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Susan Carter

Center in Colorado Springs in 1982 at a meeting of the Athletic Amenorrhea Bulletin , when the singer Karen Carpenter was suffering from anorexia. Her situation brought heightened public awareness of the condition. As anorexia was one of the original concerns of the Triad, along with osteoporosis and

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Margo Mountjoy, Jorunn Sundgot-Borgen, Louise Burke, Kathryn E. Ackerman, Cheri Blauwet, Naama Constantini, Constance Lebrun, Bronwen Lundy, Anna Melin, Nanna Meyer, Roberta Sherman, Adam S. Tenforde, Monica Klungland Torstveit, and Richard Budgett

differential responses of various body systems ( Burke & Deakin, 2015 ), many of these systems are substantially perturbed at an EA < 30 kcal/kg FFM/day (125 kJ/kg FFM/day), making it historically a targeted threshold for LEA. However, recent evidence suggests that this cutoff does not predict amenorrhea in

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Anna K. Melin, Ida A. Heikura, Adam Tenforde, and Margo Mountjoy

athletes with functional hypothalamic amenorrhea (FHA) spent more time in a catabolic state compared with eumenorrheic athletes ( Fahrenholtz et al., 2018 ) and demonstrate increased catabolic markers in male endurance athletes ( Torstveit et al., 2018 ). Prevalence of LEA, DE, and EDs in Athletics

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Nicole C.A. Strock, Kristen J. Koltun, Emily A. Southmayd, Nancy I. Williams, and Mary Jane De Souza

severity from luteal phase defects to amenorrhea consistent with the magnitude of energy deficiency, such that those with the most severe menstrual disturbances are also the most energy deficient ( De Souza et al., 2007b ). Owing to the long-term health outcomes associated with energy deficiency ( De Souza

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Sarah Staal, Anders Sjödin, Ida Fahrenholtz, Karen Bonnesen, and Anna Katarina Melin

Females Questionnaire (LEAF-Q; Melin et al., 2014 ), validated for detecting female athletes at risk for energy deficiency by assessing injury history, gastrointestinal, and menstrual function, was used. MD was defined as oligomenorrhea (<9 menstrual cycles the past year) or amenorrhea (an absence of

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Kirsty J. Elliott-Sale, Adam S. Tenforde, Allyson L. Parziale, Bryan Holtzman, and Kathryn E. Ackerman

performance. Such reproductive suppression in times of low EA is a form of functional hypothalamic amenorrhea (FHA), which manifests as persistent anovulation with no identifiable organic cause ( Gordon et al., 2017 ). Aberrant gonadotropic releasing hormone (GnRH) pulsatility at the hypothalamus leads to

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Ida A. Heikura, Arja L.T. Uusitalo, Trent Stellingwerff, Dan Bergland, Antti A. Mero, and Louise M. Burke

; METs = metabolic equivalents; tEEE = total EEE. Questionnaires Female participants completed the Low Energy Availability in Females Questionnaire (LEAF-Q; Melin et al., 2014 ), which was also used to assess self-reported amenorrhea. To examine the differences between subgroups, cumulative risk scores

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Nicole C.A. Strock, Kristen J. Koltun, and Emily A. Ricker

consensus statement on Relative Energy Deficiency in Sport (RED-S) . British Journal of Sports Medicine, 48 ( 20 ), 1461 – 1465 . PubMed ID: 25037200 doi: 10.1136/bjsports-2014-093958 Dueck , C.A. , Matt , K.S. , Manore , M.M. , & Skinner , J.S. ( 1996 ). Treatment of athletic amenorrhea with

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Sherry Robertson and Margo Mountjoy

, pp. 491–497. Copyright 2014 by BMJ Publishing Group ltd. Prevalence studies estimate up to 50% of exercising women have subtle menstrual abnormalities and 33% suffer from amenorrhea ( De Souza et al., 2010 ). The MD most commonly associated with RED-S is functional hypothalamic amenorrhea (FHA

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participated in the survey. Excluding those not of a reproductive age, 3.5% had amenorrhea, 6.0% oligomenorrhea, 42.1% eumenorrhea, 1.1% polymenorrhea and 48.4% were using hormonal contraception. 80.5% of women reported experiencing menstrual cycle-related symptoms every cycle, and 68.7% have had to alter