Abstract
Increasing caloric intake is a promising treatment for exercise-associated amenorrhea, but strategies have not been fully explored. The purpose of this case report was to compare and contrast the responses of two exercising women with amenorrhea of varying duration to an intervention of increased energy intake. Two exercising women with amenorrhea of short (3 months) and long (11 months) duration were chosen to demonstrate the impact of increased caloric intake on recovery of menstrual function and bone health. Repeated measures of dietary intake, eating behavior, body weight, body composition, bone mineral density, resting energy expenditure, exercise volume, serum metabolic hormones and markers of bone turnover, and daily urinary metabolites were obtained. Participant 1 was 19 years old and had a body mass index (BMI) of 20.4 kg/m2 at baseline. She increased caloric intake by 276 kcal/day (1,155 kJ/day, 13%), on average, during the intervention, and her body mass increased by 4.2 kg (8%). Participant 2 was 24 years old and had a BMI of 19.7 kg/m2. She increased caloric intake by 1,881 kcal/day (7,870 kJ/day, 27%) and increased body mass by 2.8 kg (5%). Resting energy expenditure, triiodothyronine, and leptin increased; whereas, ghrelin decreased in both women. Resumption of menses occurred 23 and 74 days into the intervention for the women with short-term and long-term amenorrhea, respectively. The onset of ovulation and regular cycles corresponded with changes in body weight. Recovery of menses coincided closely with increases in caloric intake, weight gain, and improvements in the metabolic environment; however, the nature of restoration of menstrual function differed between the women with short-term versus long-term amenorrhea.
Highlights
Exercising women frequently present with a chronic energy deficiency resulting from inadequate caloric intake to compensate for energy expenditure [1,2]
Zanker et al [9] followed an amenorrheic athlete for 12 years and reported increases in bone mineral density (BMD) of the proximal femur with increases in body mass index (BMI)
Resumption of menses successfully occurred in both women with an intervention that increased caloric intake rather than decreased EEE, a strategy that may be attractive to both athletes and coaches because it does not interfere with training volume or intensity
Summary
Exercising women frequently present with a chronic energy deficiency resulting from inadequate caloric intake to compensate for energy expenditure [1,2]. Participant 2: short-term amenorrhea Characteristics at baseline This participant was a 24-year old graduate student who participated in approximately 7 hours of exercise each week, consisting of dancing, running, and weight training She presented with a normal BMI of 19.7 kg/m2 and percent body fat of 22.7%; at the start of the intervention, she had not had menses for three months, and her menstrual history revealed multiple extended episodes of amenorrhea (Table 1). Menses was not reported for the following 4 months and chronically suppressed concentrations of E1G and PdG were observed, confirming the presence of another episode of amenorrhea During this period of amenorrhea, body weight and caloric intake decreased slightly toward baseline values increased again, leading to a second resumption. No significant increases in BMD were observed; P1NP increased by 51.6% and CTx decreased 36.1%, demonstrating a favorable change in bone turnover
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