Menstrual Dysfunction in Athletes

What is Menstrual Dysfunction in Athletes

Exercise has many health benefits, including maintaining good heart and lung function, strength, and flexibility. However, for girls and women, extreme amounts or intensity of exercise can have some less desirable effects, especially on menstrual cycles.

This can result in periods that do not occur regularly or are abnormally absent (menstrual dysfunction). This may also be called amenorrhea. There are different types of menstrual dysfunction:

  • Oligomenorrhea. This is having fewer than normal periods per year, or having longer than normal time lapses between periods.
  • Primary amenorrhea. This is when a girl has not yet started having her period (menarche) by the time she is 16 years old. For some girls, genetic factors may delay menarche.
  • Secondary amenorrhea. This is the absence of three or more periods in a row, after menarche has already taken place.
  • Athletic amenorrhea. This is the absence of periods that is caused by exercise. It can be primary or secondary, depending on whether menarche has already occurred.

What are the causes?

There is no known single cause of menstrual dysfunction in athletes. These conditions can develop for different reasons in different women. In general, these conditions are thought to occur because of:

  • Hormone imbalance.
  • Altered metabolism.
  • Decreased body fat percentage.
  • Genetic inheritance.
  • Psychological stress.
  • Ongoing negative energy balance. This means that you consume fewer calories than you burn each day.

What increases the risk?

This condition is more likely to develop in:

  • Girls and women who do activities that encourage or result in leanness, such as endurance sports, body building, and dance.
  • Girls and women who have experienced rapid weight loss.
  • Girls and women who engage in frequent, vigorous exercise or sports training.
  • Girls and women who have a mother who experienced menstrual dysfunction.

What are the signs or symptoms?

Symptoms of this condition include:

  • Absence of menstrual periods.
  • Irregular menstrual periods.
  • Increasing intervals of time between menstrual periods.
  • Stress fractures. These are small breaks or cracks in a bone.

How is this diagnosed?

This condition is diagnosed with a medical history and physical exam. Your health care provider will ask you about your menstrual history and ask how much you exercise. You may also need to have tests to help confirm the diagnosis and to ensure that your menstrual dysfunction is not caused by another medical condition. These tests may include:

  • Blood tests.
  • Urine tests.
  • Dietary evaluation by a specialist (dietitian).
  • Body fat composition analysis.
  • A test to check how dense your bones are (bone densitometry).
  • Ultrasound.

How is this treated?

Treatment for menstrual dysfunction in athletes depends on the suspected cause of the condition. Some treatment options include:

  • Decreasing the amount or intensity of daily exercise.
  • Increasing body weight.
  • Reducing stress.
  • Improving the amount or quality of sleep.
  • Medicines. These may include hormone replacement.
  • Vitamin and mineral supplements.

Your health care provider may also advise you to work with a registered dietitian to make changes to your diet.

Follow these instructions at home:

  • Exercise as told by your health care provider.
  • Try to reduce your stress, such as with yoga or meditation. If you need help doing this, ask your health care provider.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Take vitamin and mineral supplements only as told by your health care provider.
  • Get enough sleep. Talk with your health care provider about how much sleep you should be getting.
  • Try to maintain or gain weight as told by your health care provider. This may include eating a diet as suggested by your dietitian. Avoid trying to lose weight unless it has been discussed with your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.
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