Amenorrhea is hardly a new issue in the world of endurance sports.
Studies over the years have reported that over 60% of women athletes have what is known as “Athletic Amenorrhea,” that is disturbed menstruation due to the demands of high intensity training on the body.
My question is, why?
In almost every other arena of the sport, women runners seem to take very good care of themselves. We buy the latest apparel and gear, put our training in the hands of the most capable coaches and invest our time and money in whatever it is that promises to make us better athletes. Yet, inside our own bodies, we are losing the war for fertility.
In order for us to step back from this issue and look at it with fresh eyes, I think it’s time that we had a crash course on Fertility 101. We need to look at the body the way it is supposed to work in order to see what it is that we are doing wrong.
Lesson 1: Estrogen
There are three hormones that play a crucial role in a healthy cycle: estrogen, testosterone, and progesterone.
Estrogen reaches its peak level just before ovulation, the releasing of the egg from one of the ovaries. Estrogen is the key to fertility. If your body cannot reach peak levels of estrogen, it cannot release an egg, it cannot ovulate and you will not have a period because there is no egg in the uterus for it to shed.
So, how do we make sure that our bodies reach this peak level of estrogen?
Studies have shown that athletic women who suffer from amenorrhea and are unable to ovulate often suffer from certain vitamin deficiencies, lower than average intake of antioxidants and a lower Body Mass Index.
Today is my 24th birthday; I got my first period on my 14th birthday. In exactly one decade of menstruation, I have not missed a single cycle.
I have run as many as 135 miles per week, and yet still manage to have a cycle every 24 days. I also eat like a linebacker. I have taken Iron and various vitamin supplements for years and always make sure that I am getting enough fat and protein in my diet.
- To boost your estrogen levels, eat foods rich in Zinc, such as nuts, seeds and fish, Vitamin B6, found in peppers, eggs, chicken and brown rice and add a magnesium supplement to your daily multi-vitamin.
- Estrogen levels can also be heavily influenced by factors such as sleep, stress and travel, so make sure that you are taking a little rest-and-relaxation time that will be good for your fertility and your training!
Lesson 2: Don’t believe everything you hear
I know many women runners who suffer from amenorrhea. The hardest thing for me to hear is: “Oh, I talked to a doctor about it, it’s perfectly normal that I haven’t had a period in four years, it will come back when I stop training.”
Some women take it one step further than this and assume that when their cycles stop showing up, it means that they are training right, that a missing period is the evidence of hard work.
This couldn’t be further from the truth.
When your cycle disappears, it is because your body does not have the necessary energy required to ovulate.
You need to maintain high levels of estrogen in order to maintain your bone health. If your body is unable to produce enough estrogen, it takes calcium from your bones to keep calcium levels in the blood at a normal level. This lowers your Bone Mineral Density, sometimes irreversibly.
As years pass and a woman athlete continues to train hard without proper nutrition and the body is unable to ovulate, the BMD continues to be reduced, causing bone health to plummet to very unhealthy levels. You can guess what this means for runners: stress fractures and broken bones.
Lesson 3: Nutrition
The “A” word. Let’s just talk about it.
Anorexia is hugely prevalent among female athletes, with long distance running and dancing boasting the highest percentages.
The sad reality is that many women runners fall into the misconception that skinnier = faster. Especially problematic is the notion of starting to run in order to lose weight but continuing to expect to lose weight even after a healthy weight has been reached. At this point, losing weight becomes either a matter of restricting calories or taking training to an unhealthy level to keep shedding pounds.
Though they are not the only causes of amenorrhea, under-eating and compulsive exercising can certainly be factors. Many women runners may not even realize that they are not eating enough.
Your body burns roughly 100 calories each mile that you run and about 1,600 calories just from breathing, walking around and staying awake during the day. Let’s do the math. Lets say that today you ran 10 miles (roughly 1,000 calories) and did one hour of core work (another 1,000 calories) and then just rested on the couch for the rest of the day (1,600 calories). This means that you need to ingest 3,600 calories just to break even.
It ‘s hard to get a grasp on what 3,600 calories looks like so if you think you may not be eating enough, start keeping a food journal recording both calories burned as well as calories ingested.
Lesson 4: Figuring out your own body
Ovulation is the goal. When your body is allowed to ovulate, it can have a period and can be considered fertile. Here are some ways to keep track of what your body is up to:
Basal Temperature
With the first day of your period marking the beginning of your cycle, your body temperature upon waking should be consistent and low. As your body approaches ovulation near the middle of your cycle (for most women, around day 14, for me, day 11-12) your basal temperature will remain low, perhaps even dipping a few tenths of a degree lower. and then immediately after the egg is released, your basal temperature will experience a thermal shift.
For the rest of your cycle, called the luteal phase, your waking temperature will remain much higher than the fertile phase of your cycle. Once you see this shift and chart it for 3 days, you can assume that you have ovulated.
Cervical fluid
During the week leading up to ovulation, your body will produce cervical fluid, a clear slippery substance that is used as a medium for sperm to survive in on their way to the egg. Once this fluid is present, you can assume that you are on the way to ovulation!
Cervical position
Before ovulation, the cervix will rise and soften (a similar softness as your lips) and as soon as the egg is released, it will harden (feeling more like your nose) and drop several millimeters lower within a few hours.
Charting these signs as well as your eating habits and training stresses can help you understand when your body is not ovulating and why. It’s time to get back on the track of your fertility!
Hopefully, you found this article helpful and it answered your questions about whether missing your period is normal. I know this can be an embarrassing subject for many runners, but leave your comments and questions to participate in the discussion. You can definitely remain anonymous. While email is required to prevent spam, it will not be visible on the site. Feel free to use a fake name 🙂
References
1. Dušek T. Influence of high intensity training on menstrual cycle disorders in athletes. Croatian Medical Journal, 2001; 42(1):79-82.
2. Dale E, Gerlach DH, Wilhite AL. Menstrual dysfunction in distance runners. Obstetrics & Gynecology, 1979; 54(1):54-62.
3. Nelson ME, Fisher EC, Catsos PD, et al. Diet and bone status in amenorrheic runners. American Journal of Clinical Nutrition, 1986; 43(6):910-916
32 Responses
All good points. However, just because you’re having a period does not mean you’re ovulating (called an anovulatory cycle). So, you can bleed on a regular basis though not necessarily be hormonally healthy. Also, a cycle shorter than 26 days – though regular – can indicate a luteal phase defect or low progesterone, fairly common in athletes as the excessive stress of exercise can cause hormones such as progesterone to get “stolen” in order to make cortisol.
An anovulatory cycle is something I took into consideration, but during an anovulatory cycle, while you may experience bleeding, you will not experience the temperature shift, cervical fluid change or cervical position change, which is why I included these as ways to tell if you are ovulating. And yes, the shorter cycle can happen in athletes (and in fact does happen in my case), but is far less common than missing periods due to a lack of ovulation, which is why I chose to write about this.
Thanks for this piece — solid and to the point. I’ve dealt with this issue for several years now, and have mostly been met with either “it’s normal” or “put a birth control pill on it” as “answers.” Not especially helpful. Yours and Camille Herron’s perspectives are the best I’ve found so far!
I’m curious about your thoughts on reversing amenorrhea – i.e. any good resources on how long that takes? I’ve also read anecdotes from women who haven’t had to stop running per se, just amp up their calories … is it really that simple? Seems it’d be a little more complex … but, I could be wrong.
Camille is a good friend of mine, a great runner and writer and I have discussed the fertility issue with her before. In terms of reversing amenorrhea, it is totally a case-by-case situation. What works for one woman may not necessarily work for another depending on what is causing the loss of the cycle. In any case, talking to a doctor, one who really understands the needs of a female athlete, can be a great way to start getting back on track! One good resource that I recommend is the book, “Taking Charge of Your Fertility”, by Toni Weschler as it answers most of the questions that women have about their own cycle.
