Health & 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.

Health & Body

Girls know that growing up means growing breasts. But for dancers, going through this change can be extra awkward—especially since we spend hours in  leotards, analyzing our bodies in the mirror.

We’ve got your breast interests in mind! Read on for answers to your most embarrassing boob-related questions, from size and shape to hair and sweat.

Can I predict how big my boobs will get—and can I change my fate?

Breast size is genetic. Take a look at your mom’s chest, and ask her when she started and stopped growing. Chances are you’ll follow in her footsteps. Gynecologist Vanessa Cullins of Planned Parenthood in NYC points out that breasts are made of fat, so they’ll change a bit in size as you gain or lose weight. But for the most part, your destiny is sealed, and it’s not worth dieting to try to change it. “Try not to stress about it,” Cullins says. “Whether yours are big or small, all sizes are normal.”

(Photo by VoyagerIX/Thinkstock)

My friends have started to grow breasts, but I haven’t. What gives?

Girls may start to develop as young as 9 or as late as 14. And they’ll usually continue to grow and change throughout their teenage years. “It just has to do with when your body decides to enter puberty,” says Dr. Lonna Gordon, adolescent medicine fellow at Mount Sinai Adolescent Health Center in NYC. “You do need a certain amount of body fat to start the process, so thinner young women may go into puberty later than their heavier friends.” If you’ve had your period but still haven’t started to grow at all, get checked out by a doctor.

My breasts are two different sizes. Is that normal?

“Just as your feet may be slightly different sizes, it’s very common for one breast to be bigger than the other, especially at first,” says Dr. Judith Cothran, gynecologist at Advocate Trinity Hospital in Chicago. “But they generally even out over time.” A very small percentage of women will have breasts that are dramatically different sizes their whole lives. If your breasts have stopped growing (usually three to five years after they start growing), and you’re still concerned, you may want to pad one side of your bra or ask your doctor about other options.

Why do my breasts feel sore?

Just like the rest of your body, your breasts get growing pains. “Growing pains are normal,” says Cullins. “It’s also common for breasts to feel swollen or tender before and during your period.” You can take ibuprofen if the tenderness is bothering you. See a doctor if you notice a change in the way your breasts or nipples look along with the pain.

My breasts feel lumpy. Is that normal?

Breasts are made up of tissue that naturally feels a little uneven and lumpy. That’s why it’s important to be familiar with how your breasts normally look and feel, so you’ll be aware if a lump that’s potentially dangerous shows up. Even though it’s unlikely that a teenager will develop breast cancer, it’s good to know how to check your breasts. Some doctors recommend checking regularly beginning at age 21, unless family history warrants earlier screening. Gordon suggests doing a self-exam in the shower when your fingers are slick, rubbing in concentric circles from the outside of your breast in toward the nipple. “Ask your doctor about any new lump that is painful, hard or immovable,” she says.

My nipples look different than my friends’. What does a normal nipple look like?

Actually, there’s no “normal” when it comes to nipples. “Nipples come in all shapes and sizes and can change over time,” Cullins says. “Your nipples may get bigger as your breasts get bigger or darker or puffier as you grow older. Nipple color ranges from light pink to brownish black. Some stick out like buttons, and others look more like slits.” If you’ve already finished puberty and the appearance of your nipple changes drastically—like going from an “outie” to an “innie”—check with your doctor to make sure everything’s OK.

Why are there dark hairs around my nipple?

It’s common to have darker hairs around the areola, or the darker skin that surrounds your nipple. “About 3 out of 10 women have a few hairs there,” Cothran says. “If you don’t like them, just pluck them out with a pair of tweezers.”

My boobs have stretch marks! Will they go away?

While you grow, it’s normal for stretch marks—pink or purple lines along the sides of your breast—to show up. “This is because your skin can’t always keep up with your growing breasts,” Cullins says. “Stretch marks may start out dark and raised, but most will fade and become less noticeable over time.”

What can I do about gross under-boob sweat?

It’s common to sweat more under your breasts than on other parts of your body. If it’s uncomfortable, Cothran recommends applying a thin layer of a powder with a cornstarch base before a long day of rehearsal.

Bra Basics: In need of a support system beyond the flimsy shelf bra in your leotard? You’re not alone. Here are five tips for making sports bras work in class or performance.

