Amenhorrhea in Runners

 I am going to try and write this post in laymen's terms, as after all I am no biologist, I am a physicist, and shall not pretend to understand all of it. Put in it's simplest form; secondary amenhorrea in female runners is the absence of your menstrual cycle due to not fuelling your body with enough calories for the stress you are putting it under. It does not necessarily mean you have an eating disorder, or a negative relationship with food, although it is often linked to disorders such as in my case. It simply means for your body to be happy enough to undergo one of its primary functions as a woman, you need to give it more fuel, because otherwise it prioritises other bodily functions which are necessary for life with the fuel it's got. 

My story:

When I was 17, I had been on birth control (the patch, I am allergic to the pill because it has dairy in it) as I had a boyfriend at the time, but when that ended I came off it. This coincided with a time that I began to lose a lot of weight quite fast as my complicated relationship with food began, and I also soon found out that my dad had lymphoma (cancer of the lymph nodes). So not the best time for Helen. This was when my period decided to go walks, and didn't end up finding me again until 4 years down the road...initially when I went to the doctor I was told it was quite a common side effect for stopping the birth control, and that they would most likely come back within around 3 months. Now, I'm sure that's true, but in my case it didn't happen. I suffered with bulimia for a short period in school, although I joke now that I wasn't even capable of that. It turns out that forcing your fingers or a toothbrush down your throat to throw up the food you just ate is actually pretty difficult, especially if you have a strong gag reflex, so this usually just resulted in me having quite a sore throat a with swelling from the forcefulness. not for me. So I turned to the gym, where I started to track calories, run on the treadmill until I had burnt 500kcals then move onto weights on the floor. This was on top of a sports club each day, or sometimes 2, while on a restricted diet.

Amenhorrheic to healthy cycle

The stress of a family situation at home, body image issues and a growing eating disorder all combined to make sure I didn't get my period back for a long time. And even when I started running and began to feel better in myself when I was 19, I was still restrictive in my eating, so although my diet may have looked normal by this point, it wasn't enough to account for all the activity I was doing, especially at the start of university where I'd often go straight from a speed session at the running club to 2 hours or gymnastics without so much as a banana for sustenance. Second year of university saw my father's condition get a lot worse at home, my boyfriend at the time dealing with suicidal thoughts and I got tendinitis in my hip for around 6 months meaning I couldn't run, which for anyone with the remains of an eating disorder is the worst thing in the world. How am I going to burn all the calories I eat?? So I'd train for 3 hours in the gym, most likely just making any injuries worse, to cope with the stress I was dealing with. So from an outside perspective, or even just myself looking back, it's pretty easy to see why my body was in no condition to even consider having kids. But what I'm worried about is the effects it has on my future.

Back to facts...

Functional hypothalamic amenhorrea is a common form of secondary amenhorrea resulting in oestrogen deficiency in young premenopausal women. It is very common amongst female athletes, as a very low body fat percentage or low BMI are big contributing factors. It is especially common in distance runners.

This disorder is related to psychological stress, excessive exercise, disordered eating or a combination of these. The significance of oestrogen in women extends way beyond fertility. It plays a role on most tissues and organs throughout the body. Loss of oestrogen effects the cardiac, skeletal, psychological and reproductive systems in the body...let's just let that sink in a minute. What we've just unearthed is that, not supplying our body with the correct amount of fuel for the level of activity that we do, whether that be 20 mile weeks or 100 mile weeks, not only effects whether our body feels capable of producing a child, but also how stressed we might feel psychologically, our bone health in older age (leading to osteoporosis), and all the factors of the cardiac system that we care most about as runners. So it is definitely not aiding you in becoming a better runner, which is what I'm going to assume you want.

There is much research yet to be done on this condition. A lot of research has been done on the effects of low oestrogen in menopausal women, but not premenopausal, so there are a lot of information gaps. However, the little research that has been done concludes that the long term health effects of secondary amenhorrea are far-reaching, including being related to cardiovascular disease, osteoporosis, fertility, and cortisol levels, and these are just in the long term. The effect on your body while still in this state of stress is even worse. I am going to insert a quote from the research paper I found on this which I feel underlines the issues that need addressing amongst young runners...

"The term “female athlete triad” is a syndrome used to describe a type of FHA with three interrelated conditions: amenorrhea, osteoporosis, and disordered eating. These components are becoming increasingly prevalent among competitive female athletes, especially among those who participate in strenuous sports where leanness is highly encouraged such a competitive runners and swimmers. After the passing of Title IX of the Educational Amendments Act in 1972, the term female athlete rose in popularity as more women took part in routine exercise. In one study comparing 669 female athletes to 607 nonathlete controls, athletes reported more stress-related fractures and menstrual irregularities compared to nonathletes (p<0.05). Despite the fact that these at-risk factors have been frequently observed in women trying to excel in their sports, the female athlete triad remains an under-recognized concept, which puts more women with these factors at greater risk of worsening their symptoms if they are not detected early. Therefore, more awareness is needed to expose the detrimental impact of excessive exercise, stress, and disordered diet on bone status."-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374026/

So although I understand that if you are as stubborn as me, you probably aren't going to listen to the people who love you, and might have already brought up this issue with you and urged you to see a doctor. You're probably ignoring the fact you don't have a period, because let's face it, who wants to bleed for a week every month out their vagina anyway, and sit hunched over in pain as you wish for death. But the thing is, it may be pretty sick not having to deal with them for a while, but you're gonna regret not eating that bowl of pasta at 50 when your bones are becoming weaker than they already are and you are at greater risk of premature death. I know that sounds dramatic but it's the reality. You have people that love you and want you around for as long as possible, and by that time you might even have little ones depending on you, so please, I BEG YOU, at least do some research on what you're going through and then figure out the best plan or action to getting your oestrogen levels back up. This could be by eating enough for your activity, or dealing with the psychological stress you are dealing with in a more constructive manner.

MUCH LOVE,

HELEN XOX