Dear Alice,

I am a thirty-two-year-old female. I am someone who normally worked out about four times per week. I have recently increased my workouts to six days a week, three of those days, I work out twice per day. This last month I missed my period (I am not pregnant). I was wondering, could this lack of menstruation be related to the more intense workouts?

Dear Reader,

Your increased exercise regimen could certainly have something to do with your lack of menstruation. The absence of menstrual periods for three or more consecutive months is known as amenorrhea. When women involved in sports lose their period, the condition may be termed "athletic amenorrhea." Although the exact mechanism is not known for sure, and may vary from person to person, amenorrhea is associated with one or more of the following:

  • Low body weight
  • Low body fat
  • Physical stress
  • Nutritional inadequacy
  • Hormonal changes
  • High intensity training
  • Long duration training

Most often, amenorrhea coincides with decreased estrogen production. Many other hormones are affected as well. Estradiol, the primary form of estrogen found in circulating blood, along with progesterone, affect bone formation and remodeling. A disruption of these hormones is likely to lead to a decrease in bone mass. In fact, low estrogen levels encourage the withdrawal of calcium from bone. Despite exercise, this puts women at risk for developing osteopenia (bone thinning) and premature osteoporosis.

Losing your period is not a convenience — rather, it signals that something is out of balance. Restoring your menstruation and hormone levels is important to your health. This may be accomplished by reducing your athletic training, improving your diet with the help of a registered dietitian, possibly gaining some weight, and/or taking hormone replacement therapy.

Reconsider your exercise regimen. Are you training for a specific event or competition? If so, nutrition is of utmost importance, especially if you are engaging in "double sessions" or twice-a-day workouts. In this case, you need to pay particular attention to the timing and nutritional content of your meals and snacks. Doing so will help to optimize your performance and fuel your muscles properly. Twice-a-day workouts should only be carried out for a short, specific amount of time as part of a pre-determined plan.

If you are not training for a specific event, the program you are engaging in may not offer improved health benefits, and could be taking a toll on your body. Over-exercising is not a "healthy" obsession as some people rationalize, but may cause harm. Studies of amenorrheic athletes have revealed decreases in bone mineral density of the lumbar vertebrae (your lower back). Whether or not this is reversible after menstruation is resumed remains controversial. Other harmful side effects of over-training include decreased immunity and loss of lean body mass (yes, actually losing muscle tissue!). Overuse and insufficient rest can and often does lead to injury — pulled muscles, joint inflammation, and stress fractures, just to name a few. In addition, over-exercisers often experience disrupted personal and work lives — with so much time spent working out, there is little time for anything else.

Our bodies give us messages that we need to pay attention to. Athletic amenorrhea is one such caution, and a particularly clear sign that changes need to be made before any major, and possibly irreversible, health problems develop. If you miss your period due to excessive exercise, or for any other reason, consult your health care provider to determine the cause — don't diagnose yourself. There may be more to it than you are aware. If you're at Columbia, you can make an appointment with Medical Services online through Open Communicator, or by calling x4-2284. You can also speak with a nutrition counselor to evaluate your diet. Time to get your period back into shape!


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