Your Body

Nobody likes having a period. It’s messy, it’s often painful and it doesn’t go well with a leotard and tights. But as much of a nuisance as your monthly visitor may be, not getting it can be an indication of a serious issue. “A period is about much more than just bleeding once a month—it indicates that your body is functioning normally,” says Dr. Dana Gossett, chief of gynecology at Northwestern Memorial Hospital in Chicago. “Missing a period tells us something important about your underlying health.”

The technical term for the absence of menstrual periods is amenorrhea, which refers to two situations: not starting to menstruate when you’re of age (primary amenorrhea) and missing your periods after you’ve started menstruating (secondary amenorrhea). Do you fit either of these descriptions? Read on to learn why your period may have disappeared, and what you can do to get it back.

(Photo by WZFS1S/Thinkstock)

Should I Be Worried?

If you haven’t had a period yet, but all your friends have, it doesn’t necessarily mean anything is wrong. The “normal” time for a girl to get her first period varies widely—from 9 to 16 years old—and athletes are often on the later end of the spectrum. “When a dancer shows other signs of puberty—such as the development of breasts and pubic hair—we don’t worry about a lack of period until age 16,” Gossett says. “Without them, we begin to worry at age 14.”

When it comes to secondary amenorrhea, Gossett says you should see a doctor if it’s been six months since your last period. But, she adds, periods are generally pretty irregular for the first two years after puberty, and that’s perfectly normal. It’s also possible to miss a period due to stress, which is fine as long as it doesn’t become a regular problem.

Why Does This Happen?

Amenorrhea can have a variety of causes. The issue might be a hormonal imbalance stemming from the thyroid or pituitary glands, or a problem with the reproductive system (like a physical blockage in the entry to the vagina). In very rare cases, it’s caused by a chromosomal abnormality.

Most of the time, however, low body weight is the culprit in dancers. When a girl is about 10 percent under the normal body weight for her height, periods may stop—a warning from her body that she’s not healthy enough to maintain a pregnancy. In dancers, it’s frequently part of what’s known as the female athlete triad: 1) a girl’s body weight is low; 2) her periods have stopped (or never started); and 3) her bone density is low.

Why Should I Care Right Now?

“Many girls are actually glad to not have their period,” says Dr. Nadine Kaslow, a psychologist who works with Atlanta Ballet dancers. “There’s a lot of pressure for dancers to be thin, so it’s easy to prioritize keeping your weight down. But girls need to be mindful that amenorrhea has potential for both short-term and long-term consequences.”

Down the road, amenorrhea can lead to osteoporosis. But dancers with amenorrhea due to low body weight don’t have to wait until they’re 50 to see serious issues occur. “If amenorrhea is caused by a lack of nutrition, it can mean an increased risk of bone injuries, like fractures,” warns Dr. Joey Fernandez, an internal medicine physician at the Harkness Center for Dance Injuries in NYC.

How Do I Fix It?

The first step is to visit a doctor. If the problem is hormonal, you may need to take a medication to get things back on track. And irregularities in the reproductive system, such as an obstruction to the vaginal opening, could mean minor surgery. If your amenorrhea is due to a lack of nutrition, you may have to work with a doctor and nutritionist to remedy the situation.

Fernandez points out that getting your period back doesn’t necessarily mean gaining weight. “It might just take an adjustment in your meal timing or in your distribution of calories throughout the day to balance your energy needs,” he says. “Of course, if a dancer is severely underweight or has an eating disorder like anorexia, it can be very important for her to gain some weight.”

In some cases, an otherwise healthy dancer can lead such a rigorous lifestyle that her body fat percentage is too low for estrogen production. (Fat cells are partially responsible for estrogen synthesis.) “Then we worry about long-term implications, since estrogen is an important hormone for bone health and many other things,” Gossett says. In those cases, Gossett may prescribe an oral contraceptive or birth control pill to replace lost estrogen.

