Photo from Mount Royal, Frisco, Colorado.

"That is happiness; to be disolved into something complete and great. When it comes to one, it comes as naturally as sleep." - Willa Cather

Sunday 11 April 2010

No pregnancy, no period, lots of running

The title refers to the fact that I am now 2 weeks late for my period but am not pregnant. Am I sure about the fact that I'm not pregnant? Well, no, but I'm pretty convinced of it since I've had four negative pregnancy tests.

So, why is it that I am not ovulating? Is it due to running? Or in particular training hard? We all know that a very low body weight and/or a limited diet can lead to amenorrhea. But does running alone lead to an anovulatory syndrome? My intuition as a physician says no. Evolutionarily, women should not get pregnant if they lack nutrients or a bodily surplus. But humans are nomads and that is why exercise in itself is healthy for all of us. Interestingly, once women start running over 60 miles per week, about 25% don't get their period, but as their body weight increases, almost all ovulate normally. If they are below normal weight, up to 60% have amenorrhea (info from Ginny Ryan, University of Iowa). Just for comparison, about 5% of the female population suffers from amenorrhea at any given point time (this does not include pregnant women or those on hormonal birth control).

But let's look at a different study: Menstrual patterns in ultramarathon runners. S Afr Med J. 1987 Dec 5;72(11):788-93

70 female ultramarathoners; 9% suffered from oligo or amenorrhea, as compared to 7% of controls (I can't comment on the statistical significance of this as only the abtract is available). The study also showed that menstrual dysfunction was unchanged once they became ultra marathoners, i.e. the same 9% suffered from amenorrhea or oligomenorrhea BEFORE they started running ultramarathons. Allow me to directly quote one of the conclusions "Those likely to develop chronic menstrual dysfunction tended to be younger, had started running at a young age, trained over a long distance each week, had low body weight, had experienced previous menstrual irregularity and tended to be the better performers. In addition, there was frequently a past history of anorexia nervosa." Arrrggghhhh. These ALL apply to me. Well, "better performer" is questionable. They go on to say: "chronic menstrual dysfunction which is probably a reflection of a particular life-style, personality type, body build, and, possibly most importantly, nutritional status."

This study also found that 14% of the ultramarathoners suffered from temporary menstrual irregularity during times of increased stress and/or more intense training. Interesting that the day I was supposed to ovulate was the day of the Nike 15k and that I was training quite hard in the weeks leading up to it.

Am I surprised I am late for my period and not pregnant? No. Am I bummed out? A little, mostly because ovulation is a sign of good health.

Am I taking it bit easier in training as a result?

To answer this question: I went on an 8 mile tempo run today, now 8 days after the 50 miler, in 56:46, just 20 seconds slower than my fastest time ever on this route! I could still feel the 50 miler in my legs a little and pushed myself to the point of bubbling froth from my mouth, puking at about half-way point and completely collapsing at the end. I heard a car honk and looked up to see a 16 year old guy gesturing whether or not I was okay. I held my head up and smiled. I was more than okay!

But back to running's affect on menstruation. I am curious about my female readers. Feel free to participate in my very non-scientgific surveys in the column to the right (if you fill out one, please fill out the other as well).

Running Song of the Day: Waving Flag by K'naan (I love this whole album)


Olga said...

7 years ultrarunning, many years of continuous weeks of over 60mpw. 3 years of hard training and streaks of weeks with 90-100 miles. Granted, it is difficult to ever call me "underweight" even when I did train hard and long. Never skipped a period. In fact, I used to menstruate every 2.5-3 weeks (and finally went to 4 week cycle a few month ago, whew! tired of dealing with it and spending money on crap). Before I became a runner, some 10 years ago, my weight was 117 lbs and body fat 15%. I was fine with my period back then too. Oh, and there was a rather long battle with bulimia I had for years. Not anorexia though. Does it say anything? Not really. May be it is because of my body type, but I never suffered of absense of periods. Now, I did go into perimenopause at 36 for about 5 months, proved not only by symptoms, but by hormonal blood tests (all 6 of them). And then came out of it. And I was injured and not training hard when it happened. And went back to training, what coinsided with menses return. Gp figure:) We all an experiment of one.

Anonymous said...

I am happy to say that after 2.5 years of trying, we are finally pregnant. Many people tried to tell me it was because I was running too much, too hard, blah blah blah, even though my doc was ok with me running. I didnt run nearly as many miles you (I wish I could!!!)and always had a very regular period. Honestly, I think my problem was 2 fold... 1)my thyroid was slightly off. Nor much but enough to make a difference. and 2)I was obsessed with getting pregnant and the stress overrode us having any fun with it. Once we started to NOT think about 'trying', we were pregnant immediately ... and I ramped my workout schedule back up. You'll get there!!

Unknown said...

maybe the hormones that are detected in urine when taking a pregnancy test are affected when running higher miles.
I was pregnant with my 4th son and finally gave up taking tests because they all came up negative until I was almost 4 weeks late for my period and morning sickness kicked in.

amazon said...

