GLOSSARY

Secondary Amenorrhea Cessation of menstruation after it has previously occurred, assessed using the relevant clinical definition and differential diagnosis.

Menstrual dysfunction is a clinical signal with several possible causes, including pregnancy, endocrine disorders, medication and inadequate energy availability. Functional hypothalamic amenorrhea is diagnosed after appropriate evaluation, not from training volume alone. Missing periods should not be normalized as an inevitable sign of serious training. Withdrawal bleeding on hormonal contraception does not establish recovery of spontaneous menstrual function. A qualified team should assess the history, energy supply, bone health and other causes while coordinating nutrition, medical care and training decisions.

Nutrition for a female athlete starts with adequate energy and nutrients for the actual sport, health and life stage. Menstrual history, iron losses, contraception, pregnancy and menopause can add important context. Average sex differences do not define every person's needs, and evidence from one hormonal state cannot automatically be applied to another. Ask about symptoms and preferences without assuming that menstruation requires restriction. Preserve confidentiality and use relevant health information to support care rather than to judge selection, commitment or athletic potential.

Relative energy deficiency in sport describes impaired health or function associated with problematic low energy availability and can affect female and male athletes. The duration, severity and individual context matter. No isolated body weight, symptom, hormone value or calculated energy-availability threshold can diagnose every case. Clinical assessment integrates history, signs, measurements and alternative explanations. The IOC assessment framework supports trained clinicians; it is not a self-scoring clearance tool. Management addresses energy supply and training while considering psychological support and the athlete's overall safety.

Bone stress injury develops when repeated loading exceeds the bone's capacity to tolerate and repair it. It spans changes such as stress reaction through stress fracture; location and severity affect management. Nutrition assessment considers energy availability, calcium, vitamin D and other relevant factors alongside training, biomechanics and medical history. A bone-density result is only part of the picture. Persistent focal bone pain warrants assessment rather than being treated solely with a supplement or continued training until a fracture becomes visible.

For example, absent spontaneous periods in an athlete require appropriate evaluation even if performance remains good. Check possible pregnancy, medication and other causes along with energy supply. A withdrawal bleed after hormonal treatment should not be used alone to claim that the original nutritional or reproductive disturbance has resolved.

Energy availability describes dietary energy remaining after exercise expenditure, expressed relative to fat-free mass over a defined period. It differs from whole-day energy balance and from body-fat percentage. Calculations are sensitive to errors in food records, exercise expenditure and body-composition estimates. No single threshold or short observation establishes a diagnosis for every athlete. Persistent fatigue, impaired recovery or other concerning changes warrant assessment in the broader health and training context rather than a conclusion from one calculated value.

A nutrition care record should explain the assessment, interpretation, agreed plan, responsible professionals and follow-up criteria. Separate reported information from measured findings and clinical judgments. Record relevant units, dates, methods and changes so that another practitioner can understand the decision. Seek consent for sharing sensitive information and limit access appropriately. A referral should communicate the specific concern and urgency rather than only a broad label. In sport, documentation should support continuity of care while protecting health information from inappropriate use in coaching or selection.