My daughter is a very competitive 18 year old gymnast, who is experiencing abnormal menstrual periods. Should I be concerned?

Yes, you should be concerned about her amenorrhea. Amenorrhea is the abnormal absence of menstrual periods. Generally speaking, there are three categories of women who have experienced amenorrhea (Conroy, 2000):

· Women who have never had a menstrual period by age sixteen
· Women who have not had a period for two to three months or more
· Women who have irregular periods that may vary from 35 to 90 days

If an estrogen imbalance is causing amenorrhea, it is important to recognize the problem early. Over a long period of time, too much estrogen can cause overgrowth of the cells in the lining of the uterus (endometrial hyperplasia which can lead to cancer), while too little estrogen can cause calcium loss from the bones (leading to osteoporosis) (Conroy, 2000).

Too little estrogen associated with amenorrhea may predispose to osteoporosis. Osteoporosis is defined as premature bone loss and/or inadequate bone formation resulting in low bone mass/bone mineral density (BMD). Adequate levels of estrogen slow bone resorption and improve or maintain BMD (Anderson, 2002).

Studies of adult female athletes have shown that premature osteoporosis may occur as a result of amenorrhea and may be partially irreversible despite resumption of menses, estrogen replacement, or calcium supplementation. Amenorrheic adolescents, both athletes and non-athletes, have been found to have lower bone mass than non-amenorrheic adolescents. This may be attributable to decreased bone formation as well as increased bone loss. An overall increase in bone mass is demonstrated throughout adolescence. However, the amenorrheic teenager demonstrates decreased bone mineral density in comparison with regularly menstruating teenagers (Anderson, 2002).


Reference:

Anderson, S., (2002) Medical concerns in the female athlete. American academy of pediatrics. 106(3) 610-613

Conroy, B., Earle, R., (2000) Bone, muscle, and connective tissue adaptations to physical activity. In: Essentials of Strength Training and Conditioning. T. Baechle and R. Earle, eds. Champaign, IL: Human Kinetics. pp.57-72.

Feingold, D., (2006) Female athlete triad and stress fractures. Orthopedic clinics of north America. 37(4)

Overview of Exercise, Fitness and Sports Performance at COR Clinic

Exercise, Fitness and Sports Performance at COR Clinic encompasses personal development of individual physical fitness such as functional training, power lifting, weight training, aerobic conditioning, weight loss, lean muscle development, body weight management, and personal nutrition

After evaluating the amount of the time you have available to prepare for your athletic season, we will structure a personalized program over something as long as a year's time or as short as a 6-week mesocylcle. It is our goal to prepare you for the season by taking you through various training cycles, minding the details so you can focus on what you do best.
Each program begins with a one-on-one assessment consisting of flexibility testing, movement analysis and strength and power testing. Based on the results, the Cor Clinic Performance Coach develops a periodized program leading up to your competition or competitive season.
All programs may also include:

• detailed assessment
• free exercise technique classes when necessary
• nutrition workshops and one-on-one counseling
• regeneration/flexibilty sessions

Listed below are the services we offer.
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Assessments & Testing

• Metabolic Ergospirometry VO2 Max Testing
• Body weight/anthropomorphic measurements
• Movement Screen
• Flexibility Test
• Power Test
• Sports specific speed test
• Sports specific agility test
• Strength test

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One-on-one training
Sessions are 30-90 minutes long depending on the athlete's program and needs.
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Team Consulting

Let the COR Fitness Performance program design team, work for you. We will come in, perform testing and assessment on your athletes and then draw up a program to prepare them for the competitive season*. A follow-up assessment is performed every 4 weeks and programs are updated accordingly. Follow-up assessments are included in program price.
*Note: team consulting does not include Cor Clinic Sports Performance training.*
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Team Training
COR Coaches -- COR Clinic team training packages are hands-down the smartest investment you make on behalf of your team. We will come to your facility to perform athlete assessments, design a program based on the team and individual needs and then work with the athletes, in the weight room and on the field or court, to help your athletes develop a winning edge. A Cor Clinic Sports Performance program includes flexibility, mobility, power training, strength training, energy system development and speed and agility.
Training session duration is 60-90 minutes based on the program or phase in the training cycle.
Rates include assessment, program design and training. Please contact us for rates.
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Factility Development Consulting
Need help planning, designing and furnishing your training facility? Unsure about what you really need? Unsure about what you don’t need? A COR Clinic Fitness/Sports Performance Professional will help you plan your athletes' training facility. We will work with you to make sure you get the safest, most efficient and cost-effecting layout and equipment selection for your athletes.
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Speed/Agility Workshops (up to 20 participants per workshop)
As strength and conditioning specialist, we pride ourselves on getting people in shape and ready for the season. Our speed and agility workshops are designed to take your athletes through different phases of training and place them in the best possible situation to be prepared for competition. We focus oncore and stabilization training, sprint technique, speed development, lateral speed and agility, power development and energy system development.
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Program Design Concepts Seminar
At COR Clinic, we work hard to stay up-to-date with the latest research on training and athletic development. We can present stand-alone seminars or appear as a guest speaker at your event to discuss topics such as (but not limited to):

• program design
• sports specific training
• assessment
• periodization
• proper warm-up and cool-down
• power training
• plyometric training
• strength training
• speed and agility training
• flexibility
• injury prevention

We can also customize a seminar on any sport- or training-related subject, or present shorter seminars specific to you request. For this reason, seminar rates vary.
Please contact us for a personalized proposal and quote.
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Nutrition Education and Coaching

A COR Clinic Coach will provide you and your athletes with up-to-date nutrition information based on the latest research, presented in easy-to-understand and practical guidelines, and help you use this information to provide nutrition support for your athletes. Athletes will not be given a diet plan, merely the education and tools to learn how to properly fuel their bodies for their sport. The one-on-one education process begins during the first session and is developed through ongoing communication, monitoring and follow-up coaching sessions.
Initial Nutrition Coaching Session:
This initial consultation includes a 60 minute meeting where the athlete’s medical, nutrition, and diet history, are reviewed, and specific goals are set. During this consultation a COR Clinic Coach will provide the guidelines and basic information that form the foundation of the athlete’s nutrition education. Follow-up sessions may be scheduled as needed to assist the athlete in skill-building in the areas of nutrition and behavior change, that are consistent with the athlete’s goals.

• All nutrition sessions may include the following:
• Nutrition guidelines for goal-friendly food choices
• Meal planning assistance
• On-the-go, or away-from-home eating
• Exercise/activity guidelines
• Supplementation advice and information (no recommendations)
• Goal-setting
• Behavioral strategies
• Follow-Up Consultations

During follow-up sessions, the COR Clinic Coach will review the athlete’s progress via his or her journal (nutrition, activity and stress should be documented); address any questions and concerns the athlete presents; provide literature and references for further nutrition education, and offer tools to help the athlete attain continued success with his or her plan. The Cor Clinic Coach will also offer suggestions or changes to the athlete’s existing plan based on feedback and progress. With each follow-up session, the athlete will also be able to contact the Cor Clinic Coach via email for the next three days for additional support.
On-going Nutrition Support & Education

With on-going support, the client/athlete and Cor Clinic Coach meet once a week. The athlete can also contact the Coach via email for six days following each consultation for additional support. During on-going support, the athlete is required to provide via email, weekly nutrition journal, activity and stress logs.