Exerciserelated amenorrhoea

Menstrual disturbance is common in athletes undergoing intensive training. Between 10 and 20% have oligomenor-rhoea or amenorrhoea, compared with 5% in the general population [52]. Amenorrhoea is more common in athletes under 30 years and is particularly common in women involved in the endurance events (such as long distance running). Up to 50% of competitive runners training 80 miles per week may be amenorrhoeic [53].

The main aetiological factors are weight and percentage body fat content, but other factors have also been postulated. Physiological changes are consistent with those associated with starvation and chronic illness.

Ballet dancers provide an interesting subgroup of sportswomen, because their training begins at an early age. They have been found to have a significant delay in menarche (15.4 compared to 12.5 years) and a retardation in pubertal development which parallels the intensity of their training [54]. Menstrual irregularities are common and up to 44% have secondary amenorrhoea [55]. In a survey of 75 dancers 61% were found to have stress fractures and 24% had scoliosis; the risk of these pathological features was increased if menarche was delayed or if there were prolonged periods of amenorrhoea [55]. These findings may be explained by delayed pubertal maturation resulting in attainment of a greater than expected height and a predisposition to scoliosis, as oestrogen is required for epiphyseal closure.

Exercise-induced amenorrhoea has the potential to cause severe long-term morbidity, particularly with regard to osteoporosis. Studies on young ballet dancers have shown that the amount of exercise undertaken by these dancers does not compensate for these osteoporotic changes [55]. Oestrogen is also important in the formation of collagen and soft tissue injuries are also common in dancers [56]. Whereas moderate exercise hasbeen found to reduce the incidence of postmenopausal osteoporosis, young athletes may be placing themselves at risk at an age when the attainment of peak bone mass is important for long-term skeletal strength. Appropriate advice should be given, particularly regarding diet, and the use of a cyclical oestrogen/progestogen preparation should be considered.

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