Endocrine Abstracts

Introduction: Functional hypothalamic amenorrhea (FHA) is one of the most common causes of secondary amenorrhea. There are three types of FHA: weight loss-related, stress-related, and exercise-related amenorrhea. The latter is fairly common among competitive athletes. Currently the Olympic Committee includes amenorrhea in the “Relative Energy Deficiency Syndrome in Sport (RED-S)”. The syndrome of RED-S refers to impaired physiological function including metabolic rate, menstrual function, bone health, immunity and cardiovascular health caused by relative energy deficiency. Admission to the Military Academy is a period of intense physical exercise where trainees are at risk for amenorrhea and consequently RED-S.

Objectives: To verify the prevalence of amenorrhea in high intensity training included in a military set and to identify possible predictors.

Material and methods: Observational, descriptive, cross-sectional and retrospective study of female soldiers who entered the Military Academy from 1992 to 2016. A questionnaire was formulated to analyze variables before admission (demographic data, sports federation, gynecological history, use of oral contraceptives (ACO)) and variables after admission (period in amenorrhea, sports injuries). Descriptive and statistical analysis was performed using the chi-square test.

Results: 102 military personnel answered the questionnaire. At the time of entry, they had an average of 18.8 (17-25) years and 36.2% were federated in a sport. 37.3% took ACO, of the remaining 64 cadets, 43.8% (28/64) had menstrual dysfunction, and 35.9% (23/64) presented amenorrhea, on average 5 months. 78.3% recovered spontaneously, 17.4% resorted to ACO and 4.3% to other therapies. Of de total, 39.2% suffered injuries, and there was no difference between the group taking ACO, the group that had amenorrhea and the group without amenorrhea. No difference was found regarding previous sports history.

Discussion and conclusions: The prevalence of amenorrhea in women subjected to high intensity physical training (characterized in this study by military training) was 35.9%, and it was not possible to correlate it with previous sport history or with the presence of injuries. Studies show prevalence of amenorrhea in runners and dancers range from 20 to 66%, revealing that this condition is very common. However, investigations should include assessment of systemic and endocrinologic etiologies, as FHA is a diagnosis of exclusion.