Dear Female Runner, It's Not Normal to Lose Your Period

When I was 16 years old, I started training for competitive racing for the first time in my life. (Well, except for one awkward freshman cross country season where I was still playing competitive club soccer and my main goal during races was not to throw up, but that's besides the point.) I had finally decided to make the switch from soccer to track, and was training with the distance team with the intent of running events such as the 800 and mile. Soccer had always kept me in fairly good shape, but competitive running was a whole other level of commitment and endurance. I went from focusing on quick bursts of soccer-specific speed to running 5 miles a day with workouts 2-3 times a week. It was a big transition for my body both mentally and physically, but I hadn't realized just how much of an impact it was having on me until a few months later, when I realized that I hadn't gotten my period since the winter season.

Looking back, it's painful to admit how long it was before I actually become concerned about this issue. In fact, in the beginning, I almost looked at it as a semi-positive thing (insert cringe). A few months without having to worry about unfortunate wardrobe accidents or forgetting to put a tampon in your backpack? What's not to like?

The answer to these questions: EVERYTHING.

I didn't truly understand how serious of a problem this was until my yearly physical came around at the end of the summer. The attending nurse was going through her series of routine questions when she asked, "When was your last menstrual cycle?"

I paused and pursed my lips in thought, thinking back to my last period, then panicking slightly when I realized that it hadn't been in the last 6 months. I slowly answered, "I'm not exactly sure, maybe around Christmas?"

The nurse stopped typing and looked at me, confused. "Is your period usually so irregular?" she asked for clarification. I shifted awkwardly in my seat, then shook my head and responded, "Not normally, but it has been for the last half year or so."It was becoming obvious to me now that this wasn't a good answer. I played with the ends of my shirt and stared at my feet, suddenly very uncomfortable with the whole conversation. She looked at me for another couple seconds then nodded and jotted something down on the computer.

My doctor came in a few minutes later, and - unsurprisingly - was equally as concerned about this issue. She started asking questions about my level of physical activity, then raised her eyebrows when she looked at my chart. "Wow, you've lost a lot of weight over the past 6 months," she observed. I shrugged, unsure of what to say in response. At this point, I really just wanted to go home. She tapped her pen against her clipboard and asked, "Have you had any injures lately, like stress fractures or stress reactions?" I paused, "Well, actually, I have been dealing with a lot of foot pain lately whenever I run. And I has some problems with my hip a couple months ago." She nodded and said, "I'm going to refer you to a specialist at the Female Athletes Clinic. Be sure to keep track of the time that passes before you get your next period."

Newsflash: I didn't get a period before my appointment three months later. It had been upwards of 9 months at that point since my last menstrual cycle, and I was starting to get really worried. After my physical that summer, I immediately went home and did research on the consequences of losing your period (in clinical terms, the name is "amenorrhea") as a young woman. None of them were good, and some were outright scary, like its link to fertility issues and loss of bone density.

I met with a couple different health professionals that day. The first was a sports orthopedist who discussed my foot/hip issues and ended up sending me to get a bone density exam a couple weeks later. The other one was a registered dietitian, who wanted to talk about my daily nutrition intake. I immediately noted a difference in how she discussed food compared to all other health professionals I'd had in the past; she referred to calories only as "energy," and food as "fuel." When I'd finished describing what a typical day of eating looked like for me, she did a couple quick physical exams and then left the room for about 10 minutes. When I think back to this appointment, it is obvious to me now how restrictive and minimal my eating habits were at the time. I'd cut out entire food groups like dairy (because I thought I had a "problem" with lactose - I don't), essentially avoided all forms of added sugar, and was very conscious of my carbohydrate intake, having strict food rules like "no more than two slices of bread a day." I was clearly struggling with disordered eating and know that the dietitian was well aware of it as well, but in all honesty, I didn't really believe that I was doing anything wrong. After all, I was just following the advice of so many "health influencers" or adhering to common nutrition myths that I'd been taught since adolescence.

I thought that I was just "eating healthy," when in reality that couldn't have been further from my the truth.

When the dietitian returned to the room later on in the appointment, she handed me a sheet of paper with a list of notes and a variety of foods bulleted beneath it. Let me preface this part by saying that if you're dealing with amenorrhea or other nutrition/eating issues, it's important to meet directly with a registered dietitian to discuss a personalized plan for you. Everyone is different, and every person has different nutrition needs that are based on a variety of factors. However, I do think it's helpful to share a few pieces of advice I received that are applicable to all athletes.