1. One sports bra may not be strong enough to support bigger breasts during a fast petit allégro. “For women with larger breasts, I recommend wearing two sports bras to give proper support and help with discomfort,” says gynecologist Judith Cothran.

2. That said, trapping your breasts while you sweat can result in no-fun-at-all acne or even a fungal infection, so it’s important to make sure your breasts can breathe. Cothran recommends a bra made of cotton.

3. If you’re concerned about your bra showing in class, opt for leotard styles with more shoulder and back coverage to hide extra straps. Want to go braless? Halter or high-neck leotards tend to offer the most support and prevent spill-outs.

4. For performances, use foundation to help white or nude bra straps blend with your skin. Several dancewear companies sell bra tops with clear straps to wear under costumes. But these can reflect stage light, so apply a layer of face powder to dull the shine.

5. If your studio has a strict dress code, and you can’t find a bra that works, talk to your teachers. Chances are, they’ll be happy to help you find a solution that you’re comfortable with.

Health & Body

Breast development is uncomfortable for every teen, but it can be especially traumatic for dancers. While you can hide behind a loose T-shirt or sweater at school, at dance your leotard or fitted costume puts your ever-changing body on display. Suddenly you have these alien things on your chest: They’re lopsided, they’re big, they even hurt sometimes. How are you supposed to know what’s normal? We’ve asked experts the breast-health questions you may have been too afraid or embarrassed to ask. Read on for the answers.

Is it normal if my breasts are different sizes?

Most full-grown women have breasts that are slightly different in size, according to Dr. Kandace P. McGuire, who practices in the Surgical Oncology Division at Magee-Womens Hospital of the University of Pittsburgh Medical Center. However, size differences tend to be most dramatic while you’re still growing, because one breast may develop faster than the other. “They usually even out over time,” McGuire says. But if one of your breasts has grown very large, very rapidly (in a month or less), she says that it may be a sign of a problem and you should talk to your doctor.

Why do my breasts get sore and/or bigger a few days before my period?

Menstrual-cycle–related breast tenderness is normal, especially for teenagers. “Right before your period, your ovaries send out a bunch of hormones,” McGuire says. “Those hormones cause your breasts to grow a little bit. All that activity can make a girl pretty sore!” Soreness and swelling will usually go away within the first few days of your period, but some women experience these symptoms throughout menstruation. McGuire says that either case is considered normal.

How will I know when my breasts are fully grown?

During the first stages of breast development, your areola (the dark-colored area around the nipple) is usually raised above the surrounding skin, McGuire says. But, “when breasts are fully developed, the skin of the areola is level with the rest of the breast skin,” she says. Girls typically reach this stage between the ages of 16 and 18, “but even once your breasts are fully developed, they can still grow,” McGuire says. This often happens during periods of weight gain.

All my friends have developed. Why haven’t I?

“Most girls’ breasts fully develop in the first two to three years after starting their periods,” McGuire says. Thanks to genetics, you will likely start menstruating and developing breasts around the same age your female family members did. But diet and body weight can also impact your growth. “Young women who have very low-fat diets or low body-fat levels tend to develop later,” McGuire says. She adds that many dancers may hit puberty later than their non-dance peers because of their active lifestyles, but if you’ve reached age 16 and haven’t gotten your period or started developing, you should mention it to your doctor so she can rule out problematic causes.

Do I need to worry about breast cancer?

“Anyone with breast tissue, even teenagers and males, can get breast cancer—but this is exceedingly rare,” says Dr. Therese Bevers, a professor at MD Anderson Cancer Center’s Department of Clinical Cancer Prevention in Houston. Although breast cancer is uncommon in teenagers, McGuire urges young dancers to learn how to do self breast exams. “Teenagers and other young women are prone to cysts or even fibroadenomas, which are noncancerous tumors that can be annoying and painful,” she says. “They usually go away with time, but will need to be discussed with your doctor.”

Will my breasts change if I take birth control pills?

Maybe. Birth control pills can cause weight gain and make your breasts grow larger. They can make the lumps and bumps in your breast (like cysts and fibroadenomas) grow as well. “They will not increase your risk for breast cancer and actually lower your risk for ovarian cancer,” McGuire says.

Is it true that having large breasts makes it more likely that I’ll get breast cancer?

“We have not linked size of breasts to risk of breast cancer,” Bevers says. According to McGuire, a woman’s breast is made up of two different parts: the functional glands and ducts that make milk when you’re pregnant and breastfeeding, and the nonfunctional fat and connective tissue. “Everyone pretty much has the same amount of functional breast tissue,” she says—and cancer only attacks functional tissue. “Larger breasts usually have more nonfunctional tissue, but having more fat in the breast does not increase your risk for breast cancer.”

Is it normal for my chest to sweat this much?

“Sweating underneath and between your breasts is completely normal, especially during puberty,” McGuire says. Keep these areas clean and dry by changing and washing your bras often and controlling wetness with baby powder. Worried about developing giant sweat stains in class? Dark-colored leotards will help conceal sweat marks. If your studio allows it, a pattern or print will also help disguise sweat. While cotton is one of the most breathable fabrics, it can show embarrassing stains once you’ve started sweating, so look for a cotton-synthetic blend.

Support Systems

Is your favorite camisole leotard not giving your new chest the support it needs? If you’re well endowed, opt for leotards with wider straps, and don’t be afraid to layer your leo over a sports bra when you’re in class—you’re better off showing a few extra straps than worrying about your breasts bouncing every time you leap!

Making sure you have the support you need onstage is a more delicate matter. Let your teacher know if you’re concerned about a particular costume, and work together to come up with a solution. In most cases, you should be able to find a bra with a strap configuration that can be concealed by your costume. Try a convertible style that comes with nude or clear straps.

Former ballet dancer Kathleen McGuire is a freelance writer based in Pittsburgh, PA.

Health & Body

Monica Levy, a Hunter College senior and DS intern, was having trouble with her number one instrument—her body. “I had really irregular menstrual cycles. Months went by where I wouldn't get my period and then, when it came, the flow would be extremely heavy,” she says. To regulate her period, she went on birth control pills. But while they served their purpose, there were side effects: Her breasts increased to a double D—big enough to cause a wardrobe malfunction! “I was in a dance show at Muhlenberg College and had to wear a halter top,” she recalls. “As time passed, I had to keep adjusting the top because my breasts kept growing. Then, during a performance, my top came undone!” After this humiliating experience, Monica decided to stop taking the pill so her body could return to its natural shape.

Although not all bodies react to the pill in the same way, lots of girls worry about taking birth control because of its potential side effects. So what’s the truth behind the fiction? What is it really? What will it do to your body? What kind is the best for you? Here, DS breaks down the facts about birth control.

Why would a girl who is not sexually active go on birth control?

There are many reasons a young dancer may want to go on birth control. It can correct heavy or irregular menstrual cycles, treat painful periods and get rid of acne. The cause of these problems is the imbalance of the female hormones estrogen and progesterone. Birth control balances these hormones, which alleviates discomforts.

  • Irregular periods:

Birth control is also commonly prescribed to treat irregular or infrequent periods, a condition dancers are especially susceptible to due to their high activity level. Dale Perry, a certified nurse practitioner at Women’s Care of Beverly Hills, points out that studies have shown women with irregular periods to have an increased risk of ovarian cancer, as well as other health risks. “Since we don’t know how to diagnose ovarian cancer yet, it’s a good thing to avoid with birth control,” she says.

However, Linda Hamilton, Ph.D., a performance psychologist who works with the New York City Ballet, feels dancers should only use birth control in extreme cases of fluctuating periods. “I actually don’t like having dancers on the pill if there’s a possibility of an eating disorder, since it masks one of the main symptoms of anorexia: not menstruating.”

  • Painful periods:

“The majority of the prescriptions [for birth control pills] I write are for dysmenorrheal, or painful periods,” says Perry.

Hamilton says she’s seen dancers doubled over in pain from heavy periods. “I always recommend they see a specialist to see what their options are, including birth control, to regulate the problem.”

  • Acne:

In cases of stubborn acne, specialists may suggest birth control because the additional dosage of estrogen decreases production of testosterone (a pore-clogging hormone), leaving skin clearer. However, birth control should only be prescribed if other treatments prove unsuccessful. Hamilton says that, if acne is the only concern, “girls should really try other methods—like the blue-light treatment, which also gets acne under control—before turning to birth control.”

How will birth control affect my body?

The relationship between a dancer and her body is one of great intimacy. Even the slightest changes are easily noticed, giving dancers a leg up when it comes to detecting the effects of birth control.

