Weightlifting is a sport of speed and power and joy, but it is also a sport of misses and aches and pains. It’s not uncommon to spend hours on the platform performing snatch pulls, back squats, and overhead presses in order to perfect a perpendicular bar path or explosive jerk. Nor are tender shoulders, creaky knees, and tight quadricep muscles unfamiliar territory to most weightlifters.
 
While many athletes freely disclose detailed descriptions about their bruised shins, rotator cuff injuries, and callused hands, very few talk about a secretive medical situation that affects many female weightlifters. Sadly, this diagnosis cannot be seen by the naked eye and is not readily discussed in the training halls and gyms. It is an overlooked illness oftentimes not accurately diagnosed, and in fact, some coaches, doctors, or even the athletes themselves do not even realize it is an issue. What is this perplexing and serious condition?
 
Hypothalamic amenorrhea.
 
Maybe you have heard about Hypothalamic Amenorrhea (HA for short), but here is a quick overview of the condition for those unfamiliar with the term. According to the National Institute of Child Health and Human Development, hypothalamic amenorrhea is defined as a woman missing three consecutive periods or not getting a period for six months due to hormone production slowing or stopping.
 
Why does the cycle stop? It all boils down to hormones. The hypothalamus is located in the brain and controls the regulation of hormones and the pituitary gland. A female needs these hormones in order to have a consistent monthly period. When pregnancy or other health disorders like PCOS occur, adequate production of GnRH (the hormone needed for a menstrual cycle) is impacted and oftentimes a period will stop or become irregular. Bearing in mind that a female athlete is not going to be giving birth in the next nine months and does not have PCOS (which is sometimes the incorrect diagnosis given to a woman who is actually suffering from HA), one of the main causes of the body not being able to release said hormone is stress—physical (over-exercise and/or lack of sufficient calorie intake) or emotional stress greatly inhibits the production of GnRH and can lead to the onset of hypothalamic amenorrhea.
 
For many female athletes (and male athletes, too), stress is the norm. A weightlifter can spend hours every week in the gym, which causes a lot of muscular, skeletal, and neurological impact. However, if this weightlifter is like me and also has an eight-hour job that causes additional emotional and physical strain, an already overworked body is taxed even more. Then, consider if said athlete also has a family to take care of, friends to meet up with, and church and volunteer work to do—the stress mounts and grows. Throw into the mix lack of sleep (how many of you actually sleep seven to eight hours a night?), and ultimately, the body ends up full of cortisol with no ability to return to a calm homeostasis.
 
And then the athlete starts to diet. Or not even diet, but just doesn’t eat enough calories for all of her systems to recover from all of the stress placed upon it. And just like that, a female weightlifter that looks like the picture of health is actually in need of physical and mental recovery.
 
For many of these women, sadly, they don’t even realize that their periods are missing. Or, even worse, they assume that a missing menstrual cycle is just “part of the deal,” a rite of passage as a serious athlete. But in reality, there is nothing further from the truth. All women should be getting a menstrual cycle (barring, of course, the absence of a uterus, the start of menopause, or pregnancy). Why? Besides the fact that getting a period is a sign of a well-functioning body, NOT getting a monthly cycle can lead to osteoporosis, cardiovascular illness, and mental disorders like depression. If not addressed, the negative effects of low hormonal levels over a prolonged period of time can begin to affect bone, heart, and cognitive health.
 
Maybe you are reading this and thinking to yourself, “Oh boy. I am that athlete. I don’t have a period and haven’t for a while.” If that is you, take heart. Recovery is possible! You can get your period back. There are many steps that are involved in recovery, but the basic premise is this:
 
CHILL OUT. REST. EAT FOOD. REPEAT.
 
Often times, if a female goes to her doctor and mentions she is without a period, she will be given birth controls to “jump-start” a missing cycle. While providing hormonal therapy through pills may help an individual suffering from heavy periods or severe cramping get physical relief from these symptoms, giving birth control to a woman who would not be able to have a normal cycle on her own may be a dangerous option. Why? Getting a regular period indicates that all bodily systems are optimally operating and that there is enough energy for the body to perform all of its’ functions. Taking a pill to induce a period is not an indication that one’s body is healthy enough to have a period on its own but only masks the fact that physical well-being is being compromised.
 
Everyone’s medical situation is different, and it’s often best to defer to your doctor (or get a second opinion from another qualified health professional). But in some cases, giving a female birth control pills is similar to giving a patient Kleenex for a bad sinus infection. The Kleenex will wipe away all of the mucus and snot whenever the person sneezes (much like how birth control pills will externally erase a woman’s missing cycle), yet without antibiotic treatment to loosen the phlegm and get to the root of the issue, the poor patient’s nose will continue to be stuffed. Same for birth control pills. Synthetic hormones will not take the place of a female’s body being able to operate normally on its own, and without fixing the stress imbalances in the body, a female’s reproductive system may not be able to function as it should.
 
