Love Ya, Tina, But You’re Wrong About Amenorrhea and Running

Elite legsRecently, podcaster and elite runner Tina Muir revealed she hasn’t had a period in nine years and to get a period back so she can conceive a baby, she quit running.

I, for one, am always down to read about other runners’ period woes. There’s no question that amenorrhea can be a serious health issue with potentially scary consequences. Amenorrhea is common in women athletes and because it’s often associated with disordered eating and the female athlete triad, it’s kind of a dirty word. Open conversations about it are good! Thanks, Tina, for starting one.

But one woman’s story, in this case Tina’s, does not represent some universal truth, yet it’s portrayed as such. High level training is not necessarily bad for women’s health, reproductive or otherwise, and I fear this article portrays training as an all or nothing proposition: to reach the top of the sport women have to sacrifice their health to get there. That is not true.

Amenorrhea, the lack of a period, is a symptom and not a problem in and of itself. It’s concerning if there is reason to believe it is related to low bone density, infertility, or some other hormone imbalance. If these things are ruled out, or manageable, then athletic amenorrhea may not be a problem.

Now, before I get into this, let me just say that I can relate with Tina to some extent. I only get a period once a year when I take my two down weeks between seasons. This worried me, so this is what I did. I went to my gynecologist and then an endocrinologist. They ordered blood work and both gave me a clean bill of health. In my case, my amenorrhea is caused by my training and not an underlying endocrine issue. I do not have an eating disorder or bone density issues, and based on my history and my labs, if I want to have children, I most likely will be able to by lightening up on the miles. My doctors and I are monitoring it and I feel good about our plan.

What I did not do was write blog posts letting everyone know that I stopped having a period because my body was too busy “repairing the damage from training as a professional runner” and that I have to dramatically stop running or else be barren FOREVER!

In all seriousness, Tina wrote this:

My body does not have the resources and energy to look after a baby, it is far too busy repairing the damage from training as a professional runner. Doctors explained that my body is living in fear, thinking I am being chased by an animal so scary, that I had to run almost 100 miles to stay alive.

This is very misleading. Was she running 100 miles at a time regularly? Was she visualizing being chased by a rabid wild beast while she ran? Did she never recover or lay around in between runs? Is high-level training much like being hunted for 100 miles at a time? Do these doctors understand training?

Training is not quite the same. At least mine isn’t.

Anyway, the average person reading that might take from this that fast women who train hard are always harming themselves. Not only that, but we’re harming our frail little reproductive systems. The horror!

Of course, you can overtrain or under-eat and this can be damaging to your reproductive and general heath. All women runners who experience amenorrhea should seek medical help and take it seriously. But my point is that a woman can can be smart about her training and safely and easily avoid causing long-term damage.

Then there was this:

My mum also had low estrogen levels and missed periods, which meant I was probably more likely to have issues as well.

Wait, what? So Tina knows her mom has struggled with a similar problem, but instead of considering that she might have the same propensity to low estrogen, Tina chalks her infertility up to all the miles she runs and aims to “cure” her condition by cutting out running and gorging on dessert? Either we’re missing part of the story or this makes no sense!

I’m sure the possibility of an underlying hormonal condition is scary, but girl, go get the appropriate testing and rule that out first! (Or if you did, maybe say that while you’re being real and stuff.) What about the plethora of treatable and very common conditions that can cause amenorrhea, like polycystic ovarian syndrome or hypothyroidism? Did you consider these?

Why blame running and make it sound like every competitive woman runner is hiding this dark secret: she can’t make the babies! While I have amenorrhea that I’m monitoring with my health care providers, many many elite and very intense recreational runners have regular periods. You don’t have to look far to find a woman who conceived during high-mileage training.

It seems strange that Tina, who by all appearances loved running, was able to just drop it. She made her living not only running, but talking about running! Why then, did she so quickly blame running for her health issues and give it up? This is especially true considering her statements about going “all in” and eating anything and everything in an effort to “speed up the process” of bringing on her period. It makes you wonder what she ate while she was training. Why not try eating more and training? (Maybe she did and it didn’t work?) I don’t know. Why can’t you eat “all the cake, ice cream, and pizza my heart desires” and run?

If amenorrhea is causing infertility, and having children is very important to Tina and her doctors have ruled out all other potential causes, then by all means blame running and never do it again! But until then, stop telling people that high-level “professional” running is unhealthy for women! Stop leading women runners to believe that they will destroy their abilities to conceive if they choose to really go for it in training. Stop making women out to be weak and incapable of pushing their bodies as hard as they choose. I thought we got past the whole “it’ll make your uterus fall out” stuff.

I wish Tina nothing but the best and I hope she finds whatever works for her. I appreciate that she shared her story. But I also don’t want to turn the clocks back and start needlessly concern-trolling women runners because of one woman’s experience.

What do you think?

[5.01.17] Update from Salty: Tina posted a clarification and a very informative post with the help of Dr. Nicola Rinaldi, author of No Period. Now What? about how running can play a part in causing amenorrhea. For anyone interested in this topic both Tina’s post and the book are well worth the read. 

I'm an aspiring elite runner from the DC/Northern VA area. I love road racing and am currently training for a half marathon in April. I write about attempting to balance a career with running and enjoying the process of training and improving!

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97 comments

  1. I thought that reading between the lines, “we’re missing part of the story” as you wrote. Of course there are many high-level distance runners who get pregnant, and many who continue to race professionally after having children. But, I do think that for many distance runners, running and competing tend to be all or nothing endeavors. I didn’t take her anecdotes about eating dessert to mean that she’s literally just sitting around eating as much food as she can, but that while not running, she’s not restricting food intake with a mind toward avoiding weight gain the way she would have in the past. It almost seems like stepping away from running was the only way to grant herself permission to gain the weight she/her doctors felt necessary to sustain a pregnancy. Having spent a lot of time training with and now coaching distance runners, I know quite a few who would really struggle to run non-competitively. I love our sport so much, but the toxic, addicting elements of it are there, too!

    1. That’s a good point. I think if Tina is simultaneously struggling with overtraining/burnout then that’s a very good reason to quit running for a while. But as we know that’s not what was said. Maybe it’s intentionally vague? I think perhaps much of the story is dramatized for maximum virility and in that a) it’s coming out sounding a little off and b) is establishing some rule about women runners that does not exist. It’s really hard to say.

      1. Guys, this has been super fascinating. Can I shift the topic a little?

        I actually drafted a blog over a year ago about periods, but from a different angle. I see it as a unique gift that female athletes have, regardless of its relationship to our fertility. As women, and particularly as female athletes, have this awesome ability to see that something is off with our health and/or training, long before we are affected more seriously by issues like osteopenia/osteoporosis or other effects of malnutrition/overtraining. And actually, that’s been a big reason why I’ve shied away from oral birth control (ever since I realized I didn’t really have PCOS… I just had a 5-week cycle, just like my non-runner sister ;-P)

        My first sign of overtraining is low iron, and for others it might be an irregular or absent period. Yes! There are absolutely other causes of amenorrhea than just exercise and nutrition. But it’s pretty cool that we have another indicator that men don’t have.

        Our period is way more than just a fertility thing. I use it as an indicator that I’m eating, training, and resting in good proportions. Does anybody else feel that way?

        1. Yes! I don’t do bcp’s for the same reason and while it can be annoying (hellooooo first day of period), it’s nice to know things are relatively normal. When I was training seriously, my cycles would shorten and I’d spot mid-cycle. That was my clue something is awry. And it’s been super interesting to see how my cycle changed as I turned 30, had kids, breastfed, and now as I venture (deeper – eek!) into my 40’s. It also gives us a neat sense of time too. Love that idea!