“A lot of dancers are worried about bloating and weight gain,” says Michelle Warren, Ph.D., an endocrinologist at Columbia University Medical Center. But weight gain from birth control is actually a myth. “There may be some adjustment in the first couple of weeks, so people feel bloated or like they’ve gained weight,” says Warren, “but it’s only water retention.” A prescription with lower hormone dosages can help eliminate such effects. Lily Rogers, a dancer with San Francisco Ballet, says she wanted to try a birth control pill with a low dose for that reason. Now, six months later, she says her period has gotten lighter. “I haven’t found there to be any bad side effects,” she says.

How do I talk to a medical professional about birth control?

Talk to your parents and let them know your concerns. Then visit your gynecologist.

It’s crucial to share your medical history with your doctor, and it’s important to get to know your body before making a commitment to medication. Perry prefers that girls have had their period for about a year before treating discomfort with birth control. “Unless there are specific issues, we don’t usually do anything while the body is figuring out its normal pattern,” she says. “But lives can be dramatically changed by birth control because girls don’t dread their periods.”

Don’t worry if your first prescription doesn’t work out perfectly. Different bodies react differently to certain types of birth control and higher or lower dosages of hormones. Just like pointe shoes, you have to try a variety before finding that perfect fit.

When is it time to go off my birth control?

Responses to birth control vary. What works for one person may be an unpleasant experience for another. Birth control is meant to help you, so if the cons are outweighing the pros, reevaluate your treatment with your doctor. Michelle Warren, Ph.D., says, “What a doctor does, and what a patient can help a doctor do, is look at the list of complaints and list of benefits about the birth control and see if it’s worth it. If it’s not, you can look into another option or decide to stop the one you’re on.”

Types of birth control

Mary Wilson, Ph.D., a gynecologist with Beth Israel Medical Center in NYC, says that, while the pill is the most popular form of birth control, some people have trouble remembering it every day. Here are the other options (which have side effects of their own, so be sure to talk to your doctor before starting one):

  • hormone shots received every twelve weeks
  • the patch, worn everyday for three weeks, with one week off in between
  • the vaginal ring, inserted monthly


Health & Body

It seemed like everything changed overnight. Suddenly, 14-year-old Karen Black’s* breasts didn’t fit into her favorite camisole leotard, her thighs rubbed together in weird places, and she couldn’t get through 10 fouettés without becoming winded.

What was going on?


Your body will change a lot from now until your twenties. You’ll start your period, develop breasts and grow pubic hair. You may also develop an insatiable appetite, put on weight, or grow so fast that some steps become more difficult than they used to be.

As a dancer, this process can be particularly difficult. Maybe you dread changing in the locker room, because you think that everyone is staring at you. Perhaps none of your friends have started to mature physically and you feel uncomfortable about your figure. Maybe you’re the only one (or you feel like the only one) who hasn’t started to develop yet. To make matters worse, not only do you have to wear tight clothes and stare at yourself in the mirror, but you also stand in the spotlight and perform in front of everyone you know—all while feeling like an alien has taken over your once-familiar body.

The most important thing to keep in mind is that you aren’t alone! Here are some other ways to make growing up a positive experience.

1. Don’t compare yourself to others.

Every dancer is different—you may covet your friend’s fabulous feet, but she might envy your long legs. Lamenting your own appearance because you don’t think it’s as great as someone else’s will only frustrate you, because it’s beyond your control. Remember that dancers have many body types, strengths and weaknesses.

2. Try other dance forms.

If you feel terrible about yourself after, say, a ballet class, add another kind of class, like jazz or hip hop, to your schedule that makes you feel great. It’s important to give yourself positive experiences with movement, even if that means just dancing around your living room to your favorite hip-hop artist.

3. Understand your own biology.

During puberty, it’s normal for some things that were once easy to become seemingly impossible. Maybe you could do triple pirouettes, and now you struggle to balance in passé. Don’t panic: You’ve probably just had a growth spurt, and you need time to adjust to your new body. With practice and time, you can get it back.

4. Accept yourself—and your peers.

You may be tempted to poke fun at your friends to soothe your own insecurities, but this won’t contribute to a supportive training atmosphere and may even backfire when people belittle you. Think of this phase of your life as something that you and your friends are in together! Focus on building each other up and on being the best dancers you can be.

