Amenorrhea and Running: Is it Normal for Female Runners to Miss Their Period?
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:
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.
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!
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 🙂
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