          1. So I’m not really a blogger, though I love to reading this blog and I have to say this conversation has really made me think. I would find it hard to enjoy running without enjoying my life, so if being a mom is the life Tina wants to achieve right now she should by all means try doing whatever might help her meet that goal.

            It seems to me that what Spearmint intended to call to light is that some readers might infer that high-mileage, high-intensity training is unhealthy for women. I think most runners know all too well that hard training alone won’t help you to achieve an ideal weight or body fat. And if you go below what’s ideal for your body type, your fitness, fertility, bone health, and other things in your life will start to suffer. But women can certainly train at a high-level without sacrificing any of those things. And I hope that is the point she wanted to hammering home.

            I think where the science is fuzzy is if you aren’t concerned with your fertility at the time and all else is well, then is amenorrhea a problem that must be addressed? Particularly since there are drug companies who want to help women create this very “problem” with birth control methods? Is it only unhealthy if it occurs without drugs? I am not medically educated enough to answer these questions. But in Tina’s case, it is not clear to me if the training, low body fat, a combination of potential factors, or other unrelated factors are the cause for her condition. But it was worth it for her to see if gaining weight would help, and if she does not want to run in the meantime then we respect her decisions. Achieving one’s highest potential at any sport means making sacrifices, and the amount of sacrifices worth making very much depend on the individual. Female runners are a bright bunch of strong women and so I truly believe that if we still prioritize our health and our lives too, we’ll figure out the right balance. ~ j

          2. “Achieving one’s highest potential at any sport means making sacrifices, and the amount of sacrifices worth making very much depend on the individual. Female runners are a bright bunch of strong women and so I truly believe that if we still prioritize our health and our lives too, we’ll figure out the right balance.” Well said.

  2. Fertility/infertility is such a complex issue and people’s experiences vary so widely it’s impossible really to make blanket statements about what works/doesn’t work. I think, too, that there is danger of valuing women on their ability to make babies above all else here. A woman can train hard, not get her period, not have other health issues, and conclude that she doesn’t want children and it’s not worth treating the amenorrhea and she’ll keep training – EVEN IF training is causing infertility. That’s a perfectly plausible thing to do and it’s her body, her life, her choice. It’s also perfectly fine for a woman to feel the opposite, that nothing is worth compromising her ability to get pregnant, stay pregnant and deliver a healthy baby. Women training at the highest level is FINE if the woman doing it is fine. There’s nothing intrinsically unhealthy or disordered about high-level athletic training, even if there are some women who are disordered doing it. There are disordered men who train hard, but we’re not concern-trolling them about their hormone balances.

    1. Wow that’s a great point that women can sometimes be valued on their ability to make babies above all else. I love that. For me, (maybe I’ll change my mind someday)there’s not really a desire to have children, and I find that when I say that, people are shocked and confused about what I could possibly want to do with my life instead. I always feel a little “less-than” which is a bummer.

      1. Also agree with this – if you don’t want children, is it really all that bad to not have a period? If you ever need to vent about the stigma of being child-free, you know where to reach me! 😉

  3. While it’s true that this particular article is going pretty viral, Tina has actually been talking about this issue for several weeks already, if not longer. She did have lots of other tests and indeed, has been monitoring her health for a long time, of course. She doesn’t have an underlying eating disorder – at least she says she doesn’t, and I believe her. She has written about ruling out other factors that might be causing the amenorrhea. She does make some claims about amenorrhea being unhealthy in general and I have no idea if those are true or not true. I’m not a medical professional. I think it’s a bit unfair to claim that she is making female distance runners out to be selfish assholes, to be honest. For her, running high mileage is not compatible with getting pregnant and she wants to start a family. She also met her lifetime goal of representing Great Britain last year and her public blogging since late December has revealed that she wasn’t happy running currently, plus she’s going through a major career shift by leaving Runners Connect. She’s doing all this pretty publicly, which wouldn’t be my personal choice, but I am in my 40s, not my 20s, thank goodness. Also, I think her story is resonating with a lot of people for a variety of reasons and she’s bringing a lot of public attention to the issue of amenorrhea, which is probably a good thing. So, yeah, I’m a Tina fan, and I wish her all the best as she navigates all this. If she doesn’t do it perfectly every time, and if not every blog post explains the whole story, well, that’s the messy reality of life.

    1. I’ve been following all of her previous posts and so when the latest posts came out on her personal blog and then in RW, I really wanted to say something. I am not speculating about whether or not she has an eating disorder, simply noting that I don’t agree with the way she is attaching running to amenorrhea and infertility. It seems like she’s painting a very complicated issue with a broad brush and implying that every runner suffers the same symptoms and that doesn’t set well with me.

      I totally appreciate that she’s putting all of this out here for the world to see. That can’t be easy. But she should be careful about the way she does it. If I was a brand-new runner and didn’t know better, her posts would have made me super nervous about becoming infertile because of running and that’s not right.

    2. I don’t think she is intentionally trying to make anyone look bad or put a stigma on female runners. I think that starting a conversation is AWESOME, it’s important thing to talk about and for females in general let alone female athletes to understand. Conversation is good, normalizing it is not. Generalizing it and making it seem like it’s common and accepted and potentially “required” if you want to train at high levels is where the disconnect and issues come into play. Again, I don’t think she is intentionally trying to seem that way, though maybe it’s how she can make herself feel better about the whole thing- thinking if SO MANY others at her level or other levels have this then it’s less of her problem and more of a general problem.

  4. I think each person’s body is so individual-losing periods happens to some but not others, and it’s certainly not the norm. I have never had a missed period from running. In fact, my periods were very irregular until I started running 50 plus miles a week. Now they are like clock work. But I was once 2 weeks late when I got injured and suddenly stopped running. For me, the running helps! It also helps that I have maintained an average weight throughout my running career. The only time I lost periods was when I was underweight and unhealthy in college, before I took up running.

    1. Wow that’s pretty awesome that you have remained regular for the most part. I wonder if the stress of the injury was what made you lose it for a bit? Crazy how the body and mind are so connected.

      1. Like you Cayenne, I have never lost mine and I do believe running actually helps regulate my cycle. Even through my biggest training cycles everything was “normal”, and 2 of my last big training cycles turned up with pregnancy (I’m aware how it happens haha, we were not trying NOT to).

        A few years ago I was less regular as in my period would come very randomly (I usually had extra periods not less)…and hindsight I realized how much of that was stress in my personal life. Though I admit it was frustrating when doctors would tell me I was just fine when my period would come every 2 weeks or so….if you’re getting one at all doctors are less likely to listen to you when you tell them something is off. I wouldn’t be surpirsed if the stress from your injury caused that issue like Spearmint said- that mind body connection is crazy but I do believe can play a factor for many people!

  5. I didn’t really get the concern-trolling vibe from Tina’s post. What I took from it was that she was feeling burnt out, realized she was wanting different things (i.e. starting a family) and the best way for her to do that was to step away from running. A side effect of this decision was that, in her efforts to get pregnant, she realized that her training was having a negative effect on that goal. I don’t think she is insinuating that *all* women will have this problem or have to sacrifice their training in order to get pregnant, just that really hard training *can* negatively impact *some* aspects of your health for *some* people. I think it goes without saying that there are elite women that can get pregnant easily, it’s just that she was (is?) not one of them. We never heard from Kara Goucher or Lauren Fleshman or Alysia Montano about how hard it was for them to get pregnant, so in that respect I find Tina’s “realness” kind of refreshing.

