WOMEN AND OVERTRAINING
Physician, athlete, and holistic family practitioner Coralee Thompson, MD, says that “over-trained female athletes often have serious metabolic problems, particularly with hormone imbalance. The most common sign of this problem is amenorrhea, the absence of a menstrual period.” A recent published study (Archives of Physical Medicine and Rehabilitation) showed that 40 percent of a group of female triathletes had a history of amenorrhea. Other common menstrual abnormalities include oligomenorrhea (a menstrual cycle between thirty-five and ninety days), and, in young athletes, delayed menarche (onset of first period).
Amenorrhea is a sign of a potentially serious problem for athletes, now and for their future health. The hormonal imbalance causing menstrual dysfunction can also adversely affect sports performance. Dr. Thompson states, “The long-term risks of such hormonal imbalance include infertility, osteoporosis, and sexual and adrenal dysfunction.”
Overtraining and its associated lifestyle factors, especially dietary imbalance, contribute to amenorrhea. Endurance athletes, those focused on aesthetics, and those involved with high-intensity training and competition are at greatest risk.
In the study cited above, 60 percent of the group had diets deficient in calories and nutrients, especially protein, healthy fats, and calcium. Excessively low body weight and body fat frequently accompany this deficiency. Femoral fat stores—those around the hips, buttocks, and thighs—are important for female health. While some amenorrheic athletes consume an energy-deficient diet, others consume the same total calories as those with normal menstrual cycles but eat much less protein and fat (up to 50 percent less) and more refined carbohydrates (which alone can contribute to amenorrhea). Reduced fat intake can interfere with calcium absorption, resulting in lower total bone calcium. This is typically aggravated by concurrent low dietary calcium intake. In spite of this, blood levels of calcium most often remain normal.
Dr. Thompson also says, “Disordered eating itself is a complex issue, involving a full spectrum of problems from poor eating, dieting, and preoccupation with low fat consumption to clinically diagnosed anorexia nervosa and bulimia. The hormonal equilibrium that regulates reproductive function can also be affected by other psychological factors, the stress associated with athletic competition being a significant variable.”
Bone loss is one of the most serious problems associated with amenorrhea and is secondary to hormone imbalance. This includes reduction in growth hormone which results in reduced training benefits and poor recovery. Overtraining and competition elevate the body’s stress hormone cortisol. This overproduction of cortisol “steals” from female hormone production, resulting in lower estrogen, testosterone, and progesterone levels. This hormonal imbalance is very similar to the postmenopausal state. When this occurs at a younger age, the body has more time to lose bone and muscle. Decreased bone density increases the risk of stress fractures, muscle problems, and physical fatigue—serious conditions for the athlete now and later in life. Bone loss most commonly occurs in the spine, hip, wrist, and foot. Scoliosis (abnormal curvature of the spine) is an additional risk of bone and muscle problems.
Further structural problems in the skeleton occur later in life due to osteoporosis. Similar hormonal balances may be seen in men, specifically associated with reduced testosterone, which also causes bone loss and increased risk of fractures. Despite outdoor training, the lack of proper sun exposure and reduced levels of vitamin D, not uncommon in female athletes, places women at further risk of bone loss, muscle imbalance, and other health problems.
As more women of all ages aspire to strenuous athletics and competition, preventing the overtraining syndrome is most important. Young girls under the influence of coaches, teachers, and famous athletes need to understand that consuming an abundance of healthy nutrients and avoiding junk food and drinks is critical to their success as athletes and their health. Coaches and trainers have a responsibility to help prevent the overtraining mentality that grips budding young athletes. When one recognizes the overtraining syndrome, a comprehensive approach to treatment—including diet and nutrition, balanced training and competition, and stress management—can successfully reestablish normal hormonal profiles and menstrual activity in athletes. A healthier athlete will also compete better, without injury, and for longer periods.