Menstrual dysfunction screening and management for active females

There is a wide spectrum of attitudes among women concerning her menstrual cycle. Most athletes would prefer to not have to deal with the associated hygiene issues. This sets the stage for feeling that lack of menses (amenorrhea) is a good thing. Unfortunately, that is not necessarily the case. The menstrual cycle can be considered a vital sign related to the athlete’s overall health. Those athletes not having regular menses are likely exhibiting functional hypothalamic amenorrhea (FHA), a diagnosis of exclusion. This is one component of the female athlete triad. The FHA comes from inadequate energy availability and resultant diminished sex hormones. This also causes changes in bone health and puts the athlete at risk for stress fractures, suboptimal peak bone mass density, and future osteoporosis. Through education of female athletes and those in her circle of influence, it is possible to allow realization that amenorrhea is a medical issue and needs further attention. Determination of optimal screening for this condition has yet to be accomplished, but this chapter describes who should be screened and provides examples of questionnaires, which may be useful in sorting out an athlete’s needs. Management can be as simple as improving the athlete’s nutrition and/or decreasing her exercise intensity, but it can often be difficult to convince the athlete and her coaches of these steps.