    1. I’m the one who brought up concern-trolling, so I feel I should address that 🙂 I don’t think *she’s* concern-trolling, but I think that because of the vagueness of the article, those who already have the propensity to concern-troll could grab on to what she says as more reason to concern-troll, if that makes sense.

      I like Tina and I think that she has good intentions, but she also needs to make a living so sometimes pursuing both those aims result in mixed messages. Maybe it’s the editor in me, but I honestly think all the “problems” in Tina’s post are in the vagueness. It’s really hard to figure out what she’s saying and so we read into what we want to see or are left with questions and trying to imagine the answers. I have only followed her stuff on a surface level and read the RW post with any depth, so my thoughts are based on that and worth what they’re worth 🙂

      I see this discussion as a positive one and we wouldn’t be having it without Tina! And I know Spearmint is not the only one who took issue with or had questions about this article so it’s good to clear the air and talk it all out. So thank you for contributing to that!

  6. I felt the exact same way when I read that article. I recognize the point she was making, but her tone was alarming and would easily scare the uniformed.
    My period is actually more regular when I am training high volume. Its as if normal exercise is the only thing that keeps it on track. I run around 70-80 per week and peak around 95 during training cycles. I make sure I get plenty of fat in my diet during higher mileage. When I take time off, I have really long cycles as if the lack of exercise is also a shock to the body. Maybe I’m an anomaly though?
    I’m curious why these doctors would tell her she needed to take such extreme measures before eliminating other culprits. Or perhaps she didn’t mention them. Trying to give her the benefit of the doubt here. But what also surprised me was how she made it sound like she must eat all the things immediately… Rapid fluctuations in weight really do a number on your body. Yes, eat more to gain but don’t make it sound like you have to engorge fat-bastard style in order to get pregnant. So glad you posted this!

    1. Thanks for reading and commenting:) So interesting that you’re only regular when your running a lot!

      Also a great point about rapid weight fluctuations. Whether it’s a gain or a loss, it still takes a toll.

  7. I’ve lost my period while I was marathon training, funny thing is that I never got it back, I was 5 weeks pregnant when I did the marathon I was training for. I read her article and the alternative solutions bother me, like eating everything she wants and whenever she wants, junk food being the group choice (also very unhealthy) So she can achieve her “kangaroo pouch” for her future baby. I have much respect for her, but I would not want to give girls and women the wrong impression about training hard, not everyone is the same 🙂

  8. I stopped running when struggling with infertility. Running was not the cause but I just could not handle all that alone time with myself. I would be willing to bet that Tina is she is struggling hard with coming to terms with what infertility means for her. Infertility does crazy things to your brain.

    1 in 8 couples struggle with infertility. Tina, you’re not alone. People won’t understand choices or your feelings and you do not owe anyone an explanation. Spearmint, I know infertility is not what your post is about, and please know that I am not at all attacking the post. Infertility is poorly understood. My hope is that this comment will shed some light on it. #iam1in8

    1. Thanks, Liz! I think your comment sheds light on really important issue here: the reality of infertility and the very real and painful struggles it causes. No doubt that’s true and we’ve featured a few posts on that very subject, most notably Clove’s. Here’s just one of a few she wrote: http://www.saltyrunning.com/stroller-jealousy-the-life-of-the-infertile-runner/ As with any issue as complex as this, there are many facets, and this is one that is important to keep in mind in the discussion.

      As for Tina, we’re trying to figure out what she said and how that comports with reality, not second-guessing her statements about her feelings. She certainly doesn’t owe us an explanation for anything, but because she has put this out there in the interest of communicating “realness” that’s the only reason we’re talking about her experience or feelings.

  9. The problem I have with this article is the “you”s and “your”s all through it. What I mean by this is that it comes across as “Here is what YOU need to do if YOU are having this issue.” rather than “I, Tina, am having this issue and I wanted to share with you what I have learned could be impacting ME and what steps I am taking to make it better.” I don’t think the intention was to lump every woman having this experience into one category or one box, but writing such things as “First, address your nutrition” and “Second, your weight.” and “Third, your exercise” and “Fourth, your stress”, etc, does make it come across that way. Writing it in this style makes amenorrhea come across as one size fits all which, as we know from Spearmint’s article and all of the awesome comments below, it is most definitely not. In my opinion the “you”s and “your”s get in the way of the true point of this article which is “If you are having this happen, you are not alone. Don’t be ashamed. Here is my experience. Here is what I have learned about ME.” And that is a shame.

      1. I was in your position. So many doctors justified what I wanted. I trained so hard for so many years. My doctors gave me a pass, but my body doesn’t. Here I am now with osteoporosis and infertility, a decade later, and I haven’t been underweight since I was a teenager. Most doctors don’t know much about HA, to be honest. It’s not benign. Races are races, and I love them and all, but to have my training alter my life, it kind of hurts. You have a chance to do something about this now. I got the sense that Tina’s “yous” are pointed at her former self, not all women. Thanks, Tina. Shake off the haters.

    1. Spot on! Instead of sharing a personal story it’s made to be a clickable link piece that is generalized…..how it’s worded can drastically change the effect it has whether intentional or not.

  10. Like no training plan is one size fits all, fertility and the issues around it are not either. In my immediate family for instance, my mom had no issues getting or staying pregnant with my sister and I. With my sister, there was a whole bunch of things (my nephews are IVF babies) and she was also not allowed to run during treatment because she literally could “twist an ovary”. For me, I was training at a high level for me and got pregnant last year and struggled with miscarriage at 12 weeks. I started training again for one more cycle before we would try, and well- here I am 35 weeks pregnant. My point is, it’s SO different for everyone.

    I think that Tina’s posts about the issues are very personal, but are made to be read as more general. That is where it comes across as making it look like anyone training higher levels is doing damage to their systems and will have trouble.

    I also think that runners in general struggle to step away (particularly when running at higher levels) without a reason. Maybe it’s injury, maybe it’s pregnancy, maybe it’s something else- but as someone mentioned below the struggle with the all or nothing is definitely real for many runners. We don’t know how to take time off or step back from it without a reason, for fear of what people with say or think or because we ourselves are so intertwined with the training/racing cycles. This pregnancy has been my first real extended break from running in years and I admit it’s easier to handle because I have a “reason” or “excuse” which really makes me think about how I want to approach my running a little different in the future for me. I was long overdue for a break, but since I hadn’t been injured or had other reason to take a break I didn’t. Maybe using running as the “reason” or thing to blame for ammenorrhea is someone elses “out” to take a break.

  11. All I can say is ouch. That hurts to have an entire article written about me and my decision. A friend just sent this to me, and I wish I hadn’t read it.

    Runners World gave me a word limit, and anyone who reads my blog knows that I don’t do short very well. I encourage people to follow my blog as that is where I share the whole story (including trying everything else, and yes, weight gain was one of them), and yes, to those who did comment supporting me below, I wrote about everything, including my burnout.

    I am sorry the article came across that way, I was in no way saying everyone should do this, but that is really hurtful that you would write such a cruel article about me. I am only a person. I just wanted to get a conversation going about it, and the thousands of people who have reached out me shows me that it is helping in a way that I hoped….to allow women in my situation to see that they are not alone.

    1. Everyone respects you and your decision, Tina! I wouldn’t allow something cruel here. We’re discussing what you wrote and trying to understand it and I’m glad you’re here.

