There are a multitude of well-known health issues correlated with being overweight, including potential fertility loss. It might seem like a fair assumption that the best way to avoid these issues is to exercise as much as possible and stick to a strict diet. Exercise not only improves your physical state but also your mental state as well, which seems like a low-stakes situation for active women.
While exercise and diet are important to maintaining a healthy lifestyle, especially if you are planning for a baby, can too much of a good thing be harmful?
Relationship between diet, exercise, and fertility
Exercise is encouraged by doctors, especially for women who are planning a pregnancy. Not only does exercise improve cardiovascular health and help women maintain a healthy weight, but being physically fit can be extremely beneficial for making labor a less strenuous process. Exercise can also greatly reduce the chance of health risks in pregnant women like gestational diabetes and preeclampsia, which can affect up to 3% of pregnancies.
So if exercise can lead to so many positive outcomes, what could be bad about it?
While the right amount of exercise can certainly have a positive effect on fertility, working out can become strenuous on your body if overdone. This is especially true when matched with an overly strict diet.
Athletic women who are young and healthy may assume that they are immune to common fertility issues. However, women who participate in intense exercise and do not get enough nutrition can be at risk of health issues, such as energy deficiency.
If the body does not get enough nutrients it cannot carry out certain basic functions, such as menstruation and ovulation. Anovulation, or the absence of ovulation, accounts for 30% of female infertility, making this a serious factor to consider for athletic women hoping to get pregnant.
The female athlete triad has been named as a disorder consisting of three interrelated components that can cause infertility in highly active women.
- Low energy due to lack of nutrition in relation to the number of calories burned
- Hypothalamic amenorrhea or menstrual dysfunction
- Low bone density and cardiovascular risks
Women most at risk participate in sports that require an intense level of training such as:
- ballet
- cross-fit
- cycling
- gymnastics
- running
- swimming
How can diet and exercise cause infertility?
About 12% of infertility cases are women in sports who train too intensely. Whether you are a professional athlete or just enjoy extreme physical activity, you may be wondering where to draw the line. If the sport you enjoy puts you at risk of physical injury, that is one factor to be aware of, but the main cause of reproductive dysfunction in athletic women is energy deficiency.
When women exercise they produce certain hormones that at a high level and combined with low body fat, can reduce the level of sex hormones (estrogen and progesterone), needed to help prepare the body for pregnancy. This can cause irregular periods or in more extreme cases, stop menstruation altogether. Women athletes who stop menstruation for three months or more may be experiencing hypothalamic or athletic amenorrhea.
Exercise-induced menstrual disorders account for about 6% of infertility cases, but long-term period loss can affect more than just fertility. Estrogen is crucial to womens’ health not only as a sex hormone, but it is also necessary for proper bone strength and heart health especially as women age.
Women reach peak bone density at around the age of 30, so women who experienced hypothalamic amenorrhea throughout their 20’s may develop osteoporosis or brittle bones later in life due to lack of estrogen production over an extended period of time. Estrogen is also used to protect the heart from cardiovascular disorders.
Stress injuries are also more common in amenorrheic athletes, with 30% of ballet dancers experiencing them. This is likely due to a combination of not only low bone density but low energy levels due to nutrient deficiency.
How much is too much?
While the recommended level of exercise and caloric intake depends on the individual, research has found that intense aerobic exercise for more than seven hours a week can increase the risk of ovulatory problems. Women who have not experienced the loss of menstruation should still be aware of the potential effects of excessive dieting and exercise. While a minimum of 17% body fat is required for menstruation, 22% is required to maintain ovulation.
Women who are trying alternative methods to get pregnant, such as IVF, should also be aware that excessive exercise can reduce success rates of the procedure. However, doctors do not recommend stopping exercise altogether, which can cause other problems for women using IVF. Rather, moderate exercise such as walking or gentle yoga is the safest bet.
Women who show signs of any of the three components of the female athlete triad should see a doctor to determine the severity of the issue, especially women who want to start a family.
Is athletic amenorrhea reversible?
The good news is that when treated correctly women have a high likelihood of recovering from athletic amenorrhea. Treatment options can be as simple as reducing the amount and intensity of workouts and increasing caloric intake to gain weight. However, depending on the time period, there are still some long-term risks such as osteoporosis. Calcium supplements and oral contraceptives can be used to kickstart hormone production in more extreme cases.
The less good news is that treating women who experience the female athlete triad can be trickier than it may seem. For one, cultural attitudes about the female body can make the disorder difficult to diagnose, with only 47% of primary physicians even aware that the disorder exists.
The expectations of women, especially athletes, to fit a certain body standard is something women experience from a very young age. Up to 25% of female high school athletes experience amenorrhea. While this number does go down in older women, this is not something to be overlooked.
It is recommended that women experiencing the female athlete triad, or any similar eating disorder do not try to handle recovery alone and should seek professional treatment. In addition to a primary physician or fertility specialist, women can look to a trainer, a dietitian, or a therapist for additional guidance when it comes to healthy exercise, diet, and body image.
Women athletes can do it all
When women are energy deficient their bodies cannot properly carry out their own functions let alone take on the responsibility for providing nutrients to an infant. Period dysfunction may be your body trying to remind you to take care of yourself and should not be ignored.
That being said, highly active women hoping to get pregnant should take comfort in the fact that they don’t have to drastically change their lifestyle in order to prevent fertility loss. Women who make sure to provide their bodies with enough nutrients can continue to enjoy exercise before and throughout their pregnancies.
