Amenorrhoea: Does amenorrhoea increase the risk of cardiovascular disease in female a

Amenorrhoea - the lack of regular menstruation - can be a serious health problem in young female athletes, since the condition has been linked with eating disorders and a high frequency of stress fractures in the short term as well as increased risks of osteoporosis and uterine cancer in later life. Some scientists have also suggested that amenorrhoea may be linked with elevations in blood fats and cholesterol, which may raise a female athlete's risk of coronary artery disease over the long term.

To assess the true link between amenorrhoea and blood-fat profiles, researchers in the Department of Medicine at the University of Washington recently studied 24 amenorrhoeic and 44 eumenorrhoeic female athletes. Compared to the eumenorrhoeic athletes, amenorrhoeic females had higher levels of plasma cholesterol (5.47 vs. 4.84 mmol/L), and total blood-fat levels were about 25-per cent higher. In addition, levels of low-density lipoprotein (LDL), which is sometimes called 'bad cholesterol,' were about 1 2-per cent greater in the amenorrhoeic athletes.

Fortunately, there was some good news for amenorrhoeic females, too. High-density lipoprotein (HDL, or 'good cholesterol') was 13-per cent higher, and HDL2-cholesterol, the type of cholesterol which is considered to be specifically protective against heart disease, was 24-per cent greater in the amenorrhoeic athletes. Also, the key ratio of LDL/HDL, which has been used to predict the risk of coronary-artery problems, was not different between the two groups.

A dietary analysis revealed that amenorrhoeic athletes were eating about 30-per cent less daily fat than eumenorrhoeic subjects, but the amenorrhoeic group claimed to be ingesting just as many total calories. Strangely enough, HDL-levels in amenorrhoeic athletes were positively related with the percentage of calories coming from fat; greater fat consumption by amenorrhoeic females usually produced higher HDL readings.

The Washington study suggests that even though amenorrhoea is linked with unwelcome increases in blood-LDL and total cholesterol, it is also related to cardioprotective advances in HDL2. The overall effects of amenorrhoea on cardiovascular disease aren't clear, but it is certain that female athletes should take strong action to avoid the unhealthy triad of amenorrhoea, eating disorders, and osteoporosis. To protect their own health, female athletes should ingest adequate total calories and calcium, refrain from excessive training which leads to menstrual shutdown, and ignore their coaches' admonitions to keep their bodies ultra-slim.

'Elevated Plasma Low-Density-Lipoprotein and High-Density-Lipoprotein Cholesterol Levels in Amenorrhoeic Athletes - Effects of Endogenous Hormone Status and Nutrient Intake, Journal of Clinical Endocrinology and Metabolism, vol. 77 (6), pp. 1605-1609, December 1993