Short-Term Solutions, Long-Term Problems
My nephew and I sat by a dying fire during a cold, fall campout. It was late and he was complaining about the small fire and his thin jacket.
Rather than giving him my coat like a good aunt, I suggested he go set up a tent and get in his sleeping bag rated for 0°.
He told me no, because it was colder than sitting by the fire.
Short-term thinking is the greatest enemy of good government.
We'll come back to this quote at the end of this post.
As with my last post about the pelvic floor, I will tread carefully around this subject with respect to prescriptive science 🧪 🧬 🔬 . I am no MD, try not to play one on the internet. I am open to correction on any of the below.
Here's what we need to know:
how and why female runners lose their period
problems with missing your period
why it's so important to have one
how to start getting it back
why it's so psychologically difficult to recover
While we'll cover all of this, I'll speak more deeply about what I have credibility to: the mental block between knowing the steps to recovery, and taking them.
How Female Runners Lose Their Period
Losing your period is called hypothalamic amenorrhea. It happens when the signal hormones from the brain (GnRH) misfire. Ordinarily, they'll cascade down to the ovaries, triggering an eventual production of estrogen.
The firing never takes place, so estrogen is not produced, so you miss your period. Better said, your period stops because you miss ovulation.
Why Female Runners Lose Their Period
The exact cause is not definite. Amenorrhea could be the result of an excessively low body-fat percentage, excessively low overall weight, excessively high cortisol levels from intensity of training, or some combination of the three.
A tween girl ovulates for the first time when she crosses either a body-fat or body weight threshold. Amenorrhea may be the reverse.
When a female body gets too lean and continues demanding her body crush fifteen 400's in a row every Tu/Th, that body will begin shuttling energy normally allocated for 'non-essential' functions (like a baby-making machine) to more short-term-critical functions like the ones that allow you to breath or think.
In other words: you're stressing your body too much with too little proper nutrition, and not enough recovery. In some cases, you may not even be underweight, but you’re still eating too few calories for the amount of stress you're putting on your body.
Keep that up, and you won't be crushing 400's for much longer.
Problems With Missing Your Period
As central as this period thing is to your overall health, a doctor may not even ask about it, and I've heard stories of some women whose doctors, after finding out you they were missing theirs, said something to the effect of, “ahh, so you’re an athlete,” and moved on.
Let's be very clear: losing menstruation is NOT just a part of the game. It is very common, but it ABSOLUTELY should not be. Loss of your period is a SERIOUS sign your body is not functioning properly.
Near-term (think next few years) effects:
Infertility (no ovulation, no baby)
Persistent risk of injury
Excess body hair
Hair loss (head)
Loss of breast tissue
Long-term (think lifetime) effects:
Infertility (prolonged state of amenorrhea can alter urogenital mucosa and in the muscles of the uterus)
Osteoporosis - let's expand:
Losing your period for long spaces of time is dangerous because lack of estrogen leads to lower bone density (possible stress fractures and actual fractures due to osteopenia or osteoporosis).
Your bones are fully developed by age 30. If a good chunk of those key-bone-growth years are spent in an amenorrhea state, your peak bone mass will be far smaller than it ought to be, and you'll end up facing osteoporosis… throughout your life.
If you've continued missing your period through age 30, osteoporosis may never reverse itself because your bones have stopped developing.
I don't mean to scare you, but this is scary stuff, and I really want you to take a good, hard look at whether that extra 12 seconds in the 5k are worth it.
Why Menstruation Is Important For a Runner
Outside avoiding the above risks, let's look at what else you're getting back with a menstrual cycle in the context of running.
Predictable menstruation is a clear indicator of good health. It means your body's hormones and energy are being allocated successfully to the proper bodily functions.
It should be noted that these hormones like estrogen do not exist in a vacuum called the reproductive system - they also work with the rest of the body to trigger things such as...
Healthy insulin sensitivity
Allows for increased blood-glucose uptake
Without a period, and with lower bone density, you are at serious risk of injury. A 2012 study found women with menstrual irregularity were almost 3x more likely to be injured for seven or more days - all while unable to participate in their sport.
The Path Back to Healthy Menstruation
The beauty of all this is that getting back to menstruation is easy! It really is... physically. All you have to do is lessen your training load, eat more and nutritious meals with more calories, and sleep more.
