A physician survey of therapy for exercise-associated amenorrhea: a brief report

Amenorrheic athletes face an increased risk of osteopenia and stress fractures. Optimal treatment for exercise-associated amenorrhea remains controversial, reflecting limited data on the therapeutic effects of hormonal or nutritional intervention in the prevention of osteopenia. To determine physician opinions regarding preferred management of amenorrheic athletes, members of the American Medical Society for Sports Medicine (AMSSM) were surveyed by questionnaire. Practitioners were asked if they prescribed sex steroid replacement, calcium supplementation, weight gain, or decreased physical activity for amenorrheic athletes. The 159 respondents included predominantly sports medicine (56%) and family medicine (32%) physicians. Sex steroid replacement was endorsed by 92%, calcium supplementation by 87%, increased caloric intake by 64%, decreased exercise intensity by 57%, weight gain by 43%, and vitamin supplementation by 26%. These findings suggest that sex steroids are used commonly to treat amenorrheic athletes, despite the paucity of data demonstrating their efficacy in preserving bone mass in this disorder. Further research is needed to define the benefits of estrogen alone or in combination with nutritional intervention for preserving bone mass in female athletes.