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علاج السمنة والنحافة

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Sports Conditioning and Its Impact on Menstruation
The relationship between athletic training and secondary amenorrhea (the stopping of the monthly period) is one of the most talked-about topics in sports medicine today. Runners, ballet dancers, swimmers, gymnasts, cyclists, figure skaters, tennis players—almost any woman who trains intensively—may be susceptible to either secondary amenorrhea or irregular menstrual cycles.
What we don't know yet is whether menstrual irregularity poses a problem. Is amenorrhea in athletes a normal, reversible condition or an abnormal, permanent one? To answer this question, we need to know what causes irregularity. Is stress the culprit? Weight loss? Low percentage of body fat? Intensity of training? Training prior to menarche? Genetic predisposition to amenorrhea? A combination of factors. All these possibilities have been proposed and studied during the past several years. The number of variables involved, and how they may interrelate confound research efforts.

Rapid loss of weight and a reduced percentage of body fat induced by exercise is one of the most popular explanations; the theory being that a critical amount of fat is needed for both the onset and maintenance of menstruation. This theory is not widely accepted by the experts because, to date, no practical, accurate method for measuring body fatness has been developed. It is true, however, that fat is needed to make estrogen and estrogen is needed to maintain the menstrual cycle.

Heavy training is also being touted as likely culprit, especially as more and more women are training year round and for long periods at any given workout session. Several studies have shown a positive correlation between intensity of weekly training and amenorrhea. Data further suggests that the more active and vigorous the sport, the greater the proportion of women who will experience menstrual disorders.

Still another theory is that women who train before puberty show a higher percentage of menstrual disorders later. The hypothesis is that arduous training prior to menarche doesn't allow the endocrine system to mature to a normal functioning pattern. Again, studies have supported both sides.

One of the unknown variables is whether some women who develop secondary amenorrhea after beginning to exercise would have developed it anyway. In other words, were they predisposed to the condition? Predisposition as reflected by athletes who experienced irregularity prior to training can be documented, but an undetected predisposition cannot.

Then, there is the intriguing possibility that stress is a determining factor. Dr. Kenneth Foreman, Director of Education and Research at the Sports Medicine Clinic in Seattle, Wash., strongly supports this claim, stating, "In my experience these irregularities are almost always stress induced."

For athletes, the sources of stress are many. Training and competition are obvious ones. The pressures of balancing job/school and home life with an exercise regimen are equally as stressful. How stress leads to irregularity is not known, but psychological factors can result in the alteration of hormones necessary to normal menstrual functioning.

Because the human reproductive system is complex, the question of the effects of sports conditioning on that system is complex. That is one point everyone seems to agree on. Another is that an athlete should not assume that changes in her menstrual cycle are due to exercise alone. She should consult a gynecologist to eliminate any possible pathological problem. In so doing, she should choose a gynecologist who understands the lifestyle of the athlete and the importance of exercise to her.

The majority of women athletes continue to have regular menstrual cycles and many report favorable changes in menstrual function including a reduction in dysmenorrhea (painful menstruation).
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