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Training-induced amenorrhea
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Does anyone have any experience with this? Specifically, my diagnosis is looking like "hypothalamic amenorrhea", which from my understanding means that I'm not producing enough progesterone and estrogen to have my period.

My BMI is 21 - right in the range of normal, and though I don't know what my body fat % is, I certainly have extra! I trained an average of 10 hours per week for the first six months of the year, though it was more in the 7-ish hours in the winter, and into the 12-14 hr range in the spring.

If there is anyone who has experienced this, were you able to get your cycles to return through a reduction in physical activity? Gaining weight? And is there any chance of being able to continue training at all?

Thanks for your help!
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Re: Training-induced amenorrhea [scrumhalfgirl] [ In reply to ]
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interesting. I was just at the docs yesterday for that fun womens check we get annually...I mentioned my training for the iron distance. He said that with a lot of training estrogen can be depleted to the point that my periods would cease. He said one way to restore hormones would be to go on the pill - which of course is just hormones anyway. This is not an issue for me (I'd be happy to have a lighter period any month) but if you are concerned then maybe the pill is an option. It doesn't seem like the amount of training you're doing would be the cause though? If it bothers you, back off the intensity of your sessions...but maybe consider getting further tests done to ascertain the cause...I believe there are a few other conditions that can cause amenorrhea.Cheers
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Re: Training-induced amenorrhea [scrumhalfgirl] [ In reply to ]
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I suffer from amenorrhea. Although, I am not sure I can call it solely "exercised-induced". Likely exercise is just one of the many of the associated causes. Testing has also indicated that I do not produce enough (or any for that matter) progesterone to cause ovulation. So no ovulation, no menstruation. I have always had very irregular periods (since I started menstruating at age 15). Since coming off the pill in the summer of last year, I have only had 2 periods and one was forced by taking progesterone.

I am similar to you in BMI and training level (maybe slightly higher as I trained for ultras in the winter and now IMs but not much more). Same with body fat -- no clue but I am sure it is not super low. The last time I had it measured by calipers I was in the high teens.

I have talked about this with both my internist as well as to 2 OB/GYNs and no one seems to be all that concerned that about the amenorrhea. They have not recommended I stop training, gain weight, or any of those things. In fact, they are ok with me doing nothing at all. If I wanted to do something some ideas they have given me are get back on oral conterception or take oral progestrone every three months so I get a period. We also discussed getting a mirena IUD since not getting pregnant is something I was concerned about. We eventually went with the mirena which will help regulate my progestrone. But the main reason was the not getting pregnant thing.

Not sure if I helped or not. Is there some reason your dr is concerned about that you don't get a period?
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Re: Training-induced amenorrhea [scrumhalfgirl] [ In reply to ]
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Often in training induced amenorrhea, the cause is not low body fat or low weight but an energy deficit, IE not eating enough so that "unnecessary" function of your body ceases.

'The Athletic Woman's Survival Guide' is a good book on the subject, and I'm going to bump a thread for you about the Female Athlete Triad - read and pay attention to the part about cessation of menstruation; I am not implying at ALL that you have an eating disorder.

The article in that link is REALLY good and should answer your questions.

running the Marine Corps Marathon to raise money for LUNGevity. Many thanks for any donations! (https://lungevity.donordrive.com/...r1SFBxtl9s3SYCVnOF0c)
disclaimer: PhD not MD
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Re: Training-induced amenorrhea [scrumhalfgirl] [ In reply to ]
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I remember when I was in high school and it was thought it was low BF caused it, but there are a lot of overweight people who do crash diets and it happens to. But now studies have shown it's what what TC said. Essentially your body isn't receiving enough calories to do what you do and nurture a fetus. So it just makes sure that doesn't happen.
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Re: Training-induced amenorrhea [scrumhalfgirl] [ In reply to ]
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I went through several months recently when I was not having a period or an extremely light period despite being on the pill. My training loads were not that high at the time and I was actually gaining weight during that time as well. My doctor thought it was probably stress as my stress levels were high at the time. My period is back to normal now and my stress levels are down so maybe there is something to it.
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Re: Training-induced amenorrhea [njtrigirl] [ In reply to ]
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Thanks for taking the time to post, everyone. TigerChik - off to read the link right now!

I should have clarified that the reason I am concerned about not getting my period is because we are trying to get pregnant. I had regular periods on the pill (which was a combination of estrogen and progesterone), but taking progesterone alone has not been able to "force" a period.

My weight has been steady for quite some time, and let's be honest - I eat a lot, so I wasn't really concerned about a negative energy balance, but from the more reading I'm doing, I guess it sounds like everyone has their own unique set point. I know lots of fellow triathletes who've been able to get pregnant while training at the moderate level I have been, but perhaps for my own body, that isn't the case.
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Re: Training-induced amenorrhea [scrumhalfgirl] [ In reply to ]
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You may want to get your thyroid checked as your ammenorhea may be due to a thyroid issue (which may complicate conceiving/pregnancy) and not be exercise induced.