I'd be interested in knowing whether running could affect growth hormones detected in urine...I am nursing a 14 month old, and still haven't gotten my period back. I thought for sure I was pregnant 3 weeks ago, but I'm like sealegs, with 3 negative tests. Not that I'm running high mileage, but I am back up to 25-30/wk, which is more than I've done since before being about 5 months pregnant (almost 2 years ago).

PiccolaPineCone said...

What was happening prior to this missed period? Were you having your period more or less regularly? (though I guess some women menstruate without ovulating). I'm asking b/c I am wondering if this is just a blip caused by the increased training for the 50 miler and the race itself.
It's interesting that evolutionarily women do not ovulate when resources are perceived to be scarce (i.e. body weight low). Some plants have evolved the "reproduce and die" strategy i.e. resources are scare, I'm clearly not going to make it, therefore I (I being a plant) will invest all my resources into flowering so my progeny hopefully has a chance.
Along those lines... I always wondered what would happen to a nursing mother who suddenly had a huge drop in BMI. Would the body cut the milk supply to save the woman? I think this is indeed what happens but evolutionarily this does not make sense. The impetus of evolution is to pass along the genes and one stands a better chance of passing on these genes if one's offspring can eat (i.e. milk supply is not compromised) in a time of scarce resources.
blah blah blah, sorry, long comment, just some stuff I have been thinking about for awhile.
Anyway would love to participate in your survey but I don't want to skew your results as my period is non-existent b/c I am still nursing so perhaps I'll just abstain.

cburns said...

I love your blog and have really been interested in your pregnancy and running posts. I am 4 months pregnant and conceived less than a month after running a tough 50 miler. Ive been a distance runner for many years and have and am pretty small so everyone told me that I wouldnt be able to get pregnant with my 'lifestyle'. I went off of the pill in May after 10 years and 7 months later got pregnat (with INCREASING training intensity both milegage and speed). I was irregular since going off the pill and was pretty surprised to get the positive test.

However, I took a test when apparently I was 3 weeks pregnant and it didnt register as positive. 4 weeks and I saw a faint indicator which turned out positive. So I guess you could still be pregnant--

Turns out very active women can conceive without altering their lifestyle-- at least in my case.

Still running, just slower and not as far...

good luck and keep up the interesting blog!

sea legs girl said...

Olga, really interesting. Yes, I agree with you about your body type and the blessing/curse of regular periods. Glad you came out of perimenopause, though I would tend to doubt that is what it was, considernig you are so you, maybe just stress or weight loss? (but you know better than me)

Brooke! That is so awesome! I agree with you. Running in itself is not a "bad lifestyle" but the stresses and obsessions that sometimes are part of runners lives is the problem. And certainly your problem may have been your thyroid alone. Congrats!

Barefoot & Amazon, I have trouble explaining those negative pregnancy tests! But I don't believe running affects the accuracy of the tests; I just could not imagine how.

Piccola, I've had irregular periods my whole life, so no surprise. Between 13 and 16 years old I was not a runner and not underweight and got my period a total of 6 times in 3 years!! Good thing we don't also "reproduce and die" :). Re breastfeeding. If a woman starves herself, the milk will stop coming. I think this is because women can make multiple babies, so their survival is almost equally to the offspring in an evolutionary way, plus babies coulc survive without the milk if another woman stepped in to help.

CBurns: thanks for commenting! The explanation for your neg. pregnancy test could be that you were "3 weeks pregnant", but not yet late for your period and baby only one week gestational age. When a doctor says to a woman "You are 9 weeks pregnant", the embryo is only 7 weeks old but it has been 9 weeks since the last period. So perhaps there is confusion between gestational age and pregnancy week. Does that make sense?

sea legs girl said...

Olga, whoops. Meant to say "you are so young" and not "you are so you" :)

Unknown said...

I have been wondering about this for ages. Also -- I know the 140 bpm guideline has been systematically debunked but is there any new threshold above which your heart rate shouldn't go if you are pregnant? Everything I've read says you simply shouldn't get overheated. What about vigorous interval training?

mmmonyka said...

I have been running for quite a few years now and never had "period problems". It is pretty irregular but it has always been and therefore I do not think it has something to do with running. I used to be 800/1500m runner and never had any problems and when I started to do higher mileage (60+) nothing changed, although I had friends that lost their period when doing the exactly same trainings as I did. My BMI is normal. I lost some weight last year during marathon training, still no change. So I guess it is very individual.
No input for pregnancy related issues...not there yet:)

cburns said...

Thanks for responding-- actually my period was very late and it looks like knowing now what I know I was just going to be late so the dates were all thrown off. My dr. said that sometimes you can not pick up a 'positive' test for a couple weeks so perhaps thats why it was negative first?

This whole heartrate under 140 causes a lot of confusion and I struggled for a while with how to maintain my running without overdoing it since Ive never been one who is a 'light jogger'. I asked many people and luckily have a lot of awesome athletic friends who are mothers and who let me know about a great book for people who want to maintain their fitness during pregnancy- Its called Exercising Through Your Pregnancy and its written by Dr. James Clapp. You can get it from Amazon. Its very helpful and debunks a lot of 'myths' about pregnancy and exercise. As you have said Sea Legs Girl, pregnancy is not a disease and our bodies are made to do this; both carry children and move!

