Yuck gross, I know but periods and exercise are a place you can get yourself into some real lasting trouble. You might have heard that women who exercise a lot loose their periods and maybe even that they are infertile. While neither of these are necessarily true but they actually can be and worse, scary right? Well I’m willing to bet not a whole lot of you have ever heard about anovulatory periods and exercise specifically. Now disclaimer time I’m a doctor of biology not a medical doctor and my specialty is not even endocrinology (the study of hormones). Honestly if you read about things here that are effecting you personally it’s past time to get to the doctor! I’m writing this to make you aware of something you might not be rather than providing personal medical advice. Since I talk about half marathon training and tackling the olympic distance I feel like it’s only right to delve into the dangers too. But there are some easy things you can do to stay on top of this before it becomes an issue. So let’s get down to it then.
The myths (sort of)
The truth of the matter is female athletes can and do loose their periods. But the idea is definitely out there that it’s endurance athletes that suffer or are in danger of this but that’s not the only case. It really comes down to body fat so sprinters and body builders among others are at risk. It’s especially common in sports that value thinness like figure skating and gymnastics as well but any one can really be at risk. There is no magic number and it varies from woman to woman but 12% is the most recognized number. If you’re naturally a very thin person who has a hard time adding muscle in general (raises hand) your number is probably a bit lower. Conversely if you tend to hold onto weight and build muscle more easily the percentage body fat you need to maintain your period could be a lot higher. It’s not unheard of for women to loose their periods just below 20% body fat. But there are other complicating factors like stress, diet and generally what you’re hormones are doing. The thing is marathon training (or similar) can make you’re body and you stressed or at least mimic it. You’re obsessing over one thing, missing a lot of sleep and trying to stuff every thing else in you life into the time that’s left. I know when I’m in the heavier weeks of training my next two days is scheduled to the hour, stuff is not getting done that has to be and if we stop in to visit someone unexpectedly I’m beyond stressed, and a bit pissy, watching all that planning melt away. So take away message it’s not ‘just’ the super skinny marathon runners.
Next myth as long as you have you’re period you’re fine. Well exhale this is mostly true, if things downtown are ticking along as they normally do than you’re good, but there is the danger of anovulatory cycles. These are cycles where you’re not producing enough of the sex hormones to actually mature an egg and ovulate. It can be really hard to tell if this is happening to you, just ask Khloe Kardashian, but there are subtle signs. You’re period might be really short, or long and another sign is that is way easier and lighter or just weird compared to your ‘normal’ cycle. This sounds awesome right, easy light periods and no babies well no, not at all. First it’s like a Terrible birth control method because you literally never know when you will or won’t release an egg and the timing and clues to that months cycle come too late in the form of your period. But also you’re not getting enough of those sex hormones that month.
How your period works
I actually took this out of a first year science credit only course I teach because gross and kinda boring but we need it here. I’m going to focus on the second level of hormonal control because that’s where the issues lie here but bio geeks I got you FSH and LH for ya’ll in the image below. Basically after your last period is over estrogen levels start to rise and that get’s this month’s egg ripening in the ovary of choice that month. This reaches a peak at the egg is finished off just right and then released, some women say they can feel this, can you, I can’t. And then progesterone takes over readying the lining of the uterus for implantation, no implantation and you get you’re period. Anovulatory periods happen when you’re body is not making enough estrogen to mature that egg and so either the progesterone peak causes an early period or less progesterone as well also makes your period come later. If you don’t make any or very much at all no periods at all. If you’re on birth control you take synthetic version’s of these hormones which ‘trick’ the body into now realizing that first level of hormonal control we’re not getting into here and you don’t ovulate so you’re covered conception wise. If you’re on the pill you’re getting enough of these hormones all ready, yeah you, but talk to you’re doctor if you want more advice on the matter.
Why that’s a big deal (the female athlete triad)
So this actually in rare cases can be fatal, more often there are lifetime consequences but that’s still on the rare side. I have your attention now don’t I! The three things in the triad are amenorrhea, osteoporosis and disordered eating, though I think that last one is pretty heavy handed in a lot of cases, in other words if you don’t have a problem with food you’re not out of the woods. Basically these three things are so interrelated that if you have one as a female athlete you probably have the other two. Amenorrhea is the absence your period, osteoporosis is the weakening of bones and can be very painful. Now onto the disordered eating thing in this case it doesn’t really have to be starving yourself or purging. I’d take a pretty loose definition here more akin to not eating enough calories to maintain the level of exercise you are doing.
Let’s take a bit of a left turn here and talk about bone health, I promise it’s related. Bone is not the static boring thing we think of it as but rather living tissue. It acts as a storage space in addition to support for you body. In lean times those things are liberated and in good times replenished. The thing is though you reach your maximum storage space around age 25. Weight bearing exercises (almost everything except for cycling and swimming) does lead to increased bone density but estrogen deficiency leads to bone reabsorption by the body. Think of it like a bank exercise is like a deposit and having low estrogen is making a withdraw. On average, like a bank account if your withdraws are bigger than your deposits then you’re on your way to the poor house but with your bone density.
