[Menstrual disorders in athletes]

It is important to pay attention to bone metabolism in women long before the menopause. Irregular menstruation with anovulatory cycles or amenorrhoea persisting over several years have negative effects on bone formation and total bone mass already within a few years after menarche. They lead to a lack of oestradiol and are often associated with inadequate and unbalanced nutrition (e.g. lack of calcium and proteins). This results in severe impairment of bone formation and a net loss of bone mass. It is the duty of the doctors taking care of female athletes (as well as non-athletes) with irregular menstrual cycles or amenorrhoea to protect them against osteoporosis which may manifest itself 2-5 decades later. In the special case of female athletes a reduced bone mass is an important risk factor for stress fractures which can result in interruption or even in a premature termination of promising athletic careers. Athletes with retarded menarche, irregular menstrual cycles, or amenorrhoea must, therefore, be referred to a gynecologist for further diagnosis and treatment.