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Fertility and the female athlete
Posted by: Editor
Posted on: Wednesday 7th November 2012

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In her latest article, Nina McArthur (read her column HERE) investigates fertility in female athletes, a topic that (too) many sports women suffer from when pursuing their sporting ambitions.

Combining personal experiences with practical advice and research, Nina outlines the warning signs and provides some practical advice on how to deal with and spot the warning signs of Amenorrhea.

Fertility in Female Athletes – Find that Positive Energy Balance

I introduced the concept of the ‘Female Athlete Triad' in an article a while back when telling my own story of how intense sport at a high level led me down a slippery slope to almost losing my life. Now, I'd like to revisit one aspect of that in particular, after receiving an email from a concerned sporting couple who persuaded me to delve into the area a little deeper.

The first factor in the Triad is disordered eating. As I experienced, when the thought that ‘losing weight could be beneficial' is planted in your mind, it is very easy to start watching what you eat, whether it be avoiding what you think are ‘bad' foods or progressing to an eating disorder where you simply don't take in enough calories to keep your body functioning properly. A second factor is osteoporosis as a result of the poor nutrition, whereby your bones simply don't get enough calcium and so can lose bone density and become weak.

The third factor, and the primary issue that I would like to focus on in this article, is Amenorrhea. This is where a girls period may be irregular or cease altogether due to intense exercise and inadequate calorie intake. Basically, the level of oestrogen decreases and this is the hormone that helps to regulate the menstrual cycle. In simple terms, this will make having a family become very difficult.

Many girls that I trained with as a Junior suffered from having the onset of their monthly cycle delayed, one was even twenty-one before getting her first period due to a consistent level of high intensity swimming and running from a young age. Interestingly, the majority of my club mates that suffered were the slimmer triathletes and runners, my friends at my Swimming Clubs who had big strong builds and big appetites did not seem to. So why would this make sense?

On a personal level, I didn't suffer until my weight dropped below the eight and a half stone that my body was used to. This was when after being ill with a virus for a week and losing half a stone, I found I was running quicker due to being lighter and wanted to maintain this. I didn't think about any depletion in strength, increased susceptibility to cold or any other health issue. I just wanted to be as fast as I could possibly be....and to win.

Dr Sigridur Gudmundsdottir led some research at the Norwegian University of Science and Technology into the effects of too much exercise and fertility (

'We believe it is likely that physical activity at a very high or very low level has a negative effect on fertility, while moderate activity is beneficial'. The study involved 3000 women in Norway who were questioned about the frequency, duration and intensity of their fitness regimes between 1984 and 1986, and then asked about their pregnancies ten years later. 'Among these women, we found two groups who experienced an increased risk of infertility. There were those who trained almost every day and those who trained until they were exhausted. Those who did both had the highest risk of infertility', said Dr Gudmundsdottir, whose research appears in the medical journal Human Reproduction.

So at this moment I can imagine many female athletes reading this have gone into panic mode, but don't panic just yet. Whilst the women under 30 who exercised the most were found to be those who experienced the most problems conceiving (a quarter being unable to conceive in the first year of trying as opposed to a national average of 7%), the effect of the extreme exercise did not last long.

'The vast majority of women in the study had children in the end and those who trained the hardest in the middle of the 1980s were actually among those who had the most children in the 1990s', Gudmundsdottir said.

So what this says for me from my own experience is that you need to live life within your own limits. You know what your body is capable of and you also know when you've physically overdone it, be it working too long a day and lacking the energy to clamber up the stairs to bed or ‘bonking' on a hard bike ride when your energy levels reach zero. Consistently overdoing it and not ‘listening to your body' results in women being unable to maintain the right hormone mechanisms for successful fertilisation. A BBC Article from 2004 (www ) said ‘In extreme cases, the woman's body enters a state of 'negative' energy balance and her reproductive system shuts down to prevent a pregnancy and conserve energy' Basically, you stop ovulating because the body is energy-deficient, it is just too tired to manage anything else other then the basic level of survival!

I know that when my body weight dropped to a level half a stone lower than what was right for me, I experienced Amenorrhea, even though girls who were a similar weight as me were absolutely fine. It was simply that their bodies could still function well at their weight because it was right for them and that they could cope with their chosen level of physical activity.

Don't get me wrong, working towards a life goal such as completing an Ironman or half marathon is not to be avoided, but consistently pushing your body beyond its capabilities during the years where you might want to be looking towards a family only increases the risk of fertility problems.

So listen to your body. When you're young, in your twenties or thirties and starting to think about having a family, make sure you're enjoying the sport you do but think about either the fuel your body needs to have enough surplus to regulate all the body's mechanisms whilst not tiring yourself out every single day.

It is still possible for females who love sport to have and love a family as well, we just need to find that positive energy balance. It may be hard, but it's what I have had to do over the last few weeks to recoup my energy levels and remember my social and work responsibilities too. You have to tell yourself that listening to your body and pulling back to a level of exercise that your body can easily maintain is the right thing to do. It may just be cutting back fifteen hours of training a week to ten, making that bike ride half an hour shorter or not working as hard as you can in every single gym session.

Just look at the swimmer Dara Torres. She struggled with infertility, retired from the sport for seven years, finally had a daughter at the age of 41 then returned to win three silver medals at the Beijing Olympic Games doing the sport she loved. That is a true life achievement; sport, family and happiness all together. I couldn't think of anything better.

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