Menstrual dysfunction in athletes. How to identify and treat patients at risk for skeletal injury

Menstrual dysfunction is a common problem in competitive athletes. Exercise intensity, hypothalamic immaturity, and dietary practices are contributing factors. Although the specific mechanism is unknown, disruption of hypothalamic functioning appears to be involved. Women with menstrual dysfunction are at increased risk for bone mineral loss and musculoskeletal injury. Primary care physicians should routinely screen for these abnormalities and should be alert to the possibility of an eating disorder. Treatment options include a reduction in training intensity, improved nutrition and caloric intake, and hormone therapy to prevent bone loss and allow for safe continuation of training.