Megan, a college-aged recreational runner

A personal message from Megan

It’s hard to stop doing something that makes you feel better. I felt great when I started exercising, running, and losing weight. I started the spring of my Junior year in addition to high school sports. My “healthy” eating and exercising became obsessive and unhealthy. The summer came and went, and I went from 125 to 105 pounds. I ran every morning and swam laps during my breaks while I lifeguarded. My breakfast consisted of a granola bar and my lunch was half a peanut butter and jelly sandwich. By the fall of my Senior year and field hockey season, I was pushing 99 pounds. I had to get a physical before by my primary care physician, who told me I had lost a lot of weight (duh) and I should stop running (not going to happen). Since she showed what seemed like minor concern, I didn’t take her seriously. My dad and best friend were the other people who addressed my exercise and eating habits. They both wanted me to eat more and run less, but I liked the way I felt at that point in time. Even though I was the fastest runner on the field hockey team, but I would get really tired during games. My coach would set me out from time to time, but I always started and played my hardest.

I continued to obsess about running, counting calories, and fitting in my size 0 jeans. Even when my foot started to bother me, I ignored the cues from my body and continued to run. No one ever seemed to put it all together – that maybe I had a stress fracture and weak bones which were contributing the foot pain, and also connected with the fact that I didn’t get my period. One evening, my friend and I decided to go for a run on my street, and at the end I felt my foot pop. He had to carry me back home and I went to the ER the next day to get it checked out. Sure enough, the unknown stress fracture completely broke and I left with crutches and a boot. That was enough to stop me from running, but I still didn’t understand what had happened to my body.

My health, weight, and exercise struggles have been a learning experience. I am now stronger than ever and nourish my body with delicious, healthy foods to meat my exercise needs. I train hard, and then replenish my body and listen to it when it tells me it’s tired or worn out. I take time to relax, recover, and give it the chance to grow and be stronger. It’s easy to lose site of what it means to be healthy, especially as a female. Being healthy isn’t about looking a certain way or comparing your abilities to others. Being healthy means treating your body with respect, nourishing it with the food and movement it deserves, and loving your body for it’s capabilities. Having your period, and the ability to reproduce and have normal hormonal levels, is something every woman should take pride in and feel capable of doing. It wasn’t until after graduating college that I got my first period back. When I did, it was invigorating and empowering to know that my body was functioning the way it should. I now work on continuing to improve my health in every way possible, and believe every woman should. We only have one body to live in, so it’s important to take care of it.

Bridget Franek, 2012 London USA Olympian in 3000 m Steeplechase

A personal message from Bridget Franek, a professional runner for the Oregon Track Club (OTC) Elite who competed for the United States Olympic Team at the 2012 Summer Olympic Games in London

Bridget Franek is currently a professional runner (Primary Event: 3,000 m Steeplechase) competing for the Oregon Track Club (OTC) Elite in Eugene, Oregon under a contract with Nike. Bridget recently competed in the Final of the 3,000m Steeplechase at the 2012 Summer Olympic Games in London.

Bridget became a professional following a successful college career at Penn State University. A 10-time NCAA All-American from Hiram, Ohio, she joined the OTC Elite in October 2010 and was excited about this excellent opportunity to train in one of the top running clubs in the world. She looked forward to working with Mark Rowland, a bronze medalist steeplechaser at the 1988 Seoul Olympics, and also, training with other professional/post-collegiate athletes.

Bridget has run as long as she can remember and accredits her early participation in the sport to her parents, who were both avid distance runners themselves. She participated in several high school sports- soccer, basketball, swimming, cross-country and track. Bridget won 4 state track titles in her senior year of high school and still holds the Division II Ohio State High School records in the 1600 (4:50.10), and 3200 (10:16.50) events. Bridget was recruited by Penn State as a miler, but it was the steeplechase that became her passion. Bridget was a standout athlete in her 1st season being named Big Ten Freshman of the Year. Her college training regimen involved practicing around 45-50 miles/wk and racing almost year-round. She competed in Cross-Country in the fall followed by Indoor and Outdoor Track in the winter and spring months. She would also travel overseas to compete during the summer months, which she describes as the toughest season in terms of performance.

She became aware of the importance of healthy and optimal nutrition early in her career. She placed an emphasis on refueling before, during, and after training and competition to ensure she achieved her top performance. When her body weight would decrease in the summer months, Bridget noticed she had less energy to put forth her best efforts during training and she struggled during her races. Additionally, Bridget experienced irregular periods since her freshman year of college, and she made it her priority to seek information about the implications of menstrual disturbances for her athletic career but more importantly for her overall health. In college she was advised to go on birth control. Additionally, her physician suggested getting a bone density scan to see if her menstrual problems translated to poor bone mineral density. Her bone mineral density was within the expected range for her age and ethnicity, which she was pleased about but she still was concerned about her lack of a period. When she started experiencing some negative side effects from the birth control, she reevaluated being on the treatment. Her physician told her that since she was not losing any bone as a result of her menstrual problems, she should be fine with coming off of the pill. However, the physician strongly recommended that as long as her period was absent, she get annual bone density scans to monitor for any bone loss.