5. Embrace your appetite.

Some girls put on a layer of fat prior to a growth period. In these instances, you may grow out before you grow up. If you aren’t eating enough of the right foods, you’ll interfere with this process and suffer health consequences down the road. “Usually with a growth spurt comes increased metabolism and increased appetite,” says Dr. Michelle New, clinical psychologist, reviewer for website KidsHealth and a former dancer. “You’re hungrier, and a lot of girls are afraid of that.”

Listen to your body. If you ignore your appetite and stop eating, you may actually stunt your vertical growth and end up heavier than you would otherwise. “Buy bigger jeans and keep being healthy and active,” says New. “It’s a normal part of growth and it won’t last forever.” If you really think you’re overweight—or a teacher tells you to slim down—see a licensed nutritionist before starting any diet.

6. Don’t hide.

If your school has a dress code, there isn’t much you can do to “cover up.” But even if you want to drown yourself in baggy sweats, hiding isn’t the best way to cope. “It gives the message that you should cover up when you start showing signs of womanhood,” New explains. If you’re really uncomfortable, ask your teacher if you can wear a fashionable shrug, a skirt or warm-up shorts, but be prepared to conform to the uniform. Find other ways to make yourself feel good—try out a new hairstyle or a new cut of leotard.

7. Talk to someone older.

You may feel like you’re suffering through something that no one has ever suffered before. “Whether you feel alone because you haven’t gone through it yet or your body is becoming a woman before you feel emotionally ready to be a woman, there is somebody who’s been through that,” says New. “One hundred percent of women go through this. No exceptions.” Talk to an older dancer, family member or teacher about how you feel. When you educate yourself, you’ll feel empowered.

8. Know that it’s OK to be modest.

If you dread the locker room, it’s perfectly acceptable to shower at home or change in a bathroom stall. Everybody has their own comfort level, and you shouldn’t feel pressure to put yourself on display if you don’t want to. You control your own body in and out of the dance studio. In fact, developing a sense of privacy can actually mean you have good self-esteem, because it shows that you’re taking ownership

of yourself.

9. Explore other areas of creativity.

Broadening your horizons to include other forms of expression can be helpful when you’re going through an “awkward” phase. Join your school’s art club, audition for a local musical-theater production, or learn to play an instrument. All of these activities will contribute to your artistic development as a dancer, while taking the focus away from your physical being for a while.

Health & 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!

Health & Body

Alyssa Lemenager's large chest always seemed to get in the way of her dancing. She loathed spaghetti-strap leos and constantly altered her costumes to accommodate her 34E bust. "I couldn't take the constant back pain and discomfort that the weight of my breasts caused," says Lemenager, now captain of the Suffolk University Dance Company in Boston. "Being a dancer only heightened these issues. I felt sore and tired, and very insecure about myself and my dancing."

The breaking point came at age 16 when she had to duct tape her breasts into a competition costume to keep from bouncing onstage. That same year, she underwent breast reduction surgery. Since then, she's been able to dance and live much more comfortably.

For many dancers whose chest size has inhibited their health, training and performance, breast reduction can be beneficial. But it shouldn't be mistaken for a "quick fix”or a way to reach aesthetic standards; it's major surgery with both benefits and risks.

The Procedure

According to a report by the American Society of Plastic Surgeons, in 2005, 114,250 women in the U.S. had breast reductions. Though there are multiple ways of performing the operation, all involve removing breast tissue, moving the nipple upward and tightening the skin around the breasts, says Dr. Richard Ehrlichman, instructor in surgery at Massachusetts General Hospital. The surgery usually lasts two to four hours and is performed under general anesthesia on an outpatient basis or with a one-night hospital stay. Pain, swelling and bruising are expected, and patients routinely wear drainage tubes for a few days to remove fluid.

According to Chicago-area plastic surgeon Dr. Anthony Terrasse, dance and other aerobic activities are off-limits for a few weeks. Though recovery periods differ greatly from patient to patient, most are up for daily activities, such as lifting arms overhead, after a few days. Heavy lifting, pushing and pulling should be avoided for three to six weeks. During recovery, patients wear special bras to minimize the tension on the skin. Though there is an immediate difference in size after surgery, final results are seen three to twelve months later, as the body needs time to adjust to the rearrangement of breast tissue, Terrasse says.

The Benefits

Large breasts can cause neck, back and shoulder pain, chronic infections under the breasts, indentations in the shoulders due to the constant pressure of bra straps and, in severe cases, curvature of the spine and difficulty breathing. For large-chested dancers, these problems are amplified in the studio, especially when it comes to running or jumping. Reduced breast size can alleviate all of these discomforts, as well as make it easier to find bras and clothing and likewise, leotards and costumes that fit.

The Risks

Permanent scars are unavoidable. Anytime you take out skin and close it, you're left with a scar, and the scars are permanent, says Ehrlichman. Scarring can range from thick red marks to nearly invisible thin white lines. Because incisions are usually limited to the nipple area and the lower half of the breast, scars typically won't show in low-cut costumes.

During surgery, each nipple is removed and reattached higher on the breast. The potentially worst (and also rare) complication is lost or compromised blood supply, which can result in loss of nipple sensation or of the entire nipple itself, Ehrlichman says. An inability to breastfeed may also result. As with any major surgery, there's a risk of excess bleeding and infection.

According to Dr. Richard Greco of the Georgia Institute for Plastic Surgery, a breast reduction isn't guaranteed to be permanent, either. Weight gain or hormonal changes, which can be elicited by such causes as pregnancy and taking birth control, can result in breast size changing even after surgery.

Covering the Cost

Breast reduction surgery can cost between $4,000 and $7,000. Insurance companies have different coverage criteria; many will only pay for the procedure for individuals who have macromastia--the condition in which abnormally large breasts cause continual health problems. Lemenager, for example, was able to prove to her provider that her chest size was detrimental to her health because the back pain persisted, in spite of her active lifestyle and a year of chiropractic treatment.

Proving the necessity of such surgery can be tricky. Strong dancers, for instance, may not suffer the same back strain from large breasts that an average person would. Whether due to pain tolerance, muscle strength or the drive to perform, people experience different degrees of pain. Even if back pain is relatively manageable, dancers with large enough breasts to merit surgery will most likely suffer from other symptoms, like chronic rashes or shoulder indentations.

Pain and other symptoms are becoming a non-issue, however, as an increasing number of insurance companies are setting weight and volume restrictions in an effort to cover only surgeries that are medically necessary, Ehrlichman says. Restrictions on weight require a patient to be at or near an "ideal" weight for her height, to prevent overweight women from having surgery when weight loss alone could significantly reduce the size of their breasts. Volume requirements dictate that a certain amount of tissue be removed from each breast (usually 300 to 600 grams, the equivalent of several cup sizes)

The reality is that not everyone who truly needs a breast reduction will fit into these coverage requirements: For example, a small-framed woman may have a large chest for her body, but still not meet the volume requirements because of her petite build. In these cases, women may partner with their doctors to appeal the insurance company's initial decision.

Talking To Your Doctor

If you're considering breast reduction, ask your physician about the benefits and potential dangers for you specifically, and interview board-certified plastic surgeons until you find one you feel comfortable with. Terrasse recommends asking a potential surgeon to connect you with a past patient of similar age or situation so that you can talk about her experience.

If you're under 18, specific guidelines apply. The American Society of Plastic Surgeons says that women younger than 18 years old shouldn't have elective (also called cosmetic) breast reduction surgery, because they may not be finished growing, says Ehrlichman. Exceptions are made for extreme cases.

Careful Consideration

Risks and benefits aside, breast reduction is serious business and shouldn't be taken lightly. "Just because you have large breasts doesn't mean you should have a breast reduction," Terrasse says. "But if they are getting in the way of [dancing with] ease, grace and athleticism, then it's something to consider." Ehrlichman warns that women considering a reduction just to achieve the small-chested look of a stereotypical "dancer's body" should proceed with caution. For a woman with debilitating symptoms, scars and other risks can be a small trade-off for the health benefits; however, when surgery is a purely cosmetic decision, the risks may not be worth it.

Several years later, Lemenager is still confident she made the right choice for her health and her career. "The first day that I walked into the studio in a leotard with no bra on, I knew that the surgery was the right thing to do," she says. "My dancing was no longer painful, and it felt as if a huge weight had been lifted--literally." As with any major medical decision, only you can decide if the risks are worth the


Health & 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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