A combination of both stress on the brain and reduced fat mass leading to reduced oestrogen metabolism may lead to amenorrhoea. Reduced energy availability may play an important role in the pathogenesis (1).
This condition is particularly prevalent in ballet schools and college sports. A principal concern in the management is the prevention of osteoporosis; this is combated using hormone replacement therapy or the oral contraceptive pill - the latter being more socially acceptable to young people with the added advantage of contraception. If restoration of fertility is a main objective, the best treatment is to gain weight. Advice the patient on increasing calorie intake and decreasing energy expenditure to promote the return of normal menses (1).
Note: disordered eating, amenorrhoea, and osteoporosis together make up the “female athlete triad” (1).
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