American Medical Society for Sports Medicine
View all recommendations from this societyReleased April 5, 2014
Don’t prescribe oral contraceptive pills as initial treatment for patients with amenorrhea or menstrual dysfunction due to female athlete triad (defined as low energy availability with or without disordered eating, menstrual dysfunction and low bone mineral density).
The cause of female athlete triad is an imbalance between energy intake and energy expenditure that leads to menstrual dysfunction (abnormal or loss of periods) and low bone mineral density. Historically, some physicians have used oral contraceptive pills (OCPs) to regulate the menstrual cycle in this disorder. However, the underlying cause for the menstrual dysfunction is energy imbalance. Treatment includes increasing caloric intake and/or decreasing energy expenditure (exercise) to restore normal menses, which can take up to 12 months or longer. Additionally, OCPs do not increase bone density in females affected by the triad. By restoring menses, OCPs can mask energy imbalance and delay appropriate treatment. We recommend a multi-disciplinary approach to treatment that includes a physician, dietitian, mental health professional (when appropriate) and support from coaches, family members and friends.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
The American Medical Society for Sports Medicine (AMSSM) has identified this list of clinical recommendations for the Choosing Wisely® campaign. The goal was to identify common topics in the practice of sports medicine that, supported by a review of the literature, would lead to significant health benefits and a reduction of common procedures that can be unnecessary or cause harm. For each item, evidence was reviewed from peer-reviewed literature and several sports medicine consensus statements. The list was initially generated and drafted by AMSSM’s Quality Measures Subcommittee. It was then edited and approved by AMSSM’s Practice and Policy Committee and the Board of Directors.
The American Medical Society for Sports Medicine’s disclosure and conflict of interest policy can be found at www.amssm.org.
Sources
De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, Gibbs JC, Olmsted M, Goolsby M, Matheson G; Expert Panel. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad. Br J Sports Med. 2014 Feb;48(4):289.
Javed A, Tebben PJ, Fischer PR, Lteif AN. Female athlete triad and its components: toward improved screening and management. Mayo Clin Proc. 2013 Sep;88(9): 996–1009.
Nazem TG, Ackerman KE. The female athlete triad. Sports Health. 2012 Jul;4(4):302–11.