In the end, you’ll be glad to repack a few tampons in your dance bag. Sure, periods can be a drag, but it’s nice to have a monthly reminder that your dancer body is in excellent shape.

Your Body

(Photo by S.E.R.G.O/ thinkstock.com)

There’s no doubt about it: Periods aren’t fun. From pesky PMS to tampon woes, getting your period every month can make you feel more like curling up in bed than taking ballet class. But the more you know, the more pain- and mess-free your period can be. Whether you’re waiting to get it or have had it for years, you probably have some questions—and we have the answers.

TIMING IS EVERYTHING.

All my friends have gotten their periods, but I’m still waiting for mine. Why?

Don’t assume there’s something wrong. The average age to get a first period in the U.S. is 12.3 years old, and anywhere from 10 to 15 years old is perfectly normal. For a good prediction, ask your mom when she got hers. Besides genetics, another good indicator is weight: Since body fat secretes estrogen, heavier girls may get their periods earlier. For thin dancers under 13 who haven’t gotten their periods yet, other indicators of puberty—like breast development and pubic hair—are signs everything is most likely A-OK.

Dancers who are too thin could see a delay in menstruation that’s not healthy. “If you’re not getting enough calories, you could have hypothalamic hypogonadism or hypothalamic amenorrhea, which a lot of dancers get when they’re underweight,” says obstetrician/gyne-

cologist Dr. Leah Millheiser, clinical assistant professor at Stanford University Medical Center. These conditions could lead to further complications in your future, including osteoporosis and infertility. Millheiser adds that there are also certain chromosomal abnormalities that can cause a lack of menstruation. If you’re 15 and haven’t had a period, it’s worth seeing a doctor to get evaluated, just in case something is wrong.

Keep track of your periods. Ideally, they should begin 24 to 38 days apart and last between three and seven days. (Photo by Otto Kalman/thinkstock.com)

I know periods should come once a month, but mine seem totally random. Is that normal?

It’s not unusual to be irregular for the first couple years after starting your period. “Once you start menstruating, if you’re getting a period at least every three months, there’s nothing you need to worry about besides the inconvenience factor,” says Dr. Lauren Streicher, a gynecologist and associate professor at Northwestern University’s Feinberg School of Medicine. “But if you’re going longer than three months without a period, get an evaluation to make sure there isn’t anything serious going on.” Once you’ve been menstruating for a few years, your periods should even out. At that point, anywhere from 24 to 38 days between the first days of each period is considered normal.

How long should a period last?

“In general, a period should range from three to seven days, but some people’s periods are shorter, and some are longer,” says Dr. Diana Wang, an obstetrician/gynecologist at Austin Area OB/GYN in Austin, TX. “Remember, we’re not robots, so there’s a range that’s within normal.” If your period lasts more than eight days, mention it to your doctor.

Ive heard that friends will “sync up” and get their periods at the same time. Is that true?

“Misery loves company” actually does apply when it comes to your period. “There are pheromones women give off that can cause them to cycle together,” Millheiser says. “For example, if two girls are roommates in college and neither of them are on hormonal birth control, over the course of the first year, you often see those girls getting their periods at the same time.”

(Photo by Jumpiter Images/thinkstock.com)

SIDE EFFECTS

How can I keep from acting like a brat in the days leading up to my period?

Your hormones may go a little haywire the week before your period. You may cry more easily or snap at the tiniest things. For most people, simple fixes like getting extra exercise can relieve these symptoms. It helps to realize what’s happening and to take a second to breathe when you feel yourself getting worked up. If your premenstrual moodiness goes beyond a little irritability, there may be something else going on. “There’s a difference between premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), which can cause women to become clinically depressed for the two weeks prior to their periods,” Millheiser says. “The important distinction is that those with PMDD will have significant symptoms that affect their jobs, schoolwork and relationships, but then feel fine after their periods. If you feel your life is being disrupted, talk to a doctor about hormone treatment, like birth control pills.”

