The Mystery of Amenorrhea: The Misconception Among Female Athletes That "Not Having a Period is Normal"

"Training to the point where your period stops is actually proof of hard work." Such an atmosphere still lingers in some sports environments and diet cultures. However, the truth is quite the opposite. Changes such as irregular or absent menstruation might be a sign that the body is prioritizing survival over reproduction. The original article treated amenorrhea, which is common among highly active women, not just as a phenomenon but as an issue reflecting overall health. By tracing public information and related expert comments, factors like energy deficiency, hormonal imbalances, and often overlooked impacts on bones and mental health come to light.

The menstrual cycle is not just an indicator of pregnancy. Having a regular menstrual cycle is also a sign that the brain, ovaries, thyroid, metabolism, and nutritional status are functioning in a balanced manner. The NHS considers cycles shorter than 21 days or longer than 35 days as irregular, and U.S. women's health information indicates that irregular, heavy, or painful menstruation can be a sign of health issues. In other words, irregular cycles are not just a "common occurrence" to be dismissed.

There are several types of amenorrhea, but currently, functional amenorrhea occurring in highly active women is particularly noteworthy. If someone who previously had regular menstruation does not have a period for more than three months, or if someone with previously irregular menstruation does not have a period for more than six months, it requires evaluation as secondary amenorrhea. Professional societies and clinical information suggest that, while excluding pregnancy is a priority, multiple causes such as PCOS, thyroid abnormalities, hyperprolactinemia, primary ovarian insufficiency, medications, eating disorders, and severe stress should be systematically investigated.

So why is there a connection between exercise and menstrual cessation? The key is not so much "how much you exercised" but rather "whether you are eating enough to recover from the energy expended." Expert comments published in a German gynecological media explain that sports-related amenorrhea occurs not so much from intense physical activity itself but from a chronic state where energy expenditure exceeds energy intake, compounded by physical and mental stress. The IOC's RED-S consensus document also outlines that a state of low energy availability, where the energy remaining after subtracting exercise expenditure from dietary intake is insufficient, can affect reproductive function, bones, immunity, cardiovascular systems, and performance.

When the body lacks energy, it begins to conserve from functions not directly linked to survival. A prime example is reproductive function. Developing follicles, triggering ovulation, and preparing the uterine lining require extra energy. Without this surplus, hormonal signals from the hypothalamus in the brain weaken, making ovulation less likely, and menstruation ceases. This is not a "lazy body" but a body applying the brakes, signaling "it's dangerous to go any further." Therefore, one should not judge solely based on whether someone appears too thin. In fact, experiences shared on social media repeatedly highlight cases where menstruation stopped even though the person was not obviously underweight, and that weight alone was not a measure of health.

The most significant reason not to take amenorrhea lightly is that its impact extends beyond just "not having a period." Prolonged low estrogen levels disrupt bone metabolism, hindering the accumulation of bone mass that should be built during youth. Expert commentary emphasizes that early intervention protects against decreased bone density in young people, and research summaries report that female athletes with amenorrhea had lower spinal and overall bone density than those with menstruation. Furthermore, the RED-S concept suggests it can broadly affect mood, concentration, sleep, immunity, and training efficiency. In other words, amenorrhea is not a shortcut to improving athletic performance but could be the starting point for long-term performance decline.

It is also not unrelated to fertility. Women's health information sites indicate that irregular menstruation or amenorrhea may suggest a lack of ovulation, with ovulatory disorders being a major cause of infertility. The NICHD also explains that amenorrhea can be related to health conditions affecting fertility. Of course, menstrual irregularities do not immediately render future pregnancies impossible. However, postponing concerns with "I'm not thinking about pregnancy now, so it's okay" is risky. The few years of youth are a critical time affecting bones, hormones, and one's future.

What's important here is not to assume "the cause is only sports." Menstruation can be disrupted by pregnancy, breastfeeding, menopause transition, PCOS, thyroid disorders, hyperprolactinemia, rapid weight changes, mental stress, eating disorders, and medications. The ASRM suggests that evaluating secondary amenorrhea should involve a detailed medical history, hormone tests, and ultrasounds as needed. In other words, what is needed for those who have stopped menstruating is not self-imposed endurance but a medical perspective to sort out the causes. What might seem sports-related could actually hide another endocrine disorder.

How is this issue perceived on social media? Recent observations on Instagram and Reddit reveal four major reactions. First, the realization of the "misconception" that "it's normal for women who train hard to stop menstruating." Second, sharing experiences that "even without being too thin, periods can stop due to calorie deficiency or stress." Third, reports of recovery by "increasing food intake, incorporating rest, and adjusting exercise." Fourth, the pressing anxiety of "not knowing where to start" and "wanting to recover while continuing to compete." Although not as rigorous as medical papers, these voices reflect the reality that amenorrhea is not just an issue for elite athletes but also extends to club activities, hobby runners, gym-goers, and those dieting.

Particularly striking are the numerous posts stating, "I was told by healthcare providers and those around me that it's okay not to have a period if you're exercising." In response, accounts dealing with female athlete nutrition and RED-S strongly emphasize that "missing periods is not normal" and "it's not proof of tough training but a warning from the body." While social media can be a breeding ground for misinformation, on this topic, it plays a role in breaking the silence of those affected and questioning the "normalization" of the issue.

