Becoming ED: The Female Athlete Triad and Amenorrhea

There’s a point in your disordered eating when you become your disorder. When, without realizing it, you stop separating your own body from the image of ED in your head.

And suddenly: your body starts to comply.

You want to kill the woman who is trying to emerge from inside of you, and suddenly…you do.


You may have heard this term kicked around in conjunction with the phrase “Female Athlete Triad” or “Exercise-Induced Amenorrhea” (which usually shows up in an every-so-often article on overtraining in a women’s health publication, closely followed by an article on the “ten exercises moves you need to be doing right now…”). Or, perhaps you heard about the phenomenon on Stefani Ruper’s blog or Sean Croxton’s interview with Dr. Kelly Austin on Underground Wellness. But if you haven’t heard of it, here’s a quick primer:

Female overtraining

And the “overexercising” article ALWAYS has a picture that looks just like this…

Female Athlete Triad, a term applied to women who display a series of similar symptoms while doing intense exercise,* consists of 1. Disordered Eating, 2. Menstrual Dysfunction (or Amenorrhea), and 3. Weak Bones (or Osteopenia/Osteoporosis).  For the purposes of today’s blog post, we’ll assume number 1 and focus on number 2:

*”Intense exercise” is usually applied to serious female athletes or women who are chronic overexercisers. Please don’t use this as an excuse not to do healthy exercise. For example, I now go to the gym 4-5 times per week and lift heavy weights for 30 minutes. I walk my dog. I go to yoga a few times per month. This is healthy exercise. Unhealthy exercise is going to the gym 6 days a week and lifting heavy weights for 45 minutes followed by an hour of cardio and doing a 5 mile run on the 7th “rest” day…which is what I was doing when I stopped menstruating the first time. 

Amenorrhea is diagnosed when a woman does not menstruate even though she is of reproductive age. This is different from menopause, which is when a woman, who previously menstruated, no longer gets her period because she is past reproductive age. (This is also different from pregnancy, for the obvious reasons…)

There are two types of amenorrhea: primary and secondary. Primary amenorrhea occurs when, for whatever reason, a woman does not get her period when she reaches reproductive age. Secondary amenorrhea occurs when a woman, due to a psychological, physical, hormonal, etc. stressor, stops getting her period even though she’s not in menopause. Exercise-induced amenorrhea falls under the “secondary” category.

You might be asking yourself: if exercise is considered healthy, how can it possibly cause something unhealthy, like losing my period?

Starving for a fitness model body

Glad you asked. Turns out that women’s bodies are different from men’s (shocker, I know), and that our hormones are created, stored, and balanced differently.

As you may already be aware, our bodies like to exist in a state of homeostasis, meaning that they’ll do anything to return to balance and status quo. So, if we’re out of balance in one area, the body will do whatever it can to compensate. For example, let’s look at the case of hunger: the hormone leptin is released from our fat cells to regulate our sense of hunger. If we’re in a state of starvation (or decreased fat stores), then the hypothalamus recognizes that there’s less leptin, and sends out the appropriate hormones to stimulate our appetites.

Homeostasis is the body’s way of keeping us alive.

Now let’s look at Secondary Amenorrhea:

Women’s bodies are optimized for fertility. Whether or not you plan on having a family of 16 or hate the idea of having children so much you’ve started pinning “how to become a cat lady” articles on your “no weddings for me” Pinterest board, it doesn’t change the fundamental reality that we women were genetically encoded with the blueprint for fertility.

Just like we need a certain amount of body fat to keep our brains from freaking out that we’re depleted of leptin, so we need a certain amount of body fat to keep our brains from thinking that we’re going to be unable to expend enough energy to bear a child.

Fertility is an energy-expensive process. Our bodies have to devote a certain amount of energy to keeping the whole follicle-egg-uterus-hormones thing in balance. Moreover, the body, being the industrious system it is, recognizes that it needs to start investing early in case one of those eggs gets fertilized. (Children are expensive, even before you have to pay for their college tuition.)

The body stores some of that energy in the fat around your hips and thighs. And, like any good investor who loses it all in an unexpected dip in the market, the body recognizes an extreme loss of body fat as a time to pull out of the market and do some good old fashioned self-preservation. Instead of storing your energy in an envelope under the mattress, it conserves your energy by stopping the most stressful–read: energy-expensive–process it can: your menstruation. (After all, if you’re starving or stressed from running from lions, or whatever our ancestors had to do on an irregular basis, how can you be expected to carry a baby to term?)

 So, to those of you who obsess over toning away your butts, please keep the following in mind: in order for your body to do the thing it was put on this earth to do–whether you choose to do it or not–you need to have that small amount of body fat. If you get rid of that fat, your body stops participating in its genetic reason for living and just starts focusing on keeping you alive until you can build up those energy reserves once again. 

But if you refuse to put energy in (food) and/or keep taking energy out (intense exercise/stress), then you’re never going to refill those energy stores. Eventually, your body starts to despair. And, sensing that your body is going into the Great Depression of energy expenditure, it starts to kill itself.

Disordered eating/exercise leads to no period leads to the shut down or dysfunction of some major bodily systems, including your bones, which weaken and eventually break. You become an old woman at the ripe old age of twenty-something. All of your claims to health and strength–six pack abs, tabata intervals and seven days of crossfit with no rest, clean eating 1200 calorie days–they take on the qualities of their opposites: sickness and weakness.

It's no longer about skinny, now it's about heathy

Strong is the new skinny, indeed.

Stay hungry,


PS If you’re interested in learning more about the wonderful world of menstruation, fertility, and all of that related goodness, the best resource out there these days is PCOS Unlocked by Stefani Ruper. Even if you don’t have (or don’t think you have PCOS), it’s explains SO MUCH about hormones, amenorrhea, and just how to be a fertile, functioning female in general. I am more than happy to promote this resource, because I think that Stefani does an absolutely bang up job of covering a subject that doesn’t get covered enough.

To pick up your e-copy, CLICK HERE.

PCOS Unlocked by Stefani Ruper

This ebook is invaluable & honestly worth every penny.



And, to catch up on all of the other posts in the “Getting Healthy…Period” series, see:

Getting Healthy…Period
My Boy…Friend, ED
Sex With ED, or Let me Be Frank
The Disappearing Woman


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