Delay oral contraceptive use: improve diet first in athletic amenorrhea.(Gynecology)

VANCOUVER, B.C. -- The adolescent female athlete with amenorrhea who is found to have a low bone density should be treated first with improved diet and vitamin intake, before oral contraceptive treatment is considered, Dr. Aurelia Nattiv said at the annual meeting of the American Medical Society for Sports Medicine.

The problem of the young female athlete who develops an eating disorder and has enough of an energy deficit to become amenorrheic, thereby risking her bone, has not been generally recognized long enough for there to be any definitive guidance for physicians.

Physicians need to suspect this problem, especially in track and cross-country runners with amenorrhea and/or a history of stress fracture, said Dr. Nattiv, director of the osteoporosis center at the University of California, Los Angeles, and a team physician for UCLA.

There is a consensus among experts that a bone density assessment should be considered if a young female has had amenorrhea or oligomenorrhea for more than about 6 months, if there is disordered eating and low weight, and/or in those with a history of stress fracture or low-impact fracture.

While the experts used to prescribe hormone treatment with an oral contraceptive immediately when low bone density was found, most now advocate at least trying to have the patient add calories, calcium, and vitamin D to her diet, Dr. Nattiv said.

Experts are shying away from recommending oral contraceptive therapy as the first line of treatment because the research on whether restoring regular menses in this way actually results in an improvement in bone mass in athletes is conflicting, even though oral contraception has been associated with greater bone mass in other healthy, nonathletic females, Dr. Nattiv said.