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The cessation of menstrual function in the female athlete may reflect her inability to adapt to the environmental and lifestyle stressors associated with training and competition. As society's emphasis on thinness, dieting, and exercise continues to increase, so will the incidence of menstrual dysfunction in active females. Unfortunately, some individuals view athletic menstrual dysfunction as a benign consequence of strenuous exercise. Conversely, it is most likely a strong indicator of overtraining and a marker for future decrements in performance, and it can have long-term health consequences. Thus, it is imperative that the active female be appropriately educated regarding the adverse consequences of menstrual dysfunction and the interventions available. This paper focuses on the most current information regarding athletic menstrual dysfunction and its multifactorial etiology, especially the role of energy drain. In addition, common misconceptions, adverse health and performance effects, and available treatment options are discussed.

The purpose of this study was to determine the effect of a 15-week diet and exercise intervention program on energy balance, hormonal profiles, body composition, and menstrual function of an amenorrheic endurance athlete. The intervention program reduced training 1 day/week and included the use of a sport nutrition beverage providing 360 kcal/day. Three eumenorrheic athletes served as a comparison group and were monitored over the same 15-week period. The amenorrheic athlete experienced a transition from negative to positive energy balance, increased body fat from 8.2 to 14.4%, increased fasting luteinizing hormone (LH) from 3.9 to 7.3 mlU/ml, and decreased fasting cortisol from 41.2 to 33.2 pg/dl. The eumenorrheic subjects showed a 0.4% reduction in body fat, a decrease in follicular phase levels of LH from 7.9 to 6.5 mlU/ml, and no change in cortisol. These results suggest that nonpharmacological treatment can contribute to reestablishing normal hormonal profiles and menstrual cyclicity in amenorrheic athletes.

Chronic energy deficit is one of the strongest factors contributing to exercise-induced menstrual dysfunction. In such cases, macro- and micronutrient intakes may also be low. This study presents the results of a diet and exercise training intervention program, designed to reverse athletic amenorrhea, on improving energy balance and nutritional status in 4 amenorrheic athletes. The 20-week program provided a daily sport nutrition supplement and 1 day of rest/week. The intervention improved self-reported energy intake (El) and balance in all participants. The program increased protein intakes for the 3 athletes with a protein deficit to within the recommended levels for active individuals. Micronutrient intakes increased, as did serum concentrations of vitamin B12, folate, zinc, iron, and ferritin. These results indicate that some amenorrheic athletes have poor nutritional status due to restricted Els and poor food selections. A sport nutrition supplement may improve energy balance and nutritional status in active amenorrheic women.