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Active Voice: Amenorrhea Not Only Negatively Impacts Bones — It Can Also Decrease Exercise Performance

from By Gretchen A. Casazza, Ph.D.

Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Gretchen A. Casazza, Ph.D., is an ACSM member and assistant adjunct professor in the College of Biological Sciences and research director for the sports medicine program at the University of California, Davis. Her research interests relate to cardiovascular and metabolic adaptations to exercise, as well as the effects of ovarian hormones on exercise performance and bone health. This commentary presents Dr. Casazza’s views associated with the research article she and her colleagues published in the Jan. 2011 Medicine & Science in Sports & Exercise®.

Female endurance athletes often come to our clinic for training advice to optimize performance. Many of these women strive to be as lean as possible, as their coaches have emphasized leanness as a factor to successful performance. These women also typically have very high volumes of training and little understanding of sports nutrition and the importance of energy balance. As a result, there is high prevalence of female athletes with chronically low energy availability due to high rates of energy expenditure, insufficient food intake or both. As it is one of the most expensive metabolic processes, reproductive function is sensitive to overall energy status. The activity of the hypothalamus – a portion of the brain that links the nervous system to the hormonal system – is suppressed in response to caloric deprivation, resulting in the reduction of many hormones including reproductive and metabolic hormones. While some of these women still have menstrual cycles, their cycles are often prolonged and may not result in ovulation. Often, these athletes end up losing their menstrual cycle altogether, a condition called “amenorrhea.” more

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