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Re: Training-induced amenorrhea [scrumhalfgirl] [ In reply to ]
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ya, it's a long read :-)

You might consider seeing a registered dietician for a bit to see if you truly are eating enough and getting the right balance of nutrients - low dietary fat can also contribute.

running the Marine Corps Marathon to raise money for LUNGevity. Many thanks for any donations! (https://lungevity.donordrive.com/...r1SFBxtl9s3SYCVnOF0c)
disclaimer: PhD not MD
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Re: Training-induced amenorrhea [scrumhalfgirl] [ In reply to ]
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I had this in college when I was running track and cross county and training super high intensity. I had to go on the pill ... but obviously that isn't going to work for you if you're trying to get pregnant. I know in my case it was probably a combination of really high training and activity (no car so I walked or ran everywhere I needed to get around town and campus) and low weight/body fat. I weighed 98 pounds at 5'5". About 2 years ago I found out I had hypothyroidism. I've been on the pill since college so I don't know if the thyroid issue would have otherwise effected my period, but one thing that showed up screwy on my labs was my hormone levels (even while on the pill)... so as someone else suggested on this thread you may want to have your thyroid checked.
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Re: Training-induced amenorrhea [scrumhalfgirl] [ In reply to ]
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just as an FYI:

my sister in law is a regular ironman racer, and she and her husband conceived in '07 while she was training for IMC. she reduced her training load, but ended up miscarrying at about 14 weeks. her doc indicated that even with the reduced training and (obviously) no amenorrhea, her body couldn't sustain both training and the growth of the fetus. after that crushing disappointment, she decided to take a full year off IM, and try again - and had our beautiful baby niece in november of last year.

i couldn't give you specifics of her training load or nutrition at the time of the miscarriage (and of course, it wouldn't mean much anyway as her fitness/metabolism could be completely different from yours), and i do know she had quite low BF% (definitely <20%), but it's something to think about. if you're trying to conceive, you may want to make that your sole priority.

cheers!

-mistress k

__________________________________________________________
ill advised racing inc.
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Re: Training-induced amenorrhea [lilpups] [ In reply to ]
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Thanks for the additional feedback everyone. My doctor had checked my thyroid earlier in the year and said things looked "normal", but based on some additional reading I've done, I'm going to ask for some additional testing there.

I'm also going to take a big step back on the training - I'm thinking maybe something low-key like a yoga class might be a good break.
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Re: Training-induced amenorrhea [scrumhalfgirl] [ In reply to ]
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I had amenorrhea when I was 18 - for about 9 months. I did lose a little weight (2kgs) at the time and I think we need to understand a few things that causes this:

1) Weight loss can be ONE factor (and on that note, the BMI or body fat % may vary with each person. If you are extermely overweight, it can also cause amenorrhea as well.
2) Stress - can cause hormonal inbalance (from work, travel, trying to conceive?) - are you stressed right now?

To address 1) I went to see a bunch of dieticians at the time and they were not very useful. if you lost say 2kgs (5 lbs) that put you under, it doesn't mean you can put on 2kgs/5lbs and things go back to normal. It took me 18 months and putting on 15 kgs/over 30 lbs to get my normal menstrual cycle back (plus a lot of crazy eating). If it's truly body fat you need, sometimes putting on "weight" is not enough since you may put on muscle mass as well.

I would definitely keep an eye on your eye if you are trying to conceive - and have your bone density checked. I had to have some scans to make sure that my bones weren't like that of a elderly lady (note; if you are a 18 y.o girl and stop menstruating for 4 years, apparently your bone density can be like that of a 60 year old women, esp. if you are not eating right - losing estrogen means you cannot absorb calcium efficiently so even if you take CA supplements, it doesn't matter. Hope that helps? Good luck!
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Re: Training-induced amenorrhea [scrumhalfgirl] [ In reply to ]
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bump for another poster

running the Marine Corps Marathon to raise money for LUNGevity. Many thanks for any donations! (https://lungevity.donordrive.com/...r1SFBxtl9s3SYCVnOF0c)
disclaimer: PhD not MD
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Re: Training-induced amenorrhea [tigerchik] [ In reply to ]
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Someone PM'd me about this thread, so I thought I would post an update in case anyone else stumbles across it in the future.

After my post in 2009, I cut way back on my training and purposefully gained weight (my doctor called it the "ice cream diet"). With those modifications, my cycles started to come back, though they were very long. With the help of clomid, I conceived my daughter in August 2010, and I now have an almost-three year old!

After I had her, I switched my focus to running, and actually lost a fair bit of weight (lower than when I was first posting). But, the combination of lower overall training volume and hormonal/weight switches after pregnancy were enough for me to get pregnant on my own this time, and I'm 5 months pregnant with a baby boy (and still running every day!).

A couple of great resources for people trying to get pregnant while dealing with these issues:

http://noperiodbaby.blogspot.ca/ - great blog with lots of links and info, plus personal experiences

And there's a hypothalamic amenorrhea group on the Fertile Thoughts message board that is worth checking out.
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Re: Training-induced amenorrhea [tigerchik] [ In reply to ]
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+1 to this and you don't need to exhibit an eating disorder to have risk factors/symptoms of the female athlete triad. New consesus statement just came out. http://m.bjsm.bmj.com/content/48/4/289.full

I am an exercise physiologist and I frequently have consultations with female athletes that struggle with caloric intake, difficulty losing body fat and very low energy. Training program overhaul and dietary changes are part of what I do to help these women. The majority that I see are competitive triathletes and distance runners.

__________________________________________________
Twitter: @jayasports
Web: http://www.jayasports.com

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