Amenorrhea and infertility associated with exercise
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
Many women of reproductive age engage in some kind of exercise. Most obtain benefits such as improved exercise capacity, control of body weight, strengthening of weight-bearing bones, and reduction in cardiovascular risk factors. However, some can also become amenorrheic or infertile . In addition, excessive exercise at a critical time in development may delay puberty and menarche . In female athletes, the combination of low caloric intake, menstrual dysfunction, and low bone density is called the “female athlete triad.”
This topic will review the major issues related to amenorrhea and infertility associated with exercise. An overall approach to the woman with amenorrhea is presented separately. (See "Evaluation and management of primary amenorrhea" and "Evaluation and management of secondary amenorrhea".)
Type of exercise — Exercise alone does not induce amenorrhea. The likelihood of amenorrhea varies with the type and amount of exercise and the rapidity of increase in exercise. Activities that tend to be associated with low body weight (eg, running, ballet dancing) and sports in which scoring is subjective (eg, figure skating or gymnastics) are associated with a higher incidence of amenorrhea than are other activities such as swimming.
Gradually increasing exercise is less likely to be associated with amenorrhea than are more acute increases, such as when a woman quickly increases training for a competition.
Relative caloric deficiency — Low body weight alone is not sufficient to explain the onset of amenorrhea, because women with similar body mass indexes (BMIs) vary in their menstrual response to exercise. It appears that amenorrhea occurs only when there is relative caloric deficiency due to inadequate nutritional intake for the amount of energy expended [3,4].
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- Type of exercise
- Relative caloric deficiency
- Genetic predisposition
- Leptin and other peptides
- Effect on H-P-O axis
- CONSEQUENCES OF EXERCISE-INDUCED AMENORRHEA
- Low bone density/fractures
- Excess mortality
- Lab tests
- Bone density
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS