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Menstruation: Missed Periods in Athletes (Athletic Amenorrhea)

What is athletic amenorrhea?

Athletic amenorrhea is the term used for when you don’t have menstrual periods because you have been exercising very intensely and are very lean. Some women athletes stop having periods. Others don’t get their first period until years after the age at which most girls start menstruating. Some may not have a period until they are in their 20s.

What is the cause?

The female hormones estrogen and progesterone are important for overall body health. These hormones also regulate a woman’s periods. Intense exercise and extreme thinness can reduce the levels of these hormones enough to prevent or stop monthly menstrual cycles.

Athletic amenorrhea is often seen in sports that stress or result in thinness. These sports include gymnastics, ballet, and long-distance running. With the pressure to be thin, some young women may develop eating disorders. A person with anorexia diets to excess, sometimes to the point of starving. People with bulimia binge (eat a lot at one time) and then purge, either by vomiting, using laxatives, or exercising too much.

Estrogen is needed for healthy bones. A lack of estrogen leads to a lack of calcium in your bones. This makes the bones brittle and weak, a condition called osteoporosis. If you have athletic amenorrhea, osteoporosis, and eat fewer calories than you burn (or have an eating disorder), you have a condition called the female athlete triad.

What are the symptoms?

You do not have periods for 3 months or more.

Your bones may break more easily. Intense exercise puts extra stress on weak bones, leaving athletes who have osteoporosis at risk for fractures.

How is it diagnosed?

Your healthcare provider will do tests, including a pregnancy test, to find out why your periods have stopped or why they never started. (Pregnancy is the most common reason women miss periods.) Your provider will talk to you about your exercise patterns and eating habits.

You may have a DEXA scan, a special type of X-ray that measures the density of your bones to check for osteoporosis.

How is it treated?

Athletic amenorrhea needs to be treated in several ways because it often involves:

  • Too much exercise
  • Poor diet
  • Hormone imbalance

To treat it:

  • You may need to exercise less. If you are a high-level athlete and keep exercising intensively, you may need to take estrogen.
  • You need to eat enough food to take in enough calories for your workouts.
  • You need to make sure you have enough calcium in your diet.
  • You may need to take birth control pills or another form of estrogen and progesterone to restore your hormone balance and start having periods.

If you are sexually active you can get pregnant even if you have amenorrhea. Take precautions if you do not want to get pregnant.

How can I help prevent athletic amenorrhea?

A well-balanced diet with enough calories helps prevent athletic amenorrhea. Try not to exercise too much and eat too little.

If you think you have an eating disorder, talk with your healthcare provider.

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