The Impact of Intensive Physical Training on the Functioning of the Hypothalamic–Pituitary–Ovarian Axis in Female Athletes

Background Intensive physical training plays a crucial role in improving physical fitness and athletic performance; however, in female athletes it may also disrupt hormonal balance, particularly within the hypothalamic–pituitary–ovarian (HPO) axis. These disturbances are often associated with low energy availability and may lead to significant reproductive and systemic health consequences. Aim The aim of this review was to analyze current scientific evidence regarding the impact of intensive physical training on the functioning of the HPO axis in female athletes, with particular emphasis on underlying physiological mechanisms, health outcomes, and prevention strategies. Material and methods A narrative literature review was conducted based on publications from 2014 to 2026. Scientific databases including PubMed, Google Scholar, Scopus, and Web of Science were searched using relevant keywords related to HPO axis function, menstrual disorders, Female Athlete Triad, and Relative Energy Deficiency in Sport (RED-S). Only peer-reviewed review articles, clinical studies, and observational studies were included.