:45:36Z","timestamp":1777934736145,"version":"3.51.4"},"reference-count":26,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T00:00:00Z","timestamp":1761350400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100013921","name":"Wilderness Medical Society","doi-asserted-by":"publisher","award":["WMS Charles S. Houston Grant"],"award-info":[{"award-number":["WMS Charles S. Houston Grant"]}],"id":[{"id":"10.13039\/100013921","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Ultramarathon races cover distances greater than 42.2 km. They are often held on mountain trails with significant challenges, such as inclement weather and rough terrain. Female participation in this sport is on the rise, but potential gynecologic health impacts, such as menstrual changes and pelvic floor dysfunction, are not well characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A convenience sample of female participants at New River Trail 50-km and Promise Land 50-km races were surveyed to determine the gynecologic health impacts of ultra running on female athletes as compared with the general female population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighty participants were surveyed. The mean age was 38 y, with 92% premenopausal participants and 50% with a history of childbirth. Irregular menstrual cycles were reported by 46% of the premenopausal females, which is significantly higher than in the general population (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). Secondary amenorrhea was reported by 29%, which is higher than in the general population, and was associated with age \u226540 y (odds ratio=8.83,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.008). Urinary incontinence (UI) was reported by 39% of runners, a significantly higher prevalence than in the general population (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). There was no association between secondary amenorrhea or UI between number of marathons run and number of previous births.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This cohort of female ultramarathon runners had significantly higher rates of irregular periods and secondary amenorrhea than the general population. UI trended toward an increase in the &gt;40 y age group. These results highlight the need for further research into gynecologic outcomes among female ultra-endurance athletes in wilderness and endurance sports.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10806032251385908","type":"journal-article","created":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T20:26:56Z","timestamp":1761424016000},"page":"485-493","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Gynecologic Health in Female Ultramarathon Runners"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5765-6834","authenticated-orcid":false,"given":"Julia H.","family":"Snow","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8142-0383","authenticated-orcid":false,"given":"Lillian R.","family":"Brouwer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua C.","family":"Nichols","sequence":"additional","affiliation":[{"name":"Carilion Clinic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0683-7480","authenticated-orcid":false,"given":"Stephanie A.","family":"Lareau","sequence":"additional","affiliation":[{"name":"Carilion Clinic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0292-6785","authenticated-orcid":false,"given":"Monica L.","family":"Ahrens","sequence":"additional","affiliation":[{"name":"Center for Biostatistics and Health Data Science, Virginia Tech, Blacksburg, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6793-2740","authenticated-orcid":false,"given":"James N.","family":"Casey","sequence":"additional","affiliation":[{"name":"Carilion Clinic"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,10,25]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Route 66 Marathon. 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Pelvic floor dysfunction. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK559246\/"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.300.11.1311"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-019-01243-1"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-023-05450-3"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1139\/apnm-2021-0298"},{"key":"e_1_3_3_12_2","unstructured":"Grimes WR Stratton M. Pelvic floor dysfunction. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. 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