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/

How to Successfully Start on Your Goals.

Authors: Florence Scheepers, personal trainer and nutrition coach, and Dr. Elisabeth Scheepers, therapist and personal & executive coach.  

“Change happens when the pain of staying the same is greater than the pain of change.”- Tony Robbins

The above is a very strong quote that best reflects our motivation to change. We make the decision to change our behaviours when we say “enough” and when we understand that our current state is not serving us or making our lives better, but is making our lives more difficult. People do not just make changes, they need to be ready and this “readiness” follows a process from precontemplation to contemplation, to preparation, to action, followed by maintenance (DiClemente & Prochaska, 1998). Not all trials result in positive change and people may fall back before trying again.  For a great summary go here

Often people make a choice to change their behaviours after a particular incident, or life altering event. This can be a warning from a family doctor,a new relationship, the birth of a child or the death of a good friend.

However, to change can be very painful and appear overwhelming. We envision ourselves in a better position than our current state, and create a goal that matches with our overall vision. Unfortunately, we may create goals are too far out of our reach, unrealistic or way too big and these are the reasons why people feel that they failed.  Attempting to reach unattainable goals – and consequently failing – can lead to depression and anxiety. We might view ourselves as a failure, and lose confidence in ourselves and therefore the hope that we can ever accomplish “anything”. These negative thoughts, often referred to as “internal dialogue” exacerbate symptoms of depression.

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If we imagine ourselves reaching perfect health, including our ideal weight and fitness level, within three months’ time after having been inactive and eating too much or not the right food, we expect too much. Imagine trying to reach the perfect piece of fruit from the top tree branch. But, there are ones below it that are also good and in reach.  If our goals were to walk 10 minutes every day for five days a week and to eat a healthy breakfast for 5 days a week, rather than run 10 km a day and eat a 100% whole food, zero junk diet, we are much more likely to succeed.

If you ask yourself honestly on a scale between 1 and 10, what’s the probability of running 10 km a day, chances are, it’s a low number. But on a scale between 1 and 10, the probability to be able to walk 10 minutes a day for 5 days will be much higher. Small successes are confidence building and confidence in ourselves feels good as we will have hope that we can maintain the change and do even better!

When embarking on a change, picture what you would be like if you had everything you needed and wanted. Imagine how your life would be different, what you would be doing, how it would make you feel. Perhaps it’s been a long time since you’ve exercised and you want to improve your fitness; can you imagine yourself being fit, feeling fit, and exercising regularly? Then create a goal that matches your vision. Think about action goals. Goals that promote change need to be actions or behaviour that are concrete, rewarding and achievable. If your vision is to be more fit, working out and exercising are behavioural goals.

If you dream about being a homeowner but you have never saved a dollar in life, you will need to start writing down your monthly expenses and identify where you can cut some of your spendings. This activity might give you confidence that you can easily put away $50.00 or $100 per month.

When you are not satisfied in your career and are envious of those who have more responsibility as well as a higher income, you might have to start with identifying your interests and match these with your abilities and personality. This means thinking about different careers, what you like about these and finding out what background and experience you require to be successful. In addition to this, the career you have in mind needs to be a good fit with who you are as a person and with your values. A career coach can help.

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Once you have a goal, ask yourself, on a scale between 1 and 10, how confident are you that you can reach that behavioural goal most days of the week? If the number is lower than 7, change the goal to something more manageable. Maybe exercising 5 days a week is a 3/10, but working out 2 days a week is a 9/10. Pick a goal that you can reach with some degree of confidence.

Once you picked your goal, track how many times you have reached it in a week. If you can reach the goal 5-6 days of the week with ease, 3-4 times out of the month, you might be ready to add another goal or up the ante. Remember, the most important component of the goal setting is that they are consistently achievable with a reasonable amount of effort – while also being enjoyable. That is also the reason why it is better to do these new behaviours 5 out of 7 days rather than every day of the week.

