Dear Doc,
I’m at the peak of my cross country training. Trying to get in the best shape for the state series, I increased my running and dropped my calories after a teammate mentioned that I looked like I gained weight. But for the last three months, I haven’t had a period. Is this normal or should I be worried? It seems like every time I get near the peak of my season training, I have a setback. Last spring, a stress fracture in my foot near the end of track season kept me out of the state finals. I’m afraid of this happening again. Why do I keep having problems?
Sincerely,
Kim
With her history of a stress fracture, poor eating, rigorous training and lack of a regular period, it appears that this runner is suffering from the Female Athlete Triad. It’s a combination of poor nutrition, amenorrhea (irregular or absent menstrual periods) and osteoporosis (low bone mass which leads to risk of fracture from low estrogen levels and poor nutrition). The Triad is seen in females participating in sports that emphasize leanness or low body weight which is why it is seen more commonly in running.
What is considered amenorrhea and should you be concerned? Any female who hasn’t started menstruating by age 16, misses three consecutive periods or has periods that occur greater than 35 days should be evaluated by a physician to find out the root cause.
Although ignoring the symptoms is often tempting, the key is to recognize it early. Stay on top of your health before you suffer a long-term problem like a fractured bone, severe anemia (low blood count) or even heart disease which will completely derail your training and put you at greater risk for chronic medical illnesses. The only way to know if you have the Triad is to speak with your doctor and have a complete physical exam. He or she may also perform some tests and together you can come up with a plan to make a more healthy future and stronger running with less risk of injury and other long-term medical problems.
As far as nutrition, it is okay (and actually encouraged) to pay attention to what you eat in terms of nutritious value, but if you think that you have an eating disorder – anorexia (starving yourself) or bulimia (vomiting your food), please talk to an adult you trust. Maybe that’s a parent, coach, teacher or school nurse. The truth is, losing a few pounds generally doesn’t improve performance. People who are fit and active enough to compete in sports generally have more muscle than fat, so it’s muscle that’s wasted when a girl cuts back on food.
If you think that you have a friend or teammate who may have a problem with the Female Athlete Triad, you’re showing the most care not when you ignore it but when you express your concerns.
Here are some tips to better health:
· Keep track of your periods
· Don’t skip meals or snacks – Well-balanced meals
· There is a difference between training smart and overtraining and putting yourself at risk for injury
· Make a plan with a trusted adult and your physician
· Visit a dietician or nutritionist who works with teen athletes
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Dr. J’s Disclaimer: While I am a licensed medical doctor in the state of Florida, the information presented in this website is for the purpose of information only. Yes, I am a doctor, but I am not your doctor and we have not established a patient-doctor relationship (although I’m so glad you are reading the information in my posts!). Conclusions drawn from the information in this website are entirely your own, created from your own perception, knowledge, and understanding. Actions that you decide to take based on those conclusions are done by your own judgment and of your own accord. Nothing read on this site should be relied upon to replace or overrule a licensed health care professional’s judgment or clinical diagnosis
Dr. Johnson is a local physician, ultramarathoner, yoga teacher, mother of two high school runners and an all-around adventure-seeker.