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Menstrual disorders are frequent in female athletes, especially those participating at the elite level. Factors which may contribute to impaired ovarian function in athletes include high training volumes, eating disorders and/or low body weight, which in turn may interrupt GnRH signaling. Hormonal contraception may disguise underlying menstrual disorders, and athlete use of such approaches is common, despite limited data on whether hormonal control has positive, neutral or negative effects on athletic performance. To determine the prevalence of hormonal contraceptive use, as well as the prevalence of menstrual disorders, in New Zealand elite female athletes, we completed a national internet-based survey of 219 participants being supported by High Performance Sport New Zealand. The survey aimed to characterize the demographics, health and athletic performance history, the training load and contraceptive use. We found that athletes were training intensely, with 38% reporting training volumes of >70 hours/month. At the youngest age represented (15-19 years), 72% had been in competitive sports for more than 5 years, suggesting a young gynecological age is represented by the cohort. More than half (58%, 127/219) of the surveyed athletes reported diagnosed illness or injuries. Stress fractures (39% 50/127), concussion (31%, 39/127) and asthma (26%, 33/127) were the most common diagnoses, followed by oligo/amenorrhea (20%, 26/127), reduced energy deficit syndrome (9%, 17/194), endometriosis (8%, 16/194), and polycystic ovary syndrome (5%, 9/194). Oligomenorrhea was significantly associated with stress fracture (p=0.018) and disordered eating (p=0.009). More than 50% of athletes tracked their menstrual cycle, and self-reporting showed even higher rates of oligo/amenorrhea 37% (29/79) in athletes not using hormonal contraception. Self-reporting also indicated a high prevalence of other menstrual disorders including delayed menarche (21%,43/207), menorrhagia (30%, 60/203), and dysmenorrhea (32%, 66/203). In athletes reporting menorrhagia, there was a significant association with iron deficiency (p=0.026). Of the 219 athletes, 37% were currently using hormonal contraception, of which the oral combined pill was the most popular (64%). The most commonly cited reason for hormonal contraception was birth control, however athletes used hormonal control to manipulate either the frequency (38%) or the symptoms (29%) of menstruation, particularly around competition. The data clearly suggests that there is likely to be significant undiagnosed gynecological pathology in elite female athletes. Hormonal contraception can mask gynecological health issues and themselves can lead to side effects that affect performance. It remains that health issues, especially those related to gynecological health, need to be considered by athletes, their coaches and medical support staff.

Objective To evaluate the impact of Zika virus on preparation and management of the New Zealand (NZ) Olympic team. Design Descriptive manuscript. Setting New Zealand Olympic Health team preparation and management during the Rio de Janeiro Olympic Games, 2016. Patients (or participants) New Zealand Olympic Team members. Interventions (or assessment of risk factors) This manuscript describes the approaches used by the NZ Olympic Health team to the minimization of risk from Zika virus. Main outcome measures Although descriptive of approach forms most of the article, the results of Zika virus serology are presented. Results The NZ Olympic Health team took a proactive approach to risk mitigation, including extensive education, clothing changes, mosquito spray, mosquito nets, and voluntary postexposure testing. No positive serology was observed in those tested. Conclusions The outbreak of Zika virus in Brazil, the associated complication of microcephaly, and the evolving understanding of virus transmission created significant uncertainty for NZ Olympic team members. The proactive approach taken by the health team to the mitigation of risk, combined with the anticipated low risk of arbovirus transmission over the period of the games, resulted in enhanced confidence from team members and no reports of positive serology.

Background Depression is a significant health issue. Recent athlete studies suggest depression is of similar prevalence to the general population, with risk factors such as retirement, concussion, and severe injury reported. The prevalence and identifiable risk factors amongst elite New Zealand athletes is unknown with no previous research in this field. Objective To assess the prevalence of self-reported symptoms of depression and daily life hassles in elite New Zealand athletes. Design A cross-sectional prospective epidemiological study. Setting The online anonymous survey was administered during a 2-month period from May to July 2015. Patients (or Participants) All current NZ athletes>18 years from funded sports invited. 210 started the questionnaire, with 187 completing all responses. Only complete responses analysed. Main Outcome Measurements Demographic and health history obtained. Symptoms of depression were measured by the Centre for Epidemiological Studies Depression Scale- Revised (CESD-R). Life stress measured by the Daily Hassles Questionnaire. Results 21% (n=39) reported symptoms of moderate depression. Of these 40% met the criteria for a Major Depressive Episode. Only 2 of the 39 athletes were currently taking an anti-depressant medication. Those contemplating retirement,and partaking in individual sport had significantly increased odds of experiencing depression with young age also associated. Reported life stressors were higher in females, individual sports, those in partial employment and in a centralized programme. Troubling thoughts about their future, and concerns about meeting high standards were the highest reported life stress. There was a significant correlation between higher level of life stress and experiencing depressive symptoms Conclusion This study supports that depressive symptoms are prevalent in elite New Zealand athletes. Multiple risk factors have been identified pertaining to symptoms of depression and life stressors. These concepts and variables warrant further exploration to enable appropriate screening and support for elite athletes.