For the Ladies….
It is Eating Disorder Awareness month and I find myself fortunate to have never really struggled with food. It was always fuel that I needed for training and I knew that eating well helped me perform at my best. Another health issue for athletic women is menstruation. Others have talked about it recently, (Angela Naeth Blog, Angela on a podcast, Paula Radcliffe, The Guardian here and here) and it seems periods and athletics can be a bit confusing. Is it being too skinny? Is it too much activity? Is it what you eat? It seems that you can find any answer you want on the internet, something that is true for pretty much anything these days.
I want to write about my experience (any guys reading this can navigate away from this page now if you want) with periods, athletics and health. It should be noted, I am NOT a doctor. I have NOT done any studies. This is my experience and interpretations alone. We are all different and our bodies respond in different ways to training and other stresses.
I got my period when I was almost 16, or maybe it was at 15, but whatever, I was probably a bit later compared to my friends. I was thin, relatively tall and was training very intensely in the pool. Once I started my period it was regular. Every 30 days or so through college. I never missed one. Cramps and PMS were minimal; probably due to my level of activity and a bit of luck. For the first day of my period my back would be a little crampy but nothing so bad that it limited my activity. I think I was, and currently am, fortunate in that regard. I was never on the pill in high school or college. I have to say, something about the pill put me off from the very beginning. I just remember thinking “I don’t want to take hormones, that’s weird.”
After college I moved to Chicago, started working full time, went to the gym for 45-60 minutes a day for exercise and partied a lot. Eventually I did go on the pill, probably at 25 or 26. I can’t really remember the impetus for this, probably a combination of having some adult acne problems and a serious boyfriend. It was around this time that I began running and eventually ran my first marathon in October 2004.
There I am running my personal best marathon, 4:06. I look a bit puffy in the picture. After this race I ended up getting a stress fracture in my tibia. I did not take much time off after running the marathon, got shin splints and like a complete idiot, I decided that running “through” them was the best option. I remember rationalizing that because the pain went away after I warmed up it was okay. So stupid. It worked until I stepped off a curb at the corner of Southport and Lincoln in Chicago and I felt an intense sharp pain in my lower leg. I ran the 2 miles home and was diagnosed with a stress fracture a couple weeks later, after I returned from a ski vacation, another genius move. At this point my doctor wanted a Dexa Scan to check my bone density. It was a teeny bit low but it was my first scan. We had no way to know if the bone density had gone down from some other baseline number in the past. Plus, my mom also has lower bone density as well. And, I always wonder if being a swimmer and spending my entire life in the pool contributed to a lower bone density. I have read about professional cyclists having lower bone density because they spend all their time on the bike and don’t do any exercise with pounding (running, jumping rope, etc). Anyway, my doctor freaked a bit about my bone density. In my head, I figured the stress fracture came more from me being a moron than my bones failing me.
After my stress fracture healed I got more into triathlon. I liked the variety in training and it was a big plus swimming was a part of it. At this point, and I truly can’t remember why, I decided to go off the pill. Once I was off it I felt like my training improved and I had more internal motivation to push myself. It’s weird to say, but I felt like the pill flattened me out emotionally or something. Also, I still thought taking hormones was wrong, at least for me, anyway.
When I went off the pill I had a few periods and then they stopped. I was not crazy lean or restricting my food, but I just stopped having them. I will be honest, I found it convenient. I was not having a rash of injuries and I was getting faster so I just ignored it. I remember going to see a nutritionist who thought I was not eating quite enough for my activity level so I ate a little bit more but I still did not get a period. When I would go in for my yearly check up my doctor would be very concerned. However, her solution most often was to put me back on birth control after she ran a few blood tests that indicated slightly low estrogen. I remember questioning this by arguing that birth control was not really fixing the problem; it was just masking it and forcing my body to have a period unnaturally. However, since she pushed so hard, I went on the Nuvaring for 3 months (Jenny Fletcher’s story), absolutely hated it and I have not taken hormonal birth control since 2008.
I was racing pretty well in the late 2008-2009 time frame. I qualified for my professional license at Escape from Alcatraz in June 2009. We moved to Napa in March 2010. I did not have a period for 2.5-3 years. Yep, you read that correctly. I was still eating well and not restricting food intake all while training quite a bit. I was still improving athletically. My doctor in Napa seemed to be a little more chill about the lack of a period. She mentioned something about uterine fibroids because she told me if you don’t get rid of the lining in the uterus fibroids could possibly develop.
In the middle of the 2012 season I got my period. It was a little shocking. However, I did feel a sense of relief. I wanted to be healthy and I had started to worry I would race until I was 40, never get a period and then slide right into menopause. I knew that was not healthy! I had a period for a few months, skipped a couple months and then once I hit the off season it came back. Since then, no joke, it has been regular through the 2013-14 race seasons.
Here are my thoughts on why it disappeared for so long and then started up; I think I was just on the edge of being overworked. My body could handle the training (no major injuries during that time) but having the energy to do a monthly period was too much. I think once my body totally adapted to the work it was able to handle a monthly cycle. From 2010-present, if you look at my training hours, they have steadily increased each year as I have gained more strength and endurance. However, maybe at the very beginning, I needed to lessen the training slightly, eat a little more fat (???), and allow my body to have the energy to do what it is supposed to do.
This is why I think menstruation and the female athlete is more than just about how much you weigh and your body fat percentage. There is no magic weight or percentage of body fat that is going to make you have a monthly period. In 2006-2008 I looked different than I do now (body composition wise) and I was not menstruating at that point. I think it is about your health and the stress you put on your body. These stresses can be from life, work and training combined.
My advice is to know your body. I probably should have been more concerned about not having a period for 3 years. Perhaps a few simple changes would have led to better reproductive health more quickly.