How a period is lost: Amenorrhea and its (various) causes
Tina Muir was featured as the first athlete in our Lane 9 Project “9 Miles With” series. She is an elite runner based out of Kentucky, has represented Great Britain in the World Championships, and is open about running and training on Instagram and her website. She keeps it real, to say the least. It’s fitting that her new website and podcast are titled “Running for Real.”
One day later, she announced she was taking a step back from elite running, indefinitely.
In her public update, she shared with the world that part of her decision to stop running is to figure out why she’s not getting a regular period — or, in her words, has not had one in nine years.
She’s not alone.
A piece in Women’s Running addressed Tina’s announcement and the way it may resonate with so many active women. These things are kept secret for two main reasons: the shame women feel in talking about our periods, and the stigma surrounding eating disorders. Both “taboo subjects,” indeed. The author, Caitlyn Pilkington, shares her own experiences with running high school track, missing periods, and thinking, “It’s just what happens when you run a lot.”
Edited to add (2019): Mary Cain’s experience with the Nike Oregon Project, as featured in the Opinion section of the New York Times, brought the issues of weight expectations, disordered eating, mental health, and menstrual health, to a much larger audience. It sparked a #FixGirlsSports movement, led in part by Lauren Fleshman, who shared her experience with Relative Energy Deficiency Syndrome (RED-S) as well. This issue is pervasive, and often misdiagnosed, misunderstood, or flat out ignored. It’s not okay.
Listen to the Season 2 opener for the Lane 9 Project podcast, in which we discuss this story and its implications.
We (Lane 9 Project) hope that changes by an increase in awareness on all levels, in all circles — athletes, community, coaches, and the general public. You don’t have to be a distance runner, or a runner at all, to experience hypothalamic amenorrhea.
If you are currently experiencing hypothalamic amenorrhea, please reach out for support. Talk to a therapist, knowledgable physician (or OBGYN), and dietitian.
Amenorrhea:
an abnormal absence of menstruation, three or more missed menstrual periods or girls who have not menstruated by the age of 15. (To be clear, one type of amenorrhea can be caused by pregnancy, lactation, or menopause.) It is, by definition, not normal. It doesn’t happen just because you’re “active.” Physicians should know this, but many don’t. Or, at the very least, they don’t inquire further.
Amenorrhea is, by definition, not normal. It doesn’t happen just because you’re “active.”
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Energy availability isn’t the sole cause of amenorrhea.
Tallying up calories in and out won’t explain everything. Tracking fat, carbohydrates, and protein intake won’t always solve the problem. Correcting energy availability—i.e. what’s left from food and other caloric intake after exercise, activities of daily living, and our resting metabolic rate — will not always conjure up a menstrual cycle.
Energy availability and body fat percentage are parts of the HA diagnostic treatment equations. It’s important to address that; it’s OK to talk about it. But there’s more to consider: weight suppression, mental health, the body’s sensitivity to weight changes (individual), stress hormones, etc.
The NIH outlines the additional possible causes of amenorrhea, including some types of birth control methods, thyroid problems, or a pituitary tumor. Anti-depressants, blood pressure medications, and gynecological conditions may also affect the menstrual cycle.
Hypothalamic amenorrhea may be the most common type of amenorrhea among active women.
It is the result of any of the following: low body weight, low percentage of body fat, very low caloric intake, emotional stress, strenuous exercise, leptin deficiency (a hormone that regulates appetite), or “some medical conditions or illnesses.”
Eating disorders look different on everyone.
An eating disorder, and/or disordered eating, may present as low body weight or low body fat percentage, but not always. Emotional stress may be the side effect of an eating disorder, or a number of other things (job stress, exercise stress, family stress, personal strife, etc.). Strenuous exercise is part of the job description for elite-level athletes. Leptin deficiency isn’t easy to recognize. We can’t see it in the mirror. We can’t review a food log and conclude we are “leptin deficient” after tallying up the day’s eats.
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How do you “lose” a period?
There isn’t one answer to that question. All our stories are unique. Be cautious with assumptions about yourself or others. Part of the impetus to start the Lane 9 Project is a chorus of “Me too” that rang as Samantha, Alexis, and I told our stories. We all had amenorrhea. We all had doctors (coaches, and other health professionals) that ignored the issue. Said it wasn’t a problem. Chalked it up to “running,” and prescribed birth control pills, or nothing at all.
Health and psychological professionals need to address these issues.
First, they need to be AWARE of them. We, as women, need to be aware of them too. We need to know that being active doesn’t always result in amenorrhea. Amenorrhea doesn’t always indicate an eating disorder. But either way, it is not normal to not have a period, no matter what athletic level you’re on.
It’s okay to seek help. It’s okay to speak up. It’s important to know you’re not alone, and that it may be reversible. We’re here with you.
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If you want to share your story, get in touch with us through the form or by emailing Lane9Project@gmail.com.
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