Question for the ladies

Yes, I am a guy but I also coach many competitive female athletes who are or have been amenorrheic.

I deal with this more than I care to admit.  And 9 times out of 10 when you have a female with low body fat (yes you have relatively low body fat) AND an intense training regiment one of those have to be reduced. 

Basically your body is experiencing lots of training stress and your body, based on nature, says you should not reproduce because that would add more stress.  That is why you are not having your period.  The body looks to see if you are 'healthy' enough and when you combine close to visceral fat levels and high training stress that triggers a safety mechanism.

As long as your OB says it's not a problem, then you're good.  I personally like to keep an eye on this as a coach.  And yes, I do keep track if my female athletes are amenorrheic or not.

Note:  I'm NOT a doctor and I did not stay at a Holiday Inn Express either.

as a doc I will tell you that I do think you are pretty lean for your height.

There is some data about the intensity and frequency of cardio leading to amenorrhea

Usually I put my athletes on the pill just to keep their hormone levels stable until they want to ease up on training.

Just my two cents:

Unless you WANT to become pregnant, I don't see a problem here.  It's "normal" for a female athlete to not have her period.

If you WANT to become pregnant, you probably need to tone down the exercise and/or increase your body fat percentage.

I was on the pill for years.  In fact, the last one was Loestrin from 2007-2011.  Then I decided to stop using synthetic hormones and start using alternative methods for contraceptive.  With the Loestrin, I started to see the loss of the period.  My OB said that was a very normal side affect of that particular oral contraceptive.

But when I got off the meds in 2011 I expected the period to come back and it did not.

it is normal for elite athletes - olympic level and pro athletes. Unless the OP is making a living off of triathlon I could not disagree with you more.

Amenorrhea means that her hormone levels are off - we have data about long term effects on bone density etc  - it is NOT normal.  It is your body's way of saying you are over doing.

Personally, I would get a second opinion from another doctor.  ammenorhea is one of the points of the "female athelete triad"

http://en.wikipedia.org/wiki/Female_Athlete_Triad_Syndrome

My understanding is that you don't necessarily have to have an eating disorder to have the triad, but there are some very serious consequences including osteoperosis that can go along with loss of period.  at the very least, I would be looking into getting a bone scan.

I'm probably a similar size/build as you (bit short of 5'8" and 115-120 pounds) and, oddly, haven't had an issue with irregular or absent periods since age 20. Prior to that, yes, I would often skip months, maybe 3-4 at the longest, when I was training very hard, and never knew when I'd start--not a convenient situation!  Our coach did keep track and get after people who never got their periods to eat more/gain weight. I had a doctor suggest that I go on low-dose estrogen to make my periods more regular (which would probably have caused some weight gain) but I didn't pursue it due to possible side effects.

In my case, the issue resolved itself when I quit serious training (and gained about 10 pounds) after I finished college.  My guess is that the issue was not simply one of low body fat/hard training but probably my nutrition (I was vegetarian through most of college) and that I wasn't yet physically mature. I've seen some research that suggests the culprit may be the caloric balance rather than body fat/weight. It's possible to have a stable weight but be chronically consuming too few calories, since the body can slow down its metabolic rate.

Since starting tri training at age 40, I've become as lean as I was in college, but no irregular or missed periods--not sure why--maybe nutrition? I do know I eat a lot more, and a lot healthier, than in college. Back then runners and others were always avoiding fat and hitting the carbs, and as a vegetarian (pratically a vegan), as well as a college kid lazy about cooking, I probably ate far too little protein and healthy fat. So I wonder if the key for you might be nutrition rather than body weight/fat.

BTW I'm not a doctor, but as I recall no periods doesn't always mean not ovulating. I've had running friends who conceived when they thought they were not menstruating (?!) due to low body fat. So don't count on it as birth control LOL.  In any case, I would definitely pursue this with a doctor and/or nutritionist for your long-term health--there are well-documented risks of osteoporosis, stress fractures, etc, as well as fertility issues.

Yes, this is my thought also; however, two different OB's have both looked at my blood panels and found no hormonal irregularities.  Same thing with the pelvic ultrasound.  No irregularities.  Perhaps they're missing something?  Both are very highly regarded doctors.  Neither are concerned with the lack of period--unless I want to conceive in which case the concern is the ovulation really, not the period.

Which brings me to another thing that confuses me.  Hot Runner just mentioned that she knows someone who got pregnant with no periods.  I'm getting conflicting information on whether or not I can ovulate if I have no period--not occasional periods, I'm talking no periods.  Can you shed some light on that?

