Menstruation: Missed Periods in Athletes

What is a missed menstrual period?

Missing a menstrual period is also called amenorrhea

There are 2 main kinds of amenorrhea:

• Primary amenorrhea. This means that you do not have a menstrual period by the age of 16.
• Secondary amenorrhea. This means that a woman who has had regular menstrual periods misses 3 or more periods in a row.

Athletic amenorrhea is when a woman does not have periods because she exercises very intensely and is very lean. Some women stop having periods. Others do not get their first period until years after the age at which most girls start menstruating. Some women may not get a period until they are in their 20s.

How does it occur?

Hormones, such as estrogen and progesterone, are important for overall body health. They also regulate a woman’s periods. Intense exercise and extreme thinness can reduce the levels of these hormones. Estrogen is needed for healthy bones.

Athletic amenorrhea is often seen in sports that stress thinness. These sports include gymnastics, figure skating, and long-distance running.

What are the symptoms?

You do not have periods for 3 months or more.

Your bones may break more easily. A lack of estrogen leads to a lack of calcium in your bones. This makes the bones brittle and weak, a condition called osteoporosis. Intense exercise puts extra stress on weak bones, leaving athletes who have osteoporosis at risk for stress fractures. Young women who have osteoporosis may never get enough calcium in their bones as they grow and mature. As they get older, their bones may break easily.

How is it diagnosed?

Your healthcare provider will do tests, including a pregnancy test, to find out why your periods have stopped or why they never started. (Pregnancy is the most common reason women miss periods.) He or she will talk to you about your exercise patterns and eating habits.

You may have a DEXA scan, a special type of X-ray that measures the density of your bones to check for osteoporosis.

How is it treated?

Athletic amenorrhea needs to be treated in several ways because it often involves:

• too much exercise
• poor diet
• hormone imbalance

To treat it:

• You may need to exercise less.
• You need to eat enough food to take in enough calories for your workouts.
• Make sure you have enough calcium in your diet.
• You may need to take birth control pills or other forms of estrogen and progesterone to restore hormone balance. You will then have periods again.

If you are sexually active you can become pregnant, even if you have amenorrhea. Take precautions if you do not want to become pregnant.

How is it prevented?

A well-balanced diet with enough calories helps prevent athletic amenorrhea. Be aware of exercising too much and eating too little. Eating disorders are serious problems. Talk with your healthcare provider if you think you have an eating disorder.