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)
