Influence of Energy Availability on Luteinizing Hormone Pulsatility and Menstrual Cyclicity

A Review and Proposed Treatment Approach for the Young Athlete at High Risk for the Female Athlete Triad

“…5 Theoretically, the sequence is initiated with low energy availability (suboptimal energy consumption) and progresses to irregular menses and bone loss. [4][5][6] Early intervention is recommended 7 and provides caregivers with the opportunity to intervene before the athlete progresses along the spectrum. As regards younger athletes, the dearth of available treatment guidelines and lack of consensus creates a dilemma for those responsible for this population.…”

“…A mere decrease of 30% of energy below that required for weight maintenance may trigger the cascade toward the Triad. 5,6 A sustained decrease in training (5%-10 %) with an increase in energy availability over time should return the athlete to balance. 5 In younger athletes, it may be necessary to consume more than 45 kcal/kg at least 75% of the time.…”

“…Further detail is out of the scope of this article. Interested readers are directed to several excellent topic overviews (menses, Loucks 6 and Warren and Perlroth 8 ; bone, Loud and Gordon 9 and Misra and Klibanski 10 ).…”

“…Approximately 90% of total bone mineral mass is accumulated during adolescence, 9,10 and loss of bone mineral density associated with the Triad may be irreversible. 6,10 The risk of a stress fracture is 2 to 4 times greater in the athlete with amenorrhea than eumenorrhea. The following situations warrant a bone mineral density assessment via dual-energy X ray absorptiometry: hypoestrogenism, disordered eating, eating disorders, oligomenorrhea or amenorrhea that have been present for a cumulative total of 6 months or more, and/or a history of fractures from minimal trauma or stress fractures.…”