disclaimer: this post is not meant to serve as individual medical advice, but solely for educational purposes. always see an experienced healthcare professional if you have concerns.
For women of childbearing age, the menstrual cycle is like a vital sign. Meaning, if something is up with your period, it’s usually a signal that a deeper look into your health is necessary. This idea can date back centuries, when women facing stressful situations like famine lost their periods, to much more recently when so many women’s periods got wacky during the pandemic. The female body is designed to reproduce, and if it senses it cannot safely grow and carry a child, certain organs and hormones respond to stress (physical or emotional) by shutting things down until that stress is resolved.
Once upon a time, not having a period as a runner was often looked at as a good thing (or not looked at in the first place). From, “oh, it means I’m training hard enough” or “well, worrying about periods as a runner is annoying and I’m not trying to get pregnant right now, so good riddance!” to “I’ve got my eating ‘dialed in’”, I’ve heard it all.* While I think there is still a huge disconnect in some circles, it’s much more well-known now that female runners who lose their periods are either eating too little and/or running too much (=low energy availability), and their bodies are responding to that stress by halting reproductive processes. They’re also at risk for a whole host of detrimental health issues.
RED-S, briefly
The term RED-S, or relative energy deficiency in sport, was developed in the last decade to highlight the detrimental effects of untreated low energy availability in athletes. These include not only disruption in menstruation in women, but poor bone health, impaired immunity, fertility and metabolism, long-term cardiovascular risk and changes in mental health and mood. I don’t know how many female athletes have experienced RED-S at some point in their lives, but my guess is a fairly large percentage.
Who is at risk?
It’s important to note that some runners who lose their periods are not intentionally eating too little or running too much - it’s hard to keep up with the demands of heavy training nutritionally if you’re unsure of what you’re doing or have lots of other things going on in your life (e.g., job, family, etc.). For these women, it’s often easier to reverse things and restore energy balance and their cycles.
However, in my experience the majority of female runners who lose their periods are also struggling with disordered eating and unhealthy relationships with their bodies and/or exercise. In order to restore menstruation, these runners must realize their current behaviors have to change. That sounds simple, but this and this alone can take a lot of time and often requires the help of professionals (RDs, MDs, therapists and educated coaches). It can be difficult to understand how certain behaviors are negatively affecting health and let go of them if they are serving as a coping mechanism, point of control or measure of athletic success. My advice if you fall into this category: seek help from professionals who have experience working with female athletes and understand what RED-S is.
Restoring energy balance, briefly
I’ll cover this in more detail in another post. But! It’s important to know that every body is different in terms of how long it takes to restore energy balance and menstruation, as well as how much support they need (e.g., seeing a specialized dietitian). Eating more, and eating more consistently, helps the body feel safe and eventually can regulate stress and reproductive hormones. I can’t emphasize enough that eating more of ALL FOODS is key. I commonly hear in the running circles the advice of “eating more healthy fats” to restore menstruation, and while fat is important (it has more energy per gram than protein or carbs), it’s most often carbs that women are restricting or afraid to eat. And the body needs ample carbs to menstruate. To be continued…
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*not really. just when you think you’ve heard it all you realize you definitely haven’t.