Progress isn’t a straight line. There are many turns, ups and downs. But any progress, no matter how small, is progress. With each small victory, we become more confident and are more likely to reach more complex goals with gradually on directly observable results. Often, working on behavioural change, looking at end result only, can be daunting as progress is slow. Giving yourself credit for your engagement in a project no matter how small, helps you to focus on the process as well. To use the example of walking, when walking in nature, enjoying the warmth of the sun on your back and the mild breeze in your face, helps you to stay in the moment and find some joyment in the activity. Having achieved your goal of the day in walking time or distance, is the added bonus! Engaging in enjoyable activities increases happiness and when an activity is fun we are more likely to repeat the same.

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When you are unsure how to start, consider asking a coaching professional who can help you with giving you guidance and support. A coach asks you questions and helps you to identify the right goals and a coach can help you with a template to record and measure your progress. Also, a coach can hold you accountable for reaching the goals you have set for yourself, giving you a better chance to succeed.

Whether it’s related to fitness, nutrition, relationships, or career choices, a coach with the right expertise can be a great asset.

 

Training and Periods!

Let’s start with a topic not many like to talk about: menstruation. Why? Because it is something most women go through for most of their life, it’s not often understood, and it can both positively and negatively affect your fitness training.

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Women are unique in various ways to men, and yet these unique qualities are often misunderstood and not well researched. Both men and women have different hormones circling through their body, which affects everything from mood, metabolism, sleep, muscle growth, and exercise performance. A greater understanding of the patterns of our hormone levels may help women athletes and regular exercisers learn how to train appropriately at each stage of their cycle, and have a deeper connection to their body.

Women who ovulate experience fluctuations in strength, stress levels, mood, and appetite, depending to the stage of their menstrual cycle. Though it is often believed that symptoms are only expressed during a woman’s period, a woman’s cycle can affect her  both negatively and positively at any stage of her cycle.

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There are two main hormones than fluctuate massively during a woman’s cycle: Estrogen and progesterone. Estrogen is often viewed as opposite to testosterone and is explained as a large reason why men and women differ in their muscle strength and size. However, estrogen is not a blocker for muscle growth. It, in fact, can be viewed as an anabolic hormone, meaning it can increase muscle growth and repair.

When estrogen level is at its highest, women who train experience an increase in pain tolerance, endurance, and maximal strength. This occurs at the follicular phase (between day 7 and 14), and at ovulation. If you wanted to test your Personal Record (PR), this would be a good time.

After ovulation, women enter the Luteal phase (day 14-28) when estrogen levels drop and progesterone rises. This is where women may experience a decline in performance, feel stressed and tired, and experience PMS symptoms by the last days. Metabolism changes too: More fats and less carbohydrates are burned for energy. Endurance exercises, such as long runs, may appear less challenging and unaffected by this stage, but explosive and maximal strength performance might decline. As frustrating as it can be, know that these experiences can be due to your cycle. No one is saying that you cannot do heavy lifts at this phase, but respect your body and make sure you are not pushing yourself too far to risk injury.

What about during menstruation? This is when you are on your period and the cycle starts again – estrogen levels rise and progesterone levels normalise. Although you may feel that you want to curl up in a ball and skip the workout during this time, exercise can help relieve cramps and increase your energy. It can even boost your mood and reduce water retention and bloating. You may find bracing your core and ab exercises more difficult depending on the severity of your cramps, but most exercises should be fine. Your body temperature is also a bit lower than before, which can make working out in warm weather and at high intensities a little easier. 

Do you find highs and lows in your training performance at different times of the month? Do you find it hard to exercise during your period, feel indifferent, or perform better?

Got more questions regarding to fitness and nutrition? If you want more info on fitness and nutrition coaching specific to women by women, please visit my site at www.superwomentraining.com

Cheers,

-Florence
References
Barrie, 2015. https://www.health.com/menstruation/5-things-to-know-about-exercising-during-your-period

Bruinvels G, Burden RJ, McGregor AJ, et al Sport, exercise and the menstrual cycle: where is the research? Br J Sports Med 2017;51:487-488.

Body Form. 2016. https://www.bodyform.co.uk/our-world/exercising-during-period/

Lowe, D. A., Baltgalvis, K. A., & Greising, S. M. (2011). Strength in Females, 38(2), 61–67.

Phillips SK1Sanderson AGBirch KBruce SAWoledge RC. Changes in maximal voluntary force of human adductor pollicis muscle during the menstrual cycle. J Physiol. 1996 Oct 15;496 ( Pt 2):551-7.