In athletes with secondary amenorrhea, which factor is commonly implicated?

• A. Pregnancy.
• B. Stress.
• C. Excessive exercise.
• D. Infections.

Answer: (C)

Excessive exercise drives secondary amenorrhea through energy deficit that suppresses the hypothalamic-pituitary-ovarian axis. When the body’s energy availability is chronically low, the brain reduces GnRH pulses, leading to lower LH and FSH, and consequently reduced estrogen production. This hormonal shift halts ovulation and menstruation, a pattern often seen in endurance athletes who have insufficient caloric intake or very high training loads. The body is signaling that it's not in a state to support reproduction, so the reproductive axis stays quiet.

Pregnancy is a common consideration for amenorrhea in general, but in athletes the typical driver of menstrual cessation is this energy-deficiency–driven hypothalamic suppression, not pregnancy. Infections aren’t a usual cause of secondary amenorrhea, and while stress can contribute, the dominant factor in athletes is the persistent energy deficit from intense training.