Expert: Ryan Hale - 6/4/2010

Question
QUESTION: My name is Sarah, and I started dieting in January. At some point, the dieting became anorexia, and now I am trying to recover. I've been trying for a month, but I've really gotten serious about it this week.  I'm 15, 5 foot 3 inches, and now 101 pounds. I used to be around 108 before the anorexia. I haven't had my period since January, and I stopped running my usual 20-25 miles three weeks ago. When should I expect my periods to return? My coach told me my doctor could give me medication to make it happen. When can I start training for my fall cross country season? And what do you advise me to do?

ANSWER: Sarah- While it is true that hormone therapy will help your period return, it doesn't address why it quite in the first place.  It is important for it to return because your body is in better health/balance rather than because of medicine.  It is common for female athletes to have fluctuations in their menstrual cycles in response to training stress or emotional stress, but when it goes away for more than 3 months at a time, that is problematic.  Your focus should be on getting healthy rather than on trying to return... however, returning to training and competition can be used as motivation.  You haven't been menstruating for very long right?  Like 3 years maybe?  It is even more important for your health than say a 30 year old whose body has had a chance to develop a normal metabolism and menstrual cycle.  Also, your ability to run throughout your life and continue competing depends on your musculoskeletal health.  If you take the time now, your body will be better able to recover from training loads and avoid injury as a college runner and as an adult runner.  I understand that you want to get back at training soon.  My advice would be to take the time to get better.  I also know that being a competitive runner also means being on the razor's edge as far as healthy weight goes.  The line is often very thin between being underweight and normal weight... often 2 or 3 lbs.  It's important to be on the right side of that line though.  Even though you may cross that line briefly during peak competition or at the end of the season, it's not something that should be sustained for more than a week or two.  

I'm not sure what your coach has you doing, but it is important to realize that it is impossible to be at peak year round.  Many athletes insist on being in great form for cross country, being at top form for indoor track, being super fit for track in the spring and then be at peak for summer races.  You have to pick your events and seasons that you want to concentrate on and peak for those, allowing time to recover, rebuild and rest (usually periods of 6-8 weeks).  

Hopefully this helps.  Let me know if you have any questions.  

---------- FOLLOW-UP ----------

QUESTION: Thanks. This was very helpful. I know this isn't your area of expertise, but do you know what I should expect from a doctor's visit about this? I have already personally addressed my emotional problems that led me to anorexia, and I don't want to see a psychologist. I realize that's probably what a lot of recovering anorexics say, but I strongly believe I am done with that part of my life.

Answer
It's difficult to get past all of the aspects that can feed into an eating disorder on your own so be aware that there may still be some things that need ironed out (family, relationships, emotional stress, past history, stress related to school, work, or sports, etc).  As for your doctor, I would recommend looking for someone who is also board certified in sports medicine so they will have a good understanding of active people.  Not an orthopedist, but a family practice doctor who is also certified in sports medicine.  To get the best treatment and results, you need to be 100% accurate and honest with him/her.