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Athletic Amenorrhea

Fitness for mind and body.

Athletic amenorrhea, or the cessation of menstruation for six or more months, may seem like a blessing in disguise but that couldn't be further from the truth. The lack of circulating estrogens in the body pose serious health risks for women: premature osteoporosis, impaired performance, infertility, increased risk of injury and an increased risk of cardiovascular disease and endometrial cancer.

There appear to be several causes of athletic amenorrhea. Current research indicates that low percentages of body fat, weight loss, excessive training and poor nutrition habits may be involved. Although all of these factors seem to act synergistically, a growing body of evidence points to poor nutrition as one of the most significant causes of athletic amenorrhea.

Woman Runners' and Ballet Dancers

Woman Runner

Studies supporting this evidence report an increase in menstrual abnormalities when exercise in combined with low-calorie diets, as opposed to exercise alone. One survey conducted on the dietary habits of elite female runners showed that, as a group, these women reported eating far fewer calories than might be expected. Only 40 percent of these runners reported eating more than 2,000 calories per day, despite training an average of 10 miles per day. With such heavy training, it would be expected these women would consume well over 2,000 calories. Instead, the reported caloric intake for the non-menstruating runners was about 1,600. Menstruating runners consumed an average of 2,500 calories per day.

It's not just runners who suffer from amenorrhea and poor nutrition. In a study of ballet dancers, of whom 58 percent had amenorrhea, 48 percent consumed less than 1,800 calories per day and 55 percent consumed less than two-thirds of the Recommend Dietary Allowance for calcium. Another study of amenorrheic women confirmed these observations, showing that female runners were consuming less than the RDA for calories and calcium. When their average calorie expenditure was subtracted from their total calorie intake, these runners were shown to exist on less than 1,200 calories per day.

Besides consuming low-calorie diets, runners and ballet dancers have something else in common: They participate in a sport that emphasizes leanness, which all too often can trigger an eating disorder. Such sports -- figure skating, diving, gymnastics, running and ballet among others -- are more frequently associated with eating disorders than sports that tolerate a greater range of bodies.

For instance, the survey on female runners reported that 13 percent of them had a history of anorexia; 25 percent reported binge eating; 9 percent stated they binged and purged; and a total of 34 percent reported atypical eating behaviors. In addition, a study that examined risk factors and triggers for eating disorders in female athletes found that of the 500 hundred or so athletes responding to the first phase of research, about 23 percent were deemed at risk. Of those athletes, 89 percent could be clinically diagnosed with anorexia nervosa or bulimia nervosa. Needless to say, an eating disorder results in poor nutrition. In fact, the American Psychiatric Association's definition of anorexia nervosa lists amenorrhea among the criteria for diagnosis.

Protein Intake

Eating disorders may be just one piece of the puzzle. Another possible influence on menstrual function may be vegetarianism. One study noted that more female runners with amenorrhea were vegetarians compared to those who regularly menstruated. Similar research reported that 25 percent of amenorrheic runners were vegetarians while only 11 percent of the regularly menstruating runners considered themselves as such. Researchers speculate that components of vegetarian diets, such as trace elements or plant hormones, may affect menstruation.

But before you trash your tofu, consider this: Diet and menstrual dysfunction may be due to an insufficient protein intake. Many studies point to this as a common link among amenorrheic athletes, but researchers aren't sure why. It may be a marker for a poor overall diet. For instance, the survey of the dietary habits of elite female runners found that the when asked how many times weekly they ate beef, pork, or lamb, 61 percent of the amenorrheic athletes did not eat red meat, compared with 43 percent of the currently menstruating women. Although this component of the survey specifically dealt with the intake of red meat, other studies have shown that protein deficiency may be more common among top athletes than suspected. In a study of 53 women who competed in the 1984 Olympic marathon trials, many ate less than the RDA for protein.

Protein Foods

Amenorrhea is Reversible

Although this information may seem alarming, you should note that amenorrhea is reversible, and you do not have to give up your sport to reverse it. Talk to your doctor about treatment, which typically includes a prescription for estrogen replacement in the form of an oral contraceptive. You may also need to increase your overall caloric intake, gain 2-3 percent of your body weight, add resistance training to your workout routine, and supplement with 1500 milligrams per day of calcium.

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