All too often, when female athletes miss their period they treat it like a badge of honor. When they experience amenorrhea, the medical term for the absence of menstruation, they take it as a sign that they’re training hard.
But that’s a mistake. Missing a period during training doesn’t represent a successful training block. It’s a warning that something isn’t quite right with your body.
Athletes often think overtraining and under-eating are the only causes for amenorrhea. While they’re the primary causes, training and nutrition aren’t always to blame for missed periods. Here are some of the expected and unexpected causes of amenorrhea in athletes.
The hypothalamus is a brain region that regulates and releases gonadotropin, the hormone that starts the menstrual cycle. Low body weight, low percentage of body fat, deficient intake of calories or fat, burning more calories than you take in through exercise all cause hypothalamus amenorrhea, the most common amenorrhea for athletes—it’s often called athletic amenorrhea.
The combination of low body weight and intense exercise tricks the body into believing it is in a starvation state. When the energy expended during exercise isn’t balanced by adequate nutritional intake, the body starts shutting down organ systems that aren’t essential for survival. The first is often the hypothalamus.
Treatment for hypothalamic amenorrhea can be simple. Just increase your caloric intake or take some downtime from training. Emotional stress can also interfere with gonadotropin release, though, so eating and resting more won’t work all the time.
Hypothalamus amenorrhea is common among female athletes that train hard and eat well. The biological explanation lies in the release of cortisol, a stress hormone that is part of the body’s normal response to exercise and other life stressors. Stress, from hard training or hard workdays—but usually a combination of both—can keep the brain from producing the reproductive hormones needed to keep the menstrual cycle flowing.
The thyroid is a small butterfly-shaped gland at the base of the neck. The thyroid produces hormones that control metabolism and play a role in puberty and menstruation. A thyroid gland that is overactive or underactive can cause menstrual irregularities, including amenorrhea.
If you suspect your thyroid is causing your amenorrhea, see a doctor immediately.
Gynecological conditions, specifically those that lead to or result from hormone imbalances, may also have secondary amenorrhea as a symptom. Polycystic ovary syndrome, or PCOS, occurs when a woman’s body over-produces androgens, a sex hormone typically higher in men.
High levels of androgens can cause fluid-filled sacs or cysts to grow in the ovaries, interfering with ovulation. Many women with PCOS either have amenorrhea or experience irregular periods. Although 80% of women with PCOS are overweight, it is also common with female athletes. Some women use high-fat diets to help regulate PCOS-induced amenorrhea.
These are just a few of the most common causes of amenorrhea. Bottom line: if you’re between 16 and 50 and aren’t getting regular periods or haven’t had a period in over three months, see a doctor.
As women, we owe it to ourselves to be educated about our menstruation cycles and possible causes of disruption. As female athletes, we owe it to ourselves to treat our bodies with respect by fueling adequately, training smartly and being on the lookout for red flags indicating something off with our reproductive health.
It’s important to refrain from judging women with histories of amenorrhea. Stigmatizing missed periods prevents us from talking about menstruation health openly and without shame. Instead, we need to protect and support women dealing with amenorrhea and encourage them to get the help they deserve.