Q.Differentiate between primary and secondary amenorrhoea.

Amenorrhoea means the absence of menstruation. It is classified by whether menstruation had ever started in the first place.

What amenorrhoea means

Amenorrhoea is the absence of menstruation. It is not a disease in itself but a symptom — the body's signal that something in the hormonal chain controlling the menstrual cycle has been disrupted. In the female athlete this disruption is most often driven by low energy availability: when the energy taken in as food does not cover the energy burned in training, the body down-regulates reproductive function, which it treats as non-essential, in order to protect vital functions.

The classification into primary and secondary rests on a single question: did menstruation ever start?

Primary amenorrhoea

This is the failure of menstruation ever to begin — the girl has not experienced menarche (her first menstrual period) by the age at which it would normally be expected.

• It is identified during adolescence, when the expected first period simply does not arrive.
• In sport it is associated with intense training begun at a young age, very low body-fat levels, and inadequate energy intake during the years when puberty would normally be taking place. It is seen more often in sports that emphasise leanness or a low body weight — gymnastics, distance running, ballet, figure skating.
• Because puberty itself is delayed, it can also be accompanied by delayed development of other secondary sexual characteristics.

Secondary amenorrhoea

This is the cessation of menstruation in a woman who had previously been menstruating normally — the cycles were established, and then stopped for several consecutive cycles.

• It can appear at any time after menarche, in an athlete whose periods were previously regular.
• Typical triggers are a sharp increase in training load, sudden weight loss, sustained low energy availability, and high psychological stress — often in combination, as when an athlete intensifies training and restricts food at the same time.
• It is the more commonly encountered of the two in competitive sport, precisely because it can be brought on by a change in training or diet at any stage of a career.

The distinction, side by side

Why it matters — the link to the female athlete triad …