Loss of periods from intense workouts?

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,

It’s great that you’re paying attention to the changes happening with your body. While some might consider it a convenience to lose their period, it can be a signal from your body that something is out of balance. The absence, or irregularity, of menstrual periods for three or more consecutive months is known as amenorrhea. To your question, your increased physical activity regimen could certainly have something to do with your lack of menstruation. Learning more about the loss of periods, related health issues, and its potential relationship with physical activity may help you understand a bit more about your experience and what can be done about it.

There are two types of amenorrhea: primary and secondary. Primary amenorrhea occurs when menses doesn’t begin by age 15, or in the presence of puberty and typical bodily growth. Secondary amenorrhea is when a person has their first period, but it stops later on for a particular reason. Since you mention that you’re highly active though, it may be worth discussing one type of secondary amenorrhea further. Athletic amenorrhea is most common amongst athletes participating in sports that have a weight class, such as wrestling, or value endurance or being lean, such as ballet, figure skating, gymnastics, lightweight crew, and running. The prevalence of athletic amenorrhea amongst folks who participate in these types of sports can be as much as 69 percent compared to two to five percent in the general population. Further compounding the issue, up to 70 percent of athletes don’t consume sufficient calories and nutrients to keep up with their strenuous exercise schedule. This is significant to point out, as inadequate energy intake is known to contribute to loss of periods.

Beyond not menstruating, this and other types of amenorrhea can impact health in other ways. It can result in lower estrogen levels and infertility (due to the lack of ovarian development). It can also be a factor in unexpected pregnancy, particularly as the menstrual cycle returns (which may trigger premature ovulation — that without contraception, may result in pregnancy). Relatedly, individuals assigned female at birth with high levels of physical activity can suffer from Female Athlete Triad syndrome. This condition not only results in menstrual irregularity or loss, but energy deficiency and potential bone loss and osteoporosis as well. What’s more, those with this syndrome may also be at risk for eating disorders (due to pressures to keep their body lean).

Taking a critical look at your physical activity routine may also help to avoid potentially undesirable issues associated with over-training. Are you training for a specific event or competition? If so, adequate nutrition is vital, especially if you’re engaging in "double sessions" or twice-a-day workouts. In this case, pay particular attention to the timing and nutritional content of your meals and snacks; doing so will help to optimize performance and fuel the muscles properly. Moreover, twice-a-day workouts aren’t recommended except for a short, specific amount of time as part of a pre-determined plan. If you aren’t training for a specific event, high levels of physical activity may not offer improved health benefits and could take a toll on the body. 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 also can, and often does, lead to injury — pulled muscles, joint inflammation, and stress fractures, just to name a few.

If you’d like to investigate your situation further with a health care provider, they’ll typically evaluate the case and rule out other potential causes of irregular or missing periods first. Only after eliminating these causes can high levels of physical activity or training be considered a possible culprit. In that case, restoring the menstrual cycle and hormone levels may be accomplished by reducing athletic training, improving dietary intake with the help of a registered dietitian, possibly gaining weight, or by taking hormone replacement therapy.

All in all, it’s good that you’ve got your ear out for any messages your body may be sending you. Any time you miss a period unexpectedly, it's best to get some medical advice to determine the root cause. These signs may signal that attention is necessary to stave off any major health issues.

Here’s to being the champion of your health!

Last updated Nov 04, 2016
Originally published Aug 27, 1999

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