First off, pre and post workout nutrition -- I unfortunately had become accustomed to fasted cardio and strength workouts in the morning, and didn't really prioritize fueling after my workouts were complete. This is a BIG no-no in the sports nutrition world. I had it explained to me in this way, and I think it's a really helpful description of why fasted workouts are not the way to go: Let's say you go to bed around 10 pm and wake-up at 6 am the next morning. That's 8 hours you've gone without eating, which means your fuel tank is at a low. Then you immediately jump into a run, which drains your tank even further. But where does your body get the energy from if you were already on low to begin with? Well, it has to tap into other resources, like fat storages (reminder that carbs are your body's preferred source of energy). This can cause a lot of health issues over time, including hormone disruption, increased risk of injury, amongst others. Not to mention if you're anything like me, you feel like you have the strength of a stick figure when you work out fasted, dealing with other side effects such as nausea and dizziness. If you want

to feel strong during your workouts, try to eat a high-carb snack (think pretzels, toast, granola/energy bars) before your runs or practices to fuel your training sessions, even if you're not hungry first thing in the morning. Believe me, your body will thank you later. But that's not all: it's also important to make sure you're properly fueling after your workouts as well to refill your tank and restore all the resources used during practice. If you're eating a meal immediately after, great! But even if you're not, it's still important to eat a snack within 60 minutes that has a good mix of both carbs and protein. Chocolate milk is always a tried and true staple, not to mention absolutely delicious.

Secondly, the importance of snacking -- yep, you read that right. I used to think that snacking between meals wasn't a good thing or even really necessary, but boy was I wrong on both fronts. If you're an athlete, three meals a day is almost certainly not enough. Read that again. And this goes beyond just pre and post nutrition. Eat breakfast at 7 am and not have lunch until noon? Insert a midmorning snack. Hungry after dinner before you head to bed? Make yourself a night snack. I was told to aim for 2-3 snacks a day in addition to three balanced, filling meals, at a minimum. If you're still hungry, absolutely listen to your body and whip yourself up an additional snack/meal. Nutrition is so overcomplicated today with all the conflicting advice/recommendations constantly being released, but the most important thing is to make sure that you're eating enough. So, as painfully obvious as it seems, that means if you're hungry, you should get something to eat. Even if goes against one of your arbitrary food rules like eating after 7 pm or snacking immediately after lunch because the meal just didn't fill you up. Our bodies are super, super smart and know what they need, we just have to listen to what they are telling us. It's also important to note that when I say "snack," I don't just mean an apple or handful of pretzels. I'm talking about a fueling mini-meal with at least 2 food groups, say dairy + fruit (yogurt with berries), carbs + fat (toast with peanut butter), and so on.

At the end of the day, I left that appointment realizing how much I was underfueling my body, both intentionally and unintentionally. I just didn't have the education on what and when I should be eating as an athlete, not to mention the amount of food I should be consuming to meet my energy needs. Sports nutrition is different from regular nutrition, and it's important that athletes are aware of the distinction and don't fall victim to generalized nutrition advice from "diet culture" as I did as a high school runner. I later learned that I was suffering from something called "Female Athlete Triad," which occurs when there is the presence of (1) low energy availability, (2) loss of menstrual cycle, and (3) decreased bone density. It's unfortunately so common among female athletes, particularly in sports like distance running, that it has its own diagnosis, despite still being far too often missed among the athletic population. I didn't recognize the signs - heck, I didn't even know what Female Athlete Triad was until after the fact - and I think an unquestionable contributing factor to that is how issues such as losing your period is often see as "uncomfortable" or "awkward to talk about."

That issue is at the heart of why I wanted to write this blog post. It's important that we bring attention to and discuss problems like amenorrhea because it's a real issue with lasting health consequences, and it shouldn't be something that anyone is embarrassed to talk about. So yeah, I lost my period, and it took a really long time before it came back. But I was fortunate to have people intervene when they did and step in before it was too late. Losing your period is nothing to be ashamed about, but it is a serious problem, and it definitely isn't normal, not ever, not even if you're a female runner training 6x a week and running lots and lots of miles. You can train your butt off, meet your performance goals, AND still (should) get your period. Because as Kylie Oblak penned on her Instagram @kylierunssmiley, "Women stand on podiums, not little girls."