So if you’re not having periods or real periods because your not making enough estrogen to ovulate you are depleting you’re bones no matter how much weight bearing exercises you do you’re harming your health. At the very least your bone health and potentially your reproductive health. In most cases you will be able to become pregnant in the future as long as you put on some weight, perhaps dial back on the exercise and reestablish a regular flow. That said one of the risk factors for infertility is long periods without your cycle. There is no magic number of how long is too long but even in eating disorder patients their chance of future infertility is increased by less than 5%. In very rare cases women with this particular set of issues do experience cardiovascular trouble which is to say they have heart attacks and some of those are fatal. It’s impossible to say exactly how much of this is exercise induced vs disordered eating induced but it is admittedly very rare. If you’re not having proper periods there is something very wrong with your body, chances are you’re on your way to osteoporosis and there very well could be more unseen damage beyond that and your period will be the only outward sign.
Anovulatory Periods how to spot em
Let’s start with saying anything different than you’re used to could be a sign but not necessarily. Perhaps the biggest signal is very long or very short periods lasting less than 22 days or more than 35 days per cycle. Either your progesterone levels are closer to normal and so your body will continue to build up lining and make your period later or those are low too and the lining can’t be maintained and so it’s let go of sooner as well. If you’ve tracked your cycle and it’s always 26 days and then it drops to 22 days or moves to 31 days all of a sudden you might be not be ovulating. But …. the very next month things might return to normal, so take precautions. You might also find your periods are way easier, lighter or shorter than usual. If you suffer from moodiness, bloating, cramps, breakouts or swollen breasts and then all of a sudden you don’t, that’s a sign too. If any of this applies to you a trip to the doctor is in order!!! It’s not an emergency so don’t freak out but you need to talk to a professional about it. There are lots of other reasons these things could be happening like aging, peri-menopause, even loosing weight, changes in endometriosis or cysts, stress and you know living, but it’s still worth getting checked out in the next 6 weeks. If, like me, you want to gather some more of your own data chart your body temperature each day when you wake up. At some point (usually 10 -14 days before your period) you’ll see it go up about a degree for about a day and that’s because you’re ovulating. If you don’t see a spike at all or every month that’s a pretty clear sign. If you pay for your health care it’s the cheapest way to determine if you need more testing but doctors can and do have more direct ways of figuring out if you’re ovulating.
Possible treatment options
This is going to vary from case to case and woman to woman. Do you want more kids, how old are you, what’s your current bone density, you’re weight and the training that’s getting you there. Is it a one time iron man or are you a regular long term marathoner. Do you plan to keep competing in fitness competitions or is this a bucket list thing? And finally are there other factors muddying the water for you, so there really is no one treatment that fits all. Two great options are eating more and or exercising less, usually in 10% increments until your cycle returns to normal. Another option is to take a non-low dose oral contraceptive which will provide your body with the hormones it needs to promote bone health. This can be the best option for some women but it is like putting a band-aid on the problem. The thing is the Bandaid can and will work. It’s important you see your doctor because based on the results of especially your bone density tests they might also recommend medication to restore it faster. Personally I think this is one of the reasons athletes need to spend time not in training every year!
For a lot of women the idea of being infertile in the future is legit terrifying. For me I wish there was a light switch which I would flip to off and then break it. I’m pretty confident I don’t ever want to go down that road, thank you very much. If I changed my mind in the future well then I can call an electrician to fix that light switch but I’m pretty sure it’ll stay broken. So if someone told me there was a pretty good chance something I liked a lot, or even a medium amount, was making me infertile over time I’ld be like ‘meh’. But some of the older ladies in my family have had to take medication for bone loss in their older years, I hear it’s painful and if I start getting stress fractures I can’t run so I care a lot about that. I’ve had mostly a healthy weight and some real low but short dips into super skinny territory but never lost my period entirely. Like my doctor thought it was really, really weird that I still had it low. I’ve also spent a lot of time on non-low dose contraceptives because of the switch thing not the bone thing btw. But I’ve also had two periods of time with likely anovulatory periods once when I was really skinny and once this past year in 5 months of endurance training. For me I get these weird blips of really short, really light easy cycles in a sea of normal ones with no cramps. They can be as short of 14-18 days in a sea of 25 -27’s. Both times my doctor has been involved and we decided the right thing to do was to deal with the underlying problem only. The first time, gain weight and make a strategy for that to happen fast and this time based on recent awesome bone density numbers to just let it ride. I had a few suspected anovulatory periods in the past year and so the first one didn’t send me running to the doctor but the second one in three months did. Since I was less than 6 weeks away from finishing 5 months of back to back half-marathon and olympic triathlon training and my weight was healthy we decided to just keep an eye on it and put a treatment plan in place should it happen again. In fact if I decide to do this level of crazy training again in the future I’ll head in and talk to him about doing it preventatively the next time. But my treatment plan depends on my my exact circumstances it probably would be different if fertility was a top concern of mine.
Like I said this is different for everyone and very important! If I’m talking on here about endurance training, the odd diet post and if I’m talking about all that positive stuff I feel a responsibility to talk about the downsides an potential dangers. So time to get personal has you’re diet or exercise routine every messed with your cycle. Or did something else do it?