      1. As some others have said, I got a very cruel/attacking tone in this article as well. I think that addressing the issues of infertility in running and amenorrhea is wonderful. However, instead of calling out Tina and what you dislike about her blog post, I think that the point could have been made just as well by doing an educational article rather than tearing her down. It seems to me that Tina is going through a lot right now, and this article is not helping the situation at all. A simple, “This is what Tina had to say, but it might not be true/work for all women,” would have sufficed. Unfortunately, it left a bad impression for this loyal reader.

          1. Sorry, Saltines, but I thought this one was pretty much just cruel too. Like – look at Tina, talking about a difficult and embarrassing thing, but she didn’t do it “right.” I felt like this was kind of a low blow click bait way to try to join the conversation that Tina started, and seems pretty immature.

          2. Thanks, Sarah. I approve what goes up here. I assumed that because it was posted on Runners World that Tina was not ashamed or embarrassed about it, that it was ok to talk about it without tiptoeing around it. I would not intentionally approve a post just to be click bait or to be mean to someone just for hits. I do this (keep Salty Running running) — and it’s not easy, believe me — because I think most media underestimate the intellect of women runners and with any post here, it’s here because I think it advances the conversation and gives us a chance to learn and grow. That’s what I think it does. It’s addressing Tina who is viewed as an authority on running, not at Tina personally, but I suppose in blogging the lines are more blurred than I assumed.

            Ps This would be a very different site if it were all about the clicks 🙂

          3. Fair enough, Salty. The internet is tricky with intent and perception and so many varying opinions. There’s probably some varying opinion as well depending on how much one has followed Tina’s fuller story (several blog posts, at least one podcast, and not just the Runner’s World article)i. I appreciate what you do here and really enjoy the very substantive, data-backed posts you often provide.

          4. Yes, I notice a distinct difference between those who are avid followers of Tina and those who are not in how they feel about this one. I think her other work fills in some of the gaps it seems. Anyway, I appreciate your thoughts a lot. Thanks again!

    2. Hi Tina,
      This wasn’t at all meant to hurt you or come across as cruel! Like I said, I am super happy that you’re starting a conversation about this topic! So again, thank you!
      This is simply me asking honest questions and being real with how I felt the article came across. I’m not criticizing your decision to stop running to get your period back. You gotta do what you feel is best for your health. I just disagree with how it sounded like running is, in most cases, the cause of infertility/amenorrhea and the only way to fix the problem is to stop.Not everyone is always going to agree on everything and it’s ok to have differing opinions on this issue!

      Again, I wish you the best and am glad you started this conversation.

      1. Sorry Spearmint, but I do think it was on the cruel side of writings! I agree with poster below that yes, maybe Tina could have used some a more “this is my experience, not all peoples experience” angle, but I took see some harsh, directed criticism at her from it. We all need to just stop and be a little kinder to one another these days.

    3. Tina, I am rather sorry that I read this article too! I wish that I didn’t. I can’t even begin to respond beyond saying it’s never okay to not get a regular period and I am proud of you for sharing your personal story and working on getting your period back in a way that works best for you.

    4. The decision to speak about these issues in a public setting is brave and should be commended. This goes for Tina, Spearmint, and other people who have commented. But when you make yourself a public figure, it opens you up to people responding to your platform in a variety of ways. Sometimes people will not agree with what you say or will have an opinion different than your own. Vocalizing this differing opinion does not make someone cruel!

    5. Tina, I’m really glad you weighed in, too, because I was about to defend you, but then realized that a lot of other people are already doing it. <3 All we can do is tell our own story and share the lessons we've learned. And it should be implicit with any personal narrative that we are all different and therefore all require different conditions and circumstances to thrive. Since you brought up Steph Bruce, I think her take on pregancy/motherhood training advice was quite relevant to this discussion – "the only advice I can really give is to do what feels right to you."

      Tina HAS exhausted all of her resources to find any solution possible other than taking a break from running, and this is the last natural option and she is going at it with full force, the best way she knows how. Just as I have been jealous at times that others can maintain a lighter body weight (and therefore easily increased VO2 max) and stay healthy and train for decades, I would assume that to Tina it would feel unfair that there are thousands of women across the world who can train at 90-130 miles per week, even with high-intensity workouts AND still get a regular period. But she's not telling their stories. She's telling hers. And in doing so, she is courageously opening up the conversation to everyone else (like all of us) to chime in. So let's focus on our stories, too, instead of spending our time judging hers.

      1. I agree with you 100%, except I don’t see where Spearmint is judging Tina’s personal story. I worry that when one woman disagrees with another that it’s assumed she’s being catty or it’s some personal take-down. That is not what this is about. Even the giraffe picture is in reference to what Tina says her doctor said, not Tina herself. The title also says it’s a disagreement about what Tina wrote about “running and amenorrhea” and not anything about Tina’s personal story. I think from this discussion it seems that Tina meant for it to be about herself, but that because of the voice, editing, word count or whatever, it sounded like it was globalizing her experience. That’s fine. That’s easily cleared up and should be, because if it’s not, a lot of people read that RW article and conclude high-level training is intrinsically unhealthy for women, which is not true. If that is the claim, which it can be reasonably assumed it is based on the words in the article, that is indeed wrong. I’m not interested in perpetuating catty BS. I just want to push our conversations about this stuff to advance our understanding and as I’ve said several times, I appreciate that Tina has brought the issue out and inspired us to talk about it.

    6. I don’t think the point here is disrespect to you Tina, and clearly this a topic that strikes a chord with many running women. Telling your story about not having a period and then taking the steps to get it back is great to put out there, however I will say this: I haven’t ever followed your blog/social media accounts/etc so when I read the RW article, I had no context except what was presented in the article. Yes, there were word limits and editors involved that may have altered or shortened your point, but my general take-away was still “wait- but everything I’ve read/researched about ammenorhea lists not eating enough calories as the primary cause which can then be exacerbated by over-exercising, but not high-mileage running alone” and “wait- I know plenty of high-mileage runners, including myself, who keep their period and have gotten pregnant while training” and “wait- I didn’t ruin my fertility by running” and “wait- is this saying that basically all elite and high-mileage runners lose their periods and need to 100% quit running cold turkey to get pregnant?!” and “wait- I thought we were past the ‘running makes your uterus fall out’ days and this reminds me of that a bit.” Do you see my point? For those of us whose read this as a standalone article with no context of your prior posts, it left me going “hmmmm.” Maybe that’s a message RW should hear, too. My best wishes for you, it sounds like you’re on the right track to getting to where you want to be!

  12. For a different perspective, I’d have been fine with amenorrhea as long as it wasn’t hurting my health. I’m not having kids, so fertility doesn’t matter to me. In 18 years of running, including five marathons, I’ve never missed a period. It wasn’t until I got a magical IUD that I could leave it behind.

    1. Yes, I think the concept of bodily autonomy gets lost in this conversation sometimes. Because amenorrhea is often linked to ED, some seem to assume that anyone who chooses to continue training with it must be disordered, and of course the whole “gotta make the babies” thing. Some women don’t want to become pregnant, so fertility issues alone are not of concern. That can be a perfectly healthy outlook!

      1. Absolutely. I’ve read so much here about shame about not having a period, which is new to me. I don’t say any of this to make light of a tough health issue for many women. But I’m also sure there are women like me who are happy to get rid of their periods, which essentially have no purpose for us. You, too, are not alone.

        1. I’m definitely in the same camp. No need for one here, and basically rejoicing at its loss! I’m curious though with the more recent post from the author of No Period Now What above, I’m interested in looking further into things myself to ensure that I’m not going to have any issues if I stick with my IUD through to menopause.

