Athletic women are generally looked upon as being fit and healthy. But a look from the inside out shows a different story. Approximately 20% of active women are unhealthy to the point they stop having regular menstrual periods. This condition is called amenorrhea and is characterized by estrogen deficiency, similar to menopause. Although some women deem amenorrhea as a desirable side effect of exercise because they no longer have to deal with the hassles and possible discomfort of monthly menstrual periods, others recognize absence of periods is linked with health problems: loss of calcium from the bones; almost a three times higher incidence of stress fractures (24% of athletes with no or irregular periods experience stress fractures as compared to only 9% of regularly menstruating athletes); long-term problems with osteoporosis starting at an early age. Amenorrhea can also interfere with the ability to conceive easily should the athlete want to start a family.
Many women believe they have stopped menstruating because they are exercising too much. Not the case. Many very thin athletes who exercise very heavily have regular menses. Other women believe they have stopped menstruating because they are too thin. Also false. Studies suggest no differences in body fatness between athletic women who do and do not menstruate regularly.
The question remains unanswered: Why, given a group of women who have similar exercise programs and a low percent body fat, do some experience menstrual problems and others don't? The answer commonly relates to nutrition. The woman with amenorrhea may be striving to maintain a weight lower than what is appropriate for her genetics. When the cost of achieving this desired leanness is inadequate nutrition, she'll stop menstruating.
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Although amenorrhea is not sport-specific, sports with the highest prevalence include ballet (19 to 44% of dancers) and competitive running (24 to 26% of runners). An estimated 3 to 5% of sedentary women also experience menstrual irregularity; this is strikingly less than what prevails among athletic women. You are more likely to become amenorrheic if you have lost weight quickly, have a low body weight, low percent body fat, exercise very hard, had irregular menstrual periods even before you started to train hard, are feeling emotionally stressed, and have a restrictive diet.
Although amenorrhea exists among women with no eating disorders, loss of menses is certainly a red flag symptomatic of restrictive, anorectic type eating behaviors. The American Psychiatric Association's definition of anorexia lists "absence of at least three consecutive menstrual cycles" among the criteria. Other criteria include: weight loss 15% below that expected, intense fear of gaining weight or becoming fat, and distorted body image (i.e., claiming to feel fat even when emaciated), all of which are concerns common to female athletes.
If you feel as though you are struggling to balance food and exercise, you might want to seek counseling from a trusted physician, dietitian and/or counselor. The possible changes required to resume menses include exercising 5 to 15% less and eating a little more. If you totally stop training, such as may happen if you are injured, you may get your period within a few months. Some amenorrheic athletes have resumed menses by simply exercising less and gaining no weight or less than 5 pounds. This small amount of weight gain is enough to achieve better health yet does not result in your "getting fat".
The following tips may also help you resume menses—or at least rule out nutrition-related factors.
Amenorrheic women who resume menses can restore some but not all of the bone density lost during their months of amenorrhea. Hence, their goal should be to minimize the damages of amenorrhea by eating appropriately and taking the proper steps to resolve the problem. Every woman always wins with good nutrition!
Run The Planet thanks Nancy Clark for the permission to reprint the article "Women and Nutrition: Tips for Athletes with Amenorrhea" by Nancy Clark, posted on NaturalStrength.com on February 13, 2002. Text © 2002 by Nancy Clark. Nancy Clark, MS, RD, is the Director of Nutrition Services, SportsMedicine Associates and author of "Nancy Clark's Sports Nutrition Guidebook" and "Nancy Clark's Food Guide for Marathoners: Tips for Everyday Champions". Books and sports nutrition teaching materials are available at www.nancyclarkrd.com. For the illustration Run The Planet thanks Dr. Francisco G. La Rosa, Pathologist (AP/CP), Assistant Professor in Pathology and Immunology, School of Medicine, University of Colorado HSC and President of TelePathology Consultants, PC of Denver, Colorado (United States of America). The image refers to the Case 1 (endometrial biopsy in a 34 year-old woman with amenorrhea of 6 weeks) of the Telepathology Trial published on the website of the Congreso de la Sociedad Latinoamericana de Patología held on October 1999.