No Period, No Problem? Amenorrhea and Exercise

I recently wrote a blog post about weight lifting and menstrual cycles and how our hormones can greatly affect our performance both positively, but sometimes negatively. But there is another less talked about issue in regards to menstrual cycles and exercise, and that’s not having a cycle at all.

A few years ago, I stopped menstruating. I had assumed it was due to my birth control medication but after being off birth control for several months, it seemed something wasn’t right. I was very active due to my work and exercise routine and also underweight. My weight had become a concern, and I knew I wasn’t healthy, so I gradually added more calories to my diet. I am now at a healthy weight, but it was not until recently than my periods had returned.

When I wasn’t menstruating, I knew it wasn’t a good thing, but I also didn’t mind not having a period. It made things pretty easy not having to buy tampons and having no cramps every month. My doctor wasn’t all that positive about my issue. She wanted me to see a dietitian and have a bone density scan.

Amenorrhea means not having a period for at least 3 months. It can mean not being able to become pregnant and can lead to a decrease in bone density. The hormone, estrogen, is less in the body of someone with amenorrhea, which leads to an increased risk of osteoporosis. Osteoporosis is a condition in which the bones become brittle and weak, leading to fractures. Imagine breaking a shin bone on your daily run, or breaking a wrist trying to open a jar of pickles. Not a good thing to have.

How common is not having a period? For athletic women, it can be as common as 70%. Athletes tend to have less body fat than non-athletes at between 14-20% whereas non-athletes have 21-31% body fat. Those in sports such as gymnastics are more likely to have less body fat than those in sports like basketball.

When learning about the health risks related to body fat, the literature was very strong on that a higher level of body fat (over 30%) is highly correlated to medical conditions. However, not much is talked about the health issues related to lower levels of body fat. A low BMI of less than 18.5 is associated with an increased risk of health problems. For athletes though, using the BMI scale isn’t appropriate. BMI measures a person’s total body mass and height to estimate body fat. An athlete with a high amount of muscle mass might have a normal to high BMI, yet have a low amount of body fat.

Amenorrhea is related to the Female Athlete Triad. A phenomenon where a female does not have a period, is undereating for the amount of training she goes through, and is at risk or has a reduction of bone density. Coaches and fitness professionals need to be aware of the triad as it can be an indicator of potential health and psychological problems for the athlete. The triad is similar to anorexia, a mental disorder in which a person is refusing to gain body fat yet is at risk of developing health problems of having a low body fat percentage. However, the athlete might feel that she is eating enough and not show disordered eating behaviour.

The hard part with athletes or those who are very active is that they might be eating more food than a non-active person. They might not show the typical signs of anorexia due to their eating habits and maybe even their appearance. On the outside, they might look fit.

Some women who have a current healthy body fat percentage might also have amenorrhea if they went through a large reduction of weight in a short time, or are exercising a high amount while not eating enough calories to support the activity.

For about 2 years I really felt I was at or very close to my ideal and healthy weight. Yet, still had amenorrhea. My exercise routine was very heavy and I worked at high intensities sometimes a few hours a day. After speaking with a dietitian, I decided to slowly add more calories to my meals and reduced some of my activity. Soon after the periods came back. Not only that but my weight stayed relatively the same, and my exercise performance, strength, and muscle mass increased.

What does this mean? Although I wasn’t losing weight, I was still undereating for the amount I was working. For those especially going through weight loss, adding more calories can be anxiety provoking. We tend to fear gaining fat and are surrounded by many who are trying to cut down on calorie consumption. However, we need to see that food is fuel. Fuel to repair and grow muscle, recover from exercise, boost our performance, and keep our hormones at healthy levels. Same goes with training. Cutting back on exercise and training might feel a bit scary, but the end result can lead to an increase in performance, not the other way around. Recovery is just as important and the work itself.

I believe that more needs to be shared about amenorrhea in female athletes and active women. A woman who fits the female athlete triad criteria might have an eating disorder and would need professional help. Missing periods can be detrimental to health in the long term, as osteoporosis is a serious health problem. However, it is very hard to see or measure the issue without actually asking women whether or not they are or have experienced a loss of their period.

If you are someone who has amenorrhea or is having irregular periods, it’s best to see a doctor. Sometimes the period loss is due to a serious medical condition such as PCOS or hypothyroidism. If you think you have an eating disorder, speak to a counsellor as this can become a serious problem physically and mentally. Here are some resources:

http://www.femaleathletetriad.org(all on the Female Athlete Triad)

http://nedic.ca(Eating disorder information and help)

http://www.cwhn.ca/en/node/44804On PCOS

Want to learn more about how to train and eat for optimal health and performance: visit my website at www.superwomentraining.com

Sources for fact checkers!

https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

https://www.healthline.com/health-news/losing-period-because-exercise-is-bad-sign#10

https://www.livestrong.com/article/188526-what-is-the-typical-body-fat-percentage-for-an-elite-athlete/

https://www.builtlean.com/2010/08/03/ideal-body-fat-percentage-chart/

https://www.opalfoodandbody.com/wp-content/uploads/2016/01/summary-of-dsm-5.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435916/

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