  13. I read her article yesterday and I didn’t have nearly the negative impression that others have noted here. The one part that bugged me was the “eat all the cake and ice cream in sight” part…. clearly, it shouldn’t have to be one extreme or another. the bottom line for me is what someone else said below – loss of a regular period is a symptom of something going on. It isn’t normal in most cases and should always be viewed as cause for concern. I’m glad that many on this board have gotten themselves checked out and found there’s no specific underlying issue. That’s great. But it’s probably not the case for the vast majority of women, and having too low body weight is often the culprit. I don’t think the article implied that women shouldn’t train hard. What I took away from it is that no matter who you are, there’s a tipping point and a fine line between “training hard” and “overdoing it to the detriment of your health.”

  14. So, I can appreciate Tina’s honesty in sharing about having amenorrhea at all. It’s not talked about enough – that is a fact. Neither is infertility. But the point of a conversation is that there are multiple voices. Tina’s story is harrowing, and the steps she’s taking to address it might be useful for her, but not necessarily for another person whose amenorrhea might be chalked up to something else (PCOS, other hormonal imbalances, other primary illness, side effect of medication, etc – and yes, exercise-induced). I completely understand Spearmint’s concern about implying that running cessation is the only fix to conceive.

  15. I struggled with amenorrhea as a teenager and it was specifically due to calorie restriction. For me, I was a naive teenager reading the Cosmos and Redbooks thinking I had to eat 1000-1200 calories a day to look like the models. However, a few family members and friends chalked it up to running (since I had just started it then) and it created that stigma that too much exercise is not good for you. Eventually I went on BC and it came back and eventually I went off BC and stopped restricting my diet and it occurred naturally but it certainly was a little scary at the time. I’m glad we are talking about this topic but I have to agree that the RW article and even Tina’s blog post could have been edited better.

    In particular, it seems unclear if Tina is currently infertile or only has amenorrhea – Amennorrhea does not always equal infertility, they are not one in the same. This distinction needs to be made more clearly or else it comes off as insensitive to those struggling with infertility (i.e. if they just give up this and do that, magic! a baby will appear!).

    We’re having a great discussion and it wouldn’t have been possible without Tina’s posts or this post. Also, to lighten the mood a little (maybe) my Google spellcheck keeps wanting to replace amenorrhea with gonorrhea.

  16. I think my biggest concern with this article was the whole tone from RW. It’s no secret that I am not a fan of this publication, and it really angered me that I interpreted the tone to be that too much running was dangerous to a woman’s health. I finished reading the article thinking that the next post from them would be how my uterus will fall out if I continue to run and do long distance triathlon. The article should have left me thinking that what works for one woman may be different for another.

    I struggle with my periods. In fact, up until early April, it was over 4 months since my last one. I am on the pill, but something just didn’t click. And then it came–with a vengeance!

    I also learned many years ago that my chances of having children were pretty much at 0% unless I wanted to pursue some other options. Those are the cards that I was dealt in my life, and I just had to deal with it. At that time and even now, I was or am not at the level that Tina was.

    Hopefully, things work out for her and for all women who aspire to train, have a family or not have a family.

  17. I read Tina’s article and found it to be a brave and vulnerable post from a woman who decided to share her story in case it could help others who were in a similar situation. I re-read the article after seeing people’s comments about all of the “you” statements in it and, frankly, I found very few. I also found that Tina mentioned visiting numerous doctors before concluding that it was the running that was causing her condition. She also answers your question as to why she didn’t eat “all the cake, ice cream and pizza” while training – she needed to eat “fueling foods” to support her performance as a runner. [It should also be noted that she experimented with gaining weight while running – she revealed this on her Running for Real Facebook page. She was unable to go into every single detail of her 9-year journey in her Runner’s World article, as she had to abide by word limits (and respect readers’ time restrictions and attention spans).]

  18. Well first – Congratulations that your doctor said you not getting your period is fine! Guess what – it’s not normal. Your body is shutting down functions based on the stress response you are sending it. RUNNING AND ALL EXERCISE CAUSES A STRESS RESPONSE. It is, from an evolutionary standpoint, a well-known argument that women who are under stress lose the ability to reproduce.

    That is why Tina Muir made the argument of “running from an animal”. That was an example she made to show that her body is in a constant stressed state due to running. That is a very real reason to not get a period.

    I think you’re inconsiderate and are reading her article from the wrong perspective. Never ONCE did Tina ever encourage anyone else to not run. Her message is to BE REAL with her fans and she is sharing her journey. If she’s done everything she could to get her period back (which she has expressed that she has multiple times) and this is her choice, it is not your place to argue that.

    She is choosing not to run for her own well-being. She is explaining the reasons why she chose that. She is choosing to continue her career in the running world in a different way. She is EMPOWERING women to explore their own health and their own bodies and is proving that running does not have to be your whole life. She is proving that she is more than a runner and that everyone else can be too.

    Who are you to judge?!

    1. Hi Ally,

      Thanks for reading!
      If all of my hormone, white blood cell, iron levels etc are normal and I am not currently trying to conceive then yes, it is fine. And you’re right that running certainly doesn’t have to be your whole life! We all have different priorities and passions and that’s a great thing! However, those who choose to make it a huge part of their life shouldn’t be scared to do so and told that they shouldn’t.

      Just as Tina is being real in her post, so am I. Just throwing a different opinion out there and asking honest questions of her opinion. Thanks for adding another voice to the conversation!

      1. You’re not throwing a different opinion…you practically made fun of her!!!

    2. I’m very curious about your response. HOW DARE the author judge?! But you, read her post in which she actually isn’t vague and explains her situation and you come back at her with judgement that she is wrong, unhealthy or what not? How does responding to “judgement” (when in fact it’s just alternate opinion) with ACTUAL judgement solve this? It doesn’t.

      No one is faulting Tina for taking steps to get her period back- the causes that force someone to lose it are all so different and personal. Running at a high level might take it away for some- and for others they may have a period or even get pregnant just fine training that way (raises hand!). It’s great the conversation is being started and continued and going down different paths- that is important. Tina has created a name for herself and her “brand”- and she is in a position of influence, with that influence comes some responsibility. Clearly not everyone felt her posts were empowering in every way or there wouldn’t be posts like this, people sharing or agreeing with it. Different people read things different ways, and with the name she has made unfortunately that means not everyone will agree with everything. Different points of view are not bad, taking responsibility for how things may have come across to others is important

      1. Running 40-50 mpw is not the same as 90-100 mpw. I wouldn’t really consider your training “at a high level,” no offense.

  19. Sorry Spearmint, but I do think it was on the cruel side of writings! I agree with poster below that yes, maybe Tina could have used some a more “this is my experience, not all peoples experience” angle, but I took see some harsh, directed criticism at her from it. We all need to just stop and be a little kinder to one another these days.

  20. I am one of the authors of No Period. Now What? and have done extensive research on hypothalamic amenorrhea, reading through hundreds of articles in the scientific literature, as well as working with a large number of women on recovering not only their menstrual cycles but also freedom from disordered eating and exercise habits. My book includes the research, my story and the stories of many of these women I’ve worked with, along with data from a survey I did of over three hundred women who experienced HA and recovered.

