The Truth About Hard Training and Menstruation

Smack dab in the middle of my hardest and healthiest training ever, I toed the line at the Castle Rock 50k on Oct. 5. My legs were tired from the big miles early in the week, but I was well-fueled and excited to throw down a solid 31 miles.

The first 15 were smooth and fast, averaging under eight-minute miles on rolling trails. Then, rolling through an aid station, I was greeted with a familiar aching deep in my belly. I needed a tampon ASAP.

I got my period mid-race. Whatever. It happens to all of us. Or so I thought until I posted my run on Strava and made light of my race day womanly woes.

“First place and a course record! Three gels, some coke and lots and lots of awkward looks when I asked aid station captains for tampons after getting my period at mile 8. Holy cramps! Just jogged after cramp fest started. Super fun day!”

A race win and a course record to top off a 110-mile training week. I was excited and proud that I had almost doubled my usual weekly mileage and run a solid race despite my tired legs and menstrual cramps.

My Strava and Instagram account flooded with congratulatory messages. But I was surprised to see most congratulations followed by a remark of surprise that I still got regular periods during heavy training.

Unfortunately, many female athletes believe that training hard inevitably leads to irregular or missed periods. It’s a common myth. Even High school and college coaches told me as such.

This is not the case. Missed periods, or amenorrhea, are a sign that the body isn’t receiving adequate nutrition. Over time, amenorrhea can lead to low bone mass density, increased susceptibility to stress fractures and early onset of osteoporosis. It can also make it more difficult to become pregnant or maintain a healthy pregnancy.

Studies show that amenorrhoea is prevalent amongst female long-distance runners. But that doesn’t mean it should be accepted. I’m an elite athlete who logs huge mileage and I’m on the lower side of normal on the BMI scale. And yet I haven’t missed a period in 10 years.

Here are a few things you should know about amenorrhea.

Estrogen, the primary female sex hormone, is responsible for the development and regulation of the female reproductive system and secondary sex characteristics. It is also involved in the thickening of the endometrium, a mucous membrane that lines the inside of the uterus (womb).

Every month, the endometrium becomes thick and rich with blood vessels in preparation for pregnancy; if the woman does not get pregnant, the endometrium is shed, causing menstrual bleeding.

Excessive exercise can cause the hypothalamus, a brain region that plays a vital role in maintaining body processes such as body temperature and metabolism, to stop functioning normally, ultimately leading to a reduction in levels of estrogen and disturbed menstruation.

At first, disturbed menstruation might seem like a blessing. I certainly didn’t want to go tampon searching in the middle of a 50k race. But with menstruation comes an assurance that your body’s essential systems are working correctly.

One of the most thoroughly studied, serious and long-term effects has to do with bone health. Women’s bodies reach peak bone mass by age 18 to 20, but even afterward, our bodies continue to break down and rebuild bone. If you don’t have a period, you likely don’t have the raw materials to do so, and you’re missing out on bone-protecting estrogen as well.

Without menstruation, you run a higher risk for osteoporosis and stress fractures, according to a 2016 study published in The American Journal of Sports Medicine.

It’s a mistake to think that amenorrhea is only caused by under-eating or overtraining. While they’re both common causes they are not the only causes. Conversely, getting a regular period doesn’t necessarily mean you’re eating right or training correctly. Next week, I’ll explore other causes of amenorrhea and what to do about it.