Amenorrhea means not having menstrual periods. Missed periods may be caused by pregnancy, birth control pills, stress, travel, menopause, drugs, hormone imbalances, brain injuries, tumors, rapid weight gain or loss, malnutrition or vigorous exercise. Primary amenorrhea is defined as not starting periods by age 16. Secondary amenorrhea is the absence of at least three to six consecutive periods in a female who regularly has had periods.

Amenorrhea is more common in athletes than in the general population. Intense, vigorous participation in sports may delay the start of menstrual periods or cause periods to stop. This is called athletic amenorrhea.

Regular exercise is good, but athletes should avoid:

• excessive exercise (more than a normal training program)
• poor or abnormal eating behaviors

Excessive exercise and poor eating habits lower body fat. When it is too low, the ovaries stop making estrogen. Estrogen is the hormone needed for ovulation and menstruation. A low level of estrogen may result in bone loss, causing a risk for fractures. If bone density is lost during youth, more serious problems can occur with menopause.

Athletes require more calories, carbohydrates and protein than those who are less active. Yet they often eat poorly to stay thin and lean. Severe food restrictions or other eating disorders, such as binging and purging, can lead to malnutrition. Athletic amenorrhea can also lead to heart disease or cancer, psychological problems, difficulty getting pregnant and reduced athletic performance.

Diagnosis of exercise amenorrhea requires a medical exam to be sure no other problems are causing the missed periods. The exam usually includes: pregnancy and bone density tests; complete physical and pelvic exams; and discussion of exercise and eating habits. Estrogen may be prescribed to restore hormone balance.

Athletes with amenorrhea should take at least 1,500 mg of calcium daily. This is needed because calcium levels may be low, due to low estrogen levels. Nutritional counseling is also recommended to make dietary changes.

Ovulation and periods will begin when:

• food intake is increased and nutrition is improved
• exercise is reduced to normal levels
• hormone levels are in balance 

If you think you or someone you know may be suffering from athletic amenorrhea, contact Saint Vincent Sports Medicine at 814-835-2035.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a health care professional.