You'd likely benefit from talking with a nutritionist to get the right macro combination and amount of calories needed relative to your training load, but my guess is that if you were only listening to your body, you'd probably know what to do even without the nutritionist.
Psychological Challenges With Recovery
But you're not just listening to your body, are you? I know.
You're listening to coach. You're listening to the foot pattern of your teammate who's always two steps ahead of you. You're listening to the thin, lean little devil on your shoulder whose mantra is, more miles, more workouts, less food, faster times. That little devil also convinces you that you need to suffer more because you aren't good enough... I leave it to you to decide whether 'good' is confined to running.
Every morning you wake up feeling like you're holding on by a a thread, but you're confident the thread is all you need to podium at the race this weekend. The personal best, the "atta girl" from your coach, the approval from your parents will make it all worth it. You tell yourself, after this weekend, then you'll start to heal.
When even considering the return to a healthy cycle, you think...
'I'm already stagnant. What are my coaches and teammates gonna think if I actually lower my training? I'm wasting time. Other people are getting more fit while I sit here. What's a few more miles? I just ate so much, I should run if off anyway. What am I, average? I did not work this hard, and subject myself to this much pain to waste the fitness I've built. I'll either win or get injured, then I'can take some time off, either way.
These are powerful thoughts - powerful, persuasive, and disastrous.
I'm going to be blunt with you, so buckle up.
In this moment, you are my nephew sitting by the dying fire as the last charred log clings to its fading heat.
This version of you is not better, faster or stronger than the version of you who has a healthy period.
If the title you're trying to maintain is "Looks Like an Athlete," you're missing the mark there as well. In this malnourished state, your body holds onto water, stores as much fat as it can, won't build the muscle you're looking for, and won't perform optimally on the field.
The whole situation is a big paradox.
You work harder and harder to struggle more and more and with diminishing returns.
Sure, the early races are fun: you're light and quick, but just wait.
As you sit by this fire watching the embers die, your body is breaking down - and that's saying nothing of your mental health.
You're on the cusp of a physical breakdown from lack of nutrition and recovery, and at the same time nervous that any fitness you have now will all be lost if you just start eating more, working less and sleeping more.
Frankly, you're right. That will happen up front. You're going to lose fitness. You will get slower. The scale will read higher numbers. You will feel like a type of failure.
Then after this massive investment in recovery, something will change. Many things actually.
Your headaches will start to clear up. You'll begin to sleep deeply, and wake up with energy, and that energy will stick around throughout the day. Imagine that.
After a couple months, the 'easy' runs (read: no workouts) you've committed to will begin to increase in pace at the same effort level. One morning, you'll wake up to a terrible feeling in your stomach and blood on the sheets - a glorious day.
If you think you're fast now, just wait until your body's energy is successfully utilized in the right places for the right things.
You'll begin to absolutely DESTROY the efforts you previously thought were only the result of your "disciplined diet."
Here's what else will happen:
Greater and faster recovery
Quicker and more lasting muscular gains
Perpetual aches and pains around your body disappear
More lean muscle mass
You’ll snap back to the mileage/intensity quicker than you expect
Even above all that, you can expect HUGE mental improvements. We categorize our body and mind separately. Not so. What is the brain if not connected at the shoulders, to the torso, the uterus, the legs and the toes?
When you allow your body to function as it should, the mind will follow.
Anthony Albenese said,
Short-term thinking is the greatest enemy of good government.
While the above quote is talking of national governance, it applies just as well to individual governance.
If you're reading it without a consistent cycle, the quote probably feels like a personal attack. Believe me, that's not my intention.
I want you to run the fastest your body is capable of running. I want you to LOVE running with all your heart and soul, but I also know that running wants to love you back. The sport will not demand you sacrifice a future family, your bones, or your mental health for her. I promise, I just got off the phone with her.
Your Potential Is Before You
Please please please do not let a the fear of few month's recovery stand between you and the rest of what could be an incredibly successful career and life.
This is not a matter of '1 step back, 2 steps forward.'
This is '2 steps back, 10,000 forward.'
Take the first step to getting your period back today by going to talk to a coach or a teammate about your plans to do so. Serious. Text them to set a time to talk right now.
You have all my love and support, and so much to look forward to.