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REGIONAL ORTHOPAEDIC AND SPORTS MEDICINE CENTER

Discussing Exercise Associated Amenorrhea

December 21, 2017

Exercise can be a tricky business.  The vast majority of us don’t get enough exercise and don’t have to deal with the consequences of over-training.  However, many high school, college, professional and serious recreational athletes do indeed grapple with the effect of too much exercise.

 

Although a problem for both sexes, women face unique problems associated with over-training.  A specific condition known as Exercise Associated Amenorrhea (lack of monthly period) (EAA) occurs in women participating in a wide variety of sports.  Unfortunately, some women think that they’re “finally in shape” when they exercise so much that they stop having periods.  They think that the lack of a menstrual period demonstrates that they are indeed working hard enough.  In reality, it shows that they are on the brink of breakdown; actually it is a warning sign from the body.

 

There are many different reasons for women to stop having their period.  However, women active in all sports have shown to have a higher incidence of amenorrhea when compared to sedentary women.  When it is determined to be due to excessive exercise EAA is diagnosed.

 

EAA has been associated with higher injury rates and lower bone density in female athletes.  Studies by doctors in California have demonstrated significantly lower bone density in female runners with amenorrhea.  This was somewhat surprising since the weight bearing nature of distance running would generally be thought to increase bone density.

 

There are both long term and short-term implications to a decrease in bone density.  The immediate consequences involve being more prone to injury such as a stress fracture.  Osteoporosis becomes a genuine concern of women with long-term amenorrhea. Unfortunately, symptoms of decreased bone density often don’t surface until the late teens to 30s when women develop a fracture or stress fracture.  By then, the bone may be significantly demineralized.

 

What can be done about the decreased bone density?  Some studies have indicated that moderate lifestyle changes such as a 10 percent decrease in exercise frequency and gaining a few pounds can cause women to resume their period.  And in women who did resume menstruation, their bone density slowly increased though never to levels of women who continually menstruated.

 

The diagnosis of EAA should only be made by a physician.  Between 2 and 5 percent of all women will experience secondary amenorrhea at some point in their lives and certainly not all of these cases are due to exercise.  There are a multitude of other cases for cessation of monthly periods, which should be thoroughly investigated before the exclusionary diagnosis of EAA is made.

 

The exact cause of EAA is not known at this time. Several theories concentrate on the effect of exercise on the hormone producing organ call the hypothalamus.  In women with amenorrhea, most of the signals that come from hypothalamus that indirectly control the ovaries, and therefore menstruation, are absent.

 

Women with amenorrhea should seek medical care from a primary care doctor or gynecologist within the first three months.  If your doctor determines that exercise is indeed the cause of amenorrhea, current recommendations are to decrease exercise by 5 to 10 percent and to increase caloric intake enough to gain 2 to 10 pounds.

 

One myth about EAA that should be displaced is that women can't get pregnant if they aren’t experiencing monthly periods.  This is not true.  It is impossible to accurately predict when a woman will release an egg and could therefore get pregnant.  Sexually active women with amenorrhea who do not wish to become pregnant should practice a conventional method of birth control.  Every woman is different and not all women respond to the above recommendations.

 

If EAA continues for more than six months to one year, some doctors consider replacing the deficient hormones orally.  If you have amenorrhea, don’t ignore it.  Talk to a physician who is well informed about menstrual irregularities.

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