Female Athletes and Menstruation

How Low Body Fat In Female Athletes Causes Stop In Menstruation

By Sue Marquette Poremba

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In October 2004, Serena Williams lost in the second round of the Generali Open in Linz, Austria. It was more than a bad day on the court for this superstar tennis player. On that day, Williams suffered an excruciating menstrual migraine. She has been plagued with these migraines since she was a teenager.

Menstruation is a fact of life for nearly every teenage girl, but young athletes have concerns that their monthly cycle will disrupt their training or competition. While situations like Serena Williams's migraine aren't overly common, athletic teens do have to take nutritional and hormonal changes into consideration during their workouts.

The Body Fat Connection

Physically active teenagers might find that they have infrequent periods. It is not unusual for teenagers, especially young teens who have recently begun menstruation, to have irregular periods. Also, very active teens tend to have lower body fat levels than their non-athletic peers. Because fat stores estrogen, girls who have a small body-fat percentage can sometimes stop having periods. Teenagers need to keep track of their cycle and note the frequency and the length of the bleeding. There are certain red flags that, should they occur, the teenager should contact her gynecologist:

• If more than three months pass without a period
• If bleeding lasts for more than 10 days
• If the time between periods is less than 21 days

Because menstruation and body fat are so closely linked, athletic teenagers need to make sure their body fat is kept at a healthy level, which for girls between the ages of 14 and 19 is 20 percent. According to Barbara Dehn, an RN and nurse practitioner in Mountain View, Calif., when a girl drops below that level of body fat, her pituitary glands can shut down. This can cause depression, and the lower estrogen levels means that the body cannot properly absorb calcium. This can lead to bone fractures.

The Nutrition Connection

To ensure a healthy level of body fat, athletic teenagers must eat a healthy diet. Nutrition is important for all teenage girls and women, but athletic teens have additional needs, particularly during menstruation. "There is an increased need for calcium and iron," says Jessica Adler, a registered dietician with LiveHealthier.com. "Athletes especially need more iron when bleeding."

Adler suggests eating a lot of meat, eggs, vegetables and fortified cereals. "Vitamins A, C and E are needed for new cell growth," she says. Also, the athletic teenager needs to make sure she is getting enough calories, especially carbohydrates. Adler recommends between 55 and 60 percent of calories coming from carbs and 20 to 30 percent coming from fats.

Staying hydrated is very important as well. Adolescents tend to sweat differently than adults and can have a difficult time keeping their body temperature regulated. Not surprisingly, menstruation changes the way the body sweats. "The active girl will actually sweat less during the later part of her cycle and can become overheated more easily," says Dehn. "Sweating helps us dissipate our heat, so watch and monitor how you feel at different times in the cycle."

A Positive Spin

One benefit to being an athletic teenager is the likelihood that PMS will be less painful than it is for non-athletic peers. Experts tend to agree that increased activity lessens cramps, back aches or moodiness. (However, it is important to note that being active doesn't mean PMS will completely disappear.)

Cathy Clamp of Brady, Texas, was a weightlifter as a teenage girl. Before she began training regularly, she would frequently suffer from stomach cramps. "My coach told me early on that cramps could be easily controlled by sit-ups," she says. "So I would do more sit-ups. Not only did it relieve the cramps, it would also make my actual bleeding heavier at the front end, and then it was over in a day or two, rather than the whole week. I've done it ever since."

Clamp also says that the moodiness can work in the teenage athlete's favor. "Frankly, there's nothing better than a 'don't tick me off' attitude before competing," she says, laughing.

Menstrual migraines, however, do not appear to be lessened by an active lifestyle. According to Endo Pharmaceuticals, there are two types of menstrual migraines: menstrually related migraines and pure menstrual migraines. Menstrually related migraines are painful headaches that happen during the period, but can happen at other times of the month as well. A pure menstrual migraine happens only during the period and is believe to be caused by the drop in estrogen.

The Coping Connection

Most PMS-related issues can be easily overcome with proper nutrition and over-the-counter non-steroidal, anti-inflammatory pain killers when necessary. There is little scientific research that proves the menstrual cycle slows down a teenage girl's athletic ability. Menstrual migraines are an exception, and can stop even the most elite athletes. Teenage girls who suffer with menstrual migraines should discuss treatment with their health-care provider.

For many teenagers, however, the biggest concern is finding the proper feminine hygiene product to wear while competing or training during their period. As long as they are changed frequently to avoid Toxic Shock Syndrome (TSS), tampons are the best method for most sports. For girls who will be competing without the opportunity for a break, such as long-distance runners, try a pad with wings for extra reinforcement. As long as the athletic teenage girl remembers to care for her overall health needs, her menstrual cycle should rarely put a cramp into her ability to perform at her best.