Cramps are making me miserable! How can I cope?

Most people only cramp for the first couple days of their periods. When this happens, take ibuprofen or acetaminophen and use a heating pad, and you should feel some relief. “If you have to stay home from school, can’t dance or can’t function, talk to your doctor for other solutions,” says Streicher. “The worst-case scenario is endometriosis, a condition in which the glands that normally line the uterus are other places in the pelvis. That can cause very painful periods.”

I get so bloated during my period that I’m embarrassed to put on a leotard. What can I do?

Often, girls’ bodies retain extra salt during their periods, making them gain noticeable bulk around the middle. “It won’t help to stop drinking water,” Millheiser says. “Bloating is going to happen regardless, and it’s important for dancers to keep hydrating even if they’ve gained a little water weight.” Instead, limit the amount of salt you eat.

During my period, I have to go to the bathroom a lot (number 1 and number 2). Is that normal?

A side effect of all that bloating may be having to run to the bathroom to get rid of excess fluid. “Some women also experience mild diarrhea, which isn’t unusual,” Streicher says. “If you’re having terrible diarrhea with horrible cramps, it’s time to call your doctor.”

It seems like I’m losing too much blood. How heavy should my period be?

In general, you shouldn’t need to use more than six pads or six tampons per day. For periods heavier than that, Wang says she’ll sometimes prescribe hormonal contraception, like birth control pills, to quell the bleeding. “Birth control pills can help with many period symptoms,” she says. “That includes extremely heavy periods, severe cramping and even moodiness and bloating.”

Why is my period sometimes more brown than red—and what are those lumps?

Your period will probably be dark red on its heaviest days and brown or pink on lighter days. Streicher adds: “During your period, you’re shedding the inner layer of the uterus, so if there’s the occasional small clot or something that looks tissue-y, that’s fine.”

(Photo by Matka Wariatka/thinkstock.com)

TAMPON TROUBLES

I hate wearing a bulky pad to class, but putting a tampon in is uncomfortable—even painful. Any advice?

If you’re having trouble inserting a tampon, try lying on your back with your legs spread open while putting it in. “You may have to push it in farther than you think,” Streicher says. “Your tampon can’t get lost up there. And it will hurt if it’s not in far enough.”

If you’re experiencing extreme pain and can’t push it in at all, see your doctor. There are several possible explanations, including a physical blockage to the entrance of your vagina.

If I leave my tampon in overnight, will I get toxic shock syndrome?

“Sleeping with a tampon is fine—but don’t forget it’s in there,” says Streicher. Opt for a pad if you plan on snoozing for more than eight hours. Toxic shock syndrome (TSS) is a bacterial infection that’s incredibly rare but potentially life-threatening, which is why many tampon boxes warn to change your tampon about every four hours during the day.

Your Body

Like many female dancers, you probably have a quintessential “period disaster” tale—maybe it’s the white booty shorts you had to wear at a competition or the time you were partnered with your class crush when you were retaining more water than a camel. Still, there’s a lot more to your menstrual cycle than a monthly date with discomfort or embarrassment. Reproductive health, specifically in your teen years, impacts your body throughout your entire life. Here’s the lowdown on your period.

Getting “Started”

Every woman’s body is different, but most girls get their first period (or menarche, as it’s officially called), between ages 10 and 15. Good indicators that menstruation will begin soon (usually within 3–6 months) include breast and pubic hair growth. Occasionally, a young woman will start puberty, but she won’t get her period. This is called primary amenorrhea, and it happens in athletic and/or thin girls who don’t have enough fat to produce sex hormones. If you suspect you might have this condition, see your doctor.

Missing Periods

You may think that skipping periods is a blessing, especially during peak performance seasons, but missed periods can actually have serious consequences, so don’t rejoice just yet. The condition in which a woman of reproductive age skips periods is called secondary amenorrhea.

