title: A case report of recovery of menstrual function following a nutritional intervention in two exercising women with amenorrhea of varying duration.
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/m(2) 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/m(2). 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.
authors.affiliation: Women's Health and Exercise Laboratory, 104 Noll Laboratory, Department of Kinesiology, Penn State University, University Park, PA 16802, USA.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Mallinson
authors.affiliation: Women's Health and Exercise Laboratory, 104 Noll Laboratory, Department of Kinesiology, Penn State University, University Park, PA 16802, USA.
authors.forename: Nancy I
authors.initials: NI
authors.lastname: Williams
authors.affiliation: Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada.
authors.forename: Marion P
authors.initials: MP
authors.lastname: Olmsted
authors.affiliation: Women's Health and Exercise Laboratory, 104 Noll Laboratory, Department of Kinesiology, Penn State University, University Park, PA 16802, USA ; Department of Pediatrics, (current institution for JLS), University at Buffalo, Buffalo, NY 14222, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Scheid
authors.affiliation: Women's Health and Exercise Laboratory, 104 Noll Laboratory, Department of Kinesiology, Penn State University, University Park, PA 16802, USA.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Riddle
authors.affiliation: Women's Health and Exercise Laboratory, 104 Noll Laboratory, Department of Kinesiology, Penn State University, University Park, PA 16802, USA.
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: De Souza
keywords: Amenorrhea; Bone mineral density; Energy intake; Resumption of menses; Treatment
references.citation: J Psychosom Res. 1985;29(1):71-83
references.pmid: 3981480
references.citation: Med Sci Sports Exerc. 2007 Oct;39(10):1867-82
references.pmid: 17909417
references.citation: Med Sci Sports Exerc. 2000 Sep;32(9 Suppl):S457-64
references.pmid: 10993415
references.citation: Med Sci Sports Exerc. 2004 Aug;36(8):1433-9
references.pmid: 15292754
references.citation: Eur J Clin Nutr. 1989 Nov;43(11):793-9
references.pmid: 2627927
references.citation: Hum Reprod. 2010 Feb;25(2):491-503
references.pmid: 19945961
references.citation: Osteoporos Int. 2006 Jan;17(1):77-84
references.pmid: 15889315
references.citation: Med Sci Sports Exerc. 2004 Jan;36(1):137-42
references.pmid: 14707779
references.citation: Am J Physiol Endocrinol Metab. 2007 May;292(5):E1401-9
references.pmid: 17227959
references.citation: N Engl J Med. 1984 Aug 2;311(5):277-81
references.pmid: 6738640
references.citation: Am J Physiol. 1996 Jan;270(1 Pt 1):E1-19
references.pmid: 8772468
references.citation: Med Sci Sports Exerc. 2011 Aug;43(8):1575-81
references.pmid: 21681120
references.citation: J Clin Endocrinol Metab. 2001 Nov;86(11):5184-93
references.pmid: 11701675
references.citation: Int J Sport Nutr Exerc Metab. 2011 Aug;21(4):280-90
references.pmid: 21813911
references.citation: Nature. 1998 Jun 18;393(6686):684-8
references.pmid: 9641678
references.citation: Med Sci Sports Exerc. 2000 Sep;32(9 Suppl):S498-504
references.pmid: 10993420
references.citation: Osteoporos Int. 2005 Dec;16(12):1955-62
references.pmid: 16027954
references.citation: Hum Reprod. 2011 Mar;26(3):685-94
references.pmid: 21227945
references.citation: Am J Clin Nutr. 2000 Jun;71(6):1495-502
references.pmid: 10837290
references.citation: J Clin Endocrinol Metab. 2004 Jul;89(7):3536-42
references.pmid: 15240643
references.citation: Fertil Steril. 2007 Oct;88(4):971-5
references.pmid: 17418159
references.citation: J Clin Endocrinol Metab. 1998 Dec;83(12):4220-32
references.pmid: 9851755
references.citation: Int J Sport Nutr. 1999 Mar;9(1):70-88
references.pmid: 10200061
references.citation: Fertil Steril. 2003 Apr;79(4):947-55
references.pmid: 12749436
references.citation: Bone. 2009 Jan;44(1):137-44
references.pmid: 18929691
references.citation: Appetite. 2009 Feb;52(1):184-92
references.pmid: 18929607
references.citation: Eat Weight Disord. 2007 Mar;12(1):20-6
references.pmid: 17384526
references.citation: Endocrinology. 2000 Apr;141(4):1464-9
references.pmid: 10746651
references.citation: Med Sci Sports Exerc. 2011 Nov;43(11):2063-71
references.pmid: 21502892
references.citation: J Clin Endocrinol Metab. 2004 Sep;89(9):4434-8
references.pmid: 15356043
references.citation: Lancet. 2005 Jul 2-8;366(9479):74-85
references.pmid: 15993236
references.citation: Int J Sport Nutr. 1996 Mar;6(1):24-40
references.pmid: 8653102
references.citation: Science. 1974 Sep 13;185(4155):949-51
references.pmid: 4469672
references.citation: Exp Cell Res. 2008 Jul 1;314(11-12):2249-56
references.pmid: 18501893
references.citation: Appetite. 2007 May;48(3):359-67
references.pmid: 17184880
references.citation: Bull World Health Organ. 1995;73(5):673-80
references.pmid: 8846494
references.citation: Bone. 2008 Jul;43(1):140-148
references.pmid: 18486582
references.citation: Med Sci Sports Exerc. 2005 Sep;37(9):1481-6
references.pmid: 16177598
references.citation: J Clin Invest. 2003 May;111(9):1409-21
references.pmid: 12727933