    Unfortunately many doctors brush off not having a period, saying “just take the birth control pill and you’ll be fine”. Perhaps for some that might be fine – if you have had a bone density scan and have good bone density, and do not suffer from the multitude of other symptoms commonly associated with HA like absent libido, brittle hair and nails, moodiness, anxiety, foggy thinking, bradycardia – for example. But there is quite a bit of evidence in the scientific literature of bone density issues in athletes (runners) that in my opinion warrants investigation of the amenorrhea and the causes behind it instead of just sweeping it under the rug. Here are some references: Gibson JH, et al. “Determinants of Bone Density and Prevalence of Osteopenia among Female Runners in Their Second to Seventh Decades of Age.” Bone. 26(6) 2000: 591-98. doi: 10.1016/S8756-3282(00)00274-X; Gibson JH, et al. “Nutritional and Exercise-related Determinants of Bone Density in Elite Female Runners.” Osteoporosis International. 15(8) 2004: 611-18; Keen AD, Drinkwater BL. “Irreversible Bone Loss in Former Amenorrheic Athletes.” Osteoporosis International. 7(4) 1997: 311-15. (I also include references for the long term effects of increased risk of cardiovascular disease and potential increased risk of early dementia in my book as well as discussion of why it is that running and other high intensity exercise can prevent the return of menstrual cycles (it’s the cortisol and other stress-related hormones for the most part.))

    My take on Tina’s post is that she was trying to get women with amenorrhea, who quite possibly may have been told by their doctor that their amenorrhea isn’t a problem, or that their weight, exercise, eating aren’t a problem (if those factors are even discussed) to think about their overall lifestyle and whether some of those factors may in fact play a part. In fact I think she has raised more awareness with her post than I have in the 10+ years I have been working on this, for which I am very thankful.

    I think it’s wonderful to have more people in the running community, and athletic community in general discussing these issues – I hope that the discussions can take place in a respectful manner where we focus on the issues and research.

    1. Thanks so much for weighing in! This is super helpful and much appreciated. Without Tina we wouldn’t be having this conversation ourselves and as Spearmint wrote in her post: “Open conversations about it are good! Thanks, Tina, for starting one.”

      On a personal note, I have my children now, but this conversation has sparked a lot of interest and I have a lot of questions on this topic, so I’m off to do some reading.

    2. Double thanks for your contribution to the conversation! As someone with a Mirena IUD I haven’t had a period in 7 years and have been very thankful to lose it (I always considered it a pain in the *** more than anything), but definitely am interested in the topic and skeptical of whether or not it’s healthy to go so long without it, especially as you provide peer reviewed resources! So awesome! ??

      1. I am in a similar boat – I am on Amethyst – the generic version of Lybrel, which is the “no periods” pill. So, I have not had a period other than the occasional breakthrough spotting during times of stress or if I forget to take the pill (which has happened once or twice…ooops).

        I guess there are two themes that really stand out to me in this discussion: one is that I do believe that not having a period is an indication of _something_ , and thus does require some examination, if there’s not an obvious and immediate cause. The other is that a woman’s body is her own, and each of us are entitled to make our own decisions regarding that body.

        I am not a medical expert myself, but I have been told by some that women’s bodies in ancient times are believed not to have had periods every month, due to hard times or being regularly in some stage of pregnancy. But then I’ve been told by others that it is unhealthy and unnatural for women to not have periods, even if it’s due to one’s BC choice. So lots of arguments on each side, and lots of judgment.

        I do see a lot of judgment and perceived judgment on all sides of the issue. Someone takes one position, and others read (rightfully or wrongfully) judgment, and then respond accordingly. And so it continues. I wonder if this period discussion isn’t the serious female runner’s version of the mommy wars.

        1. darkwave, I’d encourage you to research and discuss with your ob/gyn the side effects of the pill versus the Mirena IUD. You end up with the same outcome (no bleeds) but with the Mirena your natural cycles are not suppressed, unlike on the pill. From the research I have done, the effects of the pill on bone density are not entirely clear, but I don’t think that one can support an argument that they do any more than maintain bone density, whereas it seems that with natural cycles bone density does continue to increase (albeit slowly) through the second and third decade.

      2. Cinnamon, I am actually on the Mirena as well – I never thought I would do hormonal birth control again, but after researching the Mirena and finding out the the hormones it contains are such low doses and also localized so that they do not actually affect your menstrual cycle, I decided to go on it. I believe I am continuing to cycle based on changes in cervical mucus and a tiny bit of spotting each month (I’ve been toying with the idea of confirming with OPKs and perhaps bloodwork with my doc, just out of interest). If this is true for you also, then you are continuing to get the benefits of the natural rise in estrogen and progesterone that occur each month and I would not put this in the same category as hypothalamic amenorrhea. If you are not experiencing CM changes throughout the cycle, I’d suggest that you try and confirm whether you are ovulating or not. If not, perhaps consider whether you are experiencing HA and think about working toward recovery. The first chapter of my book and an HA info sheet are available as a free download from my website here: http://www.noperiodnowwhat.com/hypothalamic-amenorrhea-info/hypothalamic-amenorrhea-resources (the post includes additional references for your perusal if you’re interested.)

        1. Yeah my curiosity is just that – curiosity. I’ve had CBCs since then with no indication of abnormalities so I’m not worried about my health, I just think science is cool. I hated my period, but after I read the Secret Life of Fat I’m sort of interested in the topic of menstruation generally, and particularly in the context of how our health as women has been perceived and treated socially. Thanks for the link! I’m definitely interested in reading your entire book. It’s on my list!

  21. Reading this post was a relief to me, because I, like Spearmint, do not have regular periods but EVERYTHING my physicians have tested over the years has shown that I’m 100% healthy. It’s nice to know that there are others in this same boat! I follow Tina’s blog and her recent posts scared me into thinking my physicians have been wrong. I’ve been a runner since age 11, and from the time I began menstruating at age 14, I have always gone multiple months to multiple years between periods (except when taking the pill, and including when I’ve been heavier during times of injury); for whatever reason, that’s how my body functions. I appreciate Tina bringing the issue to light, and relate to feeling shameful about it as she mentioned. I also appreciate Spearmint for adding this information that it IS possible to be 100% healthy without having monthly cycles! Thank you, strong ladies.

  22. If anyone is setting women back it’s a woman telling another woman what she should and shouldn’t do with her body.

  23. Thank you, Eddie!!! This post is honestly unnecessarily abrasive towards Tina Muir. Tina is obviously at a different stage in her running career and has publicly stated that she has lot the JOY in it. You fail to mention that aspect. In ALL, as females we are at the liberty of choosing to do whatever we please with our bodies. It is HEARTBREAKING when fellow female distance runners are clearly suffering from an ED and/or depression but what is even more heartbreaking is that we fail to support one another in a loving, nonjudgmental way. We should celebrate the fact that Tina has made a decision towards happiness & the fact that you too are aware of your ongoing amenhorrea and are taking the necessary steps towards recovery. Because RECOVERY should be the achievable end goal. There are multiple avenues to achieve it. Deciding to not run is legitimate. Deciding to continue to run is legitimate. Deciding to eat more and taking your bodily cues more seriously is legitimate. This sport can be so sad sometimes and seeing something like this, on multiple levels, deeply worries me. We should NEVER ignore the lack of a regular period & should never accuse someone else’s story as being illegitimate.

    1. I think Spearmint was just informing people that running doesn’t necessarily make you infertile. She didn’t mention Tina’s underlying problems because Tina wrote extensively about running being the possible sole cause of her problem. I think it gave the wrong idea to girls/women who want to pursue both a career in running and motherhood(hell, it spooked me and I’ve never missed a period) Maybe people should try and be objective about this discussion because it is for our own good(women who run). Giving partial information is misleading and wrong.

