WHAT IS THE EFFECT OF STRENUOUS
PHYSICAL EXERCISE ON A WOMAN'S REPRODUCTIVE CYCLE?
A. Strenuous
muscular activity, especially when continued regularly for weeks or months,
suppresses the hypothalmus-pituitary-ovarian axis, which controls the ovulatory
mechanism in the ovary. This is physical stress and the effect becomes
more and more evident if the stress is continued. In women of reproductive
age, and of good health, the cycles become irregular often with short luteal
phases. Then some episodes of bleeding may occur without preceding ovulation.
Finally ovulation stops and there is amenorrhea. Ovulation has been suppressed.
If the strenuous activity is stopped, or at least greatly reduced, fertility
will gradually return.
IS TAKING CONTRACEPTIVE MEDICATION
A GOOD THING FOR YOUNG WOMEN ATHLETES TO CONSIDER IN ORDER TO REGULATE
THEIR PERIODS?
A. The contraceptive
pill is intended to suppress ovulation and usually does so. It is therefore
irrational for the stressed athelete to take contraceptive medication.
Such unwise treatment would be equivalent, in treating disease, to taking
medication which had actually caused the disease. Some women athletes are
concerned about prolonged lengths of time without bleeding. All they need
is reassurance that their fertility will return with reduced physical stress.
There is no need to take drugs to bring it back. Instruction in the BOM
(Billings Ovulation Method) will give them all the information needed to
manage their fertility naturally throughout the different stages of their
reproductive life; achieving or avoiding pregnancy; irregular or regular
cycles; breastfeeding, pre-menopause etc. (Website: http://www.billingsmethod.com.)
The idea that cycles or menstruation can be regulated by contraceptive
medication is pure mythology. The medication abolishes the normal cycle
and replaces it by uterine bleeding which is manipulated by the chemicals
administered.
HOW IS BONE DENSITY AFFECTED
WHEN AN ATHLETE DOES NOT CYCLE FOR LONG PERIODS?
A. The most
important way for women to protect themselves from osteoporosis in later
life is to maintain an active exercise programme when they are younger.
Exercise is the most important influence of all in maintaining good bone
structure. So the effect of exercise would protect against any effect on
the bones resulting from perhaps several months without ovulatory cycles.
However, it would be prudent for these young women to so organise their
competative schedules that they regularly have long times without sufficiently
intense physical training to cause amenorrhea.
WHAT STUDIES HAVE THERE BEEN
REGARDING WOMEN OLYMPIC ROWERS AND WHAT ADVICE WOULD YOU GIVE THEM CONCERNING
TRAINING FOR OLYMPICS 2000 IN YOUR COUNTRY, AUSTRALIA?
A. The classical
study was carried out at Harvard University in USA by our colleague Prof.
James Brown and some others working together. The subjects of the study
were women rowers training for the Olympics. This was about ten years ago.
It was found that the strenuous training gradually resulted in long cycles,
irregular cycles and finally the suppression of ovulation and amenorrhoea.
In the September of that particular year the very strenuous training was
stopped and normal ovulatory cycles returned by Christmas. I cannot see
any objection to temporary interruption of the strenuous training and just
following a more simple lifestyle with light exercise and the avoidance
of obesity with a later return to more strenuous training as the Olympic
events come closer. It could even be that this respite would so much improve
the health of the women that in the end they would achieve much better
results. This simple, natural management is very much to be preferred to
any kind of medication, particularly the contraceptive pill. The contraceptive
pill would ensure that the normal pattern of the ovarian oestrogens would
be completely suppressed. There is no need for rest from strenuous training
to occupy several months. I would suggest that after the return of ovulatory
cycles there could be a gradual build up again to the level of preparation
appropriate to Olympic contests.
J.J. Billings AM, KCSG, MD, FRACP, FRCP (Lond.)
E-mail address: billings@ozemail.com.au Website: www.
woomb.org OR www.billingsmethod.com
Ovulation Suppression by Stress
and Pharmaceuticals
by Hanna Klaus, M.D., Natural
Family Planning: A review 17-18, Sec. edit. July 1995.
The role of physical and emotional stress in suppressing ovulation via
alteration in the hypothalamo-pituitary axis is well known and well documented.
