Amenorrhea (The absence of periods)

Amenorrhea is known as the absence of menstrual periods which is often brought about through disruption in the reproduction system. This condition occurs within 3-5% of those who menstruate and can often cause distress to the person experiencing it and possible additional health problems.

While amenorrhea can occur in female athletes from any sport or level of expertise, it is not an acceptable consequence of any level of athletic or fitness training.

Consistently missing your periods is NOT NORMAL.

There is an array of potential causes for amenorrhea which may include the following:

• Birth control use
• Either low weight or being underweight
• High stress levels
• Overtraining syndrome
• Low energy availability
• Eating disorders such as anorexia and/or bulimia
• PCOS (Polycystic Ovary Syndrome)
• Genetic conditions (i.e., Turners Syndrome)
• Pituitary gland issues
• Defects in the genital tract
• Premature ovarian failure
• Use of antidepressants and other mood stabilising medications
• Weight gain

It’s important to note that even when one or several of the above causes are present, it may not cause an onset of amenorrhea, but it is something to be aware of and seek medical advice where necessary.

There are two types of amenorrhea, known as primary and secondary which are vastly different and often have varying causes.

Primary amenorrhea

Primary amenorrhea is often diagnosed from two determining factors:

• When menstruation hasn’t commenced by 14 years of age, paired with no signs of secondary sex characteristics (e.g., pubic hair and breast development).
• Menstruation hasn’t begun by 16 years of age despite sexual development being evident.

 Secondary amenorrhea

Secondary amenorrhea is more common in elite athletes and occurs following the absence of three or more consecutive menstrual cycles where there is no pregnancy or breastfeeding evident in those who have previously had menstrual cycles.

To diagnose amenorrhea, your doctor will need to eliminate all other possible causes first. This may include:

• Physical examination to examine overall health
• Medical history assessment, including contraceptive use and gynaecological history
• Hormone tests
• Pregnancy test

If amenorrhea is left untreated for an extended period of time, there are numerous long-term complications that may occur including:

• Poor adaptation to training
• High levels of blood cholesterol
• Increased risk of stress fractures
• Osteoporosis due to loss of bone mineral density
• Increased risk of musculoskeletal injuries
• Increased risk of heart disease later in life
• Reduced fertility
• Premature aging

While primary amenorrhea may resolve itself over time, your doctor will be able to assist you in this endeavour and explore options to treat secondary amenorrhea. Some treatment options may include but are not limited to:

• Referral to a nutritionist to adjust diet and achieve a healthy weight
• Stress management techniques such as engagement in psychology and complementary therapies like yoga and meditation
• Implementation of an appropriate exercise routine in the case of overexercising
• Surgery and more invasive treatments are sometimes required in certain cases.
• Identification of any disordered eating or eating disorder behaviours often associated with RED-S and Amenorrhea.

If you have concerns about the absence of your menstrual cycle, we encourage you to seek medical assistance.

If you think you may have amenorrhea (i.e., your period has not commenced by 14 years of age or you have missed three consecutive periods) or have concerns about your menstrual cycle influencing your life and athletic performance, we recommend you get into contact with a specialised women’s General Practitioner or gynaecologist a Ignite Athlete as soon as practical.

They will be able to explore your symptoms in conjunction with a physical examination and assessment of your medical history, to identify whether further investigation is needed. If you track your menstrual cycle, this log will be beneficial to bring to your appointment.