Gynecologic and obstetric problems of the female dancer.

ABSTRACT

PIP: This paper reviews the gynecologic and obstetric literature on problems encountered by women involved in strenuous physical exercise. Those who begin training prior to puberty tend to have delayed menarche as compared with nonactive controls and to experience significantly more menstrual dysfunction. Attainment of a minimum weight or a certain percentage of body fat appears to be an important factor. Increased androgen levels resulting from stress on the adrenal gland or ovary may affect the female athlete's hypothalamus, and weight loss may cause additional abnormalities of the endocrine system. Physical examination of athletes with menstrual dysfunction should include evaluation of height and weight, general nutrition, the presence or absence of galactorrhea, and the presence of obvious hormonal abnormalities. Management of the pregnant athlete is controversial; however, there is general agreement that a woman can continue athletic activity at medium effort until the 8th month of pregnancy, at which point activity should be reduced until the 4th week postpartum. Barrier contraception is generally recommended for physically active women. Currently, there is little factual information on the effects of athletics and exercise on women. For example, it is not known whether there is a lasting negative effect on the young dancer's menstrual cycles and her reproductive capacity after discontinuation of active training. Until more research evidence is accumulated, careful medical follow-up of female dancers can enable them to safely perform with minimal risk of present or future health problems.