Why is it a big deal? Oddly enough, it has to do with your bones. Peak bone mass is built between ages 15 and 25. After that, bone building stops, so it’s important to develop strong bones now to maintain bone health throughout the rest of your life. Low bone density leads to osteoporosis, a weakening of the bones, which in turn can lead to stress fractures. (Test your bone health and calcium knowledge with our quiz on p. 70!)

How does this relate to menstruation? When your period stops, estrogen levels fall. This hormone is necessary for optimum calcium absorption, a key mineral in bone building. Dr. Steven Chatfield, the executive director of the International Association for Dance Medicine and Science and an associate professor and coordinator of dance sciences at the University of Oregon, explains that while it’s uncommon for young dancers to develop osteoporosis, it is possible, especially if calcium intake is also restricted. Alternately, amenorrheic dancers who don’t seek treatment may develop osteoporosis at a much earlier age than they would have otherwise. That can also cause injuries that end dance careers.

So what causes secondary amenorrhea?

  • Over-exercising
  • Restricted caloric intake
  • Stress
  • Weight loss
  • Other medical issues

The Female Athlete Triad

You’ve probably heard the term “Female Athlete Triad” tossed around in the news. It refers to a combination of disordered eating, amenorrhea and early-onset osteoporosis that can develop in athletes who train intensely. This is how it happens:

  • Disordered eating occurs when you don’t consume enough calories or eat the right combinations and quantities of foods for your body to absorb needed nutrients. It can also mean full-blown eating disorders like anorexia nervosa or bulimia nervosa.
  • Restricting caloric intake and dancing long hours—in other words, consuming less food than needed to fuel your physical activity level—can lower your body’s estrogen. This hormone is needed to regulate your cycle.
  • The combination of low estrogen levels and poor diet leads to osteoporosis.

Besides the long-term consequences, such as slowed bone building, the Female Athlete Triad will interfere with your performance. Research shows that the incidence of injury is higher in amenorrheic dancers.

When To See the Doctor

If you’ve started menstruating but haven’t had a period in three months, talk to your parents and then go to the doctor. Since a woman’s monthly cycle can vary from 21 to 35 days, after three months, you may have skipped up to three periods. Your doctor will check for other problems that can cause irregular periods besides disordered eating and intense exercise, such as polycystic ovary syndrome or thyroid disorders.

It’s important to find a doctor who understands dancers and with whom you feel completely comfortable. If there isn’t anyone in your town who specializes in dance medicine, your best bet is someone who works with athletes. If you don’t have an eating disorder and your doctor says “eat more and work out less,” find another doctor.

To regulate your period, your doctor may prescribe the birth control pill—weigh the benefits and side effects of this option carefully. Your doctor may also refer you to a nutritionist to help you balance your caloric intake with your exercise load. Chatfield points out that it’s important to work with a nutritionist who’s licensed by the American Dietetic Association, since this field isn’t regulated and any person can claim to be a nutritionist.

A Pain in the Belly

Is this scenario familiar? You’re getting dressed for class just like any other day, but suddenly the idea of putting on tights seems completely overwhelming and you burst into tears. This isn’t normal, you think! They’re just tights!

It could be premenstrual syndrome, or PMS, which refers to a group of common physical and emotional symptoms that occur prior to menstruation—mood swings, diarrhea, cramping, bloating, breast tenderness and lower back pain. About 85 percent of women who menstruate have at least one PMS symptom during their cycle, according to The American College of Obstetricians and Gynecologists!

Keep track of your symptoms in a notebook. If they interfere with your day-to-day life, show your notes to your doctor. In severe cases, you may need prescription drugs. But if your symptoms are relatively mild to moderate, some lifestyle adjustments may help you feel better. If you have PMS, try these ideas:

  • Go to class. You might be tempted to skip dance when your monthly cycle has you feeling blue—don’t do it! Research suggests that moderate exercise can alleviate mild bloating, cramps and mood swings. If dancing feels like too much, try a yoga class.
  • Stay stocked. Over-the-counter pain relievers like ibuprofen may lessen cramps, breast tenderness and joint aches. For cramps, you can try heating pads like ThermaCare Heat Wraps. Most pharmacies or drugstores carry them.
  • Eat right. Drink plenty of water, eat your fruits and veggies and lay off the caffeine!
  • Pamper yourself. Set aside time to do something special for yourself. Watch “So You Think You Can Dance” on TiVo, take a walk in the park or get a massage.

