UPDATE: Since writing this article, I have taken EVERYTHING I learned in my journey to get my period back, and wrote a book on the topic, so you have everything I know about amenorrhea in one place. This book is written for runners who have lost their period, but regardless of what sport you do, if you don’t get your period, Overcoming Amenorrhea: Get Your Period Back. Get Your Life Back will help.
Five weeks of no running.
Not a step.
Last week, while at my strength training (the only exercise I am doing), Drew asked me to jog a few laps of the turf to warm up.
I am not running until I am ready.
I know that sounds ridiculous, what does a few steps of slow jogging mean?
But to me, it is more about the principle. I don’t mind skipping to warm up, but I don’t want to run until I am choosing to commit to a run, until my heart is there.
Until I get my period back.
If you are interested, here is a video I recorded last week on my progress so far, but I thought I would go into a little more detail into athletic amenorrhea and why running causes missed or irregular periods.
Well, actually, saying running causes irregular periods is not quite right, but we can say it definitely plays a part.
I realized I hadn’t actually explained this in my post a few weeks ago where I talked about stopping running to focus on recovering from this running amenorrhea (or hypothalamic amenorrhea to use the medical term, I will use HA from now on). I dropped two giant bombshells on you, and then just kinda left it.
But quite a few people have told me they do not understand.
How can some people lose their period at a seemingly normal weight, and others are able to hold theirs steady no matter how many miles they run or how much they weigh?
I thought it was time I explained a little more about this.
What are the causes of amenorrhea?
I mentioned in my post that the reason I did not say anything was because I was ashamed. Looking back now, I am angry at myself for that, for not being brave enough to share, but allowing the fear of being judged to bring that shame.
There is nothing to be ashamed of, and I am on a mission to prove it.
That being said, it is NOT healthy to be without a menstrual cycle, and as much as doctors try to brush it off, I am determined to make a difference in this world about the awareness of this issue with female athletes and periods.
There is a stigma associated with amenorrhea saying that no period=not eating enough, and for years, I allowed people to tell me that this MUST be the reason I didn’t have a cycle. I knew it wasn’t the case, nutritionists had told me so, but I didn’t want to ruin friendships just for the sake of being “right”.
I told you I have been reading No Period? Now What, which has been a lifesaver in this journey, and I have had the fortune of getting to know Dr. Rinaldi (the author and researcher) and Stephanie Buckler, coauthor, who have been very helpful along this process.
This book explains all the factors that can cause lack of menstruation.
I actually had Nic and Stephanie read this blog post to make sure I didn’t get it all wrong, so I have a few things from them for you to read along the way, kind of in the same way they have it in the book. You will see those in italic.
What are those factors you ask?
Well, before I get to those, let me just say that it all comes down to how incredibly smart and intuitive our bodies are. I am always telling you that our bodies know best, especially when it comes to running, if we listen to what they are telling us, that is when we perform at our best at everything we do.
Well, when your body realizes it is in danger for some reason, and having a baby would not be a good idea, it will shut down your reproductive system to save the energy for your other systems.
We all know about the first two factors, in fact, many people still assume these are the only causes of amenorrhea (they are not!!), but they definitely play a big part, and if you are extreme in either of these two, it is almost guaranteed you will put your body at risk.
Many medical doctors see very few cases of HA and don’t really understand either the causes (the five factors Tina lays out below) or the repercussions. Birth control pills are often prescribed as a Band-Aid, but their ‘protection of bones’ is debatable, and they’re certainly not going to help with getting pregnant. The best long-term solution is to recover your own natural menstrual cycles! -Nicola Rinaldi
This is the most obvious one. If you are not eating enough to fuel your body, how can you possibly fuel another person inside you and have enough milk to support the baby once it is out. This is the factor (along with number two) that is best known.
This is also the one I had checked by various nutritionists and consultants who confirmed that not only was I eating enough, but I was eating enough of all foods for this not to be an issue.
A few weeks ago, you hopefully heard my podcast episode with sports nutritionist Matt Fitzgerald who has done a lot of research on what the best diet is for runners (and for people in general), and he talked about eating everything, yes, including fried food, sweets, and things people consider “bad”. If you are restricting a food group in any way, you might think its “healthy”, and it is, but that gets us in trouble.
Ask yourself, do you see any foods as “no go” bad foods? Are you eating enough calories to make up for the energy you are expending?
Weight and weight loss
This one is also a common assumption. If you are not getting your period, your weight is not high enough. If you lose weight quickly, this may be the reason for the irregular and cessation of your menstruation. This again makes sense, if your body senses that you do not have enough body fat, you are not going to be able to support a baby.
I also had this checked. Although I did not know my body fat percentage. Various doctors over the years (including my endocrinologist) told me that my weight was not the cause of my amenorrhea. I had been various weights during my time with no period, and that did not seem to make a difference.
I also did gain 5-10lbs a few times last year to put me into the 20 BMI range, hoping it would be enough, but it wasn’t.
I don’t need to beat these two into the ground as they are pretty obvious and have been talked about more than anything.
Ask yourself, is your body fat percentage high enough? Would it do any harm to gain a little weight to see what happens?
Ask yourself, have you lost weight recently? If you lost more than 10lbs within the space of a year (no matter what weight you were originally), that could be a trigger.
The final common one, but many do not realize that you do not have to be an elite runner, a high mileage runner, or even a runner at all. It can be any type of exercise and even just a combination of workouts.
I’m not a runner, but for me it was a combination of restricting my intake and playing ice hockey, volleyball, squash, lifting weights, biking, and golf – all of which probably adds up to the same stress on a body – that led to my missing period. I’ve spent the ten years since I recovered researching and helping others to likewise restore their cycles and fertility.- Nicola Rinaldi
As you can probably guess, this one was my kicker, the reason my body was in fear. It makes sense though, right? Running 90 miles a week, of course your body is in a state of distress, how would you possibly be able to look after a baby if you are always running from something? Our bodies don’t know the sedentary life we live the rest of the time, they just fear we are running from something.
Now, the key thing here is the intensity. Actually, from what I have read, the volume of training is really not as important as the intensity. For the last 14 years of my life, other than maybe 4-6 weeks a year, I had run 2-4 hard workouts per week, in addition to the high volume of miles.
Interestingly, when I first started having irregular periods, for the very first time, I was actually only running about 30 miles a week, but three of those days were very intense track workouts at Bedford and County Running Club in England.
When I lost them again the second time (and pretty much for good), it was not losing weight, it was not eating any less, it was when I started to train with more intensity. I believe especially as I am able to put myself into a hole so much, push my body so much harder than it should be capable of in races (and previously in workouts too), it was just too intense for my body.
Hence the no running. In No Period. Now What? They talk about how running is a high intensity exercise, all of it. It doesn’t matter if you are running easy or hard, it is still very hard on your body. That is why there is such a big correlation between running and irregular periods.
Ask yourself, what is more important to you? Getting that adrenaline rush or having a regular menstrual cycle.
Don’t worry if it is exercise, for me, it was for the last nine years!
Cutting down or out the exercise that you love can be one of the absolute hardest things you will go through, especially because there will be a lot of people who just don’t understand. But the results on the other side – restored fertility and more balance in your life – are so very, very worth the struggle.- Nicola Rinaldi
This one is talked about less, but it plays a huge role.
Have you ever heard anyone talking about how people get pregnant after they adopt or when they have given up completely?
Maybe the removed stress is part of the reason this is often the case.
It is the same with our cycles. It can be physical, mental, emotional, or spiritual stress. Our bodies don’t really know the difference, all they know is that they are working too hard to be able to sustain a baby at this time.
I am a high-strung, Type A, competitive, worrier, which makes me the prime candidate for high stress levels, and it is not really surprising that my cycles were gone for that reason, at least partially.
In the email responses I got from people who were going through the same thing, many were not even runners, but stressful events like a divorce, a bad boyfriend, moving, were enough to cause irregular or missed periods, so if those events can do it, surely other things can too.
Ask yourself, is there a lot of pressure and stress in your life?
Unfortunately there is not much that any of us can do with this one, but it definitely plays a part. My mum also had low estrogen levels and missed periods, which meant I was probably more likely to have issues as well. Even as a teenager, my periods were never heavy, so that should have given an indication that they could be lost easily.
Ask your family members, did any of them have issues?
How running affects your period
By explaining those factors above, you can probably put it together how running affects your period.
It all comes down to babies.
Although we see periods as just a natural thing, a part of life, at the end of the day, those monthly cycles have a reason; for reproduction.
When you do not have a period, your body thinks it is in danger, you are in some sort of stressful situation that would not be a good environment for a baby.
Makes sense, right?
But also even more frustrating, after all, running is meant to be good for us. All those studies showing how much healthier runners are than the rest of the population.
And then there are all the media messages bombarding us telling us how we are getting fatter and we NEEEEDDD to exercise.
How are you meant to fight against that by stopping running, gaining weight, and doing nothing?
It’s not as easy as it sounds, I can tell you that from experience, I am in it right now!
Is amenorrhea serious? Can amenorrhea lead to infertility?
This was always one of my fears, and it was the reason that little voice in the back of my mind felt unease whenever any doctor would say it was fine.
Of course it’s not fine, if my body is that stressed that it doesn’t think I would do a good job with a baby, surely everything is not okay?
And it’s not, but we convince ourselves it is okay as we are not doing any real damage….or so we hope!
The longer you let it go on, the longer you are putting your bone health at risk, and there have been some studies that have shown our cardiac health might be at risk without those female hormones; I guess I will find out if there were any long-term effects sometime in the future, but overall, if you are eating well, avoiding illness and lots of injuries, then you are probably okay…
BUT, and this is a big but…
The longer you leave it, the longer you wait, the more damage you are doing to your bone health.
Some good news though?
I always thought the longer I went, the longer it would take to come back, but actually Nic found that was not the case, phew!
I don’t want to go into the details as to why we do not get a period because of running or stress, you will have to wait for my podcast with Dr. Nicola Rinaldi to come out in a few weeks to hear that.
My endocrinologist (the primary doctor I am working with for now), and all the other specialists I have worked with have said they have no concerns for my fertility at this point, but if we get 2-3 months down the road and I have not seen any improvements, then I will move forward with some other tests.
How can you get your period back if you have hypothalamic amenorrhea?
Well, once again, the book gives an amazing insight into this, and gives so many helpful quotes from other women who have been through this, so I would really suggest picking up this book ASAP, but for a summary of what I am up to:
First, address your nutrition.
As I mentioned, I did this over a year ago, by seeing nutritionists and consultants, so your number one priority is going to be to go work with someone, make sure you are not restricting your calories or not taking in enough.
Second, your weight.
I have not run in five weeks, and I am still eating a lot. As you can imagine, I have gained quite a bit of weight. Check out my Instagram post I did this weekend if you want to see what I said about it, but when you compare my body now to a year ago, I have definitely added quite a bit.
I threw away my scale (and I think you should too), so I don’t know my exact weight, but I would guess it is probably 10-15 pounds heavier than when I ran London a year ago.
I intend to gain more weight if needed. In No Period. Now What? they talked about most women with HA needing to get up to a BMI of 22-23 as the bottom end of the “fertile zone. As I mentioned, I am not a fan of weight, but this puts it into context, as most of us have a rough idea of what our BMI is. Last I checked about 6 months ago, I was around 19 BMI, which would mean I would need to get to around 130lbs to be within that range.
Lots of “fertility foods”, which mean lots of ice cream, “junk” food, and….well, whatever the heck I want!
Coincidentally, I have been told by a few people that you should try to make your life resemble what it was like when you last had a regular cycle, which for me, would mean back to my time in California, where my weight probably was around that, and my training was very…lets just say….relaxed 😉
Third, your exercise.
This one you know all about. I have cut all exercise other than strength training with Drew twice a week. I wanted to keep this just as it is something I am enjoying, and as I mentioned in my video, I am following my joy right now.
But I have not run, not jogged, not even done a walk faster than a stroll.
It may seem extreme, but to get it back, you often have to go further than you think you should, to reassure your body it is not in danger, so that is what I am doing. If you want more information on this part, there is a blog post on the No Period. Now What? website about it.
Besides, this way, I can find out if running really was the cause!
Fourth, your stress.
Now, in a lot of ways, this is actually the toughest one to do.
How can we remove stress? Especially if we are Type A planners? Its pretty hard to just say “I am gonna just chill, and be fine with a 6 hour Netflix marathon while I relax on the couch”, but it is part of the recovery process, and it will only help.
I have learned to embrace this part.
Although my life is changing fast, I feel quite at peace right now, and that I know things will unfold the way they were supposed to. I believe that my journey will reveal itself, and I just have to trust.
Of course I am still a worrier, and as much as people can say to not think so much, it’s not as easy as that, but I am working on it as much as I can.
In the book they call this approach I am taking going “all in”, and although it is scary, although it brings a lot of highs and lows with my mood as I get used to this new lifestyle, it is enjoyable, and it is good to know I am facing those mental demons that tell me I am going to end up obese or people will think I have “let myself go”.
Most people have to face these fears as they are coming back after pregnancy (while dealing with the stress and sleep deprivation it brings!), but in a lot of ways, I am happy that I am going through it now, learning to love my body and who I am.
It’s not easy, but I know already it is going to be worth it.
I could literally write a post double the size of this one to talk about it in more detail or to talk about the fact that although men do not have menstrual cycles, they can still get a lot of bad side effects from those same behaviors.
But I don’t want to make this a MONSTER MONSTER post, so I would encourage you to read up on RED-s if you want to learn more, and buy this book! You can read the first chapter here.
My podcast episode with Nicola and Heidi Greenwood is here, but until then, I thought this would be a great way to explain some of the background of it.
I haven’t been sponsored or paid in any way to write this article, I just thought it would be helpful for anyone going through this to read, or anyone who hasn’t been through it, to learn about. Maybe someone close to you is going through it, and feeling very alone. Hopefully this can help them.
Think we could be friends?
I am always this honest, real, raw. If this article speaks to you, I really believe we could be friends and I could help you as you get your health back. Drop your email below, and I will reach out to you
Since writing this article, I have taken EVERYTHING I learned in my journey to get my period back, and wrote a book on the topic, so you have everything I know about amenorrhea in one place. This book is written for runners who have lost their period, but regardless of what sport you do, if you don’t get your period, Overcoming Amenorrhea: Get Your Period Back. Get Your Life Back will help.[bctt tweet=”Amenorrhea is far more common than we realize. @tinamuir explains why we get irregular periods. #running4real” via=”no”]
How much did you know of hypothalamic amenorrhea?