The association between exercise and menstrual cycle regulation is multifactorial and complex. Competitive athletes have several contributing factors to their hypothalamic-ovarian dysfunction: intensity of physical exercise, decreased body fat, inappropriate dieting, and stress. The consequences of amenorrhea include osteoporosis, increased risk of fracture, deleterious lipid changes, and infertility. Athletes have special considerations when choosing contraception. Prevention of breast injury and irritation is a concern for many athletes. The literature to date on athletic amenorrhea is limited by poor study design and too few subjects. Future studies should include prospective, randomized, controlled, multicenter studies in order to achieve significant results.