A personal message from Eva, a female runner from The Netherlands
After a fairly inactive childhood, at the age of 19, I began my participation in swimming and a few years later, I recognized an innate ability to run. By the age of 22, I started training with a group in Houston in combination with rather vigorous swimming. Due to my increased participation in training, I noticed that I had begun to lose a lot of weight going from a thin physique of 52 kg (BMI of 19 m/kg2) to very skinny, notably underweight 46 kg (BMI of 17 m/kg2). I was not consciously following any diet however, it was clear I ate way too few calories for my active lifestyle and this led to a disordered eating behaviour.
When I got back to the Netherlands, I seemed to be on the path to recovery but I still struggled to gain weight and was too thin (around 50 kg). Despite constant reminders from family and friends of being underweight, I had the unshakeable fear of getting fat. I participated in swimming again and ran about once a week and was surprised to see that I was able to run a half marathon (13.1 miles) in 1 hour and 46 minutes. This was satisfying for me since my focus had never been on speed or improving my time.
After being on oral contraceptives for 5 years, I decided to come off them when I was 23 years old. However, my period did not return. I thought that I would have greater luck after gaining some weight, but since my periods had always been irregular I waited for a long time before seeking any medical advice on this issue. A few years later I started oral contraceptives again, and upon coming off of them, my period came back once after more than a year of being absent. However, at that point, I did relatively little physical activity, hardly any running, so getting my period back could be attributed to my more normal training regimen.
When I moved to the US again in 2008, to Chicago, I took up running and ran 2-3 times per week, while swimming once a week. I noticed major improvements in my running strength and time. My running partner and I participated in a number of races and my pace went up from 12 to 14 km/hour in 10 km races! I was very pleased with these results but still I had trouble maintaining a healthy body weight and ended up losing weight again. Needless to say, my period never returned.
In 2009, I moved back to The Netherlands and joined a running team. I trained with a competitive group of runners and improved my half marathon time to 1 hour and 34 minutes, which was 12 minutes faster than my personal best. My progress continued, and I became faster and faster and even placed first in several races. In April, I signed up for the Chicago-marathon with my running partner from the year before, which turned out to be the worst decision of my life. I took up a training schedule aiming for 3 hours and 30 minutes, a time that I was keen on achieving. My obsession with running was enabled by the enthusiasm of my running mates and I became very extreme about my training sessions and intensely determined on improving my running performance.
It was clear that this obsession with running was taking a toll on my body. With this in mind, I visited both a dietician and a doctor to get advice on how to gain weight and get my period back. They provided me with a lot of helpful information but I only followed parts of it. I ate healthy as per their recommendations, but it was still not enough calories for my lifestyle. Nonetheless, I was eating more than before and I managed to gain some weight, despite training so much.
By September, I was training 4-5 times per week, and once per week I went on a really long run. I did not really enjoy running any more, and found the long runs monotonous and boring. I was becoming noticeably tired and was hungry all the time. More and more, I missed doing things that I used to find a lot of joy in doing, like cycling and swimming, and more specifically, having a social life and seeing my friends.
One Sunday in September I joined a group for a 35 km run and I felt noticeable pain in my right buttock muscle, which had been giving me problems for quite some time. The next day I could hardly walk, but within a day or two, the pain started to be relieved and I went on a short run in an attempt to get rid of the persistent muscle cramps. After running for 20 minutes, I could not keep going and I started to walk since the pain in my leg became unbearable. The next morning, I managed to get myself to my doctor. She thought it was a torn muscle or a constricted nerve and advised me to rest, and to maintain a positive attitude, which I was keen on doing since the Chicago marathon was in 5 weeks.
On Monday, I saw my sports doctor, who diagnosed bursitis trochanteria, an inflammation of the bursa at the outer side of the hip. All my signs matched this diagnosis, and he put me on anti-inflammatory drugs. The drugs helped in relieving the pain and as per his advice I tried to keep moving by going on bike rides (while avoiding running) to prevent deconditioning and to stay flexible. On Friday I saw a physiotherapist who tried to massage the affected muscle but he couldn’t turn my leg without causing me an unbelievable amount of pain. He gave me a pair of crutches and I struggled through the weekend on pain killers and saw my doctor again on Monday. He, along with the physiotherapist sent me for an X-ray which showed that I had a fracture in my medial collum femoris (neck of the femoral bone) (see X ray image – Circle indicates the fracture.). Luckily for me, the fracture remained ‘stable’ which was most likely a result of my very strong muscles. I had surgery that night and I got three metal pins in my hip (see image).
My doctors wanted to find out how this could have happened to a 29-year-old woman because it’s not normal for women my age to break their hip. I searched the internet for answers myself and came across the Female Athlete Triad. After reading on this particular condition, it was shocking how much I fit the profile of the women affected by this disease. It was clear that my extremely thin physique and vigorous training for so many years had caused me to lose my period and furthermore, it was my lack of a period that was linked to a bone disease called osteoporosis, probably the reason I had fractured my hip. More and more, I realized that this was my fault, and that my own behaviour over the past years resulted in a broken hip and quite possibly the end of my participation in running. My sports doctor supported my suspicions and scheduled me for a DEXA scan which would measure my bone mineral density. It was not a surprise when my scan showed that my bone mineral density was low, very low! The doctor stated that my bone mineral density was in the range of osteoporosis (Z-score: -2.8 SD, T-score: -2.9 SD) for my Lumbar spine and in the range of osteopenia (Z-score: -2.0 SD, T-score: -2.0 SD) for my femur. Now everything made sense to me and I experienced a major wake-up call. I recognized that I needed to take much better care of myself and prioritize my health over my passion for running.
Presently, I’m recovering quite well. I walked on crutches for about 3 months and had physiotherapy care for 6 months after my surgery. I have been biking, swimming and doing a lot of muscle training, which has helped me make noticeable progress and soon I was be able to walk normally. Since January, I experienced major improvements in my condition, and I even started running again, which I can do for about 30 minutes now. I’m not sure if I will ever be able to get my previous strength back but I am not pushing myself since I know the cost is much too great. I’m pretty sure that I will NEVER run a marathon in my life but my health is much more important and there is more to life than running and being thin.
I am eating a greater amount of food than before and I feel less tired than before, and without having to gain too much weight. Now I’m rather weight stable at 51 kg. I don’t ever intend to eat unhealthily, but at least I have a higher calorie intake, and know how much I should eat in order to have the appropriate amount of fuel for an active lifestyle. I think this whole story made me realize that I was wearing down my own body before the age of 30, and that because of my low body weight and very low body fat percentage (about 10%) which I maintained for several years, I had disrupted my hormone levels and this caused me to lose my period.
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