Fixing stressful imbalances may sound like a relatively easy task, but in reality, being able to work towards recovery by chilling out and eating is quite challenging (especially if you are constantly busy with work, family, and training). What looks like “chilling out” is different for each individual—some find peace in meditation, while others prefer journaling or taking a slow walk in nature.
 
Whatever it is that allows you to find a place of “chill,” do it. Why is mental and physical rest (or “chilling”) so important? Well, if physical and mental stress are the causes of HA, then reducing the amount of overall stress on the body is typically THE BIGGEST step one can take towards recovery. The time spent away from the platform is just as important as the time spent on it. Rest from intense exercise. Give your CNS and muscular-skeletal system some time to recover and get back to a place of homeostasis. Put yourself and your mental and physical well-being first.
 
And then there is the food part. Food plays into stress because a body that is not fed is crazed and in a constant state of wanting, hunting, and searching for nutrition. So, the answer to this issue is to eat. Eat food. And lots of food. Among the three macronutrients (protein, carbohydrates, and fat), each one has been demonized at some point within the past few decades (remember the low-fat craze of the nineties and our society’s current obsession with Keto?). But the fact remains that our bodies were created to utilize all three macronutrients in order to run properly.
 
Case in point: have you ever tried removing carbohydrates from your diet, only to find that you suffer from brain fog, lethargy, and an overall malaise? That’s because carbohydrates are a primary energy source and are needed for your body to do basic functions like think, walk, and breathe. Sure, go a day or two without carbs and you won’t die. But go weeks and months on end without carbohydrates? Your body WILL begin to slowly self-destruct.
 
The same is said regarding fat. There is a misnomer that eating fat will make you fat, but that is quite incorrect. Dietary fat intake is necessary for the body to metabolize food and regulate hormone production—and that hormone production is what is needed for women to have regular menstrual cycles and function properly. Baring all of that information, the average woman needs around 20-25% bodyfat on her body in order to have regular periods, and fat should be around 20-35% of total calorie intake. Yes, fat is good.
 
According to a 2013 case study, “Resumption of menses coincided closely with weight gain and improvements in energy status that were achieved by increases in caloric intake.” Basically, what this means is that those with HA need to eat (and eat a lot) in order to regain a missed period. How much is “a lot”? Well, it depends on a host of factors: age, height, stress levels, and health history are just some of the determining factors that influence how many calories your body needs daily to function optimally. How then will you know how much to eat? You can meet with a nutritionist, dietitian, or health coach to guide you through the refueling process, or you could also log your own food to see your current baseline calories and then add calories every week/few days until your body hits a homeostasis point.
 
In her book No Period, No What?, researcher and author Nicola Rinaldi suggests that a good caloric baseline to start at would be 2500 calories a day, as research indicates that roughly around this amount of calories would be needed to repair overstressed bodily systems and keep an individual adequately performing her daily activities. In fact, Rinaldi also noted that the majority needed to increase food consumption beyond 2500 calories as recovery time progressed, and 96% of these women did so through the consumption of more fat and simple carbohydrates (read: Ben and Jerry’s ice cream, cookies, and other seemingly “unhealthy” foods).
 
Ashley Koff R.D., CEO of The Better Nutrition Program and recent presenter at the IDEA World Convention, similarly suggests that adding in more fats to one’s diet will help in Hypothalamic Amenorrhea recovery. Getting enough magnesium and calcium is also key (another great reason to eat chocolate, since that delicious sweet has a great magnesium content!), as these two micronutrients eaten in appropriate quantities aid in bone and heart health and calcium absorption. Ultimately, not eating enough of ANY calorie and/or nutrient will cause the body to react in a negative way, so in order to regain a monthly cycle, those with HA JUST NEED TO EAT.
 
For many female athletes, the thought of NOT training and consuming more food than normal seems absurd. Crazy. Scary. Why? It all boils down to fear. Fear that she will not be able to hit certain numbers on the platform at a higher weight. Fear that she will no longer be able to compete in the weight class she currently is in. Fear that others will look at her and wonder and talk and think she is “letting herself go.” Fear that she may eat more and move less yet still not get her period back. In reality, the athlete’s exterior, her physique, bar path, and squat technique pale in comparison to being truly healthy. Weightlifting is a wonderful sport, but so is having a body that is functioning well and operating as it should. Hitting PRs is grand, but one cannot do so if her body is not strong, inside and out. In the long run, true wellness and strength are more than how much one can snatch or clean and jerk. It is being able to apply the lessons learned from weightlifting—the physical prowess, mental focus, and persevering work ethic—to everyday life so that you can thrive on and off the platform.