ABSTRACT
Menstrual disorders are common among female athletes, especially adolescents, but they should not be accepted as part of the life of an athlete, because they may be a sign of pathology. Many pathologies can cause menstrual disorders. The underlying origin of pathology in the Female Athlete Triad (the Triad) is believed to be low
Introduction ............................................................................................................205 Regulation of the Female Reproductive System ....................................................206 The Myth of the “Normal” Menstrual Cycle .........................................................209 Menstrual Disorders in Athletes ............................................................................. 211
Surveys of Clinical Menstrual Disorders .......................................................... 212 Primary Amenorrhea .................................................................................... 212 Secondary Amenorrhea ................................................................................ 214
Observational Studies of Menstrual Disorders.................................................. 214 Clinical Menstrual Disorders........................................................................ 214 Subclinical Menstrual Disorders .................................................................. 215
Prospective Experiments ................................................................................... 216 Further Contradictions of the Body Fat Hypothesis ..................................... 216 Experimental Evidence for the Exercise Stress Hypothesis ......................... 217 Experimental Evidence for the Energy Availability Hypothesis .................. 218 The Definitive Tests of the Exercise Stress and Energy Availability Hypotheses ................................................................................................... 219 Discovery of the Energy Availability Threshold .......................................... 219 The Insensitivity of Reproductively Mature Women to Low Energy Availability ................................................................................................... 221
Treatment of Menstrual Disorders ......................................................................... 223 Summary ................................................................................................................224 References ..............................................................................................................224
energy availability (i.e., eating too few calories to support basic physiological functions in addition to exercise).* The consequences of these menstrual disorders are many and may include low bone mineral density, poor cold tolerance, abnormally short or tall stature depending on the age at which energy deficiency occurs, reduced endurance, and so forth. Because effects on bone may be irreversible, early detection and prompt treatment of menstrual dysfunction are imperative. This can be difficult, however, because some menstrual disorders have no overt signs or symptoms. This chapter clarifies the difference between menstrual irregularity and menstrual disorders and comments on the prevalence of menstrual disorders among female athletes. It then presents evidence suggesting that low energy availability is the underlying cause of menstrual disorders in the Triad and explains their treatment options.
