Female Athletes Who Stop Menstruating May Face Heart Disease Risk

Women who stop menstruating because of excessive exercise may be at risk for developing future health problems. Athletic-induced amenorrhea (absence of menstruation) is known to cause premature osteoporosis and infertility. For instance, a young woman who hasn't menstruated in four years may have the bone strength of a 50-year-old.

It's estimated that almost three million girls and young women compete in American high school and college sports. Nearly a quarter of all female athletes may have an abnormal menstrual cycle. While studies have shown that women and girls who participate in sports and fitness programs are generally healthier and have higher self-esteem, it is important they are aware of what is called the Female Athlete Triad.

This recently recognized syndrome is made up of three distinct yet interrelated conditions: disordered eating, amenorrhea and osteoporosis. Well-meaning coaches, friends and parents may encourage weight loss in female athletes due to a mistaken belief that excessive leanness enhances performance. These young women may be goal-oriented, compulsive perfectionists, and the long-term effects of the Triad can be quite serious.

We know when post-menopausal women stop having their menstrual period, their risk of having cardiovascular disease increases significantly. We believe female athletes in their early 20s may be at risk for premature heart disease, too. However, no one has studied the correlation between lack of menstrual periods and premature heart disease. Medical College of Wisconsin researchers are now undertaking such a study.

The Medical College is in a unique position to perform this study because of its world-renowned Cardiovascular Research Center and the only Women's Sports Initiative Program in the Midwest, based at the Froedtert & Medical College Sports Medicine Center.

Initially, the Medical College is looking at runners, although gymnasts and ballerinas also have high rates of amenorrhea. To qualify for the study at this time, women must be at least 18 years old, run 25 miles per week, have missed a menstrual period for more than six months and not be on birth control pills. Participants are compensated $100 for their involvement.

The two-to-three hour screening involves filling out an exercise and diet survey and ruling out physical causes of amenorrhea, such as pregnancy or thyroid conditions. Bone health then is measured using a bone mineral density scanner, which takes five minutes. The cardiovascular health of participants is examined with a non-invasive ultrasound technique that assesses the ability of blood vessels to dilate under different conditions.

Loss of blood vessel dilation is one of the earliest manifestations of cardiovascular disease in post-menopausal women and is thought to be the first precursor to the development of heart disease.

All study participants will have an opportunity to receive medical counseling to help them regain their menstrual cycles. Treatment of the Triad often requires intervention via a team approach. A physician, nutritionist and psychologist with expertise in treating female athletes may need to work with athlete, coach, parent and others. Nutritional monitoring, hormone replacement and reduced training may be recommended.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.