Sport Gynaecology TOG 2019 Flashcards
How to calculate energy balance based on weight
45 kcal/kg fat-free mass/day
Is low energy availability, how can this impact health?
metabolism, bone health, immunity, cardiovascular health and psychological wellbeing, as well as menstrual and reproductive function.
Graph explaining energy deficiency in sport
How does RED-S impact menstrual function?
Downregulation of HPO axis oligomenorrhoea/amenorrhoea, delayed menarche
65% in long distance runners, 79% ballet dancers
LH pulsility is disrupted per what amount of kcal per day?
20–25 kcal/kg fat-free mass/day
What is intense exercise defined as? How much does intense exercise increase you risk of infertility
> 1 hour a day with energy expenditure >6kcal/minute.
6 fold increase in infertility
How much lower is bone mineral density with sports women with hypothalamic amenorrhoea?
10-20%
When does bone mineral density decrease based on kcal per kg
30 kcal/kg fat-free mass/day
Linear relationship between N of menstrual cycles/year and BMD
Following onset of hypoestogenism, when is osteoclast reasorbtion increased?
Accelerates for 6 months, peaks within 3 years
Biggest impact if occur in adolescent girls/delayed menarche
If any history of amenorrhoea, how much more likely to develop stress fractures?
2-4 times more likely
When urogynae condition are elite sportsowmen more likely to experience
Urinary incontience
Screening questions to ask athletes who present to gynaecologist
When did you start having periods?
When was your last menstrual period?
How long is your menstrual cycle?
Are you presently taking contraception or hormone replacement therapy?
Have you ever missed a menstrual period for a year or longer?
Is your body mass index <18.5?
Do you worry about your weight?
Have you ever had an eating disorder?
Have you lost more than 5 kg in the last 3 months?
Have you ever had a stress fracture?
Have you ever experienced low bone mineral density or osteoporosis?
Do you leak urine when training or competing?
Have you ever had a problem becoming pregnant?
Which menstrual disorders should be investiaged?
Menstral dysfunction > 6months
No secondary sexual characteristics by age 14
Not started menarche age 16
When are sportswomen diagnosed as having LOW EA?
BMI <17.5
10% weight loss in 1 month
How to assess energy availability
Food diary + assess energy expenditure - fitness loss etc
BMI <17.5
How to assess menstrual fucntion
Menstral diarty
If menstrual disorder >6 months what tests? Results if hypo hypo
Preg test (-ve)
FSH/LH (low)
TFT normal
Prolactin normal
Estradiol low
AMH low
Bone density low
Pelvic USS
If signs hyperandrogegism 0 LH/FSH ration, total testosterone, sex hormone binding globulin, 17 hydroxyprogesteonr
What BMD Z score presentment osteoporosis
< -2 (<-1 is osteopenia)
Conservative management of hypothalamic amenorrhoea
Increase energy intake 300-600 kcal/day
Target BMI >18.5
Psychological and dietician input
Serial LH measurements to aid treatment
Should medical management be offered initallit for RED-S?
No as may mask condition and response to treatment
Which hormonal theft down regulated insulin like growth factor 1
COCP - with high oestrogen
When can hormonal therapies be offered, which hormonal theories should be offered?
Following conservative management of 1 year
Transdermal estrogen and associated progesterone as does not interfere with IGF-1
Transdermal oestrogen does not work as contraceptive
What other supplements should be given?
1500 mg/day calcium
Do not give bisphosphantes or selective oestrogen receptor modulators
Management of urinary incotinence in sportswomen
Pelvic floor exercises
Surgery/dulextine unlikely to be suitable
How to restore fertility with RED-S function
Restore energy balance
If oestrogen deficient - offer pre-treatment with oestrogen supplement
Ovulation induction gonadotrophin therapy
Luteal support with progesterone not needed
Which fertility drugs are prohibited by the World Anti-Doping Agency
Clomifene and growth hormone
Advise on exercise regime’s in 1st trimester
Limit high intensity training in week after ovulation, avoid repetitive heavy lifting in 1st trimester
