Three to four percent of female athletes will experience amenorrhea — the loss of menstruation for at least three months for those with previously regular cycles, and six months for those with previously irregular cycles. It can occur in any woman whose caloric intake does not meet her energy demand. In an athletic environment where pressure exists to perform well, this improper fueling is often a product of chasing race weight and peak performance.
There was a time when amenorrhea was somewhat accepted as a simple result of hard training. Dr. Erin Dawson-Chalat, a marathoner and physician in Portland, Maine, disagrees, stating that “absence of a period is always reason for concern.” Exercise-associated amenorrhea is a diagnosis of exclusion, which means a doctor must rule out other (usually more serious) causes for the interruption in the patient’s menstrual cycle.
That’s not to say that exercise-associated amenorrhea isn’t serious. The most common type of amenorrhea in athletes is known as FHA, or functional hypothalamic amenorrhea. It involves a change in the way the hypothalamus releases hormones, resulting in a low estrogen balance. This not only stops menstruation, but can result in lower bone density, which can lead to stress fractures.
Some research indicates this lost bone mineral density is permanent — it can’t be significantly reversed once it occurs. Some damage can be mitigated with hormone replacement patches, but this won’t replace lost minerals. In straightforward terms, if you are experiencing amenorrhea, you’re entering territory that will not only impair your current athletic performance, but can damage your long-term bone health.
Fortunately, studies have shown that exercise-associated amenorrhea (EAA) can be eliminated with a simple increase in caloric consumption, generally within three to 12 months after an intervention is made. Dr. Dawson-Chalat recommends keeping a food journal. Many busy athletes don’t have time to think through every meal during a day, so making notes and being able to revisit later with a doctor or nutritionist can help pinpoint the right balance of nutrients and calories for optimal performance.
If you (or a coached athlete) are having difficulty finding a balance with training and diet, or are experiencing EAA in that three- to six-month criteria, see your doctor! While performance might not be affected early on, your bones can be, as well as your long-term bone health. Once any other medical causes are ruled out, simple intervention with a food journal, a balanced diet, and a nutritionist will put you back on the path to good performance and long-term health.