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Female Athletes and Menstrual Irregularities

Reproductive function is a significant health concern for both male and female athletes and, for those who use anabolic steroids, the concern becomes even greater. Whilst men may experience changes in libido and natural testosterone production, the effect training, dieting and anabolic steroid use has on the female body is immediately noticed via changes in the menstrual cycle. In fact, many female athletes report menstrual irregularities or amenorrhea (the absence of periods for 3-12 months). There are several reasons for this disruption in the normal menstrual cycle, the most frequent cause being a dysfunction at the hypothalamic level - often referred to as functional hypothalamic amenorrhea.

Put simply, the hypothalamus secretes gonadotropin-releasing hormone (GnRH), which regulates the release of luteinizing hormone (LH) and follicle stimulating hormone (FSH). These hormones are released by the pituitary gland and are involved in regulating the release of other key hormones (e.g. estrogen) from the ovaries. When there is an absence of menstrual periods (amenorrhea), this means that a suppressed level of both GnRH and LH levels has been observed. This suppression can be caused by many factors and is not just related to the use of anabolic steroids. For example:

LOW BODY FAT

Female athletes often have very low body fat levels - this is especially true of women bodybuilders who diet to reduce their body fat levels well below what could be considered ‘healthy'. The level of body fat needed in order for normal menstrual function can differ from individual to individual. There are many textbooks out there that throw out percentage requirements (usually around 8%) for maintenance of the menstrual cycle; however, some women can fall below this and still experience a regular cycle. On the other hand, some women can experience disrupted cycles when their body fat is over 10%. This is where individual body chemistry comes in to play. Another factor which plays an important part in menstrual function is...

TRAINING INTENSITY

When women undertake high-volume/high- intensity exercise programs they often exhibit significant changes in gonadotropins, cortisol and testosterone levels. Add to this a reduction in body fat level and the presence of anabolic substances and it is not hard to see why the menstrual cycle decides to go on vacation. There is just too much hormonal chaos to deal with! You have also got to bear in mind that the whole menstrual cycle is there to facilitate procreation. In order to support the growth of another life form, the body has to feel that ample sustenance and a healthy environment is present, and intense exercise low body fat and an extreme diet could hardly be considered as healthy in this instance.

DIETARY RESTRICTIONS

Low fat, low carbohydrate diets can also result in significant changes in circulating hormone levels. Any form of dietary restriction can create nutritional deficiencies and place stress on the body. When calorie restriction is severe the production of adequate hormones to allow menstruation to occur is not on top of the body's ‘to-do' list...keeping you alive is! You have to remember that your survival is of ultimate importance and the body will do whatever it needs to conserve energy so that vital functions are maintained. In this case menstruation is not a vital function.

ANABOLIC STEROID USE

The use of anabolic steroids by female athletes is often responsible for a range of menstrual irregularities including the complete cessation of the monthly period. Certain steroids like Nandrolone, Oxymetholone and Ethylestrenol are known to inhibit ovulation and trigger amenorrhea. However, the amount of these substances used would also play a significant role when it comes to inhibiting menstruation, as would individual body chemistry. In fact, when it comes to the effect anabolic steroids have on the reproductive system individual body chemistry is key. There have been many reports of women taking small amounts of testosterone and still maintaining a regular menstrual cycle- although such individuals are definitely the exception rather than the rule. On the other hand, some women can lose their monthly period on small amounts of Anavar due to its interference with the estrogen/progesterone cycles

THE HEALTH RISKS

When there is a prolonged absence of menstruation there can be a substantial change in bone mineral density and an increased risk for osteoporosis. This would be less of a concern for women who use anabolic steroids although it would still be important for those athletes to pay attention to the acid balance in their body and to keep their calcium intake high. The verdict is still out as regards the long term health risks of amenorrhea and some women even welcome the reprieve from their ‘monthly visitor'. In fact some forms of contraceptive pills are designed to reduce the amount of periods a woman has each year so that would lead us to believe that it is not necessary to menstruate every month. One thing is for sure though, the menstrual cycle is pretty resilient and once all the factors that have been interfering with it are removed it usually returns in a few months at most. Whether this return is welcome or not depends on how you view its presence in your life. I know some women who feel lost without their period whilst others consider it totally liberating. However, this is a subject for debate all by itself...and one which we will save for later!

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