• amenorrhea;
  • hypothalamic amenorrhea;
  • bone density;
  • bone turnover marker;
  • eating disorder;
  • female athlete triad

Female participation in high school athletics has increased 800% in the last 30 years. The problem of exercise-induced amenorrhea was initially thought to be analogous to hypoestrogenism, but recent studies suggest that nutritional issues underlie most of the pathophysiology and that the mechanism is different from that seen in the primary hypogonadal state. Exercise-induced amenorrhea can be an indicator of an energy drain, and the presence of the other components of the female athlete triad—bone density loss and eating disorders—must be determined as well. Addressing skeletal problems related to nutritional and hormonal deficiencies in this population is of very high priority.