Firstly, let’s define Amenorrhea – Amenorrhea is when a woman does not have menstrual periods. There are two kinds:
– Primary Amenorrhea: this is when there is a delay in getting period for the first time.
– Secondary Amenorrhea: this is when you have missed a period for 3 months in a row or greater.
Causes of Amenorrhea:
It is important to recognise that not everyone experiences amenorrhea due to the same cause. We highly recommended seeking advice from your doctor to ensure that you get to the bottom of the cause of your absent period. From there, you can create a plan to address.
There are many different causes of amenorrhea, including:
- Being underweight or overweight
- Having an eating disorder
- Excessive amounts of exercise
- High training loads for athletes
- Poor diet and reduced calorie/energy consumption
- High levels of stress
- PCOS
- Family history
- Menopause
- Genetics
- Pregnancy
- Chemotherapy and radiation treatments
- Uterine scar tissue
- Thyroid or pituitary gland conditions
- Various other Chronic medical conditions
A lot of the above causes might be difficult to prevent, for example, we cannot help our family history.
However, for the purpose of this blog, we are talking about the impacts that excessive amounts of exercise and training loads have on our menstrual cycle, and the toll this can have:
Amenorrhea is a sign in women that they might be over-exercising or not getting adequate nutrition/energy needs. When this occurs, the body adapts so that they can preserve this energy for essential bodily functions. When there is little energy available, this can negatively impact the reproductive system and the menstrual cycle causing the menstrual period to stop. This is because the body is prioritising its energy elsewhere (such as to the heart, lungs and brain).
Whilst not everyone needs to be underweight to experience amenorrhea, it is quite common that amenorrhea is experienced in people who are underweight or living with an eating disorder.
Amenorrhea and Bone health:
There are hormonal changes in women who experience amenorrhea and/or an eating disorder. Estrogen is a hormone particularly important for bone growth. Low body weight can stop the body from producing Estrogen and can also cause menstrual periods to stop. So low body weight reduces estrogen levels, alongside other growth-hormones, which can negatively impact our bone health. This can then lead to reduced bone density, and consequently increase the risk of developing Osteoporosis, leading to increased risk of fracture.
Fertility Issues:
Often women with amenorrhea do not ovulate, so this reduces chances of getting pregnant. It is possible to ovulate without having a typical period (although, less likely). If amenorrhea is due to very low body weight or due to eating disorders such as Anorexia Nervosa, there are also greater risks during pregnancy such as low birth weight, premature birth and also mental health struggles.
Here are some tips:
Talk to an exercise physiologist about your current training load to ensure that you are not over-training/over-exercising. Exercise physiologists can recommend what a healthy amount of exercise looks like
If you are an athlete who has a high training volume, it is important to increase your calorie intake accordingly to ensure that you are getting enough energy, and to ensure you are getting enough of the right nutrients. Talking to both a dietitian and exercise physiologist would be very helpful in this context.
Ensure you have a balanced diet and that you are:
a) eating enough calories/energy if you are underweight
b) if you are overweight, making modifications to facilitate healthy weight-loss
c) Talking to a dietitian for personalised advice
If you are underweight or living with an eating disorder, and having trouble increasing your calorie intake or having trouble tapering your exercise load, we recommend talking to a psychologist, preferably one that specialises in eating disorders.
Engaging in stress management techniques: relaxation, meditation, whatever works for you!
Try to improve sleep duration and quality of sleep.
Talk to your GP or specialist such as a gynaecologist or obstetrician.
To summarise, over-exercising and training can lead to the body stopping the menstrual period because the body needs to use that energy elsewhere. In order to regain your period and to avoid potential health complications such as Osteoporosis, fertility issues and early menopause, you need to talk to your medical team, exercise physiologists and dietitians to ensure you have the correct strategies to get your period back on track.
If you would like to learn more about exercise and your menstrual period, book online with one of our exercise physiologists Tresna or Rhiannon. For recommendations for referrals to other allied health professionals including dietitians and psychologists, check out our recommended referrers page.
Resources:
https://www.deepdyve.com/lp/wolters-kluwer-health/female-athlete-triad-and-relative-energy-deficiency-in-sport-in-yrdHbmghqZ?utm_campaign=pluginGoogleScholarDownload&utm_source=pluginGoogleScholar&utm_medium=plugin
https://familydoctor.org/condition/amenorrhea/
https://nedc.com.au/eating-disorders/eating-disorders-explained/disordered-eating-and-dieting/
https://healthybonesaustralia.org.au/your-bone-health/about-bones/
https://healthybonesaustralia.org.au/wp-content/uploads/2020/11/HBA-Fact-Sheet-Anorexia-Nervosa.pdf
https://my.clevelandclinic.org/health/diseases/3924-amenorrhea