MENSTRUAL IRREGULARITIES IN ATHLETE.pptx

Menstrual irregularities in female athletes

1. MENSTRUAL IRREGULARITIES IN ATHLETES

2. Menstrual Dysfunction can be described in – frequency, Regularity, Duration and volume FREQUENCY Normal  24-38 days <24 days  Frequent cycles( polymenorrheoa ) > 38 days infrequent cycles( oligomenorrheoa )

3. Regularity Amenorrheoa  No bleeding at all Regular if the cycle to cycle variation is 2-20 days Irregularif the cycle to cycle variation is >2-20 days Duration of flow Normal 4.5-8days Shortened bleeding <4.5 days Prolonged bleeding > 8days Volume of blood Normal  20-80ml Light bleeding <20ml Heavy bleeding  > 80 ml

4. Primary Amenorrheoa -Absence of menstruation by 15 years of age in presence of secondary sexual characters or -Absence of menarchae by 13 years of age in the absence of secondary sexual characters - mcc : gonadal dysgenesis

5. Secondary Amennorrheoa - Absence of menstruation for 90 consecutive days in a female who has had previously normal menstrual cycles or - Absence of menstruation for 6 months in a female who has had previously irregular cycles. - mcc: Pregnancy(d/t increased progesterone)

6. Risk In Athletes for Menstrual Irregularities Over training. H igh intensity training. L imited food intake or dieting or lack of balanced diet. Excessive intentional weight loss. N ot enough nutrition and hydration during increased activities. RISK   The amount of energy used by athletes exceeds the amount of energy taken in through nutrition  Hormonal imbalance  Menstrual irregularities.

7. Treatment Nutrition therapy Exercise revision Hormone Replacement Therapy -A multi-disciplinary approach led by primary care or a Sports Medicine provider which may include referrals to sports nutrition, adolescent gynecology and endocrinology specialists. Treatment is tailored for each patient. Daily calcium and Vitamin D intake will be looked at.

8. Hormone Replacement Therapy C onjugated estrogen 0.625 mg/day + medroxy -progesterone 10 mg/day x 14 days per month Estradiol transdermal patch 50 μg /d ay + medroxy -progesterone 10 mg/day x 14 days per month

9. ADDITIONAL PHARMACOTHERAPY Calcium supplementation if daily dietary intake < 900mg/day. RDA of calcium is 1.2 to 1.5g/ day for females between 11 and 24 years of age 400 to 800 IU of vitamin D / day to facilitate absorption of Calcium SSRI (Paroxetine, T. PAROTIN 10-50mg/day 1-0-0) for eating disorders(Anorexia nervosa & Bulimi a Nervosa) Bzd for anxiety disorder

10. PREVENTION Get enough sleep G radually increase activity and training C orrect nutritional problems M aintain a well-balanced diet E nsure appropriate energy consumption (ex. extra snacks or small meals before practices or games)