    1. I agree. I believe Tina was very brave for telling her story and, while discussion and having a different opinion is good and constructive, this was way too harsh.

  24. I’m really enjoying the discussion this article has created, Spearmint! Thanks to Tina and yourself (and other commenters) for opening up about this area. We don’t talk about it enough.

  25. Well, pass the popcorn. This has certainly been entertaining to read! First of all, I see nothing cruel about this. It’s an opinion on another opinion. Let us not forget that. Tina’s story is not the be-all, end-all narrative on amenorrhea, and that was the point of Spearmint sharing her own experience with the condition. She did NOT tell anyone what to do with their bodies, but offered ANOTHER experience as an elite runner with amenorrhea as she AGREED that there was not an appropriate existing narrative. She’s allowed to do that, you see. That’s how free speech works. Not only did she offer her personal experience, but she did so diplomatically. Then, enter the the people who didn’t think that Spearmint was *allowed* to have an opinion differing that of a public figure. Honestly, give me a break. If you think you are going to put your personal, private life out there so self-importantly and receive NO criticism, you are sorely mistaken. This discussion devolved from an educated one in which people shared personal experiences into a whine fest about how blogging is cruel. If blogging is so cruel, why do you participate? Seems kind of an immature take on one’s own career. And finally, for those who think this article is cheap click-bait, but don’t view Runner’s World in the same light, PUH-LEAZE. RW IS capitalizing on Tina’s struggles. THAT seems kinda cruel to me– Using Tina and her voice to project her experiences which she is clearly not ready to discuss with anyone who disagrees in the slightest.

  26. What in the world is this post. How is this useful, besides trying to make someone feel bad about their own concern for their health?!

  27. I’m definitely seeing this post as cruel, to use Tina’s words. I’m not seeing this as simply “another opinion”. This woman was definitely trying to make Tina feel like she’s doing something really wrong by bringing this public. Saying things like, “stop telling people that high-level “professional” running is unhealthy for women! Stop leading women runners to believe that they will destroy their abilities to conceive if they choose to really go for it in training. Stop making women out to be weak and incapable of pushing their bodies as hard as they choose.” I didn’t get that sense at all in Tina’s article. From what I’m seen, she’s always wanted to be a “strong, fit” runner. Sorry.

  28. This post pits “one woman’s” story against another “one woman’s” story. So two anecdotes. Neither Tina nor Spearmint are reproductive health specialists, so this is entirely unhelpful to readers, if not misleading and confusing. Spearmint makes the dangerous statement that amenorrhea “may not be a problem”. Strong words for a runner who obviously doesn’t have a background in healthcare. Publishing this post was a mistake. I’m a fan of presenting opposing opinions, but unless you are Mr. Web, M.D. himself, it’s safest and smartest to refrain from posting medical advice on the internet.

  29. I am glad there is an ongoing discussion about amenorrhea and running, but I cannot express enough that it is important for female athletes experiencing amenorrhea to have this evaluated and monitored by a physician who understands the proper work-up and management. It is “common,” but not “normal” for a female runner to be amenorrheic. As a sports medicine physician, an endocrinologist, and a specialist in Female Athlete Triad, I encourage girls and women to have the proper work-up. If you doctor says amenorrhea is normal, I disagree. Working with an expert dietitian, physician, and others on your treatment and training team can help maximize your running and your health! For more information, please see
    http://www.childrenshospital.org/centers-and-services/female-athlete-program
    or consider attending the June 9th and 10th Female Athlete Conference:
    https://bostonchildrens.cloud-cme.com/Aph.aspx?P=1&EID=333

    Kate Ackerman, MD, MPH
    Assistant Professor- Harvard Medical School
    Medical Director- Female Athlete Program, Boston Children’s Hospital
    Team Physician- USA Rowing

    1. I’m glad to see a medical doctor chime in here. Thank you. Been thinking about this one a lot over the past few days. I read a lot of running articles and blogs (here on Salty and elsewhere) and when things get heated like this case, my first thought is often “thou doth protest too much”… it can feel like we’re trying to convince ourselves and each other that something we know is maybe not quite right, is totally OK and its the rest of the world that has the problem. We all know that endurance sports can, and often do, coincide with disordered eating and body image. Of course women can train hard, and should not be dissuaded from doing so when their physical and mental health is not threatened. But the bottom line here is that our bodies are different from men’s bodies, and whether or not you choose to become a parent, your body is designed to do so at some point in your life. When you aren’t getting a period, it is a sign that something is probably not right. There are many reasons why that could be. Is it possible that there’s nothing wrong? Sure. But is that likely? My gut and the medical opinion I see here (and every other one I’ve ever heard) indicates no. I don’t know how old most of you are. I’m 43 and I have 2 kids. I struggled with an ED in my teens and early 20s, and at one point did lose my period for a few months. I also remember how easy it was to convince myself I was fine and other people should just leave me alone. When you are young, you don’t realize the long-term effects that your actions and decisions can have on your health. I didn’t try to have kids till I was in my early 30s. I had been on the pill for so long I didn’t even know what a “normal” period was like. Turns out my thyroid was also shot (can’t say exactly why but likely linked in some way to my weight fluctuations and tendency to try to run off my calorie sins). Compared to many women, I had a relatively easy time once my thyroid was regulated and I allowed my menstrual cycle to get back to normal. But I can tell you, it was stressful, and heartbreaking when we suffered a loss. Impossible to say why these things happen, hard to place blame. My point in saying all this is that please don’t take your reproductive health for granted. If you are in your 20s, maybe not thinking about having kids for a while, or maybe not at all…. when there are signs that something is probably not right, don’t ignore them. It will save you a lot of heartache later. Running is just one part of your life, regardless of how important it seems right now.

    2. Thanks! I’ve also been wondering about the actual medical consequences of amenorrhea – and teasing apart the impact of ‘not ovulating but having your uterine lining slough off hormonally’ (what you would get on the pill during placebo weeks) versus actual primary hormonal amenorrhea (not ovulating and not getting a period).

      The other thing I’ve been wondering: From an anthropological perspective, in many pre-industrial societies, menstruation was suppressed by pregnancy or lactation. Is there, in and of itself, a health impact of menstrual suppression this way? Is our perception of what is ‘normal’ skewed by our industrial-society data?

  30. I love Tina but I have to agree that she probably didn’t handle the situation well! There’s nothing cruel about this post at all and I admire Spearmint for having the courage to discuss this issue.
    We need to be objective and open about these issues because I do agree that the way it came out it seemed like all elite runners have fertility issues and running is the ultimate sacrifice. It sort of reminds me of the ‘running marathons destroys your kidneys’ article that came out a while ago(RW published an article explaining the study last week). This is how false information is spread. When I started running a few people told me I won’t be able to have kids(fyi I have never missed a period!)

    Here Spearmint clearly says to do the proper tests in order to find what causes your amenorrhea. Sounds pretty reasonable to me!

  31. Hello. I was once an aspiring elite and am married to a former elite runner. I also spent a number of years coaching at a competitive D1 university. I appreciate both sides of the argument and have seen it from the perspective of both athlete and coach. As an athlete, my body type is thick, muscular legs, but crazy skinny arms. I never missed a period and even running high mileage, my BMI never went under 11%. Because my arms are so skinny people would occasionally assume unhealthy eating/training habits (despite my thick legs). I hated that and still hate for people to assume that about anyone. So I appreciate your defense of all former, current and future runners. I also appreciate that you bring the perspective that as long as those missing their cycles are being closely monitored by their doctors, they should be fine and not be intimidated to chase their dreams of training & competing at a high level.

