What it Is, Causes & Treatment

Editor’s Note: This put up was initially printed March 2014 and has lately been up to date and revised for accuracy and comprehensiveness.

It is estimated that as much as 45 p.c of feminine athletes in sure sports activities expertise menstrual irregularity, additionally known as Athletic Amenorrhea. Within the final 20 years, our society has witnessed a major enhance within the stage of athletic participation by ladies and in consequence, ladies are extra conscious of the modifications skilled of their menstrual cycle.

There is very regarded hypothesis that in a roundabout way the feminine physique “senses’ when energy reserves are inadequate to sustain a pregnancy and thereby ceases ovulation to prevent conception. Research has defined a level of body fat of 11 percent as the “critical level” for the onset of menstruation. This stage varies plus or minus 4 p.c in lots of wholesome, energetic females. During the previous 4 years there was an abundance of research indicating a excessive incidence of menstrual irregularities amongst ladies athletes.

Evidence has demonstrated that persistent, high-intensity train stimulates profound modifications within the menstrual cycle. At the identical time, a rise within the stage of testosterone within the blood stream of girls who have interaction in strenuous bodily exercise has been famous. It is theorized that the mass of physique fats relative to lean physique weight is a essential issue within the onset of secondary amenorrhea. This situation is clinically outlined because the absence or suppression of menstruation from any trigger apart from being pregnant or menopause.

The time period amenorrheic refers to ladies whose menstrual cycles happen at intervals of longer than 90 days, and is the one medical symptom to point a disruption of the reproductive system. Female athletes usually have a share of physique fats decrease than 20 p.c, and aggressive physique builders can attain as little as 10 p.c. The common non-athletic lady’s physique fats varies between 22-28 p.c, with a stage of above 30 p.c thought-about overweight.

Evidence has demonstrated that persistent, high-intensity train stimulates profound modifications within the menstrual cycle.

Factors Leading To Amenorrhea

Some of the elements which result in the irregular incidence of the menstrual cycle, embrace the next:

  1. Low physique fats (beneath 12 p.c).
  2. Early pre-pubertal athletic coaching.
  3. Decreased hypothalamic exercise.
  4. Intensity of coaching regimens.
  5. Reproductive maturity.
  6. Stress (psychological in addition to bodily).
  7. Diet, (a excessive protein, low-carbohydrate weight loss plan can disrupt menstrual cycle).
  8. Anabolic steroid utilization: the Influx of male hormones, whether or not artificial (Anavar, Deca-Durabolin, and so forth.) or testosterone, can wreck havoc on a lady’s physique.
  9. Severe train (heavy weight coaching or long-distance working).

Changes within the Body

There are a number of modifications that happen within the feminine who’s experiencing amenorrhea due to strenuous train. These embrace a lower in ovarian perform and metabolic and hormonal modifications (the ratio of estrogens to androgens within the physique).
Hormonal Changes

It is understood that Luteinizing hormone (LH) and Follicle-stimulating hormone (FSH), each of that are concerned within the onset of ovulation, enhance in focus within the blood earlier than train. Critical modifications are going down within the hypothalamus, and the heart beat frequency of the gonadotrophin-releasing hormone is altered. All this exercise is expounded to the modifications in insulin receptor sensitivity within the hypothalamus. The potential for long-term results on ladies who expertise persistent amenorrhea are as follows:

A decrease bone-mineral content material, which may result in diminished bone mass and the sooner onset of osteoporosis.
The potential for a feminine athlete’s incapacity to change into pregnant. Studies present that girls runners who develop amenorrhea have decreased spinal bone mineral content material. The magnitude of the loss seems to be associated to the period of the amenorrhea.

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Research on the University of California, San Francisco, was performed to find out whether or not the bone loss was gradual, as within the getting older course of, or fast at first after which slower, as in menopause. Bone loss (osteoporosis) makes bones simply prone to breaking.
One Probable Cause: Low Levels Of Calcium.

Lowered calcium ranges have been present in ladies who prohibit their carbohydrate! Caloric consumption whereas growing their protein consumption. Research has demonstrated that top protein consumption is expounded to decrease calcium ranges. Estrogen ranges drop dramatically when a lady ceases to menstruate.

Forty ladies runners, ranging in age from 18 to 40 had their bone mineral content material checked. These athletes had been experiencing amenorrhea for six months as much as ten years. Those who had been amenorrheic for lower than three years misplaced roughly 4.2 p.c of their bone content material in the course of the 12 months. The longer-term amenorrheic ladies misplaced an insignificant quantity of bone. This examine concluded that important bone loss happens in the course of the first years of amenorrhea and tapers off within the persistent amenorrheic athlete.

It is necessary to emphasize that girls athletes ought to seek the advice of their physicians instantly if menstruation ceases. In order to stop irreversible bone injury, it is necessary to comply with the instructions and recommendations beneath.

Directions and Suggestions

The potential for unintended effects for girls experiencing amenorrhea on account of strenuous train has been discovered to be extra pronounced within the leaner and lighter athletes. Pharmacological remedies can embrace prescribing Clomiphen citrate, a non-steroidal anti- estrogen drug that acts to stimulate the ovaries or estrogen alternative.

This kind of intervention ought to be used on the advise of a gynecologist or endocrinologist, as these medication do have potential unintended effects. A extra smart strategy to reversing an irregular menstrual cycles (oligo-menorrhea) or an entire cessation of menses (amenorrhea) could be to comply with some fundamental ideas. Try to cycle your coaching through the use of lesser depth in the course of the off- season and permitting the physique to return to its essential fats stage (roughly 13 p.c) in the course of the off -season.

Nutritionally, there are a number of dietary supplements (amino acids, nutritional vitamins, and minerals) which were discovered to assist throughout these months of irregular cycles.

L-Tyrosine (free kind), 800 mgs per capsule, two capsules 20 minutes earlier than breakfast and at mid-afternoon. Taking 4 to 6 ounces of fruit juice will improve the uptake of this and all amino acids.

L-Glutamine, 500 mgs per capsule two capsules twice a day, mid-morning, and mid-afternoon. This amino acid assists in sustaining blood sugar ranges, whereas bettering general gastrointestinal well being.

Multi-vitamin mineral: One capsule 3 times a day with meals. Be positive this product is yeast -sugar- and starch- free.


Based on obtainable analysis, it seems that exercise-associated disturbances in menstrual perform could be reversed with average modifications in life-style with out severe penalties so long as the situation doesn’t persist indefinitely. In order to perform their short-term objectives, it is necessary for feminine athletes to ascertain peace of thoughts to proceed competing and coaching with out inflicting any long-term well being results. With this in thoughts, feminine athletes can take part within the actions of their selection and stay in concord with their sports activities in addition to their our bodies.

If you’re a Certified Personal Trainer or Coach, and work with feminine athletes, the AFPA Sports Nutrition Consultant Certification program could be a superb course to study extra about Athletic Amenorrhea and the best way to successfully information your athletes to well being, wellness and optimum efficiency.

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Author: Mark J. Occhipinti, Ph.D.,ND

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