Great, much-needed article of information, Sarah. Struggled with the female athlete triad throughout my college career – that is, energy deficit/disordered eating, menstrual disturbances/amenorrhea, and then the start of osteopenia (precursor to osteoporosis) (great resource on that here: http://www.femaleathletetriad.org/for-athletes-coaches/what-is-the-triad/). I only started seriously running in college and found great success with it right away. Ended up a multi time All-American, and fell in love with the sport, but there was an ugly side to it for me. I never really had anyone confront me about a possible problem with the way I did things, so I just kept plugging away with high mileage and a perpetual energy deficit and within two months of the best race of my entire life, had a stress fracture and consequently ended up unable to run for the next six months. It was at that point (a very low point in my life!), mid-2011, I finally sought help- counseling for anorexia/disordered eating, saw a nutritionist twice a month, and found a coach with knowledge of the triad and overtraining who helped me keep my mileage lower and had me take more rest days. Two years and probably 15-20 pounds later (thought I don’t weigh myself anymore), I finally have my period back after having it gone for 5+ years. It’s been a long process and I definitely couldn’t have done it without seeking help. Wanted to share my story in hopes that others out there will consider seeing a therapist and nutritionist and find a coach who truly understands their needs. Sometimes it takes a fairly lengthy break from running to get your period back, and in my case my body truly thanked me for finally listening to it. I am mad at myself for not being more educated in college, but being newer to high level running, I just assumed it was normal for elite female runners to not have their period. Hopefully more and more women will read articles like yours and Camille’s and know it’s never positive/a good sign. In my experience, it’s almost always traced back to undereating. I’ve now learned to eat like a linebacker, too! As well as recognize every woman’s body is different – from their nutrition needs to amount of stress their body can handle– which emphasizes even more the need to seek help in designing a custom plan based on an individual’s needs.
Thank you to BOTH of you lovely ladies!! I found this so so helpful… I just started seeing a nutritionist, doctor, and therapist for disordered eating. I have not had my period in over 2 years. I was not a college runner, but I take running very seriously and it is my favorite thing– as is ALL exercising! I feel like I do not over train at all (especially since collegiate runners run up to 70 miles or more each week and I put in only 30-40).
I am gaining weight and trying to get my period back, and I WANT it back! But I am having a hard time mentally overcoming the changes my body is showing.. I was wondering if you have any advice? I see these lean, taught-tummy runners and here I am trying to put on weight (and succeeding) and it just can be so so hard and frustrating!! Just wondering if you had any suggestions! Thank you so so much for sharing your stories! Please know you are helping so many women out there!!!
That is a really tricky question, isn’t it? I’ll tell you the truth Andrea, I don’t know a single woman that is 100% okay with her own body. It’s easy to see those “taught-tummy” runners and compare ourselves, but even those women compare themselves to other women. My only suggestion is to sit down with a piece of paper and list all the things that you do like about your body, then keep that list somewhere you can see it when you’re feeling down about your body. When you see a runner with a six pace, remind yourself, “Hey, she would probably kill for my breasts!”
Hi! So I’m a female cross country runner in high school and am 16, but have not started my period yet. I run about 40 miles/ week and do about 20 minutes of core/ week. I eat quite a bit of food, including lots of antioxidants and nuts. I’ve also had the clear cervical substance quite a bit, but still no period. Any reason why?
It’s fairly common for young runner to start their period a little later than non-athletic girls. Clear cervical fluid often shows up a year or two before your first period so I would try not to worry about it, it will probably show up in a year or less. My sister began running in 8th grade and ran fairly high mileage all the way through high school, she started her period just before she turned 17.
I’m 36, 5’9, 159lbs. I’ve taken BCPs for two decades. Started endurance running in the last ten years. I’ve been experiencing missed or almost no period, usually following runs of 18miles+ I eat red meat regularly. I don’t feel like I fit the criteria for most amenorrhea. Any insite?
You are right that you don’t seem to fit the criteria for most amenorrhea cases, but anovulation has far more to do with fat than with weight, so I would gt your Body Mass Index checked. If you are within normal range and still not experiencing normal periods, I would see a doctor.
5 ft and probably 95 pounds..I have PCOS AND im a runner ( not crazy high mileage but on an average of 25-30 miles a week).. def dont eat AS much as I should on a regular basis but enough to fuel myself and not feel weak.. have increased food intake in the last year and went from 90 pounds to 95(or maybe even a lil more)..But I have missed my period for a year and only got it thrice last year!!! i’m sure the polycystic ovaries are a cause but have had pcos since I was a teenager and since ive started getting more serious/consistent about running ( in the last 2 years ) my period have been mia…any insight on such a case?
