1. Primary amenorrhea is defined as the absence of menarche by the age of 16.

2. Secondary amenorrhea is the absence of three to six consecutive menstrual cycles in women who have experienced menarche.

3. It is believed that exercise in the setting of inadequate calorie consumption may contribute to an "energy-deficient" state, which may lead to amenorrhea.

4. In this setting, amenorrhea represents a hypo-estrogenic state, which can predispose to osteoporosis.

5. Exercise-related amenorrhea is a diagnosis of exclusion. Other causes of amenorrhea, such as pregnancy, must be considered before it is assumed that cessation of menses in an athlete is exercise-driven.

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