My second dietetic intern has a story and a message worth sharing. Read her first blog post all about the female athlete triad, a topic near and dear to not only her heart, but mine.

By Kara Peters, Dietetic Intern at the University of Saint Joseph

I was fortunate enough to be a three-sport athlete in high school and the two most common things my teammates complained about were 1) coaches making us run sprints and 2) periods/cramps. My closer friends on the team didn’t hesitate to express to me how painful their cramps were and the heaviness of their period. Although I was fortunate enough to have pain-free, lighter periods, I still dreaded my time of the month. The mystery of its arrival and wondering if I’ll need to change my pants is still never fun.

Then one random day during junior year, my period decided not to show up…for a whole year. I was PUMPED! Especially because I didn’t have to deal with it during soccer and tennis playoffs. I told one of my close friends and she responded “ughh I’m so jealous, you’re so lucky!”. Do you think I told my mom? Nope! Do you think I told my female coaches? No way! Do you think I wanted to tell my doctor? No! I was happy as could be!

Although I didn’t bring it up to her, my mom was being attentive, as moms can be, and she noticed of course. She dragged me to the doctor and my mom expressed her concerns. This is verbatim what my doctor said: You don’t need to worry, getting a period isn’t a required body function, you’ll be just fine, it’ll come back.

Although I took a health class in 5^th and 9^th grade and I was an A-B student, I still never fully understood the underlying importance of menstruation. All I knew is that it was important to have so a woman can have a child one day and that I needed to stuff my backpack with feminine products. I was never aware of menstruation’s relationship to hormonal and bone health. Someone please tell me I’m not alone.

According to a recent study published in the North American Society for Pediatric and Adolescent Gynecology, 49 percent of high school female athletes thought losing their period was normal. This a staggering statistic and proves that indeed, I wasn’t alone. Losing your period is not normal or healthy. I know it can be uncomfortable to talk about, even with friends, family, a physician, or a registered dietitian but it can’t just be swept under the rug.

I’ll admit it, losing my period for those 12 months was a relief! But looking back now, I shouldn’t have been pumped, my friend shouldn’t have been jealous, and I wasn’t lucky. I completely understand that bleeding every month is very inconvenient, painful, and can be perceived as “embarrassing” -but without a natural, monthly period, serious short and long-term health consequences can occur. NINE years later I’m JUST learning this. That’s a real issue.

If you lose your period, your body is telling you it doesn’t have enough energy available to maintain the reproductive system. Your body suppresses “less essential” functions (menstruation & reproduction) in order to conserve energy for life-sustaining bodily systems (heart, lungs etc). Although menstruation is the first to go when caloric + nutrient intake is restricted, it is still a crucial part of bone health, fertility, and several other functions.

Unfortunately, this is a very common occurrence among female athletes. According to a very large study published by the American College of Sports Medicine, up to 60 percent of athletes had lost their period for 3-6 months and up to 40 percent had low bone mineral density. Because this is such a common situation, the loss of a period, plus inadequate caloric intake, plus damage to bones has been termed the Female Athlete Triad.

The Female Athlete Triad

In official terms…

Three interrelated conditions found in physically active females involving one or more of the following:

Menstrual Dysfunction (MD), Low Energy Availability (EA) with or without an eating disorder, and Low Bone Mineral Density (BMD).

By consistently consuming enough calories + nutrients to support all bodily functions AND replacing the energy spent from exercise… the body says, “okay it’s safe enough to spend energy menstruating”. These two processes are essential in supporting the body’s ability to build/retain bone mass for optimal bone health.

By not consuming enough calories and nutrients (whether purposeful or accidental) the body says, “I don’t have enough energy to menstruate this month.” If treatment is delayed or the athlete remains untreated, she can lose 2-3% of bone mass per year and can face osteoporosis much earlier in life.

Since the age of 5, I was constantly active and involved in several sports year-round. Reflecting back to my junior year, I lost my period because my body just couldn’t handle the stress of exercise anymore, even though I was consuming enough calories to maintain my weight and body fat. Exercise releases the hormone called cortisol, which is also released during stressful situations. Everyone has a different threshold of when stress from exercise and daily life begins to interfere with the ability to menstruate. At the time, I was also extra stressed because I was preparing to take the SATs, along with a heavy course load. My body was spent.

When cortisol levels are high, the body is less sensitive to estrogen. Adequate estrogen levels are essential in the process of menstruation and building/retaining bone mass. Synthesizing enough estrogen requires adequate body and dietary fat. Body fat cells produce estrogen, so without an adequate percentage of body fat, they won’t produce enough estrogen. Usually, 17 percent body fat is needed to stimulate the first period and about 22-23 percent body fat for maintaining regular periods. Dietary fats assist in the absorption of vitamins A, D, E and K. Vitamin D and Calcium work together and play very important roles in the ability to build/retain bone mass, therefore it’s important to ensure you’re consuming enough of both every day.

Calcium Recommended Dietary Allowance (RDA)

Females 9-18 years: 1300 mg per day

Females 19-50 years: 1100 mg per day

Vitamin D Recommended Dietary Allowance

Females 1-50 years: 600 IU (15 mcg) per day

My bones and body took a serious hit during that year I was without my period. I was still a young, growing girl for heaven’s sake! Females accrue 90% of their bone mass by age 18. Therefore, it is essential that young women have monthly periods and gain as much bone density while they still can. Bone mass continues to accrue into a female’s late 20’s but at a slower rate and they only have 10% to gain after the age of 18. The window of opportunity for females to accumulate as much bone mass as possible is very short, which is one of the many reasons as to why this is such an important topic!

Birth control makes this whole situation tricky. Thankfully I didn’t accept my doctor’s offer for a birth control prescription, so I was able to assess what was really going on with my body. But this isn’t the case for some girls. Most physicians are quick to prescribe the pill because it’s requested by girls to “solve” their acne and “fix” or “start-up” their period. Getting your period while on the pill is called a withdrawal bleed which is different from your body’s own physiological period. It’s called this because the placebo pills at the end of the pack have lower levels of hormones, “withdrawal of hormones – hence withdrawal bleed” which then mimics a “period”. Your body isn’t going through an actual menstrual cycle. Getting your “period” on the pill doesn’t always mean you would also get your period off the pill, especially if you weren’t menstruating prior to taking the pill.

Although the Female Athlete Triad consists of three components, athletes may present with only one or two conditions.

If you feel that you may be at risk for the Triad or if you think you may have one or more component, please speak openly with your parents/guardians, gynecologist, physician, and dietitian immediately.