While menstruating isn’t most women’s favorite time of the month, it doesn’t have to be the worst either. (It’s sort of a miracle, right?) Pay attention to your body, and don’t be shy about seeking medical advice. You’re worth it!

Your Body

If you’re a dancer whose menstrual cycle has stopped, you could be wondering what’s happening. Are you pregnant? Is it early menopause? You may even be thinking, “Big deal, so I don’t get my period.” But it is a big deal, not only for overall health, but also for the future of your dance career. Besides leading to reproductive problems and osteoporosis, amenorrhea, the condition in which your body refuses to menstruate, may increase susceptibility to stress fractures.

There are two types of amenorrhea: primary and secondary. Primary amenorrhea occurs when a woman hasn’t had her first period by age 16. Secondary amenorrhea, more common among dancers who train long and hard, occurs when regular periods stop for three months or longer. Up to 30 percent of classical dancers have stopped or will stop getting their periods at some point in their careers, says Dr. Michelle P. Warren, a professor of women’s health in the department of obstetrics and gynecology at Columbia University who has studied this condition for 20 years.

Address the Causes

Reduced caloric intake, over-exercising and stress are typical causes of amenorrhea. “The body has a way of picking up when there aren’t enough calories around, [so] it shuts down reproduction,” says Warren. In other words, if your caloric intake is too low to sustain your activity level, your body will divert calories from reproduction to fuel vital organs.

Spending long days training in the studio is part of being a dancer, so exercising less in order to restart your menstrual cycle may not be an option for you. There are other ways to address the issue, however. Increasing caloric intake, especially from such nutrient-rich foods as red meat, spinach and yogurt, can stop amenorrhea by sending the appropriate signals to your ovaries to restart the cycle. Eating consistently, never skipping meals and avoiding yo-yo diets will also help to keep periods regular. Manage your stress with yoga, massage and relaxing baths. Also avoid using supplements as meal replacements. According to Warren, there’s a high incidence of fractures in women who replace food with supplements, because nutrients aren’t absorbed as well from supplements as they are from food.

Bone Health

Failure to reproduce is an obvious side effect of irregular periods, but amenorrhea can also interfere with the amount of calcium deposited in your bones, even if your diet is high in calcium. For young dancers, it’s especially important to build bone density, because bone growth stops after about age 25. (The exact age varies according to the individual.) If irregular periods cause your body to build less bone than it should before you stop growing, the chances of stress fracture and early osteoporosis rise.

While calcium is vital for healthy bones, protein is just as important. Studies have shown a correlation between low protein intake and low bone mass. “In an effort to keep weight down, I see young dancers who are vegetarians, and you have to be very careful on this diet because it’s hard to get enough protein,” Warren explains. “You can’t just make trips to the salad bar and expect to be on a well-balanced diet.” Lean meats such as chicken and fish are good protein foods, however, these don’t provide enough iron, another valuable nutrient that promotes growth and maintains high energy levels. Warren recommends eating spinach and parsley and cooking in iron skillets. Vegetarians may even need to consider eating red meat—if only in small amounts. “I usually ask [my patients] if they would consider eating at least three ounces of red meat at least three to four times a week,” says Warren. Amenorrheic vegetarians can also strategize with their nutritionists on ways to increase protein without eating meat.

Luckily, secondary amenorrhea is reversible in most cases with diet change and lower stress. If your periods don’t return within three months (barring pregnancy), schedule an appointment with your ob/gyn immediately.

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