Exercise amenorrhoea is a medical condition in which women involved in heavy exercise experience absence of menstruation of varying periods of time. It occurs because of neuroendocrine dysfunction and is usually reversible.
Exercise amenorrhoea is a component of
female athlete triad
Relative energy deficiency in sport (RED-S) is a syndrome in which disordered eating (or ''low energy availability''), amenorrhoea/ oligomenorrhoea (in women), and decreased bone mineral density (osteoporosis and osteopenia) are present. It is ca ...
.
Etiology
Exercise induced
amenorrhoea
Amenorrhea or amenorrhoea is the absence of a menstrual period in a female organism who has reached reproductive age. Physiological states of amenorrhoea are most commonly seen during pregnancy and lactation (breastfeeding). In humans, it is wher ...
occurs in 5-25% of athletes and 1.8% of the general population. The incidence is higher in marathon runners and is more frequent in women who weigh less and were slightly younger.
Exercise amenorrhoea has also been reported in ballet dancers, cyclists, swimmers and those involved in non-weight bearing sports.
Pathophysiology
There occurs a suppression in the generation of
gonadotropin releasing hormone
Gonadotropin-releasing hormone (GnRH) is a releasing hormone responsible for the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary. GnRH is a tropic peptide hormone synthesized and released ...
(GnRH). The secretion of GnRH normally occurs in a pulsatile fashion, every 60 to 90 minutes. This is absent in exercise amenorrhoea. The function of GnRH is to stimulate the secretion of
leutinizing hormone (LH) and
follicle stimulating hormone
Follicle-stimulating hormone (FSH) is a gonadotropin, a glycoprotein polypeptide hormone. FSH is synthesized and secreted by the gonadotropic cells of the anterior pituitary gland and regulates the development, growth, pubertal maturation, ...
(FSH). As a result, LH and to a certain extent FSH are secreted in low quantities. These hormones are necessary for normal menstruation, and result in amenorrhoea if not secreted in adequate quantities.
Diagnosis
Exercise amenorrhoea is a diagnosis of exclusion. Girls who exercise at a young age may have
primary amenorrhoea. The differential diagnosis are androgen excess,
pituitary tumor
Pituitary adenomas are tumors that occur in the pituitary gland. Most pituitary tumors are benign, approximately 35% are invasive and just 0.1% to 0.2% are carcinomas.[malnutrition
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is a deficiency, excess, or imbalance of energy, protein and other nutrients which adversely affects the body's tissues a ...]
. Diet history and bone density investigations should also be done to determine if female athlete triad is present.
Management
Exercise amenorrhoea can be managed by eating a diet rich in calories and by decreasing the duration and intensity of exercise for at least 12 months. Amenorrhea usually persists and may take over 6 months to reverse.
References
{{reflist
Menstrual disorders
Sports medicine