Women were designed to have regular periods, somewhere between every 23 and 35 days, which end a cycle or ‘failed conception’. Each month the body should release eggs whose job it is to find a sperm to merge with. When this fails, a period arrives, approximately some two weeks later. After the first year, periods usually establish a pattern, which become the normal cycle, and for many this continues until they reach their menopause. Others experience irregular periods, or an absence of periods altogether, which means they are not releasing eggs (see Painful Ovulation page 355).
The medical term for an absence of periods is amenorrhoea, and there are two types. Primary amenorrhoea is when no period ever arrives, which is rare, and secondary amenorrhoea, is when periods have ‘disappeared’ for in excess of four cycles. Primary amenorrhoea may be associated with late puberty or a defect in the hormone and reproductive system, and there is little that can be done to correct that. There are many underlying causes of secondary amenorrhoea though, most of which can be addressed. Your periods can become irregular or disappear because of:
• Pregnancy and breast-feeding – but this is perfectly normal. Very often when fully breast-feeding, periods will not return for between six months to a year.
• Sudden weight loss due to any illness, including the slimmers’ disease, anorexia nervosa.
• Over-exercising. Athletes and ballet dancers often develop amenorrhea, and as a result, decreased oestrogen levels, which greatly increase their chances of developing osteoporosis later in life.
• Episodes of extreme stress, e.g. bereavement or divorce.
• Undetected and therefore untreated thyroid disease.
• Anaemia and monitored deficiencies, especially of vitamin B.
• Long-term medication.
Susan was the first woman in Britain to break 70 minutes for the half marathon, in 1988. She is a well known Olympic marathon and cross country runner who, with her twin sister, has been training since the age of 20. Her periods stopped for ten years as her diet did not meet her energy requirements.
‘Both my sister and I have discovered that we were at risk of having osteoporosis. When we began our training long-term damage didn’t really seem relevant to us then. We felt fit and healthy and had the chance of going to the Olympics. At that time it would have been hard to persuade us about a possible risk in 30 years time.
I was conscious that I was a little on the plump side for a runner, and as I ran better when I was lighter I paid far too much attention to dieting. Looking back I realise that I was not eating an adequate diet to meet my energy output, and was certainly not consuming anything like enough calcium in my diet. I’m 5ft 4 in tall, and at one point weighed as little as 46.8 kg (7st. 5lbs). My weight was so low that my periods stopped for ten years, which I now know would have reduced my oestrogen levels, and increased my chances of getting osteoporosis. I used to eat fruit only for breakfast, a scone for lunch and a slice of quiche and salad with fruit for my evening meal.
I sometimes felt pretty weak, and I became very susceptible to injury. In my career I have experienced three stress fractures in my legs, with a fourth suspected. Because of this record the British Olympic Association included both myself and my twin sister in a bone-scanning survey that they were conducting. We were both found to be at risk of osteoporosis and put on a course of HRT and calcium. My sister came off HRT after the first course, but I stuck it out for six or eight months before giving up.
I felt bloated, moody and my running was impaired whilst on the HRT, but once off it my running performance improved again. I was due to compete in the Commonwealth Games in Auckland in 1990 but had to pull out because of a stress fracture, and at that point I realised that I would have to call a halt to my running career. I got married in 1991 to Geoff who is also an international marathon runner and after eating a better diet, my periods returned and we managed to produce twins. I am delighted to say that a recent test showed that my bone mass has improved and I no longer have signs of osteoporosis. If I had my time again I would undoubtedly have eaten more sensibly, and I would not encourage a young female athlete to diet as we did. I still run 40 miles per week, and work as a PE teacher in Nottingham. I have improved my diet, and I now take Efecal with the hope that I can maintain my new bone mass.’
If your periods haven’t arrived by the age of sixteen or seventeen it is time to ask your doctor for some advice. You will need to be investigated by your doctor initially, and subsequently by an endocrinologist. If you had established periods, but they have since disappeared there are a number of things your doctor can do:
• Check to see whether you are pregnant.
• If you are taking prescribed drugs – assess your programme to see whether they are interrupting your cycle.
• Take blood to check your thyroid and iron levels.
• Assess the function of your pituitary gland, which is responsible for hormone function.
• Refer you for gynaecological investigation to check that your ovaries are functioning, and that there are no other obvious problems.
• Follow the recommendations for A Very Nutritious Diet on page 437.
• Take regular vitamin and mineral supplements. • Introduce naturally occurring plant oestrogens, better known as phytoestrogens into your diet. Phytoestrogen rich foods are predominantly soya, linseeds and pulses (see Phytoestrogen-rich menu page 480). These compounds have a modulating effect on the body’s own supply of oestrogen which is useful for treating any type of menstrual irregularities.
• Take a phytoestrogen-rich supplement like Novogen red clover. This provides 40mg of isoflavones which can be taken in conjunction with a phytoestrogen rich diet to help balance hormones.
• Take the herbal supplement agnus castus which has been used for centuries for its ability to regulate the menstrual cycle. The first major clinical study on the use of agnus castus was published in 1954 showing positive results on women with menstrual irregularities and even amenorrhea. It is the fruit of the agnus castus which contains essential oils, glycosides and flavonoids.
• Get some help with sorting out any stressful situations that face you or counselling if you are bereaved or recently separated or divorced.
• If you are an athlete, a professional dancer or an exercise addict, work hard to ensure that you are meeting your calorie requirements.
• If your weight is low for your height and frame, actively work to increase your weight to the optimum range.
“ I am delighted to say that a recent test showed that my bone mass has improved and I no longer have signs of osteoporosis. If I had my time again I would undoubtedly have eaten more sensibly, and I would not encourage a young female athlete to diet as we did. I still run 40 miles per week, and work as a PE teacher in Nottingham. I have improved my diet, and I now take Efecal with the hope that I can maintain my new bone mass.”
Susan