Nutrition: So you're not getting your periods

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 It’s “normal” for female dancers not to get their periods, or for them to be irregular, right? Actually, no. It may be common, but we would not regard it as “normal.” There are multiple reasons why hormone balance is extremely important for your overall health, particularly for dancers. In this, the first of a three-part series, we’ll be taking a dive down into the whats, whys and hows.

There are a number of different reasons a female can can lose her menstrual cycle, the most common of which for dancers is called hypothalamic amenorrhea (pronounced “hy-po a-men-o-ree-a”) or HA. There are a few other reasons, but for this edition, let’s explore this common presentation.

Some definitions

Primary amenorrhea = I haven’t ever had a first period

Secondary amenorrhea = I’ve my period but then it hasn’t come for at least three months

Oligomenorrhea = my period is irregular

Why do periods go missing?

In HA, signals that are supposed to be sent out by the brain’s hormonal control centre, the hypothalamus, are shut off or turned down. This means that no egg grows, no ovulation (egg release) happens, there is no period. It is commonly understood that in HA, there are a small number of primary culprits for missing or irregular periods and the good news is that it’s reversible in most cases.

What’s the big deal?

You might be thinking “Ummm….ok. It’s not like I want to have a baby right now. And seriously, periods are annoying!” Yep, I get it, not the most convenient bodily function on an everyday level but certainly one of the most essential – and it’s not just about fertility. Arguably most significantly for dancers of all ages, bone health is pretty important. We now have a really good understanding about the role of hormones in building and maintaining strong bones and, unfortunately, when hormones are off-balance, so is the way our bone cells are turned over. What this essentially means is that you’re more at risk of stress fractures if you’re not getting your period naturally. In the next edition, we’ll talk about the pill (and how it’s not the same as actually getting your period) and what are some other reasons your period might not be appearing regularly.

Why am I not getting my period, and what can I do?

Dietary intake: If you’re not eating enough, your period will soon say goodbye.

To address this, you may need the specialist help of a Sports Dietitian (see who you can speak with about the demands of your dancing and support you with your eating. It’s likely that you’ll either need to increase your energy intake (calories/kilojoules), or increase your food variety (to include food you may have been eliminating or restricting) or both.

Exercise: Many females with HA exercise a lot. And we know dancing can be very strenuous. A team of researchers in US found that it is highly likely that someone exercising two hours a day, seven days a week, will have HA. But there are plenty of women who exercise much less than that, or conversely much more than that.

Alongside addressing dietary intake, you may need to take a look at activity levels. Depending on what’s going on, it may be advised that you slow down on any “non-dance” activity you may be doing, or reduce the intensity of your classes. Please be reassured that for most people, this is temporary, but if you’re period keeps being temperamental, dance-related activity will be the priority above anything extra.

Weight loss: Most people think that only females who are very underweight lose their period, but in my experience this is not the case at all. You can lose your period at any weight, but yes, the lower your weight, the more likely this is to happen. And did you know that even if you lose weight unintentionally (eg, due to an illness) the same thing happens? Most adult females who have HA have experienced some weight loss (intentional, or unintentional) at some point, which can start the “cascade” of hormone imbalance.

Please seek the help of your GP first, then a Sports Dietitian if you’ve lost weight, lost your period and you know that things don’t feel right, for whatever reason. Research is showing that if you’ve lost weight, and your period, at just one time in your life you remain at risk for losing your period again in the future.

Stress: It’s well understood that a single highly stressful event can cause a missed period. However, the hormones that result from more long-term stress are also known to shut down the hypothalamus and, therefore, particularly in combination with some of the other factors, can cause periods to stop. If you relate to being “a perfectionist” or have a tendency to be anxious, it’s important to understand that these mental processes can have a significantly effect on your hormone function. I’m not saying “don’t be anxious!!” or “stop trying to improve!!” (because perhaps both of these are unfair and unrealistic) but there are ways we can be focus, determined and persistent without being perfectionistic, and techniques we can use to help with anxiety. Please see a psychologist if you need some extra support.

I hope this has helped you understand a little more about the importance of hormone health and the factors which can influence hormone balance and health. 

*If you are concerned about yourself, or a family member, please see your GP first for a medical consultation.

Fiona Sutherland is an accredited practising dietitian and nujtrition consultant and a yoga teacher at Body Positive Australia and The Mindful Dietition. She is a regular writer for 'Dance Australia'.

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