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.

Keywords: Amenorrhea; Bone mineral density; Energy intake; Resumption of menses; Treatment.

Figure 1

Reproductive hormone profile for Participant 1. This figure displays the reproductive hormone profile during the study for Participant 1 and the changes in caloric intake, body weight, and energy status that coincided with each category of menstrual recovery. Arrows indicate menses. Body weight was measured within 1 week of menses. ‡ Indicates data were collected 2 weeks before menses. † Indicates data were collected 6 weeks after menses. %BF: percent body fat; BMI: body mass index; BW: body weight; E1G: estrone-1-glucuronide; PdG: pregnanediol glucuronide; REE/pREE: measured resting energy expenditure/predicted resting energy expenditure; TT3: total triiodothyronine.

Figure 2

Reproductive hormone profile for Participant 2. This figure displays the reproductive hormone profile during the study for Participant 2 and the changes in caloric intake, body weight, and energy status that coincided with each category of menstrual recovery. Arrows indicate menses. ‡ Indicates data were collected 5 weeks after menses. † Indicates data were collected 3 days after menses. %BF: percent body fat; BMI: body mass index; BW: body weight; E1G: estrone-1-glucuronide; nr: not reported; PdG: pregnanediol glucuronide; REE/pREE: measured resting energy expenditure/predicted resting energy expenditure; TT3: total triiodothyronine.