In addition, the women in this case C188-9 chemical structure report presented with current amenorrhea of varying duration, i.e., short-term amenorrhea defined as the cessation of menses for <100 days and long-term amenorrhea defined as the absence of menses for >100 days [13]. Screening procedures Participants signed an informed consent approved by the Institutional Review Board at the University of Toronto or Pennsylvania State University. Height and weight were measured, and participants completed questionnaires to assess medical

history, exercise and menstrual history, eating behaviors, and psychological health. A physical exam and blood sample was performed to determine overall health. A semi-structured psychological interview

was conducted selleck chemicals to ensure that the women were not experiencing major psychiatric disorders, and a registered dietitian assessed eating patterns and food preferences. Dual-energy x-ray absorptiometry (DXA) scans were performed to assess BMD and body composition. Baseline procedures During a 4-week baseline period, menstrual calendars and daily urine samples for the assessment of menstrual function were collected. Body weight was measured weekly. At week 3 of baseline, energetic markers (leptin, ghrelin, total triiodothyronine (TT3)), markers of bone formation and resorption, body composition, resting energy expenditure (REE), and dietary intake were assessed. Participants also completed a test of aerobic fitness. Classification of baseline menstrual status Upon study entry, classification of menstrual status was based on self-reported menstrual history, which was confirmed by a 28-day urinary profile of E1G, PdG, and luteinizing hormone (LH) profiles during a 4-week baseline period. FHA was assessed by confirming a negative pregnancy test, normal endocrine panel, no menses in the past 90 days, and

not documentation of chronically suppressed E1G and PdG profiles observed during the baseline period. Intervention procedures for energy calculations Both participants were asked to increase their caloric intake 20-30% above baseline TEE while maintaining their usual exercise training regimen. For the purpose of this report, baseline TEE was operationally defined as the sum of REE and purposeful EEE. Energy bars that contained approximately 250–300 kilocalories (1,046-1,255 kJ) were provided by the research staff to increase caloric intake. The target increase in caloric intake was gradually achieved by a slow increase in calories during the first several weeks of the intervention to encourage compliance. A registered dietitian met with the participants regularly to provide strategies to meet the target caloric intake.