Amenorrhea

I have suffered from Amenorrhea for many years. As I navigate the road to recovery it seems like now is the right time to talk about my experience more openly, in the hope that it might raise awareness and help others in providing a source of knowledge.

The simple definition of Amenorrhea is the absence of menstruation, which for me began in my early twenties. I’m now 30, so that’s nearly a decade of abnormality, physiologically speaking. I was road racing at this time, and also working and balancing a degree in Architecture. With cycling being such an integral part of my life, mental and physical stress levels were elevated over a period of time and my period went AWAL. Of course it was so convenient; one less thing to have to think about and no period to disrupt my training/racing plans! I knew that it wasn’t normal, but that it could be addressed during a more convenient time; perhaps after my studies or during the off-season. With this naivety months turned into years, and without any significant side effects to urge the situation to be addressed Amenorrhea became my normal.

In hindsight, I realise that there was (and still is) a profound lack in information regarding Amenorrhea in women’s cycling. The problem here is that the ‘walking well’ such as myself often have no bothersome symptoms of low hormones and in particular are unaware of the consequences of oestrogen deficiency. The significance of oestrogen extends beyond fertility and plays a role on tissues and organs throughout the body. Aside from infertility, oestrogen deficiency is known to increase cardiovascular disease and adversely affect bone health. As bone mass density decreases naturally with age, prevention at a younger age is crucial for bone health later on in life.

In my personal experience with road racing a lot of emphasis is placed on weight and physical performance to the detriment of personal health and wellbeing. And this mindset is easily fuelled by personal ambition and the desire to conform to an ‘ideal’. As an amateur this was my downfall, leading to a cycle of energy deficiency which led to Amenorrhea. But the fine balance of performance, health and mental well being is paramount to cycling success. Perhaps even more so when considering ultra distance, and I have a much more holistic approach to cycling now than I did 10 years ago.

The point is that the knowledge and information that I have now, gained from going through the experience would have been invaluable to my former self. I’m aware that my story is quite a typical one which is why I want others in a similar predicament to reach out and ask for help sooner rather than later.

“Researchers estimate that as many as 60 percent of exercising women may experience one component of the female athlete triad, which includes disordered eating, loss of a menstrual cycle, and loss of bone density.

When an athlete’s nutritional intake doesn’t meet the body’s needs, whether due to reduced dietary intake—intentional or not—or increased exercise, the body shuttles resources to systems that are essential to survival, suppresses energy-intensive processes like menstruation and growth, and alters hormone levels.”

I find now that it helps to think holistically in terms of energy input and energy output. Per day there is only so much energy I have (via food) at my disposal and my energy requirements are made up of BMR (Basic Metabolic Rate) and any additional activity I do. To put this into perspective my BMR is approximately 1400 calories a day if I were to be completely sedentary. I would burn through an additional 350 – 500 calories per hour cycling at Z2 or ultra distance pace dependant on environmental factors and terrain. And now for some quick maths and we can quickly see how things can potentially get out of hand for an ultra cyclist! During a typical four hour endurance training ride I would expect to burn around 1600 calories, elevating my total requirement to 3000 calories for the day. And in a race situation I could be cycling 18 hours per day, putting my total calorific requirement at a hefty 8,600.

Now, I would never expect to meet these requirements every day in a race situation (it’s a lot of food) which is why it’s best practice to go into the race carrying some surplus weight to act as a buffer. That’s not an excuse to binge on pizza during the race taper, but for the Trans Alba Race in 2019 it was a particularly important strategy in case of food scarcity in the highlands of Scotland, and also to help combat the cold and wet conditions. I still lost weight (approx 1.5kg) as expected, and I will always expect to loose at least a small amount of weight during a multi-day race, simply because the calorific requirements would be so hard to keep on top of.

So at what point does Amenorrhea occur? You certainly don’t have to be cycling crazy distances, proven by the fact that I wasn’t really cycling any long distances until I got into Audax in 2015, completing a Super Randonneur series, various century rides along with the 1200km Paris-Brest-Paris Audax. It also worth noting that I felt great; it was a good year on the bike even without a regular menstrual cycle for a few years prior to this. However this no doubt added fuel to a fire that I had long neglected.

Amenorrhea occurs when an energy deficiency creates a temporary suppression of the sex hormones (Estrogen, Progesterone, Testosterone) which aren’t crucial for survival. Other causes could include pregnancy (most common!) or a functional problem with the reproductive organs. You certainly don’t need to have the extent of an eating disorder to experience Amenorrhea, the menstrual cycle is delicate and various factors can affect it’s normal function. Thankfully I’ve never had to deal with an eating disorder but I have suffered from disordered eating. These two are distinct things and I expect disordered eating to be more common amongst cyclists than we like to admit. Disordered eating is characterised by inflexibility and a need to be in control of food intake for fear that it will cause weight gain. This trait still surfaces from time to time and I’m well aware of how it can trigger anxiety. The difference is that I have a healthy approach to food and ultra cycling has definitely helped with a shift in mindset because all ultra cyclists know that really it’s just an eating competition at the end of the day. But if I need a reminder every now and again, this is the best advice I can give.

Eat to train, don’t train to eat.

And if this means a higher weight, so be it. A number on the scales is irrelevant when health is at stake. In terms of training the idea is to fuel the body sufficiently to achieve consistency and progressive overload. With sufficient energy, quality nutrition (and sleep), recovery and progression is optimised.

Recovery

A year ago I had a Dexa Scan, otherwise known as a Bone Densitometry Scan and the result showed that my bone density was lower than average for a female of my age. Osteoporosis is also a condition that runs in the female side of my family, and this combined with the test result was enough to shock me into being proactive in making the return of my period a priority.

It was quickly suggested that Hormone Replacement Therapy (HRV) would be a route to take, which I wanted to avoid at all costs due to the frightful risks including increased risk of breast cancer, ovarian cancer, womb cancer and blood clots. The body has an incredible ability to heal if it is given the respect and help it needs, and I believe that a natural course of action should always be the first point of call.

In October 2019 I was going through a change in life circumstances and decided to take an extended time off the bike (5/6 weeks) which is the longest break I’ve taken since I started cycling over a decade ago. I also kept active and made sure to optimise my diet along with yoga and meditation to address any underlying stress. The strategy worked and my period returned towards the end of 2019, it actually felt like a miracle had occurred! Since this my cycle has been long at around 5/6 weeks, and some irregularity is to be expected as my body starts to settle into a rhythm. I have a new found fascination with the female reproductive system and the function of hormones for other aspects of health such as energy levels, mental wellbeing and bone health.

My recovery is an ongoing one, and like all things it will fluctuate especially with regards to cycling. Moving forwards the key is balance, and I believe that this can be achieved even if I plan to race across a continent in 2021. I feel stronger and happier now than I have done in a long time; perhaps it is the start of a new decade with more joy and success on the bike without compromising long term health. I have come to acknowledge that health and fitness are two very different terms, although reliant on each other to realise full potential. Health should take priority because otherwise, fitness potential is greatly compromised.

 

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