While some may view amenorrhoea (the absence of a menstrual period) as a desirable side-effect of training, as there’s no longer the inconvenience and discomfort of monthly bleeding, it is in fact a serious health condition that can result in irreversible bone loss, a higher risk of stress fractures and long-term problems with osteoporosis starting from an early age. Amenorrhoea can also markedly reduce the chances of conception when choosing to start a family.
How common is it?
The number of female athletes with amenorrhoea varies considerably with sport, age, training volume and bodyweight. Amenorrhoea is certainly more common in 'thin-build' sports, in particular ballet (between 24% and 79% of participants) and long distance running (24-65%). Studies have also found that approximately 12% of swimmers and 12% of cyclists are affected.
What causes it?
There’s no single cause of amenorrhoea but an athlete or fitness enthusiast is more likely to develop the condition if they:
• Have lost weight quickly.
• Have a low bodyweight.
• Have a low percentage of body fat.
• Exercise very hard.
• Had irregular periods before they started training.
• Follow a restrictive diet.
• Feel emotionally stressed.
How can it be treated?
Since the underlying problem with exercise-related amenorrhoea is a mismatch between energy intake and expenditure, coupled with a high level of physical stress caused by a high training volume, the key to treating the condition is to increase food intake and reduce training volume (by 10-15%). Training programmes should include short periods of lower-intensity training and more rest.
Studies show that when amenorrhoeic athletes improve their diet and restructure their training programme to improve energy balance, normal menstruation resumes within about three months and performance improves consistently.
The following tips may help to resume normal menstrual cycles:
- If you have suffered amenorrhoea for longer than six months, seek advice from a GP to rule out medical causes of amenorrhoea.
- Be realistic about goal weight – you may be striving against your genetic body type.
- If you have weight to lose, don’t crash diet, but rather cut back on calories by about 15%. Seek advice from a nutritionist or dietitian if you’re struggling to balance food intake and exercise.
- Aim to lose weight/body fat gradually, to minimise the loss of lean mass.
- Eat at least 20% of calories from fat. It won’t make you fat; some fat is crucial for health and sports performance. Eat mainly unsaturated fats found in oily fish, nuts, avocado, and olive and other plant oils.
- Ensure you consume adequate calcium to maintain bone density. Include three or four servings of dairy products or other calcium-rich foods daily.
- Reduce the training frequency, volume and intensity, or change the current programme to include more cross-training.
- If you have some degree of disordered eating, seek advice to help you overcome this problem.
For more information on the effects of training on the menstrual cycle, click here.
The views and opinions expressed in this article are those of the author and not of Fitness Professionals Ltd or Virtual Magazine. Consult a qualified health or fitness professional before making changes to your diet or exercise.