Exercise-related reproductive dysfunction appears to be multifactorial in origin and remains a diagnosis of exclusion. The main factors etiologically correlated with menstrual disturbances in athletes are body composition, stress (physical exercise and psychological stress), energy balance (energy availability), diet, training methods (sports character) and reproductive maturity. Recent data highlight the endocrine role of the adipose tissue in the regulation of metabolism and reproduction, providing further elements on our current comprehension on the pathophysiology of exercise-induced reproductive dysfunction. The emerging role of adipose as an active endocrine organ has attracted the scientific concern and revealed a number of adipose-secreted factors (known as adipokines) involved in signaling and regulating homeostasis, energy balance, insulin action, reproductive function and inflammation process. Recent studies have implemented energy availability (defined as dietary energy input, minus exercise induced energy expenditure), rather than body weight or exercise stress, in the pathogenesis of reproductive dysfunction in female athletes. Clinical manifestations range from primary amenorrhea or delayed menarche to luteal phase deficiency, oligomenorrhea, anovulation and secondary amenorrhea. Amenorrhea constitutes the most serious clinical consequence involving skeleton and bone loss. Early diagnosis, thorough evaluation and individualized management (ranging from diet and exercise behavior adjustments to pharmacologic treatment) should be a priority, in order to preserve bone mass. Management strategies mainly include the use of oral contraceptives and hormone replacement therapy and a remodelling of energy balance with enhanced energy input and reduced energy output on a equilibrated daily training program.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology