Amenorrhea: Athletes with No Period

The Role of Nutrition for Amenorrhea and Fertility

Are you a female athlete with no period?

Have you been told that it is normal to not have your period while training?

Ready to have a baby but your period is still missing and you don’t understand why?

You may be loving aspects of not having your cycle because it means no cramps and less mess. Please hold off on those party balloons, as not having your cycle has some serious health repercussions, one important one being fertility.

What is amenorrhea?

The lack of period is known as amenorrhea and may likely be hypothalamic amenorrhea (HA) but very few women get a HA diagnosis. Amenorrhea refers simply to a missing period and there can be many causes of this including PCOS (polycystic ovary syndrome) and endometriosis.

HA is when the hypothalamus is involved, and signalling gets messed up due to hormone imbalances and chemical mess-ups. I have spoken to multiple different clients, colleagues and friends who have experienced HA at some point in their life. The cause of it may be a combination of undereating, energy imbalance, over exercising, stress and genetics. The exact combination and degree of cause will look different for anyone who experiences HA.

Let’s take a quick jump over to athletes…

Causes of amenorrhea in athletes

Athletes experiencing a lack of period is not normal (unfortunately I have heard too many athletes say their physician told them this is normal)!

The combination of training and low energy availability can lead to a loss of menstrual cycle which is brushed off as a normal part of being an athlete all too often.

Low energy availability does not mean you are underweight or have an eating disorder. It means that you do not have the energy coming in that sustains your menstrual cycle on top of your high volume of training.

Many health professionals often miss this concern since you may be a healthy body weight (according to the BMI categories) and are very active (what we see as a ‘healthy’ lifestyle) yet your cycle has disappeared. When you lose your menstrual cycle this is a clear sign that something is off with your health.

The challenges of not having a period

Your menstrual cycle is a vital sign, it tells us more about what is going on with your body than just your reproductive function. Putting fertility aside for one second (as this is definitely one of the negative health effects of no period), the absence of a period means estrogen, progesterone and testosterone levels drop. This will affect athletic performance.

The other short-term effects include thinning or loss of hair, brittle nails, low libido and skin problems. Long term, it leads to weak and brittle bones, cardiac disease, increased risk of early dementia and earlier cognitive (estrogen is highly protective of brain cells).

Before you panic, regaining of your cycle can reverse negative changes or prevent further damage.

Your menstrual cycle is a vital sign of health!

What should I do if I have missing menstrual cycles?

Regaining your period is very possible but it will take some work and commitment. With every individual having a different combination of factors at varying degrees to why they lost their period, the treatment to regaining of your period will all look slightly different.

For some, the addition of a few more snacks for a few months is the key, others, it means slowing exercise down for a bit and keeping intake the same; but for some, it takes a bit more tinkering with the factors before a result is seen.

Nicola Rinaldi, PhD and author of “No Period, Now What?” states that a full recovery plan will include eating more for a while, cutting out high-intensity exercise, working on negative thoughts and mental health and allowing the body time to re-equilibrate. This will not happen over night. Support is also critical!

Getting support from loved ones, teammates and coaches is greatly important, but you may also need support from a health care team that can include a Registered Dietitian, Therapist and Doctor.

In a survey done by the writers of No Period, Now What, out of over 300 women, 53% were able to regain their natural cycles back, 90% were able to do this within 1 year of starting a recovery plan. 

I want to leave you with feelings of hope. Your period is a sign of health, no matter what anyone tells you. Even with a loss of period from amenorrhea, recovery is possible!

Nutrition for amenorrhea: where to start

Here are 3 important tips for you to keep in mind if you have lost your menstrual cycle when it comes to your eating and activity patterns:

1. Start slow. Whether you have been struggling with restricting or too much exercise or simply just not enough calories, it can be a difficult transition to increasing intake. Emotions like guilt, shame and frustration can quickly slip in. Start yourself with small increases and gradually build up. This can be adding in an afternoon snack or including grains with every meal.
   
2. Progress not perfection! Recovery from HA is not going to happen overnight. Be kind to yourself in the process. I wish I could offer you a solution that was easy, but with diet culture and the never-ending messages we hear and see, it is difficult to now go against all those messages and increase intake and/or reduce exercise. Focus on the progress, not the so-called mistakes.
   
3. Stop ‘healthifing’ every recipe. Generally, when a recipe is made to be ‘healthier’ it does not mean it is actually healthier for everyone. Often calories and fat are reduced in these recipes. When it comes to recovery, increasing energy intake is the focus so use the full fat yogurt, butter and cheese. Enjoy what you are eating and eat until you are satisfied.

More support for amenorrhea and everyday healthy eating

Looking for more support for athlete nutrition or ensuring you have sufficient nutrition to support a healthy menstrual cycle and fertility?

Contact us for more information and to book one on one nutrition counseling with a Calgary Dietitian / Virtual Nutritionist on our team. We specialize in nutrition support for sports nutrition, meal planning , women’s health, eating disorders and fertility.