Thank you, I was hoping to hear other athlete's stories.  Interesting that the change in diet has you eating more and just as lean--yet now functioning "normally".

I'm definitely not a vegetarian, I eat chicken and egg whites pretty much daily.  I'd say I'm a moderate carb eater.  I don't avoid or count carbs, but I don't overdo them either.  I may be light for an endurance athlete, just shy of 50% of my calories from carbs.  The other 25% is split pretty evenly between fat and protein.  I don't really count calories but my guess is that I take in about 1800-2000/day and generally train 1-2 hours six days/week.

When I say that I train "strenuously", I guess I just meant that I've been a 1-3 hours x 6 days/week person for so many years.  Right now my sessions are not that intense (and always under 2 hours) as I'm working on base building for sprint tri.  Just wanted to clarify that I'm not out there putting in IM volume or doing super hard core intensity every day.  This may still be considered a strenuous amount of exercise to some but definitely not to others 

well particularly if blood work reveals normal levels (I assume they checked FSH and estradiol) then yes, you CAN become pregnant.

You do not have cycles happening where you are building enough of a uterine lining to shed (that is the reason you had no menses on loestrin)

the blood work done by OBs was a snap shot in time

overall your lack of menses suggests your overall estrogen level is too low

so, yes a weight gain of 5 pounds and backing off of cardio might fix it

It's interactions like this that help me greatly as a male coach to help my female athletes.  I want to thank BOTH of you!

But if I have lack of uterine lining and I do become pregnant, does that imply it would be very difficult to sustain it?

I ask because though I'm not trying right this minute, it is a concern for the not so distant future considering I'll be 40 in less than a year.

I wanted to add that my OB put me on two rounds of progesterone to force a period.  Neither round worked.

depends on the dose of progesterone used and which one

could be you have scarring in your uterus if no withdrawl bleed from provera

If you want to get pregnant, seriously gain 5 or so pounds and stop cardio (strength training not as big an issue)

I would probably do an HSG (hysterosalpingogram) to make sure your uterus is not scarred....

I'm sending you a PM to spare everyone else the details 

I did not have mine for almost 7 years but have been regular for the last 4 years.  I have pretty low bodyfat for a female (underwater test 1 year ago was 10.8%, at my race weight) 

The only thing that had changed when I started up again was the amount of fat that I was eating.  I eat far more fat than before.  I actually train more now and have 1-2% less bodyfat than I did for those 7 years.

Awesome   There are so many conception horror stories out there, especially for those of us close to or over 40.  It's nice to hear one with a happy ending, especially coming from another lean female with a history of amenorrhea.  Thanks for sharing!

Interesting....I never really thought about consulting a nutritionist on this but now I will definitely consider it!

I was in the exact same boat as you starting after the birth of my first child (I was 31).  At first, we thought it was the nuvo-ring, then the low-dose estrogen BCPs, but I never really menstruated again.  I did, however, conceive and give birth to our second child (I was 33 when she was born).  I did the same test as you for the same reason, and we did conceive without additional intervention.  My doctor (and my sister, who is also an OB/GYN) were satisfied that I was ovulating because of the test and thought I was weird for being concerned about the lack of menstruation. 

For additional info, I am 5'3ish and about 120lbs with a sturdy frame [wide shoulders, etc] so a little bigger than you.  The amenorrhea pre-dates my triathlon training, but coincided with an increased activity level (1 hr of relatively strenuous cardio every day).  This is definitely TMI for the guys, but I have not had a regular period since after my first child (I am 40 now) and did not even really have lochia after my second child was born.  I don't know why.  My GYN is unconcerned.  She is also an athletic woman and says that I either have low body fat or am perimenopausal, but since I take BCP to prevent pregnancy, I have enough estrogen on board to protect me from osteoperosis.  My mother started menopause in her mid-30s, and I've started with the night sweats, so it may just be my time.

Being in your late 30s, though, if you want to have children, now might be the time to get busy.  If you are having unprotected intercourse with your partner and it does not result in pregnancy in a couple of months, maybe then try gaining some weight.  What a great excuse for an extra glass of wine and a cheese plate! : )

So, what I am saying is this:  Yes, you can get pregnant without menstruating.  I have done it.  However, the amenhorrea means something, which may be that you are starting to move down the perimenopause path or that your body fat is too low.  Either way, if you are ready to start your family, I would not delay for another couple of years.