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The female athlete triad can place you at risk for some potentially serious health problems. The lack of periods indicates inadequate production of the female sex hormone estrogen, which is essential for maintaining bone strength. If you miss your period for more than 4 months, you will begin to lose bone mass, which can lead to frequent stress fractures and osteoporosis. Failing to keep your body weight at a normal level can have adverse effects on your heart, hormone system, and digestive system.

In addition to the lack of periods, common symptoms of the female athlete triad include:

• Fatigue

• Anemia

• Depression and other psychological problems

• Stress fractures

• Inability to concentrate

• Intolerance to cold; having cold hands and feet

• Constipation

• Dry skin

• Light-headedness

• Slow pulse

• Low blood pressure

• Downy hair growth on the face and body

Having your periods stop is not a normal consequence of intense training. It is a sign that your body is not getting enough nourishment and, to help protect you from starving, your body has shut down your reproductive system. If you exercise vigorously on a regular basis and your periods have stopped, see your doctor so you can prevent further bone loss. He or she will encourage you to gradually gain some weight and cut back on your training, enough to restart your periods. Your doctor may also prescribe estrogen replacement therapy (possibly in the form of birth-control pills; see page 470), which may help forestall bone loss until your body weight returns to normal.

If you have amenorrhea, remember that an egg can be released from an ovary at any time, so if you want to prevent pregnancy, you must still use some form of contraception throughout your menstrual cycle.

Irregular Periods

A woman’s periods are considered irregular when 35 or more days (at least 7 more than the usual 28) pass from the first day of one cycle to the first day of the next. Variations in the regularity of menstruation can result from stress, a change in contraceptive method, or taking medications such as corticosteroids. Menstruation depends on a balance of estrogen and progesterone (the two main female sex hormones). When this balance is disturbed, irregular periods can result. Menstrual periods and ovulation (release of an egg) are sometimes irregular after menstruation begins in puberty and for several years before menopause (see page 851).

Vaginal bleeding between periods sometimes indicates an unrecognized pregnancy or an early miscarriage. Abnormal tissue in the lining of the uterus can also cause bleeding between periods. Sometimes underlying disorders of the uterus, ovaries, or pelvic cavity can produce irregular or painful periods.

Diagnosis

Keeping track of your periods on a calendar can help you become aware of any variations in your cycle. If your periods are irregular only occasionally, such as once or twice a year, the irregularity is probably caused by stress. If your periods are frequently irregular, your doctor will give you a physical examination and may order diagnostic tests to find out if an underlying disorder, such as endometriosis (see page 870), might be causing the problem.

Treatment

Your doctor will treat any underlying disorder that is causing your irregular periods. If he or she does not find any physical problem, stress may be the cause. Try to eliminate stress as much as possible from your daily life and see if that helps regulate your periods.

Painful Periods

Many women experience cramping pain in the lower abdomen during their periods, and some women have painful menstrual cramps just about every month. This type of pain is known as primary dysmenorrhea and is thought to result from the normal hormonal changes that occur during menstruation. Primary dysmenorrhea can persist for years until menopause. Painful periods that are a symptom of another disorder—such as endometriosis (see page