Sports Medicine: Just the Facts

CHAPTER 98 • THE FEMALE ATHLETE 577

diagnosis of exclusion. Pregnancy is the most common

cause of amenorrhea in sexually active women, and

must be excluded. Other diagnoses to rule out include

polycystic ovarian syndrome (PCOS), Asherman’s

syndrome, and thyroid or pituitary abnormalities.

• If a woman over the age of 30 is presenting with sec-
  ondary amenorrhea, other etiologies to be considered
  are premature ovarian failure, endometrial hyperpla-
  sia, and carcinoma.
  •Exercise-related amenorrhea is thought to be second-
  ary to an energy deficit from an inadequate caloric
  intake in relationship to energy expenditure. It is
  thought that girls or women who are having menstrual
  irregularities secondary to an energy deficit are at risk

of decreased bone mineral density (BMD) as well.

The primary treatment that is recommended at this

time is correcting the energy deficit by increasing

caloric intake to the point that there is a spontaneous

return of menses. This has been associated with an

increase in bone mass as well.

OSTEOPOROSIS

• Osteoporosis is characterized by microarchitectural
  deterioration of bone tissue leading to enhanced
  skeletal fragility, low bone mass, and an increased risk
  for fracture.

FIG. 98-1 Laboratory Evaluation of Amenorrhea. Source: Adapted from: Fieseler CM. Special con-
siderations for the female runner. Journal of Back and Musculoskeletal Rehabilitation.Vol. 6. 1996.