My 15 daughter is experiencing a femoral stress fracture. She has not had a period in a year & half. While on crutches– she had 1 period. She only had 3 in a row at 13 years & then nothing thereafter until now. She truly eats well but I suspect not enough. Does an oral contraceptive help her w/ ovulation & future bone density? She takes vitamins but I am concerned about future problems & what we can do now to prevent this (beyond increased intake).
Hi, I’m Filippa and I’m 15 years old. I dont remember the last time i had my period, maybe 3-4 months ago. I used to have a tiny amount and i always had it for 1-3 days! Now i dont know, i havent had it and i just Love not having it. But i researched and read That it can be dangerous for me, I am training a lot! Maybe 6 times a week mostly, this week 5 or 4! I eat super healthy every meal, but I like to have 2 or 1 time a week when I eat chips or cake or something like a treat! I’m feeling great but I’m getting conserned, is this dangerous? That I haven’t had my period in a couple months? Will it come back? Ive never cared about my weight and don’t have an eating disorder, love food too much. But I eat restricted, no white bread, no pasta, no rice and so on! What should I do?
I’d love an answer, thanks! Loved the article!! xx
Hi, I am 14 and i started my period before my 14th birthday with a week by the end of november and 2 weeks after my birthday i joined track for the first time in my life. I was put into distance running whivh i lpved but i didn’t care about or anything at all bit i wad upset when i gained 10 pounds and became 110 pounds, but i lost those pounds in a month after tge winter and spring seasons of track were over. The problem is i never got my period again is that normal??? Please help
My period is missing now that I am in the peak of my marathon training. However, I am not even close to underweight. I have a BMI of about 24 with a body fat percentage near 25%. I’m about 30 lbs heavier than I was at the beginning of the year, having gained weight after quitting smoking. So obviously for me, anorexia does not apply. I’m taking multivitamin and magnesium. Maybe it’s the cortisol. I have noticed a (subjective) increase in belly fat, despite keeping the exact same weight throughout my training.
I’m 13 and I got my period during the summer but then what happened was I only got it 3 times before it started on september and I only go 2 times a week and now I don’t have my period what is happening?
Hi Tori, are you saying you only run twice a week? It could be that your body is not quite in a routine yet, how many months has it been since your last one? Just make sure you are consuming enough fuel, including good fats to keep your body in a place where it is able to support having a period. Hope this helps!
Hi,
I’m 28 years old & had my first baby last year in July. My period returned at 6 months post partum but recently stopped due to recent training. I’m only running about 25-30km a week but my doc said its normal because of hormone imbalance from running. I’m eating a lot so I’m unsure as to why I’m missing my period. Could this Impact future fertility?
Hi Kristen, that is a debated topic, and your best bet would be to go see your gynecologist to get tested to see what they think about that for you. Hope that helps! It would be difficult for us to say that for you without seeing you.
Hi I need help! Very serious runner in D1 xc and track and I need a good season this year for my senior year. Lots of colleges are looking at me. However when I started running I was 110 but I dropped a bunch of weight from running a lot and eating good and went to 93 pounds. I lost my period! I am 5’3, I know too skinny!!! I went up to 98-100 and preformed VERY well and I feel like that is my ideal racing weight. I weigh about 98 now and I still don’t get my period. Very frustrating because someday I may not eat enough just because I don’t ever count calories but most days I seriously stuff myself! All I want is my period but I also want to preform well and not screw anything up. I know getting your period is healthy. I need some tips! And I can’t find any dietitians near me! Please help!!!
Hello, thanks for reaching out. Sorry to hear you have been struggling, and yes, it does sound like you need to change your diet slightly if you want to optimize your health. It is good that you realize being underweight is not healthy, and it is damaging to your long term health. Many runners do not realize how dangerous this can be. You should take a listen to this podcast episode to learn more about this topic https://runnersconnect.net/rc60 as that will answer a lot of your questions. It is probably just that you are not consuming enough fats to maintain your cycle. Make sure that you include lots more healthy fats in your diet for the time being; nuts, seeds, avocado. Best of luck with your senior year, and if this does not help, we would be happy to make more suggestions. Hope this helps!
