Athletic Amenorrhea

What is amenorrhea?

Amenorrhea is not having a menstrual period.

There are two main kinds of amenorrhea, primary and secondary. Primary amenorrhea is not having menstrual periods by the age of 16. Secondary amenorrhea is the absence of 3 or more periods in a woman who has had regular menstrual periods.

What is athletic amenorrhea?

Athletic amenorrhea is when a woman does not have periods because she exercises very intensely and is very lean. Some women with athletic amenorrhea stop having periods. Others never get their first period until years after the age at which most girls start menstruating. Some of these women may never get a period until they are in their 20s.

How does it occur?

Intense exercise and extreme thinness may reduce the levels of hormones that regulate a woman's periods. These hormones, estrogen and progesterone, are important for overall body health. Estrogen is especially vital for healthy bones.

Athletic amenorrhea is often seen in sports that stress thinness, such as gymnastics, figure skating, and long-distance running. When thinness is heavily emphasized, some young women may develop eating disorders such as anorexia or bulimia. 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.

For more information on anorexia nervosa, see .

For more information on bulimia nervosa, see .

What are the symptoms?

You do not have periods for 3 months or more.

Your bones may break more easily. A lack of estrogen leads to a lack of calcium in your bones. This makes the bones brittle and weak, a condition called osteoporosis. Intense exercise puts extra stress on weak bones, leaving athletes who have osteoporosis at risk for stress fractures. Young women who have osteoporosis may never get enough calcium in their bones as they grow and mature. As they get older, their bones may break easily.

When a woman has a combination of athletic amenorrhea, an eating disorder, and osteoporosis, it is called the female athlete triad.

How is it diagnosed?

Your health care provider will do various 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.) He or she will talk to you about your exercise patterns and eating habits.

Your health care provider may order a DEXA scan, a special type of x-ray that measures the density of your bones to see if you are developing osteoporosis.

How is it treated?

Athletic amenorrhea needs to be treated in several ways because it often is a problem involving:

• too much exercise
• poor diet
• hormone imbalance.

To treat it:

• You may need to exercise less.
• Eat enough food to take in enough calories for your workouts.
• Make sure you have enough calcium in your diet.
• You may need to take birth control pills or other forms of estrogen and progesterone to restore hormone balance. You will then have periods again.

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

How is it prevented?

A well-balanced diet with enough calories helps prevent athletic amenorrhea. It is important to recognize when you are exercising too much and eating too little. Eating disorders are serious problems and should be discussed openly with your health care provider.