Sudden weight loss, environmental stress and/or change, have led to amenorrhea,
(1) When stress suppresses ovulation, a pattern of intermittent mucus without
a peak is seen. Such a cycle is, of course, monophasic, and shows no increase
in progesterone. Often the emotionally or physically stressful events are
easily correlated with the mucus patterns, and resolution of conflict is
then followed by (delayed) ovulation. (2) Athletic amenorrhea is associated
with normal body composition, low baseline concentrations of LH and normal
concentrations of FSH, normal to hyperresponsiveness of LH and FSH to GnRH
testing, and normal and possibly increased frequency of LH pulsations.
(3) McArthur et al. believe that an alteration in the hypothalamic control
of gonadotropin release, independent of body composition, is operant in
the development of athletic amenorrhea. While mucus observations were
not made by their subjects, vaginal cytohormonal studies indicated moderate
vaginal atrophy. Taylor et al. (4) have correlated the highest karyophyknotic
index with the peak mucus symptom and found close correlations.
The use of psychotropic drugs, particularly the phenothiazines, is associated
with amenorrhea and, at times, with inappropriate lactation, presumably
as a result of prolactin increase. In such women, the normal ovulatory
mucus pattern is disturbed and can signal the disturbed hormonal picture.
There are anecdotal reports that smoking THC (tetrahydro-cannabinol) -
potâ€™Ă„Ă¹ (marijuana) - suppresses ovulation; and when this occurs it is reflected
in the mucus patterns. No hormonal correlations have been published to
date. While ovulatory disturbances are seen in hard drug users, they are
difficult to define due to erratic use, life style, and diets. (They are
known to become pregnant.) Any systemic illness which interferes with ovulation,
i.e., hypo- or hyperthyroidism, will be reflected in the mucus and thermal
patterns.
References:
(1) Reichlin, S., et al.: The Role of Stress in Female Reproductive
Dysfunction. J. Hum. Stress 5: 38, 1979
(2) Billings, E.L. and J.J., Catarinich, M. Billings Atlas of the
Ovulation Method, 5th ed. The Ovulation Method Research and Reference
Centre of Australia, Melbourne, 1989
(3) McArthur, J.W. et al. Hypothalamic Amenorrhea in Runners of Normal
Body Composition. Endocrinol Res Commun 7:13. 1980
(4) Taylor, R.A., Woods, J.B., Guapo, M.: Correlation of vaginal
hormonal cytograms with cervical mucus symptoms as observed in women using
the ovulation method of natural family planning. Journal of Reproductive
Medicine 31:167-172, 1986
Stress - Application of the Early Day Rules
- Dr. Kevin Hume answers
( "An Introduction to the Billings Ovulation Method" page 16)
Copies are available from: Family Life Centre, 27 Alexandra Parade,
North Fitzroy, Melbourne, Victoria 3068, Australia - @ $5.00 Aus.
"The usual effect of stress is either to completely
inhibit ovulation or, more commonly, delay it. Some women are very
sensitive to stress. Sometimes the mucus symptom is just beginning, or
may be even quite well devoloped, when the stressful situation
intervenes.
There are many examples of stress, e.g. anxiety - for
oneself, a spouse, children or relatives; an intercurrent illness or an
operation; an emotional shock; an accident; travel, - and so on. While
not a stress situation, the taking of certain drugs may interfere with
the process of ovulation, e.g. anti-inflammatory drugs such as aspirin
and Indocid and the phenothiazine group of anti-allergic and
tranquillizing drugs.
The effect may be to interrupt the symptom fairly
abruptly, imitating a Peak Symptom, but resulting in an anovular cycle.
More commonly the interruption is followed by a return of the symptom
when the stress subsides, leading to a proper Peak. The first apparent,
but false, Peak in such a cycle is typified by a gradual fading of the
symptom unlike the precipitous decline when the true Peak is defined.
Women are of course aware of the stressful situation, and are on their
guard under these conditions.
The ordinary rules for the lengthening of the
pre-ovulatory phase are applied, with a greater emphasis on the "wait
and see", (count 1,2,3) rule.
Amenorrhoea - In the absence of periods a woman
finds herself in a situation somewhat similar to breast-feeding,
whatever the cause of the amenorrhoea. The early day rules applying to
an indefinitely prolonged pre-ovulatory phase are therefore followed if
pregnancy is to be avoided. Conversely, if pregnancy is desired then
careful attention must be paid to the sensation and appearance of any
mucus of a fertile type."
Kevin F. Hume K.S.G.
