The risks to sportswomen of exercise related menstrual dysfunction and impaired bone health are important and under-recognised. Exercise related menstrual dysfunction may include any abnormality along the continuum of luteal phase deficiency, annovulation, oligomenorrhoea, amenorrhoea, and delayed menarche. Such dysfunction is multifactorial in origin, with a high degree of individual variation, but its main underlying mechanism is hypothalamic inhibition with suppression of gonadotrophin releasing hormone pulsatility (the frequency at which pulses of the hormone are released by the hypothalamus).1

This hypothalamic suppression has a variety of causes in sportswomen, including the physical and psychological stress of training and competition, caloric deficiency, low body mass, low body fat,1 2 inadequate leptin values,3 and altered peripheral hormone metabolism.1 Relative hyperandrogenism and …