ATHLETIC AMENORRHEA

What Is Amenorrhea?    Amenorrhea is not having a menstrual period.  There are two main kinds of amenorrhea, primary and secondary.  Primary amenorrhea is when a young woman has not had a period by the age of 16.  Secondary amenorrhea is when a woman begins missing periods and has only two periods in a year or doesn't have a period for 4 to 6 months.

What Is Athletic Amenorrhea?    Athletic amenorrhea is when a woman does not have periods because she exercises very intensely and is very lean.  Some women with athletic amenorrhea stop having periods.  Some young women with athletic amenorrhea may delay their first period for years, even into their 20's.

How Does Athletic Amenorrhea Occur?    Intense exercise and extreme thinness may reduce the levels of hormones that regulate a woman's periods.  These hormones, estrogen and progesterone, are important for overall body health.  Estrogen is especially vital for healthy bones.

Athletic amenorrhea is often seen in sports that emphasize thinness, such as gymnastics, figure skating, and long distance running.  When thinness is heavily emphasized, some young women may develop eating disorders such as anorexia or bulimia.  A person with anorexia diets excessively, sometimes to the point of starvation.  People with bulimia binge (eat a lot at one time) and then purge, either by vomiting, using laxatives, or exercising excessively.

What Are The Symptoms?    You will not have periods.

A lack of estrogen leads to a lack of calcium in your bones.  This makes the bones brittle and weak, a condition called osteoporosis.  Intense exercise puts extra stress on weak bones, leaving athletes with osteoporosis at risk for stress fractures.  Young women who have osteoporosis may never get enough calcium in their bones as they grow and mature.  As they get older, their bones may break easily.

When a woman has a combination of athletic amenorrhea, an eating disorder, and osteoporosis, it is called the female athlete triad.

How Is It Diagnosed?    Your doctor will do various tests, including a pregnancy test, to find out why your periods have stopped or why they never started.  (Pregnancy is the most common reason women miss periods.)  The doctor will talk to you about your exercise patterns and eating habits.  A DEXA scan may be ordered, which is a type of x-ray that measures the density of your bones.

How Is It Treated?    Athletic Amenorrhea needs to be treated in several ways because it often is a problem involving:
-    too much exercise
-    poor diet
-    hormone imbalance

To treat it:
-    you may need to exercise less
-    eat enough food to take in enough calories for your workouts
-    make sure you have enough calcium in your diet
-    you may need to take birth control pills or other forms of estrogen to restore hormone balance.

If you are sexually active you can become pregnant, even if you have amenorrhea.  Take precautions if you do not want to become pregnant.

How Is It Prevented?    A well-balanced diet with enough calories helps prevent athletic amenorrhea.  It is important to recognize when you are exercising to much and eating too little.  Eating disorders are serious problems and should be discussed openly with your health care provider.


The Sports Medicine Patient Advisor
by Pierre Rouzier, MD
Athletic Amenorrhea pp 311-312