The principle of addressing this issue is not to suppress symptoms but to unravel the causes. Public expert comments highlight that the core of treatment is correcting energy deficiency, increasing food intake, reviewing training intensity and volume, and setting recovery days. It is desirable to support with a multidisciplinary approach involving gynecology, endocrinology, nutrition, and psychology as needed. Hormone therapy may be considered, but it alone does not resolve the low-energy state. The resumption of menstruation is a goal, but the essence is to "restore a state where the body can judge it is safe."

Menstruation is often spoken of as a nuisance. However, from a different perspective, it is a health report delivered by the body every month. Irregular cycles or sudden cessation are not silences to be dismissed with "I'm still young," "I'm exercising," or "I'm busy." Rather, they serve as an entry point to reassess one's condition, including daily performance, future bone health, mental stability, and fertility. Those who are working hard should not regard a stopped period as a "badge of effort." There is a reason from the body for absent menstruation. Listening to that reason is the first step towards recovery.

*Medical diagnosis cannot be made from the article alone. If you have not had a period for more than three months, or if you experience cycle irregularities along with fatigue, susceptibility to fractures, mood changes, or sudden weight fluctuations, it is safe to consult a gynecological or endocrine medical institution.

Source URL

https://www.aerztezeitung.de/Medizin/Amenorrhoe-Was-ein-unregelmaessiger-Zyklus-ueber-die-Gesundheit-aussagt-462247.html

German gynecology article (used for background on sports-related amenorrhea, RED-S, effects on bones, mental health, fertility, and response strategies)
https://gyn-community.thieme.de/aktuelles/panorama/detail/ausbleibende-periode-trotz-training-warum-zyklusstoerungen-bei-sportlichen-frauen-ernst-zu-nehmen-sind-51348

German Endocrinology Society press information (used to confirm the society's message that "missing periods is not normal")
https://www.endokrinologie.net/pressemitteilung/wenn-die-periode-ausbleibt.php

NHS explanation of irregular periods (used as a guideline for irregular menstruation)
https://www.nhs.uk/symptoms/irregular-periods/

Office on Women’s Health (used to indicate that irregular periods can be a sign of health issues or difficulty in conceiving)
https://womenshealth.gov/menstrual-cycle/period-problems
https://womenshealth.gov/menstrual-cycle/your-menstrual-cycle-and-your-health

MSD Manual Professional (used for the definition of primary and secondary amenorrhea)
https://www.msdmanuals.com/professional/gynecology-and-obstetrics/abnormal-uterine-bleeding/amenorrhea

ASRM committee opinion (used for the differentiation, testing, and evaluation flow of amenorrhea)
https://www.asrm.org/practice-guidance/practice-committee-documents/current-evaluation-of-amenorrhea/

IOC's RED-S consensus document PDF (used for low energy availability and its effects on bones, reproduction, cardiovascular systems, and performance)
https://www.casem-acmse.org/wp-content/uploads/2024/11/1073.full_.pdf

Boston Children’s Hospital (used to indicate that amenorrhea can be a sign of RED-S)
https://www.childrenshospital.org/conditions-treatments/female-athletes-and-menstruation
https://www.childrenshospital.org/conditions-treatments/reds

NICHD (used to indicate that excessive exercise, stress, and eating issues can relate to amenorrhea)
https://www.nichd.nih.gov/health/topics/amenorrhea/conditioninfo/causes
https://www.nichd.nih.gov/health/topics/factsheets/amenorrhea

PubMed summary (used for research summary indicating lower bone density in female athletes with amenorrhea)
https://pubmed.ncbi.nlm.nih.gov/18519482/

SNS reaction reference example 1: Reddit (used to understand personal experiences, exercise volume, low nutrition, stress, and recovery process)
https://www.reddit.com/r/Amenorrhearecovery/comments/1rmfzfk/ama_period_recovery_dietitian/
https://www.reddit.com/r/Amenorrhearecovery/comments/1hj5lna/too_active/
https://www.reddit.com/r/Amenorrhearecovery/comments/1s7yf3e/period_loss_endurance_sports/
https://www.reddit.com/r/Amenorrhearecovery/comments/1hhk7x5/got_my_period_back_while_staying_active/

SNS reaction reference example 2: Reddit (used to understand voices stating "it happens even if not underweight" and "it was a sign something was wrong")
https://www.reddit.com/r/xxfitness/comments/4llqxn/lost_periods_my_experience_and_how_it_might_help/
https://www.reddit.com/r/xxfitness/comments/2x2ujl/two_missed_menstrual_periods_normal_for_athletes/
https://www.reddit.com/r/xxfitness/comments/2kk0hp/in_response_to_all_the_girls_wondering_if_their/

SNS reaction reference example 3: Instagram (used to confirm trends in awareness posts stating "missing periods is not normal")
https://www.instagram.com/reel/DOnTmRyj2de/
https://www.instagram.com/p/DWTcAFDl2QG/
https://www.instagram.com/p/DOnTmRyj2de/