Emma Abrahamson, a 22-year-old runner who hosts a popular running YouTube channel, ran competitively full-time from the time she was 11 years old. But she didn't get her period until she was 22, and she recently revealed this on her vlog as a way to spread awareness about the common condition that affects runners, amenorrhea. "I didn't know what was really wrong with me, and why I hadn't gotten it," she said in the video, about not having her period at 18 years old. When her training schedule slowed down at 22, she finally got her period.
It's often said that your menstrual cycle should be treated as a "vital sign," because it gives you clues about your development and can hint at underlying medical conditions. But if you're someone like Abrahamson, who has been extremely active for the majority of her life, it's common for menstruation to be delayed or go away after a period of time.
This is called exercise-induced amenorrhea, and it typically affects women who do rigorous activities, according to the Mayo Clinic. To be clear: running alone doesn't cause amenorrhea, but it is more common in women who exercise a lot, like runners. The physiological reason why people get amenorrhea has to do with the hormones that trigger menstruation. Basically, extreme physical stress causes the area of the brain that releases hormones, the hypothalamus, to slow or stop, according to the National Institutes of Health (NIH). As a result, the menstrual cycle can't begin.
People with this kind of amenorrhea may also have low body weight, low body fat percentage, and very low calorie intake, per the NIH. We also know that stress, including emotional and physical, can be an influencing factor as well. In Abrahamson's case, she said that she wasn't fueling enough to match her training program. But after giving her body and mind time to chill, gaining weight, and listening to her appetite and cravings, her body was able to recalibrate.
Treatment for amenorrhea depends upon the cause. (Obviously, if amenorrhea is caused by an underlying medical condition, such as polycystic ovarian syndrome, then addressing that condition would be the first step.) Doctors and healthcare providers might suggest getting to a healthy weight, starting some stress-reducing activities, or decreasing the amount of physical activity, according to the NIH. Oral contraceptives can also be helpful, because they help the menstrual cycle get on track or regular.
Ultimately, whether you're a runner or not, it's always a good idea to mention any menstrual cycle changes to your doctor. Amenorrhea can increase your risk for osteoporosis, as well as impact your fertility, so it's really much more than just a matter of a missed period. Because, as we said, your periods are really more like vital signs.