Everyone's experience with amenorrhea will be different. As part of an ongoing series, we will be hearing from lots of different kinds of women from all over the world. Some will have recovered, some not. Some will be ready to have children, some have chosen a different path. We are all ages, races, shapes, and sizes...but none of us is ever alone.
Today we have part 2 of Abby's story.
I’m not sure when exactly the other symptoms started to happen, but I think they were around the time of the first season of marathon training. Some of the changes that I now recognise as characterising my hypothalamic amenorrhea were night sweats, brain fog, forgetting people’s names, and poor short-term memory. I also had difficulty speaking/stuttering and was constantly thinking about food. I had dizziness, low (or no) libido, anxiety, obsessive behaviours, stress fractures, as well as weight loss.
I remember during my second season of marathon training, I had some domestic issues and felt like I was going to pieces. I had a few sessions with a psychotherapist and remember her saying how the running must be helping my mental state because of the endorphins. She said I would have to be careful about “turning off the tap”, as my brain chemistry could struggle without the regular hit of happy-hormones. She also seemed to conclude that the sadness I seemed to be carrying about was unexplained, as it seemed disproportionate to the events in my life up to that point. I think she either didn’t know about HA or she didn’t recognise it in me in spite of my detailed confessions.
Incredibly, I continued with this slew of symptoms, ignoring almost all of them and associating none of them with my exercise levels for about 4 years before learning about RED-S at a triathlon coaches nutrition seminar. Around the same time I needed a repeat prescription of the contraceptive pill, so when the pack finished, I decided to take a break to check my body was functioning normally. I went to the doctor after 3 months of no period and mentioned about my exercise levels but they were dismissive and said it was normal. They told me to come back after 6 months.
At the next visit they said it was still not unusual, again dismissed my concerns that it had anything to do with exercise, sent me for a blood test, and told me to come back in another 6 months if it had not returned. Even though I knew about RED-S, I didn’t know enough about all the symptoms to equate it with myself and I thought it was something that only affected elite athletes. Although I thought it might explain my missing period, I was far from sure that this was the cause and the doctor’s scepticism kept me in this headspace. What’s more, it’s quite easy to forget about your period when you don’t have one - you literally don’t have to think about it and 3 months can turn into 6 without you realising. I came across a mention of Nicola Rinaldi’s book No Period Now What by some from the triathlon community on Twitter and bought a copy of the book. I started to learn about hypothalamic amenorrhea, the condition that characterises RED-S in female athletes, that I started to grasp that this was exactly why my periods were absent. I obtained my last blood test results from my doctor and compared the numbers with the figures in the book. I immediately booked another appointment and marched to the doctors surgery with my printed out spreadsheet and a handful of scientific paper references. The GP neither disputed nor concurred with my theory and agreed to send me to an endocrinologist.
In the meantime I had been keeping my triathlon coach in the loop on things, she had been cautiously supporting me by designing a programme that was as gradual as possible, encouraging me to gain weight and being philosophical about missed sessions. Once I shared with her my findings about my blood test results and the fact I was being referred to an endocrinologist, she signed me off from training and advised me to just do light, unstructured activity. Following advice in NPNW, I avoided exercise as much as possible - which was not that much given I was leading spinning classes at least once a week plus cycling to all my work appointments. I also tried to eat at least as much as I had been while doing heavy training, and made an effort to eat as soon as I felt hungry. It was a scary time. I was suddenly stopping the routine that over the last 5 or 6 years had become my social life, my stress relief, and my sense of identity. I had no idea if it was the right thing to do or whether it would work. However, I tried to enjoy eating foods that I would have previously considered too calorie-laden and made the most of having more time for other things. My life felt a bit less chaotic not having to coordinate getting to the pool, running, fitting in turbo-training sessions, and multiple extra showers each day!
After about 3 months, my period returned. This seems quick and hearing stories from other women, I feel very lucky. I thought there was a small possibility I might have HA 18 months before my periods came back, but it took me 15 months to research, learn, accept and finally take decisive action. The last 9-10 months have been equally as hard, if not harder. Getting my period back gave me a purpose, a direction - I’ve learned that I’m quite goal driven so having this goal gave me motivation and justification. Now I’m on the other side of that milestone it’s hard to know where I’m aiming for next. I started out by signing up for a middle-distance triathlon, to prove to myself that I could still do one and get my periods. This worked to a degree, but I think it may have been too much too soon as I noticed some of the monthly symptoms being a bit weaker and a few days being added to my cycle during the months of training. I’ve now found out that I have osteopenia so I want to focus on bone-building exercise, although bone density takes a long time to improve, especially as I’m past 30 years old, so it will take a few years to know if this is working.
