Let's Talk About Periods!

Can we just talk about menstruation? I mean, seriously, let's talk about it. On every different level. 

To tell you the truth, this blog post is delayed not exactly because I've been overwhelmed, but mostly because I've been doing well. I think I've just been taking time for myself to sit with being okay, and believing that things in life are okay. This is one of many reasons I want to talk about a less "heavy" topic (depending on how your periods come, hahaha). 

Let me just tell you about my experience with periods for a second. 

Growing up my visits from Aunty Flow were very inconsistent. I got them about every few months, and going 3 months without getting a menstrual period is called "amenorrhea."

This is important because this is going to be a more fun blog post, because talking about periods is just SO enjoyable, but also serious and important. 

 Unfortunately, still in 2021, we have doctors and coaches still telling parents and kids that it's normal for a kid to completely lose their period if they are involved in sports, or to be 18 and have not gotten a period if they are an athlete, or to only get them very infrequently, more than a few months apart. 

While there are hormonal imbalances that can cause irregularity (such as PCOS), these outcomes are NOT normal, and NOT okay. Missed menstrual periods indicate something larger going on. It does not always indicate an eating disorder, but it indicates something larger going on. 

There are a couple reasons I have had issues with my periods. 

After high school when I was going months without getting them, between ages 18-20, my period completely disappeared. Aunty Flow just ghosted me, as if she hadn't been visiting me multiple times a year and I meant nothing to her!

At this time in my life, I had a significant eating disorder, which was a very obvious reason behind my lack of menstruation. The prospect of this did terrify me, because I want to have kids someday. While I know that's not a gift promised to everybody, I know it is definitely impossible if I am not having periods. 

When I eventually started eating consistently and was excelling in my recovery, I finally went to a period doctor, who ended up being a doctor I see on a consistent basis now. 

She put me on something called the progesterone challenge. This is 10 days of taking progesterone pills, (female hormones), to kickstart your period. 

After day 10 in May, you will never believe it! Aunty Flow came to visit for the first time in 2 years. I immediately took a picture of the blood and emailed it to my dietitian and a couple close friends along with the song "Man, I Feel Like A Woman" by Shania Twain. 

It was a special moment for me.

Moving on, 

I didn't get a natural period again until August. 

What happened in August, you may ask? 

Well, I was a counselor at my church's teen camp, and approximately 4 hormonal teenagers came to me in tears that day about something, then it turned out that half my cabin of 7th graders were on their periods, and suddenly, I was cured! 

Hormonal teenagers cured my period drought. It was beautiful. 

What WASN'T beautiful was learning how to use tampons for the first time. Yikes. I think about 3 different people taught me how to do that on more than one occasion.

When I finally got it to stay in for the first time, I emailed my physician assistant with pride and excitement, and she responded with congratulations and "Make sure you change it out multiple times a day!"

Are you serious?! Why are we subjected to this. I am just a woman. 

Moving on, I was still only getting periods every few months. At this point, I was doing great at recovery. I was eating consistently at least. My doctor tested me and I had some athlete's version of PCOS. 

She informed me that I had more androgens and testosterone (boy hormones) than the average female. 

I asked,

"Does this mean if I put on dresses and wear makeup more I might be able to become more female again?"

She informed me no, this was not the case. 

Thank God.

It does explain my problem, at least. 

There are so many reasons people don't get periods. However, based on the research, it's a pretty bad idea to just put someone on birth control to regulate a period if there may be an underlying cause. It's wicked important to see a doctor who truly specializes in this subject area, and I would be happy to give out recommendations. It's dangerous to mask a serious underlying cause of something like that. 

Unfortunately, it's not just missing a visit from an annoying relative you have. Not getting periods can decrease bone health, which, especially because we only have until about 30 years old to gain bone mass before we start losing it and we gain 90% of our peak bone mass by the time we are 18, is significant. Osteoporosis is not something you want before you're 100 years old. Constant stress fractures is not something you want at all, which you might already be getting if your bone mass is currently low. 

Often it's caused by disordered eating. If anyone was wondering why I get fractures or stress fractures approximately every other year, I have uncovered the mystery. Although if you've been following my blog you might know this by now. 

Low bone health is linked to inadequate energy, or food intake. 

This isn't always because someone has an eating disorder. A significant portion of the time unfortunately because society tells women in sports that it's all about their body and not just about their performance, but they have to look the part to be the part, girls and women think that they have to maintain a certain weight to perform well. Or that they can't fuel the same way that men do.

Men can go home and eat carbs, women have to go home and eat rabbit food. 

You know, because the rabbit Olympics are coming up. 

No kidding, they used to feed women differently in the military than they did men. Men would get full fat food and carbs, and women would get low fat, more fruits and vegetable options and less carb heavy meals.

I'M sorry, are these women actually super human robots doing the exact same things that men are but actually can survive on half the energy? Women were leaving with more fractures than you can imagine. This is anecdotal from a woman speaking of her and her friends experiences and I do not remember the year this was, but it hurt to hear about.

There's a term right now called "Relative Energy Deficiency in Sport," also known as "RED-S." 

The term was coined by the International Olympic Committee, to address consequences related to people not getting enough fuel for the activity they are doing. The point of expanding the female athlete triad to RED-S was to encompass all consequences, include men, and also to show that people don't need to have an eating disorder in order to have this problem. 

