Women's Health Articles

Q: I am kind of embarrassed to ask this question...but I am not sure who to turn to. See, I exercise regularly and intensely, and I recently missed two of my periods. Could my intense exercising be affecting my regular menstruation?

A: First of all, don't feel embarrassed about asking such a question. It's really more common than you might think. And, thank you for trusting us; however, before I answer your question, remember, if you ever have any serious health problems or questions, you should probably use a physician as your first line of defense. Now, let me answer your question, the best I can, from the knowledge I have with this subject.

"A complex group of hormones determines your monthly menstrual cycle. If something goes wrong at any stage of the process, menstruation can be interrupted."The technical term for "absence of periods" is called ammenorrhea. There are two types: either primary amenorrhea, which is when menstruation fails to begin before age 16, or secondary ammenorrhea, which is when a woman has previously had regular periods but stops menstruating for six months or more. This problem occurs in about two to five percent of all of the female population of reproductive age, although this percentage goes up dramatically in female athletes (up to 44%).

Here are the most common medical reasons this might occur:

Hormones controlled by the hypothalamus?an area at the base of your brain that acts as a control center for your body?regulate your menstrual cycle. The hypothalamus sends chemicals to the pituitary gland, a tiny gland also located at the base of your brain. The pituitary gland releases hormones that travel through your bloodstream to your ovaries, where they cause ovarian follicles to produce estrogen and progesterone. These hormones prepare your uterus for pregnancy. A complex group of hormones determines your monthly menstrual cycle. If something goes wrong at any stage of the process, menstruation can be interrupted.

Factors to Rule Out There are many reasons secondary ammenorrhea may occur. Pregnancy is obviously the main reason and should be ruled out first.

Contraceptive Pill

Some women who take birth control pills may not have periods. Even once you've stopped taking contraceptives, it can often take three to six months for regular menstruation to resume.

Stress

Having extra stress in your life can lead to a lack of menstruation. Although I believe this is slightly overstated as most women carry on with normal cycles during exam time, wedding planning, or similar stressful situations, it's something that should be considered. Usually when the source of stress is removed, the menstruation resumes.

Medication

It's possible that certain medications may interfere with a regular cycle; for example, antidepressants or thyroid medication. This should be discussed with your doctor if you've started taking a new medication for any reason.

Illness

If you've suffered from chronic illness recently, this can be a huge stress on your body and its normal functioning?and therefore may disrupt your periods.

Hormonal Imbalance

A common form of hormonal imbalance in women is "Polycystic Ovary Syndrome." This condition causes relatively high and sustained levels of estrogen and androgen, a male hormone, rather than the fluctuating condition seen in the normal menstrual cycle. This can result in lack of ovulation and, therefore, a lack of menstruation.

Thyroid Problems

Thyroid disorders can cause an increase or decrease in the production of prolactin?a reproductive hormone generated by your pituitary gland which can disrupt your cycle.

If you're still concerned, you should visit your doctor, and he or she can discuss all the above conditions with you to rule out these as being the cause of your lack of menstruation. If none of these contribute to this, as you exercise regularly and intensely, then you may be suffering from the "Female Athlete Triad."

The Female Athlete Triad This phrase was coined in the 1990's to describe a combination of three conditions that are related to athletic training: disordered eating patterns, ammenorrhea (lack of menstrual periods), and osteoporosis.

"Weight training can also strengthen bones and give an increased sense of confidence; however, you should also be aware of the side effects of overreaching."Incorporating an exercise regimen into your life is overwhelmingly positive: studies have shown that it can improve cardiovascular health, improve immune function, and promote a healthier and more optimistic lifestyle. Weight training can also strengthen bones and give an increased sense of confidence; however, you should also be aware of the side effects of overreaching.

The Female Athlete Triad is usually caused by such factors as not eating enough to sustain the amount of calories burned during exercise and excessive exercise. Sometimes women will restrict calories to maintain a low bodyweight or to gain an advantage in their sport of choice, such as running or gymnastics. The hormone leptin alerts the brain to the amount of bodyfat that's in your body. If the percentage of bodyfat is too low, then menstrual function can be affected.

Although secondary ammenorrhea is usually classified by six or more missed periods, you should still seek the advice of your doctor if you're concerned before six. Loss of menstrual periods may signal a change in your hormone levels. In fact, a paper published by the American College of Sports Medicine recommends that short-term ammenorrhea should be considered a warning signal for the Female Athlete Triad and that women should seek health-care advice within the first three months of a missed period. Also look for other symptoms, such as fatigue, anemia, or depression. These sometimes subtle signs may indicate that you are at risk for the Female Athlete Triad.

Bear in mind that female athletes must take in enough calories; otherwise, they run the risk of tearing down muscle mass and losing bone mass, which could lead to injuries, such as stress fractures. (I suggest consuming at least eight to 10 calories per pound of bodyweight.) Low bodyweight causes you to stop producing estrogen, which can halt ovulation and periods. Long-term ammenorrhea can also lead to osteoporosis later in life.

Recommendations to Reduce the Risks Recommendations for reducing the symptoms of ammenorrhea are based on the cause. Your doctor may suggest that you make changes in your lifestyle depending on your levels of stress, physical activity, or weight loss or gain.

The lack of estrogen caused by athletic ammenorrhea can be treated with estrogen replacement therapy in the form of oral contraceptives. However, lifestyle changes can also help you avoid athletic ammenorrhea.

First, even though you're following an exercise program, you'll need to evaluate whether you're maintaining a healthy lifestyle and bodyweight.

You may have to make changes in your diet and activity level to increase your bodyweight slightly. Ensure that you're eating enough calories to make up for the amount of exercise you're doing. You can still maintain a low bodyweight, within healthy limits, by eating the right kinds of foods?a good balance of protein, complex carbs, and essential fats.

You may also want to consider reducing your amount of exercise by 10 to 20% for a time to see if your menstruation resumes.

Also, try to balance other areas of your life, such as work, recreation, and rest. Instituting a more balanced, smarter diet and moderating how much you exercise may result in the natural return of your periods.

Supplements That May Help Research has shown that athletes who suffered from more stress fractures or injuries had lower calcium intake. Try supplementing with 1,200 to 1,500 mg of calcium per day, but remember that only 600 mg can be absorbed at one time, so space them throughout the day. Additional Vitamin D (400 to 800 IU) may help with the absorption of the calcium.

Also, consider taking an iron supplement every day (15 to 18 mg)?particularly if you find that you are anemic.

In Closing
Remember, the Female Athlete Triad is a preventable problem. By listening to your body, including your menstruation cycles, you can ensure your "healthy" lifestyle really is healthy!