A minority of female athletes participating in ballet, gymnastics, distance running, rowing, and cycling, as well as other sports activities, occasionally experience menstrual and associated physiologic changes. Women competing in the sports of ballet and gymnastics have been reported to have a particularly increased incidence of primary and secondary amenorrhea, decreased bone density, stress fractures, and symptoms of anorexia nervosa. Results of several studies have indicated decreased levels of circulating estrogen as well as other metabolic changes.
Research designed to determine the etiology of the amenorrhea and the associated changes has shown mixed results.
Low body fat cannot be linked in a causative fashion to hormonal changes or decreased levels of circulating estrogen. Early studies linking minimum body fat and menarche, as well as maintenance of regular menstrual cycles, have not been replicated. However, measurement of percentage of body fat may be helpful in assessing the nutritional status of athletes.
Ballet and gymnastics are perceived by some to be activities that are stressful psychologically. Although stress has been shown to cause amenorrhea, studies to date have not demonstrated the presence of significantly increased levels compared with agematched girls not participating in ballet and gymnastics.
Some authors have postulated that tall, thin athletes who may be genetically at risk for delayed maturation are naturally attracted to these sports. Some of the delays may relate to preselection. However, no evidence currently exists proving a definite relationship between preselection and the physiologic changes in these athletes.
There is an increased emphasis by athletes, coaches, judges, and spectators on a slender physique for female gymnasts and ballet dancers.
- Copyright © 1989 by the American Academy of Pediatrics