Tawnee recently featured the elite runner Tina Muir on Endurance Planet, where she shared her journey about getting her fertility back. As I was also dealing with HA (hypothalamic amenorrhea, aka no period because of over-exercise and under-eating), I found Tina’s story really inspirational.

Still, I’ve been feeling discouraged for having gone an eternity (cough, cough 8 weeks) without exercise and gaining an uncomfortable amount of weight without any certainty of when I’m going to get my period back. What motivated Tina through those dark patches was her goal of trying to conceive (TTC). But that’s not my goal. I don’t want kids in the near future. A loud part of me says, “Just keep doing Ironman, stay super lean, and you’ll sort this out when you actually want kids later.”

WRONG! This is so wrong! Ladies, no matter if you want kids or not, it is a major problem if you’re not menstruating regularly. Below is a list of some scary, scientifically-proven health consequences associated with HA:

  • Impaired heart health
    • Low levels of estradiol result in endothelial dysfunction and abnormal changes in the lipid profile. And you know what these irregularities lead to? Cardiovascular disease.
      • Not-so-fun-fact: Cardiovascular disease is the leading cause of death in women in developed countries. Numerous studies have shown that women with HA are higher at-risk for coronary artery disease than regularly menstruating women. 
  • Decreased bone mass density
    • In the short term, this increases the likelihood of fractures (every runner’s worst nightmare)
    • In the long term, this drastically increases the likelihood of osteopenia and osteoporosis, which are irreversible conditions.
  • Increased risk of early onset degenerative brain disease
  • Significantly higher rates of depression and anxiety
    • Estrogen plays a major role in regulating mood, so when your serum sex steroid levels are low, cue the breakdowns.

The heart health factor was the biggest wakeup call for me. Osteoporosis is debilitating, but a heart attack could kill you! The reason why many of us got into health and fitness in the first place was to maximize life expectancy and quality of life. But when you take health and fitness to the extreme and wind up with HA, you’re contributing to the exact opposite of that ideal. And osteoporosis is pretty terrible too. I want to be doing my sport for decades (qualifying for Kona or the Boston Marathon at 80 sounds like a pretty cool goal). You can kiss that dream good-bye if your bones are prone to stress fracture at the slightest stimulus. Also, let’s talk about early onset degenerative brain disease… you’re willing to risk your brain capacity so you can look hot in a sports bra and short shorts and podium at your next race?! I’m sorry to be harsh or slightly dramatic, but the fact is, this kind of hard, honest talk is necessary.

I’ve referenced almost ONE HUNDRED scientific studies below backing me up here. This is a highly studied problem with conclusive evidence that HA is seriously dangerous, way beyond causing infertility.

So next time you’re doubting yourself for going “all in” for recovery, think of these facts. Get real with yourself. This isn’t about having a baby. This is about living a long, healthy, functional life. Apply your superhuman capacity for discipline to hold strong to your purpose. Because here’s the really good news: if you recover from HA then all those wonderful hormones will repair the damage that’s been done! So eat, rest, and recover, ladies. I’m right there with you.

—Samantha Morse



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