Since learning I was pregnant, Ive cut my miles down a lot and have tried to switch my mindset from training to fitness and enjoying running to run and be healthy. I did run a half marathon which is a pretty short distance for me a couple weeks ago and planned to just listen to my body. I had a great run and was able to run a time that is consistent with most of my 1/2 times and I wasnt pushing it at all so I felt good. ANd there are days when my average trail run is so tough so I just take it easy and enjoy the run but Im still out there. I dont know about other pregnant runners but I dont really do intervals or speedwork at all but try to run within a zone where Im not totally comfortable but Im not pushing it- as I dont need to right now and I think my body can use the lesser mileage after years and years of intensity and distance!

This is a good discussion and Ive been encouraged by this blog as there are lots of people out there who ask me if Ive gotten "approval from my doctor to keep running!"


Amber Dawn said...

I have been training for IM distance the past 5 years and this year switched to ultra running. I have been running 80-110km per week and have never had irregular periods. My BMI is 18-18.5 and has always been.
I've been unable to get pregnant despite almost 2 years of no contraception. I stopped training for 6 months after being told repeatedly I needed to 'slow down' to conceive. Unfortunately I was still not pregnant and even more miserable without the outlet of training.
Personally I think that high intensity training can influence menstruation more than mileage. The same way that other stress such as travel etc does.
Your 50mile race results are impressive! I am running my first 50miler May 31 in prep for a 125km race in August.

Olga said...

Darling, if you saw my night sweats, day temp changes and mood swings, as well as my lab tests for hormonal pannel, you wouldn't have questenned. BTW, at this point I rather would have had it over with, because on IUD, which officially cause "minor spotting in-between periods", I am bleeding 3 weeks out of 4, with real period for a week, and the rest of it just whatever. Doesn't make my life any easier, if you know what I mean. I'll take the menopause, I am done.
And, I have another theory I could run by you, speaking of early menopause, which does happen. If we are given a ceratin number of egs to ovulate (as they say), then if you have more often periods, it means you "use them up" faster. That was my thought when my GYN told me I hit menopause at 36. Also, PERImenopause happens as early as 10 years prior to real and final one, so again, very much possible.
Although obviously my discussion has nothing to do with your blog post and with questions posed by all the young female runners, able and willing to child-bare for a few more times:)

sea legs girl said...

Sandhya, See how you feel! If you are really up to interval training, than I say go for it.

Thanks for the input monyka!

cburns and Amber Dawn, See my blog post response!

Olga, that egg theory almost makes too much sense to be true. But I have also heard it from others, so there may be something to it. If it is true, I will hit menopause at 80.

Anonymous said...

Thanks for the article! I am halfway through my pregnancy and running has never felt better. I'm running 40-50 mpw. I run 60-70 when training. I just take it easier now. I wanted to respond to Amber. Amber, you sound a lot like me. I unfortunately had to bump (no pun intended) up closer to 19 to get pregnant. Figured I'd have to gain that weight anyway. It took me 1.5 years to get pregnant. But, my mom was sick with cancer at that time so I was extra skinny with all the sadness. Cheers to running mamas!

Anonymous said...

I have been running for two years but just until the last few months I have been running more. I started spotting two months ago and then now I am three weeks late. My dr did cbc's and also a cmp test a month ago and everything was fine. I know I am not pregnant and I have never suffered from anorexia or bulimia. I am more on the smaller side but not underweight. I am assuming I am not having my period due to training harder and more often since I have my first half-marathon in two weeks. I am doing 24 miles a week when I used to just run maybe 15. Should I contact my dr or just wait a month?

Your blog has really made me feel better about all of this.

sea legs girl said...

Hi Jennifer,

Thanks so much for your question and I'm sorry about the delay in response. As you can see, this is an old post, so the comments here show up in the spam box. Anywhoo, no problems! Well, in the research I did, it looks the development of irregular periods or amenorrhea (you do not have amenorrhea yet - it has not been very long since your last normal period) or most tied to body weight and nutrition. I guess the first step I would recommend is taking a look at your diet and making sure you get enough proteins and fats. I personally found I got my period back after years - not due to gaining weight - but due to adding fish to my diet. So the first step I would recommend is analyzing your nutrition. If women have a normal or close to normal BMI and good nutrition, the general rule is they get their periods no matter how hard they train. Again, it's the nutritional status and BMI that matter. If your problems go on over 6 months, I would visit your doctor again, to be on the safe side and for further recommendations.

Anonymous said...

I run about 26-30 miles per week which isn't too much and I'm about 16% body fat but I haven't gotten my period in over 2 months! I took a pregnancy test and it came back negative. I'm 22 and I've had irregular periods until about a year ago when they became regular and now its back to this! It stinks. I increased my mileage to 35-40 miles per week for a while and that was a little before my period became irregular. I also recently started doing a lot more weight training... I don't know what the problem is.. its annoying though.