Female Athlete Triad Coalition cumulative risk assessment tool: proposed alternative scoring strategies

We (i) identified alternative scoring strategies for the Female Athlete Triad Coalition cumulative risk assessment (CRA) tool to be utilized when particular risk factors (bone mineral density (BMD), oligomenorrhea/amenorrhea) cannot be determined; (ii) objectively defined dietary restriction for use in the CRA tool; and (iii) explored proxy measures of energy deficiency. This cross-sectional investigation of exercising women (n = 166) utilized an existing database derived from multiple studies designed to assess health, exercise, and menstrual function. Data from the screening/baseline period of each study included: anthropometrics, dual-energy X-ray absorptiometry, disordered eating questionnaires, descriptive data, and proxy measures of energy deficiency (total triiodothyronine (TT3) and ratio of measured-to-predicted resting metabolic rate (mRMR/pRMR)). Substituting delayed menarche for BMD was the best-fit replacement resulting in 15 (9%) participants being categorized in different clearance categories. When menstrual status cannot be assessed, such as during hormonal contraceptive use, low energy availability (EA) determined using self-report and disordered eating questionnaires was the best substitution, resulting in 34 (20%) participants being categorized in different clearance categories. Based on original clearance categorizations, the provisional group had lower TT3 (78.3 ± 2.2 ng/dL; 92.7 ± 2.7 ng/dL) and Harris–Benedict mRMR/pRMR (0.85 ± 0.01; 0.90 ± 0.01) than the full group. Until an updated risk assessment tool is developed, delayed menarche can substitute for low BMD and low EA for oligomenorrhea/amenorrhea. Novelty This investigation addresses previous limitations of the Triad CRA tool. Disordered eating questionnaires can be used to objectively identify dietary restriction for the low EA risk factor. When a risk factor cannot be assessed, delayed menarche can substitute for low BMD and low EA for oligomenorrhea/amenorrhea.

Huge abdominal mass with hematocolpometra due to imperforate hymen: an unusual clinical presentation

The imperforated hymen is one of the commonest genital tract malformations usually present with cyclic abdominal pain and an obstructive pelvic mass at post-pubertal age. The unusual pre­sentations are delayed menarche with obstructive symptoms rarely acute retention of urine, te­nesmus, and constipation. We report an unusual case of 12- year old girl with a huge mass in the lower abdomen examination revealed imperforate hymen at early pubertal age. Further investigation of Magnetic Resonance Imaging (MRI) confirmed hematocolpometra. Then, she underwent simple hymenotomy and drainage of collected menstrual blood from the genital tract. She recovered well during the postoperative periods. We conformed normal menstrual flow at her first follow-up. In conclusion, Imperforate hymen at peripubertal age with an unusual huge abdominopelvic mass concerns further imaging to assure the best outcome.

Exercise, physical activity, and eating and weight disorders

Consistent with trends in adults, the weight-control practices of children and adolescents appear to reflect a heightened concern with body image.7,16–20 The potential long-term consequences of inappropriate weight-control practices in young people are serious and include disordered eating practices,21–23 growth retardation, delayed menarche, amenorrhoea, osteoporosis, and psychological disturbances.12,24–26 The commonly employed weight-control practices, dietary modification, and exercise are pervasive,8 and not limited to the female population. As medical practitioners are widely consulted and held in high esteem by the general public, they are in a good position to identify potential problems in children and adolescents in their care.11 The aim of this chapter is to provide an overview of the range of factors contributing to inappropriate eating and activity behaviours, particularly in children and adolescents.