Sometimes women (and men) truly just don't know how to eat enough food for their sport, and then these things happen. Unfortunately, there are serious consequences. If you experience any of the symptoms, you might have no idea but you actually have the condition. The research shows that consequences significantly increase WITH disordered eating patterns, but that you do not need to have an eating disorder to experience it. 

Here's a list of what can happen when we don't fuel properly for our sport. 

Performance Consequences: Decreased endurance performance, increased injury risk, decreased training response, impaired judgment, decreased coordination, decreased concentration, irritability, depression, decreased glycogen stores, and decreased muscle strength. 

Health Consequences: Gastrointestinal, Immunological, menstrual function, bone health, endocrine (hormones), metabolic, hematological, growth and development, psychological, cardiovascular.

These are some real and serious outcomes, and a lot of the time we don't know WHY they are happening. 

If you've had any of these problems, it's not because you aren't training hard enough, but it might be because you're training too hard or not fueling enough.

So many people, women in particular, but men too, do not know what "enough" is. If you are having these issues, something else is going on. One moment to tell you the response to GI issues is NOT EVER, an elimination test diet.  

I beg you to go to a trained medical provider, a sports medicine doctor, endocrinologist, an eating disorder specialized physician or dietitian, a sports dietitian, etc. Go to people who won't put you on further restrictive diets, or tell you these things are normal for girls, etc. If you want more info I am so happy to provide more info. I've gone through the research, written several papers on the subject, and am constantly updating myself on what's new and will more than gladly point you towards the right professionals and help convince you that this is all real. 

So many girls improve, improve, improve in their sport, until they suddenly don't anymore. Until they start getting injured or losing their edge. And often-times it is related to this condition. People who have a great relationship with food can have these consequences. Sometimes we just don't know how to fuel for our sport, and sometimes it does mean eating past being full, and sometimes we just need the extra help. 

Periods are important. They're SO important. We need to find the reason behind our inconsistent menstruation and not just write it off as "normal for an athlete." The only thing that makes it normal is that society normally tells us women not to eat enough carbs or fat and to lose weight and to look skinny to perform, not to encourage us to gain strength. It is NOT an appropriate norm, it is the most dangerous one for athletes. For long term health, and short term health, for long term performance, and short term performance. The same reason it's "normal" to find needles on the ground in certain neighborhoods. It is not normal for a healthy reason. It is a dangerous culture that fosters this outcome. 

Anyway, back to the anecdotal portion of this message.

Now, I wanted to bring this up to everybody, but can I tell you my LEAST favorite consequence of RED-S? Like, LEAST? 

It's when you aren't used to this period thing, and then suddenly, like, out of the blue, when you were completely fine all week, you start to feel like the world is ending. Everything is getting worse, everyone around you is out to get you, everything is wrong, and all you can do is cry. You think something is wrong with you because you are a woman, and why would your experience be real? You must be crying because there is something wrong with you, not because your emotions are valid (written with sarcasm). Now, my psychiatrist always cautions me not to invalidate the fact that an increased emotional response is completely real and warranted with the things I am going through, but it of course is always great to notice other things going on. 

Like, if you just spent a morning crying and thinking everyone was going to leave you more than you did yesterday  and then you go to the bathroom and there's blood.

Ohhhh. 

You see, I get it now. 

And you people have just been doing this every month of your life since you were a teenager? Can we just please take a moment of silence for all women? For dealing with these cramps and hormones and needing to act like people aren't all the worst when they are and you're feeling it at a higher intensity and are more sensitive and loving and compassionate and also angry and indignant and everything because you now have the hormonal power of a freaking freight train goddess with hormones? That makes us stronger and better leaders?

It surprises me every. Single. Time. Because I'm not used to it. Aunty Flow just visits like that, unannounced. Like, you're welcome to come, but please knock first? Or ring the doorbell? Or at least call me maybe?? 

I think there are teenagers who are more used to this than I am. 

Don't get me wrong - I am thrilled to have a working woman's body, It's just, WOW. Come on ladies. 

Anyway, it's important to note that you are completely valid in your accentuated period emotions, and don't let anyone just call you "emotional." Listen to yourself. We get periods and have these hormones for a reason. Just like, note to yourself that if you have any voices telling you mean things about yourself, that those could be period related, and that's the most important thing to remember so you can talk back to them. Or have a friend talk back to them, or a stuffed animal. Whatever works.  

Gosh. I feel like I'm talking about something most girls learned by 5th grade? If you have a 4th grader I guess she can read this. I'm officially caught up though. Cheers to that! 

References:

Ackerman, K.E., Holtzman, B, Cooper, K.M., Flynn, E.F., Bruinvels, G., Tenforde, A.S.,...Parziale, A.L. (2018). Low energy availability surrogates correlate with health and performance consequences of Relative Energy Deficiency in Sport. British Journal of Sports Medicine, 53(10), 628-633. 10.1136/bjsports-2017-098958

Mountjoy M, Sundgot-Borgen J, Burke L, et alThe IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S)British Journal of Sports Medicine 2014;48:491-497.

Man, I Feel Like A Woman… on her period.