There is little doubt that exercise is good for you, but as with most things, too much of anything can have its drawbacks. Female athletes in particular, such as Olympic gymnasts and professional dancers, can experience a condition called amenorrhoea from too much training.
Amenorrhea means the absence of menstrual period – it can be primary (period hasn’t started by the age of 16) or secondary (no period for three consecutive cycles or longer than six months).
However, it is not just the amount of exercise that affects the menstrual cycle, but certain types of exercise, specifically those associated with low body weight. Long distance running, ballet and gymnastics are all common culprits, and it is this low body weight combined with intense exercise which can cause amenorrhea.
What causes exercise-induced amenorrhoea?
Excessive exercise can suppress the luteinizing hormone, which is the hormone which triggers ovulation in women and is necessary for normal reproductive health and sexual development.
Professional athletes such as Olympic gymnasts already have a training schedule involving several hours a day of exercise, and when competition time comes around, their training times and intensity increase, which puts even more stress on their bodies.
This is often accompanied by inadequate nutrition to compensate for the excessive exercise, which results in insufficient calories, protein, vitamins, and minerals in the diet. This causes a considerable loss of body weight, which may lead not only to amenorrhea but also decreased bone density and an increased risk of stress fractures, and eating disorders such as anorexia nervosa.
Together these three conditions – inadequate nutrition, amenorrhea, and low bone mass – are known as the Female Athlete Triad.
How amenorrhoea is treated
In professional athletes experiencing amenorrhea, the treatment generally includes some testing to determine the root cause, and often includes the following:
· A complete physical examination and pelvic examination
· A pregnancy test, as this can also cause amenorrhoea
· Laboratory testing to check hormone levels
· Testing for anabolic steroids
If the athlete is determined to be experiencing amenorrhoea because of restrictive eating, it is recommended she receive counselling, a personalised nutrition plan and medical evaluation to determine her overall health and ability to continue training.
Along with a diet overhaul to ensure the athlete gets enough calories to remain healthy during the extensive training period, a focus on increasing their calcium intake to at least 1,500 mg daily is often included to protect the bones from losing density.
In some cases oestrogen replacement therapy is necessary, such as with a low-dose oral contraceptive.
Prevention of amenorrhoea
Exercise-induced amenorrhoea should not be considered a normal response to exercise and should be taken very seriously, especially in young athletes.
A focus on a healthy, balanced diet to meet the caloric demands of high intensity training as well as a review of the exercise intensity, duration, and frequency should be considered carefully to ensure athletes are not at risk.
If disordered eating is a concern in adolescents with amenorrhea, a multidisciplinary approach is needed, including services of a physician, nutritionist, and mental health professional, as well as support from coaches, parents, and teammates.
Education, not only for the athlete, but also the parents and coaches regarding disordered eating, menstrual dysfunction, decreased bone mass and nutrient intake to meet energy expenditure is necessary for everyone involved.