EAA - Exercise Associated Amenorrhea

Congratulations! You've decided you're going to take charge of your life and your body and whip yourself into shape. You plan to be in the gym five days a week (at least) and you have cut calories brilliantly. It won't be long before you have the body you have dreamed of for ages and the excitement is overwhelming.

Then, after several months of this you have discovered you are no longer menstruating. You've exercised and dieted so much that you have stopped having regular periods. This condition is called amenorrhea. By the way, just in case you think you can't get pregnant if you're not menstruating ... well, we do have some information for you.

Risk Factors for EAA - Exercise Associated Amenorrhea

In order to have regular monthly periods, your body needs a certain amount of body fat, protein and calories. Additionally, you may be more at risk for amenorrhea if any of these factors come into play:

· stress

· excessive weight loss

· intense physical training or exertion

· a history of irregular menstruation

· late menarche (first period)

What Studies Indicate About EAA

Studies have found that female athletes in almost any kind of sport tend to have more incidence of exercise-associated amenorrhea (EAA) than women who are less active. EAA, contrary to what you may think, is not a sign that your performance is peaking. Rather, it is a serious indication that your body may be headed for collapse. Higher injuries, poorer bone density and myriad other complications are associated with amenorrhea.

One of the more serious ramifications of amenorrhea is the loss of bone mass. The implications of this condition include:

· increased likelihood of broken bones

· stress fractures

· osteoporosis over time

The thing is that some of this fallout doesn't happen until you are in your late 20s or early 30s when you might experience a stress fracture and then in your 60s when you break a hip.


Loss of Bone Density with EAA

Barbara Drinkwater, PhD and colleagues at the Pacific Medical Center in Seattle, and Chris Cann, PhD at the University of California at San Francisco, found in a study they did that female runners with amenorrhea had significantly low bone density. Loss of bone mass is not something associated with weight bearing exercise, which is what running is thought to be.

In follow-up studies of the women in this group it was discovered that lifestyle changes made a big difference in the resumption of menstruation and increasing bone density. By simply cutting the exercise time by 10 percent and gaining as little as four pounds menstruation resumed. Bone mass slowly returned but not to the level of women athletes who menstruated regularly. The message here is loud and clear: cessation of menses leads to irreplaceable bone loss.

Two Types of Amenorrhea - EAA is Secondary Amenorrhea

There are two types of amenorrhea:

· Primary amenorrhea refers to the absence of menses by 16 years of age. If a girl has not had menarche by 16 she needs to see a doctor to find out why.

· Secondary amenorrhea is the absence of menstruation for three consecutive menstrual cycles after a woman has had two normal menstruations.

It is not unusual for a woman to miss a period. Between two and five percent of all women will have secondary amenorrhea at some point in their lives. It can be caused by any number of medical conditions including ovarian cysts, thyroid issues, and pituitary tumors. It can also be caused by over-training (EAA).

Diagnosing EAA

EAA is diagnosed by exclusion of all other factors, including pregnancy. Blood tests, a complete history, including dietary habits, and a physical examination are all part of the diagnostic process. Amenorrhea can be the result of an eating disorder - something that is common to athletes and women who go overboard in fitness and physical training. It is thought that amenorrhea is the result of a shut-down of signals from the hypothalamus to the pituitary gland causing energy for hormones that are necessary for menstruation (and reproduction) to go elsewhere in the body.

Referring back to our comment about being safe from pregnancy if you're not menstruating: EAA is very unreliable as a form of birth control because there is no way of knowing when an egg will be released from the ovaries. If you are sexually active and have amenorrhea, then a pregnancy screening may be necessary if you aren't using protection.

Circumventing the Potential Damage of EAA

To circumvent some of the potential damage of amenorrhea, women can ensure their calcium needs are adequately met. A normal, menstruating woman needs about 1,000mg of calcium daily. An athlete or woman with EAA needs about 1,500mg. It won't preserve bone loss, but it will meet more current needs.

If you are experiencing amenorrhea, be sure to contact your physician within the first three months to correct dietary deficiencies and get the help necessary to avoid permanent bone loss and other complications associated with EAA.

There are other causes of missed periods, including underlying causes when a woman comes off birth control. Read about it in this section.

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