Athletic women are generally considered fit and healthy. However, approximately 20 percent of active women don't experience regular menstrual periods. This condition is called amenorrhea and is characterized by estrogen deficiency, similar to menopause. Although some women deem amenorrhea a desirable effect of exercise because they don't have to deal with the hassles of monthly menstrual periods, others associate it with the following health problems:
* Calcium loss
* Almost a threefold increase in the incidence of stress fractures (24 percent of athletes with absent or irregular periods experience stress fractures compared to only 9 percent of regularly menstruating athletes)
* Osteoporosis occurring at an early age
* Interference with fertility.
Causes of Amenorrhea
Many women believe they stop menstruating because they exercise too much. However, this is not the case. Many athletes who exercise intensely have regular menses. Other women believe they stop menstruating because they are too thin. This belief is also false. Studies have found no difference in body fat percentage between regularly menstruating athletic women and their non-menstruating counterparts.
Why, given a group of women with similar exercise programs and low percentages of body fat, do some experience menstrual problems and others do not? The answer usually relates to nutrition. Women with amenorrhea may be striving to maintain a weight lower than appropriate for their genetics. When the cost of achieving this desired leanness is inadequate nutrition, menstruation will cease.
Prevalence of Amenorrhea
Although amenorrhea is not sport-specific, sports with the highest prevalence of amenorrhea include ballet (19 to 44 percent) and competitive running (24 to 26 percent). An estimated 3 to 5 percent of sedentary women also experience menstrual irregularity. A woman is more likely to become amenorrheic if she has a restrictive diet, low body weight or body fat percentage, lost weight quickly, exercises intensely, had irregular menstrual periods before starting a demanding training regimen or is stressed.
Amenorrhea and Anorexia
Although amenorrhea exists among women who do not have eating disorders, loss of menses is certainly a red flag for restrictive, anorexic-type eating behaviors. The American Psychiatric Association's definition of anorexia lists "absence of at least three consecutive menstrual cycles" among the criteria. Other criteria include weight loss 15 percent below normal body weight in relation to height, intense fear of gaining weight and distorted body image (i.e., feeling fat even when emaciated)--concerns common among female athletes.
Resolving the Problem
If you feel as though you struggle to balance diet and exercise, seek counseling from a physician, dietitian or counselor. To find a local sports nutritionist, call (800) 366-1655 or visit www.eatright.org and use the American Dietetic Association's referral network.
The possible changes required to resume menses include exercising 5 to 15 percent less and eating a little more. If you stop training, you may resume menstruation within a few months. Some amenorrheic athletes resume menses by exercising less, not gaining weight or gaining less than five pounds. This small weight gain is enough to achieve better health, yet does not result in "getting fat."
The following tips may also help you resume menses--or at least rule out nutrition-related factors.
1. Throw away the bathroom scale. Rather than strive to achieve a certain weight, let your body weigh what it weighs.
2. If you need to lose weight, don't crash diet. Instead, cut back on calories by about 20 percent. You are eating too few calories if you are always hungry or obsessing about food.
3. Include small portions of red meat in your diet two to three times per week. Surveys suggest amenorrheic runners tend to eat less red meat and are more likely to follow a vegetarian diet. Vegetarian women are five times more likely to have menstrual irregularities than women who consume meat.
4. Eat adequate protein. Amenorrheic athletes tend to eat less protein than their regularly menstruating counterparts. If you are a vegetarian, eat additional yogurt, fish, beans, tofu and nuts.
5. Consume at least 20 percent of your calories from fat. If you believe you will gain weight by eating foods that contain fat, think again. Although excess calories from fat are fattening, some fat (20 to 30 percent of total calories; 40 to 60+ grams fat/day) is an appropriate part of a healthy sports diet. Nuts, peanut butter, salmon and olive oil are healthy choices.
6. Maintain a calcium-rich diet to help sustain bone density. A safe target is three to four daily servings of low-fat milk, yogurt and other calcium-rich foods. Being athletic, your bones benefit from the protective effect of exercise, but this does not compensate for a lack of calcium.
Is there long-term damage?
Amenorrheic women who resume menses can restore some, but not all, of the bone density lost during their amenorrheic months. Hence, their goal should be to minimize the damages caused by amenorrhea by following a healthy diet and taking the proper steps to resolve the problem. Every woman wins with good nutrition!
Nancy Clark, M.S., R.D., is director of nutrition services at SportsMedicine Associates in Brookline, Massachusetts. She is author of Nancy Clark's Sports Nutrition Guidebook, Second Edition ($23) and her new Food Guide for Marathoners: Tips for Everyday Champions ($20). Both are available via www.nancyclarkrd.com or by sending a check to Sports Nutrition Materials, 830 Boylston St. #205, Brookline, MA 02467.
COPYRIGHT 2002 Aerobics and Fitness Association of America
COPYRIGHT 2002 Gale Group