Despite her frustrations with her absent menstrual cycle and unsuccessful attempts to restore regular menses using the pill, Bridget continued to make an effort to look into non-pharmacological solutions for her absent period, to include increasing her calories and gaining weight. To date, she has not been successful in resuming her period on a regular basis. At times this is extremely discouraging for her, but since her performance goals are high and she is hesitant to make any drastic changes to training, she continues to monitor her nutrition and bone health to avoid any more detrimental health outcomes. Bridget has luckily never experienced a stress fracture or any serious injuries and makes her physical health a priority. Due to these experiences, Bridget felt it was important to make the most of her resources at Penn State. She took it upon herself to be as educated as possible by contacting nutritionists, exercise physiologists and sport medicine professionals to become better informed on nutrition and proper training and its implications for her performance and general health. Bridget also fostered a supportive relationship with her coach and communicated her health, nutritional and training goals very clear, which she found to be a major contributor to her successful performance as a college athlete and led to her current position as a professional athlete. She describes her first year with the OTC Elite as a learning experience as she transitioned to higher mileage and much more intense training workouts combined with the greater competition amongst athletes within the club. In her second year with the club, Bridget is much more confident and is thankful that she now has a year of experience behind her. She has already set a P.R. (personal record) in the 3000m indoors and has run very near her best times in the 1500m and 5k- all great indications for a great season of steeplechasing to come!

She currently works with the company Orreco, made up of a team of elite sport performance specialists including world-class nutritionist, hematologists, and physiologists. Nutritionally, her current focus is taking in adequate carbohydrate for energy during training and increasing her protein consumption for better recovery post-training. She also pays close attention to her glucose levels, concentrating on keeping it as consistent as possible throughout the day. With the guidance of the team, she has added Omega-3 Fatty Acid supplements to her diet as well as probiotics to help with her recovery and immunity. This is meant to prevent her from getting excessively run down by the high amount of training that she does. Bridget recognizes that she is burning a very high amount of calories and needs to refuel to maintain her body weight and provide adequate food intake to support her vigorous training. She has noticed that eating smaller meals more frequently is an optimal fueling pattern for her training regimen, which involves up to 2 practices/day 7 days/week. To monitor recovery between sessions, she is taking daily measurements of body weight, resting heart rate, mood state, muscle soreness, and sleep quality. These give her and the team a more thorough picture of her physical health and well-being and how it fluctuates. Ideally, she will compete into the next Olympic cycle (4-5 more years) and possibly transition into Triathlons and marathons.

Rachel, a college-aged fitness instructor

A personal story from Rachel, a fitness instructor at Penn State University

Being a late bloomer during adolescence, I wasn’t initially concerned when I entered high school without having experienced my first menstrual period. At the age of 16 I had my first period followed my second about 12 months later. When I continued to have missed periods, I decided to consult my physician. She explained that judging by my body weight and height I appeared to have a healthy BMI. However, based on my highly active lifestyle and the irregularity in my menstrual cycle even at the age of 17, she suggested that I begin taking oral contraceptives in order to “get my body on the right track”. By this time I was a freshman in college, training to become a fitness instructor, and attending fitness classes most days of the week. After about a year of being on oral contraceptives, I decided to discontinue my usage. My period was regular for 2 or 3 months after I stopped taking the pill but soon after I became irregular again.

I continued to exercise frequently and at relatively high intensities and my periods remained irregular. As a Kinesiology major, I became aware of the Female Athlete Triad through several of my required courses. Although I displayed some symptoms, I always ate when I was hungry and I tried to maintain a healthy diet to compensate for the energy that I expended during exercise. When I began teaching fitness classes, I actually gained several pounds and have managed to maintain a healthy weight throughout my college career. Although I knew that my menstrual irregularities were not normal, I did not know of any other actions that I could take to improve my condition. In addition to fitness classes, I decided to take up running.

During the Spring of 2011 I decided to participate in a study where I completed a DXA scan measuring my bone density at the hip and the spine. My BMD Z-scores at my hip and spine were 0.6 and 0.4, respectively. These results were favorable to me as my bone health is very important to me especially given my background knowledge in the area of women’s health, exercise, and bone.

In the summer of 2011, at the age of 21, I began training for a marathon. In addition to teaching muscle conditioning and aerobics classes, I went for 6 mile runs usually 3 times during the week. By the end of the summer I began having foot pain and when I returned to school in August, an MRI showed a stress fracture in my 2nd metatarsal. My orthopedist suggested that in addition to staying off of my foot, I should take vitamin D and calcium supplements and eat a sufficient amount of calories to replace the energy that I expend during exercise. I struggled with recovery during the whole semester and took up swimming and weight lifting to replace running and high intensity aerobics. After about 2 months of decreased exercise, my period became somewhat regular. I resumed my normal fitness aerobics activity in January 2012 but have not picked up running yet. Since October I have had a menstrual period for 6 consecutive months although they have been at somewhat irregular intervals.

As a fitness instructor, I am a health and exercise role model for other students and fitness enthusiasts. Yet, even though I exercise routinely but not excessively, eat a healthy and sufficient diet, and maintain normal BMI and BMD values, I still struggle with several major factors associated with the Female Athlete Triad. I’ve been frustrated by the fact that I seem to do everything right and follow the recommendations of my physicians, but my body continues to display signs of a significant problem. I think that the Female Athlete Triad Coalition plays a very important role in promoting awareness and encouraging education, research, and treatment for athletes like myself. Personally, I would like to see more research done on the signs, causes, and interventions for the Female Athlete Triad.

Eva, a female runner from The Netherlands

A personal message from Eva

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).

Circle indicates fracture.

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.