I’ve learned a lot about HA, RED-S, eating disorders, and also about the body positivity movement. While this has opened up a new world to me and the communities I’ve been able to contribute to have been immensely beneficial, I also find myself questioning myself constantly and I often feel more confused than I have in years. I’m a personal trainer and have huge internal conflicts over the ethics of helping people improve their fitness. I have no doubt that my own practise as a fitness professional supports a positive body image and that there is no aesthetic goal or judgement involved, but I worry that externally it might seem like I’m promoting the same messages as the rest of the fitness industry. Unfortunately, that is the meaning that is projected onto anyone labelled as a personal trainer by default. In addition, I believe my own HA was motivated only in part by wanting to conform to a particular appearance. Wanting to get fitter and to be faster played a huge role so I recognise that putting too much emphasis on these can also be detrimental. I’m still working on how to structure my work life and how I promote myself so that it fits with these beliefs.
In thinking of my own personal body image (I hate to admit it because it doesn’t fit with my new set of values), I still struggle to accept my changed appearance. In many ways I think I look better, but others aspects I’m not so keen on - but if I take a step back I know that I’d rather not make a judgement, good or bad. Ultimately, my value and place in the world isn’t dependent on what I look like. I worry that people will make judgements about me as a triathlon coach or trainer because of my appearance. This may well be true and I have to accept that I can’t change the way everyone else thinks, so it’s probably more helpful to tell myself why this does not matter, rather than to deny it or seek to change it. This sounds simple but for someone who has perfectionist tendencies and has gone through life refusing to accept compromises, the status quo or answers that don’t suit her, that acceptance is hard will take time. I think body image for me is not just based on appearance, but also how I see myself in my body generally. Over the years I started to attach my value and identity to what I could do with my body; how fast I could swim, cycle or run, my VO2max, or my running economy. I now need to accept that while my body doesn’t do these things as well (because I’m not training like I used to), it does more important things much better, like keeping cortisol in check, being able to use my brain, being less anxious, improving my bone density... not to mention having normal hormones and all the other things that entails.
Homeostasis is hard to get excited about! It is awkward feeling like I have one foot in the endurance sport camp and one in the body acceptance camp. On the one hand, I think most people involved in endurance sport, especially at an organisational level or as coaches, absolutely believe in athlete wellbeing and want to value people as individuals rather than for their sporting achievements. At the same time, the sports wouldn’t exist if we didn’t celebrate incredible achievements, stories of overcoming adversity, and determination. It’s incredibly difficult to be involved in them without feeling driven to push yourself to achieve something extraordinary. For now, I feel I want to stay involved because I still want to help others facing a similar dilemma.
I know now that properly recovering from HA is a much longer process than just getting your period back. The body needs a lot of time to adjust and become resilient again, then there is the bone density that will take years to improve. Healing my body has forced me to evaluate what is going on in my head too. Since I made fitness my career, this affects almost all aspects of my life. I’m still in the process and it will take a long time to run its course. I’d like to feel like I have the space in my head to help others with their challenges, to listen and be empathetic without making anxious remarks when anyone says anything about what they’re going to eat or how tight their clothes are getting. I’d like to be able to go back to doing the activities I enjoy, like exploring the world by bike, on foot and sometimes in water, without judgement about how fast I’m going or how hard I’m working. A part of me would like to get to a place where I’m not thinking, talking and writing about this all the time. Although if I stay involved in fitness and endurance sport or move into helping others, it seems like I’ll keep talking about it for a long time to come. I think this will resolve itself in time.
I’ve learned a lot that could help others, but if I could sum it up first and foremost I wish all other endurance athletes knew that RED-S and HA are not for just elite level athletes and that being on the pill may mask the most obvious symptoms. I wish doctors in the UK were better informed about this, as I feel like I could have gone on for years not understanding what was going on if I hadn’t chanced upon some of the information online that educated me about the problem. I’d also like other female athletes reading this to know that they are not alone. Yes, HA is pretty rare in the general population, but among endurance athletes it is more common than you might think. It doesn’t make you some kind of freak and you need not feel alone. Connect with other women dealing with HA online. If you feel up to it, talk to your friends that you train with about it, it will help you more than you can imagine. It’s also scary, but it’s an adventure worth embarking on and will make you more mentally resilient and confident than the most gruelling sporting event.
If you’d like to connect with Abby, feel free to reach out to her via her website or social media: