Fitness shape and menstrual disorder: part II

In the previous part of this article I wrote about the probable reasons and consequences of functional hypothalamic amenorrhea (FHA). In this part, just like I promised, I will pay attention to more practical aspects and I will offer few solutions which may help to regulate menstruation with high intensity physical activity and low amount of body fat.

You should definitely read:

Fitness shape and menstrual disorders – part I


Fitness shape and menstrual disorder: part I

Energy supply

Energy supply inadequate to the needs of body is probably the most important factor causing menstrual disorder among physically active women [1]. Research led by dr Anna Loucks and her research team from the University of Ohio proved that in order to ensure proper release of luteinizing hormone (LH), the amount of “available” energy per day should not be less than 30 kcal per lean body mass [2]. I just want to remind you, that lowering the release of LH causes worse stimulation of the ovaries and decrease of the release of estrogens.


  • a woman weighing 55kg (body fat – 20%, lean body mass – 0.8 x 55 = 44kg)

  • 4 strength workouts a week (each session lasts 60 minutes, high intensity); energy expenditure per day ~350 kcal

Daily energy demand to guarantee proper release of LH in this case should not be less than: 30 x lean body mass in kg (44) + the amount of energy used in physical activity in kcal (350) = 1670 kcal.

Few moths ago some interesting results of tests were published, which cover the same topic [3]. A group of untrained women was divided into four smaller groups:

  1. no energy deficit (added physical activity)

  2. small energy deficit (-8% of energy demand)

  3. moderate energy deficit (-22% of energy demand)

  4. large energy deficit (-42% of energy demand)


The results of the experiment were following:

  • in groups 3 and 4 the total of menstrual disorders was larger than in groups 1 and 2

  • it was estimated that energy deficit over 22% of energy demand (from diet and physical activity) may be connected with menstrual disorder

  • lack of ovulation occurred in case of some women in the groups with moderate and large energy deficit, but (it is important) even in the group without energy deficit (only with added physical activity) and in the group with small energy deficit there were women with oligomenorhea (long cycles, over 35 days)

  • women with the smallest energy deficit lost the most after 3 months, and women with the largest energy deficit lost the least (and it's not a mistake!)

According to the presented results, the occurrence of menstrual disorders as a response to various stress factors (dietetic restrictions or physical activity), is an individual matter. Some women may experience menstrual disorder with small energy deficit and moderate intensity/volume training. However, the risk of occurrence of such disorder is very high, when the amount of available energy is below the amount which was obtained by dr Loucks in her research.

I would suggest women who subtracted too many calories from their diets, what resulted in menstruation disorder, to increase the calorific content of their diet (+ 100 – 200 kcal per week), what should prevent from significant growth of body fat. I also have to point out, that the offered minimal amount of available energy may prevent from the menstrual disorder, but it may be insufficient when the aim is to regain regular monthly cycles. Having such goal, one should aim at 45 kcal of available energy per lean body mass per day.


There are many substances which take part in the regulation of monthly cycles. One of these substances – leptin, informs brain about the amount of energy stored in a form of body fat, the amount of energy supplied and lost during physical activity and the amount of time spent on sleeping. Together with lowering the amount of body fat, the amount of leptin falls. Limiting the supplied energy also leads to lower amount of leptin, e.g. 3 days of starvation lead to decrease of about 10% of the baseline [4]. Sleep deprivation has similar effect. It was estimated, that lowering the amount of sleep (5 instead of 8 hours) causes that the level of leptin falls by 15% of the baseline [5].

In many experiments it was proved that the level of leptin is lower among women with functional hypothalamic amenorrhea (FHA) [6]. What's more, the exogenous supply of leptin for women with FHA leads to the normalization of the concentration of thyroid and adrenal hormones, as well as restoring proper function of the hypothalamus-hypophysis-ovaries line [7, 8]. As a result of the supply of this hormone, higher bone mineral density was also observed – high frequency of injuries (connected or not connected with bone fractures) is one of the main consequences of FHA.

Leptin has not been prescribed regularly to women with FHA yet. Fortunately, there are few natural ways of increasing the level of this hormone or improving the sensitivity of tissues to its action:

  • proper amount and quality of sleep; having correct daily cycle

  • introducing 1-3 days a week with larger amount of carbohydrates (the best would be the workout days), carbs influence the leptin release really strongly, fructose is an exception

  • including “breaks” from reduction diet every 8-12 weeks – 1-2 weeks without energy deficit

  • sufficient supply of long-chain fatty acids omega 3 – 400-600g of fatty fish per week with a diet poor in omega-6 fatty acids; alternatively, high-quality supplementation with fish oil or cod-liver oil (1-2 g of EPA + DHA per day) [9].

Leptin seems to be the key factor for the reproductive system. In the next part of this cycle, having this hormone on my mind, I will take a closer look at the influence of particular macro elements, especially fat, and I will present the ways of limiting the release of stress hormone during long intensive training.


Fitness shape and menstrual disorder: part I

Sources: 1) Warren i Perlroth. 2001. The effects of intense exercise on the female reproductive system. J Endocrinol. 170: 3-11. 2) Loucks i Thuma. 2003. Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women. J Clin Endocrinol Metab. 88: 297-311. 3) Williams i wsp. 2015. Magnitude of daily energy deficit predicts frequency but not severity of menstrual disturbances associated with exercise and caloric restriction. Am J Physiol Endocrinol Metab. 1;308: E29-39. 4) Chan i wsp. 2003. The role of falling leptin levels in the neuroendocrine and metabolic adaptation to short-term starvation in healthy men. J Clin Invest. 111: 1409-21. 5) Taheri i wsp. 2004. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 1: e62. 6) Chou i Mantzoros. 2014. 20 years of leptin: role of leptin in human reproductive disorders. J Endocrinol. 223: T49-62. 7) Welt i wsp. 2004. Recombinant human leptin in women with hypothalamic amenorrhea. N Engl J Med. 351: 987-97. 8) Chou i wsp. 2011. Leptin is an effective treatment for hypothalamic amenorrhea. Proc Natl Acad Sci U S A. 108: 6585-90. 9) Dyck. 2005. Leptin sensitivity in skeletal muscle is modulated by diet and exercise.Exerc Sport Sci Rev. 33: 189-94. 10) Lyle McDonald. 2005. A Guide to Flexible Dieting.