Hi! So I’m am 16 year old distance runner, and I have problems with my period. I originally got it at 12 years old and was always irregular. But going into freshmen year, when I started running, I became very underweight(I dropped 10 pounds) and lost my period completely after a couple of months. Now I’m back to a healthy weight, but still do not have my period. But in cross country of sophomore year, i had anemia, which affected my performance until May I don’t want to take medication and for the past couple weeks,I tried to add more fat in my diet, But my question is, how much fat is enough? Also, do you think protein could be a factor? How long would it take to get my period back if I consume more of these products? I really want to improve with my times and get healthy again.
Hi Maya, thanks for reaching out. It is good that you have put this as a priority, and you are being smart about gaining the weight back. You may enjoy listening to our podcast, as this episode goes over this topic in more detail (including how much), and gives you some other answers to questions you likely have. https://runnersconnect.net/running-interviews/sarah-crouch/ If this does not answer your questions, let us know, and we will try to help as best we can.
Hello. I started my period when I was 14, and I havn’t had it since then. I have run xc and track since 7th grade, and I have been a competitive swimmer for 7 years. I didn’t think of it until I read this article. I just thought that maybe I was a late bloomer or something like that. I am about to turn 16. About 4 months ago I got a stress fracture in my ankle. I didn’t run on it for two months, and then I tried to run on it. Unfortunately I started back too soon and prolonged my healing process even further. About a week ago I started back and I am taking it super easy. So far it is going good, and I haven’t felt any pain. My doctor said my bone health was perfectly fine, and he thinks I was just over training. However, now that I am starting back I want to prevent myself from having a stress fracture ever again because it is terrible. What should I do? I am worried that I got a stress fracture from amenorrhea even though my doctor thinks my bone health is fine! 🙁 What is your opinion?
Hello, thanks for reaching out. Sorry to hear about your struggles, it is good that you realized what was going on and backed off the training. You probably did just overdo it while you were training hard. You do need to do everything you can to get your period back, and I would recommend you listen to this podcast about female related issues https://runnersconnect.net/rc60 This should help to put your mind at ease. The longer you go without your period, the more at risk you are putting your body of bone related issues. if you still have questions after this podcast, let us know, and we will do what we can to help you! Feel free to email if you need to 🙂
Wonderful article thank you.
Hi, my name is Chelsea and I’ve been an athlete my entire life. I first received my period at age 13 and had it consistently until I was 19. I then began to run more and eat less (~1600 cals) to lose some weight and improve my running. I dropped weight very quickly and lost my period. It has now been about 2 years since my last period. Since then, I have been eating much much more, decreased my exercise (I mainly lift weights now as I cut back on cardio), and have put on about 20 healthy pounds. I am at a very healthy weight for my size with a lot of muscle and a healthy amount of body fat yet there’s still no period in site. My doctor keeps telling me to just wait but I’m beginning to get more concerned. Any advice would be greatly appreciated!!
Great article!
When I was 19 I lost my period, and got it back when I was ~21 and a half. I was doing a lot of running and not eating enough. I lost weight really fast and got very tiny. I started eating more, and my period came back, and it’s regular now! I’m glad this was posted because I used to have the mentality that no period was good because it meant I was training hard and had little body fat. Now, I’m happy that I have my period every month and I feel healthier because of it. I’m losing weight the healthy way
Hi,
Thank you for the article. What is your opinion on LunaBars? And can I prevent bone loss / osteoporosis by upping my Calcium intake?
Thanks,
Marie
That’s a really good question. Think calcium should do sth for you to prevent stress fracture. I also take extra vitamin D+K supplements (for bone health).
Don’t want to put on weight as it’s highly correlated to my running performance (sorry).
Hi!
I’m a 26-year-old avid runner and have increased my mileage over the past 4-5 years. Training for my third marathon this summer my period was completely off- I either would spot for a day or two or it would be late. This past month I didn’t get it but I spotted a bit and got every other symptom- my hormones felt really out of wack and my emotions showed it! I am roughly 5’3″, 133lb and 21% body fat so I’m not sure why this is happening. I have PCOS, but my last test didn’t show any cysts. I hate hearing- this is normal- from doctors- I want to take this into my own hands before I want to have children. Any insight?