Date of Award

Winter 12-5-2022

Document Type


Degree Name

Doctor of Medical Science (DMSc)


Department of Physician Assistant Medicine

First Advisor

Erika Barber, M.D.

Second Advisor

Justin M. Gambini, DMSc, PA-C, DFAAPA


Hormonal balance and normal menstrual cycles are key factors in athletic performance. Unfortunately, female athletes themselves are often under the impression that a lighter weight will improve their performance. Even many healthcare providers do not emphasize or are unaware of the health consequences of prolonged irregular menstruation. The main purpose of this article is to review the health consequences hypothalamic amenorrhea has on female athletes and to provide education for healthcare providers regarding the importance of recovery. A literature search was conducted utilizing PubMed, Scopus, PLOS One and EBSCO. The following keywords were input into the search bar: hypothalamic amenorrhea, female athletes, irregular menstruation, health consequences, RED-S, female athlete triad, bone health, cardiovascular health, immunity, recovery time, and psychological health. Of the results, 26 pertinent articles were chosen to be included in this literature review. Current evidence suggests that hypothalamic amenorrhea is indirectly associated with decreased athletic performance due to hormonal effects on various body systems. Performance may be affected by increasing the risk of stress fractures, impairing immunity, affecting cognition and mood, prolonging recovery time, altering gastrointestinal (GI) symptoms, and increasing reaction time. At present, there are many unknowns related to this topic. Minimal research has been conducted regarding the direct impact of hypothalamic amenorrhea on short term and long-term health. Future studies should consider how performance indicators differ between female athletes with normal menstruation cycles versus those with developed amenorrhea.