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The Female Athlete & Athletic Amenorrhea

Amenorrhea means the absence of menstruation, or a period.

Amenorrhea can be classified as either primary or secondary.

Primary amenorrhea is when a female has not menstruated by the age of 15 and has otherwise shown signs of puberty.

Secondary amenorrhea is the absence of menstruation for 3 months in a female who previously had regular menstrual cycles OR 6 months in a female with previously irregular cycles.

The most common cause of amenorrhea in athletes is what is known as functional hypothalamic amenorrhea (FHA).

The hypothalamus is a regulatory centre in the brain that releases hormones (including oestrogen and progesterone), which control multiple bodily systems, including the female reproductive system.

In FHA, the hypothalamus is ‘silenced’ from releasing hormones that ultimately allow for ovulation and a normal menstrual cycle. FHA can be caused by low energy intake, excessive exercise, excessive weight loss, stress, or a combination of these factors.

Amenorrhea should never be considered an acceptable consequence of any level of athletic or fitness training.

Amenorrhea is a red flag that the body is not functioning to its full potential, and should always be addressed, in conjunction with a health professional.

Treatment of FHA includes addressing the causative factors, including, but not limited to, increasing caloric intake and/or decreasing energy expenditure.

It has been estimated that for every year without a menstrual cycle, females can lose more than 2% of their bone density, which can be irreversible.

Low bone mineral density increases the risk of fractures including stress fractures.

A common diagnosis among female athletes is The Female Athlete Triad, which is an interrelationship of menstrual dysfunction, low energy availability (with or without an eating disorder), and decreased bone mineral density.

Treatment requires a multidisciplinary approach involving health care professionals, as well as coaches and family members. Prevention of this condition is important to minimize complications of the female athlete triad.

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