    From the coaching perspective I saw a couple athletes experience disordered eating, both of them experiencing amennorrhea (that was absolutely related to their eating habits), but neither of them knowing/admitting they had a problem. Call it denial or delusion, they didn’t know and they vehemently denied having an issue. So even if they are seeing a doctor, the doctor can only go off of what the patient is telling them. So theoretically speaking, it is true that if their tests are coming back as “fine” they should be fine. But if there is actually a lifestyle problem causing it, the doctor may not be able to address it. It’s because of this point that Tina is right to publicly share her experience, so as to [perhaps] reach some of these athletes who “don’t know” they have a problem. But I agree that any public figure should be careful not to cast a light of that antiquated idea that “training is bad for women.” We have come too far as a society to go back.

    I appreciate that you address the opposing side of the issue and continue to open the conversation. Your response did read as very critical to me, and yet because it is such a sensitive issue for anyone who has ever experienced this sort of judgment, it is easy to understand the emotion that would fuel a harsh defense of female runners. Personally I would suggest a less confrontational approach in the future. Best of luck in your athletic & professional endeavors!

    1. This is a really good bunch of points. To the ED point, we’ve talked about it in a round about way in the comments. With ED casting a shadow on this issue, and it being a disorder that often is paired with intense denial, I think we (the peanut gallery) might feel more comfortable making a judgment about what a woman should or should not do if she’s faced with the condition. On one hand, it’s her life. Why is she not free to make an informed decision for herself, whatever it is? Why do so many people feel it’s their right to tell someone that they must feel or act a certain way? But on the other, if there is an ED at the root of this, and the person is in denial, than how can we, at least those who love and care for that person, not feel obligated to intervene?

  32. I finally got to reading Tina’s post on her website (insert all the excuses) which apparently is what the RW article was adapted from, not sure if that’s been made clear in the RW post or in the comments before. As far as Tina’s personal story is concerned, much of what feels missing from the RW piece is there and I think most everything makes a lot more sense if you read the long form post over the one in RW.

  33. read this when it first came out, have listened to Tina’s podcast, chewed on the ideas for a bit, and came back with renewed thoughts.

    So, I’m also proud of Tina for sharing and love the discussion that she’s kicked off.

    Here’s my beef with her message- it’s “amenorrhea is bad for you, and I knew it was bad, but I kept running because it served me at that time. Then I achieved my goal and I decided to go back to being actually healthy.” It’s not walking the walk. It’s, “do as I say, not as I do.” I guess maybe she just had more trouble than average having a period, but I think telling other women they should get their periods, but not having done that until she wanted to, is hypocritical. I feel like it’s cheating for some people to train that hard, get amenorrhea, and run good times, and then say “oh we weren’t supposed to do that, but we did it anyway.”

  34. This is hands down, without question, the most ignorant post I’ve ever read re: hypothalamic amenorrhea. Honestly, you did zero research, you know nothing about HA, you have no business posting this. It makes me so angry that people googling Tina Muir and HA are going to encounter this crap. I suffer from HA, and its without question due to overexercise. Now that I’m trying to get pregnant, I would give anything to go back in time, before I lost my period and stopped ovulating, and try to find balance. Had Tina been around then, I would’ve at least known this problem exists. The fact that you think giving up running for six weeks is equivalent to “giving up your health” just shows how disordered your thinking is. Don’t you think it’s more than a coincidence that this blog contains a lot of infertility stories? Seriously, so frustrating. Do some research.

    1. Seriously, so frustrating when you attack saying it’s all ignorance and then come back with your own statement that rings without a firm knowledge base. Sure there are many stories of infertility out there and on this website, and many with runners but that doesn’t mean that it is because these strong women are ignorant and it doesn’t mean it’s solely because they are runners.

      There is an infinite number of combinations of things that can cause fertility issues. Running is far from the only thing that can do so, and it’s rarely JUST because someone runs. It may be someone runs, but doesn’t eat enough to fuel said running. Maybe it’s hormonal, maybe it’s got NOTHING to do with running. This is the point of it all- Tina’s message implies that ALL female runners are hiding issues with their periods and fertility, and implies that it’s solely because they are runners. This kind of thinking is very dangerous, and gives female runners a bad rap. Not all female runners lose their periods. Not all female runners have fertility problems. Not all female runners need to stop running to get pregnant. Not all female runners are disordered. Ignorance is believing that all females are the same.

    2. I completely agree. Regular fertility is a sign of health. If you are not getting your period, it means your body is not functioning to its full extent. This post was so disheartening and even triggering to some extent. I am a previous runner who has been backing off to regain my period and find more balance in my life. Obviously, it is possible to run a lot and still ovulate, but in order to do so, you need to be fueling properly and at your body’s set point. Finally, you cant just say ammnorhea is only a symptom and if you dont have other symptoms your fine….ammnorhea stops your body from getting estrogen. When you don’t get estrogen, you cannot absorb calcium and so you start to draw calcium from your bones. It takes time, but overtime you will eventually suffer bone density problems- maybe not for a few years maybe not for a few decades, but you are putting yourself at risk. I hope you solve your own ammnorhea and find better doctors before it is too late.

  35. I love you for this, God bless friend! Stop scaring women- I am 21, and her post legit scared me- and let’s all focus on the real issues here. We’re all different, and obviously not everything works for everyone.

    1. Krista if you are missing your period, I do encourage you to learn more… it *can* have negative consequences that you might not recognize at the moment. Don’t take this post as a reason not to be concerned. Just because one person’s doctor has told her that she is “healthy” does not mean that an absent period is healthy for you. And also know that many doctors are not educated on this topic but give out advice regardless – check out Dr. Kate Ackerman’s response from April 29 2017.

  36. The recent article that came out from the International Olympic Committee (https://journals.humankinetics.com/doi/pdf/10.1123/ijsnem.2018-0136) is well worth a read for anyone who finds themselves with a missing period. “Relative Energy Deficiency in Sport (REDS)” is the term that is now replacing “female athlete triad” of which “hypothalamic amenorrhea (HA)” is one symptom, because A) men can likewise experience negative effects from underfueling/overexercise/stress/weight loss/genetics (noting that that the combination that causes REDS is different in each person) and B) there are many other symptoms that can be associated with the syndrome, including metabolic effects, endocrine, immunological, psychological, bone effects, cardiac effects… I hope that anyone who is missing her period does investigate further to try and figure out her particular recipe for why her period is missing (it can be HA as Tina experienced, which is probably the most common cause in athletes, or it could be PCOS (be aware that HA is often misdiagnosed as PCOS http://www.noperiodnowwhat.com/research/pcos-vs-ha-research-update/), it can be high prolactin secondary to breastfeeding or a pituitary microadenoma, it can be Asherman’s syndrome… ). And generally it is more healthy to have one’s period that not, for the many benefits of the monthly rise in estrogen, progesterone, and all the other hormones associated with ongoing menstrual cycles. If you disagree, read the IOC paper and look at the references therein.

    The recipe for each woman without a period is different, both in terms of how the loss happened, and what needs to happen to resume cycling. Some lose their period when they increase training but do not increase fueling to compensate, some lose it when they go on a diet, some because of serious stress with the loss of period maintained by a slight energy deficit… some can resume cycles without cutting exercise, but many women DO need to cut back on high intensity exercise, including running, or cut it out altogether for a time, in order to resume periods… that passes no judgement on running, women in running, anything like that – and as far as I am aware, everyone who wants to resume exercise again is able to do so.