1. Exercise Causes Amenorrhea When the Body Enters a âStarvation Stateâ
There is no question that exercise is good for the body. However, in women who stop having monthly periods or stop having periods altogether (âamenorrheaâ) due to exercise, the amount that they are exercising is probably excessive. It is not just the amount of exercise that influences the menstrual cycle, but also the type of exercise. Certain types of exercise, specifically those associated with low body weight, like long distance running and ballet dancing, are more likely than others to cause amenorrhea. The combination of low body weight and intense exercise causes amenorrhea if the body believes it is in a âstarvation stateâ. That is, when the amount of energy expended during exercise is not balanced by adequate nutritional intake, the body begins to shut down organ systems that are not absolutely essential for survival. This includes the reproductive system. If a womanâs body believes it is in a âstarvation stateâ, it makes sense that it would also feel it is not the right time to carry a pregnancy.
2. Exercise Causes Release of âStress Hormonesâ
Even among female athletes that train hard and eat plenty, amenorrhea is common. The biological explanation for this lies in the release of âstress hormonesâ that are part of the bodyâs normal response to exercise. These âstress hormonesâ are similar to those released during âfight or flightâ situations, and are also what makes people feel so good after exercising (also known as post-workout euphoria). Unfortunately, these âstress hormonesâ interfere with the brainâs production of the reproductive hormones necessary to keep the menstrual cycle flowing.
3. Exercise-Induced Amenorrhea Has Long-Term Health Consequences
Most women actually donât mind it so much when their periods stop coming. And in fact, menstruation can be a big inconvenience particularly for competitive athletes. But many women are not aware of the serious long-term health consequences of exercise-induced amenorrhea. Because of the altered production of reproductive hormones, women with exercise-induced amenorrhea are estrogen-deficient. Estrogen is one of the most important female hormones, and when there is too little of it, the risks include infertility, atrophy of the vagina and breast, and osteoporosis which can lead to fractures of the spine, hip, and other areas. Prolonged exercise-induced amenorrhea may also increase the risk of heart attacks later in life.
4. Exercise-Induced Amenorrhea is a Diagnosis of Exclusion
Prior to starting treatment, women with exercise-induced amenorrhea should be evaluated by their doctor for other possible causes of irregular or absent periods. These include pregnancy, thyroid dysfunction, prolactinomas (benign tumors of the pituitary gland), and premature menopause. Since exercise-induced amenorrhea is considered a diagnosis of exclusion, one cannot assume the exercise is the culprit until every other potential cause is eliminated.
5. Treatment Restores Estrogen to the Body
Once the diagnosis is confirmed, the main objective of treatment is to restore estrogen levels to the normal range. In many women, this can be accomplished by increasing caloric intake, allowing the body to come out of the âstarvation stateâ. In women who are reluctant to increase their calories, estrogen can be given in the form of the birth control pill or birth control patch. It can also be given as hormone replacement therapy, similar to that used by postmenopausal women. Such treatments will protect a womanâs bones from fractures due to osteoporosis, but will not treat her infertility. Infertility due to exercise-induced amenorrhea can be treated with fertility medications, but if a woman is underweight, optimizing body weight by improving nutritional intake before trying to get pregnant is the preferred approach.
