When I was in high school, I was recruited by dozens of college cross county and track programs. This was a strange experience, and sort of an ego-boost. Because of my burgeoning eating disorder, I often isolated myself in the name of "being best." I thought that if I trained hard enough, or dieted enough, I would be fast enough to earn a scholarship. Attention from so many schools validated that belief in an extremely tangible manner, and has shed light on the dark underbelly of this disordered pattern of thinking.

A coach from the University of Texas A&M at Corpus Christi called me one afternoon, and after the obligatory inquiries about my latest races and school, he got down to business. "I have to ask you," he said, "if your menstrual cycle is regular? I've found that many of our girls lose their cycle and it's a precursor to injury. We take measures to ensure our team stays healthy so they can perform their best." I told him my period was anything but regular, and he assured me that, should I choose to run for him, the team doctor would help me regulate my period through proper nutrition, supplementation, and blood testing if necessary. He drew a parallel between running, eating disorders, menstruation, and injury that was entirely uncomfortable for 17 year-old me, likely because it struck so close to home.

Eating disorders are not uncommon in the running community. In 2007, researchers at the Norwegian School of Sports Sciences found that about 47 percent of elite female athletes in sports that “emphasized leanness” had clinically diagnosed eating disorders compared with 21 percent of women who were not elite athletes.

These staggering statistics were one reason the Texas A&M coach wanted to discuss my menstrual cycle. Lack of a regular period is one sign of the female athlete triad, which is only a small part of RED-S (see diagram).

RED-S stands for "relative energy deficiency in sport," and is the result of insufficient caloric intake and/or excessive energy output. People with eating disorders, especially athletes, often suffer from both insufficient intake and excessive exercise. RED-S can alter many physiological systems, including metabolism, menstrual function, bone health, immunity, protein synthesis, and cardiovascular and psychological health.

The RED-S concept was adapted from the female athlete triad, which affects active women with low-energy availability, menstrual dysfunction, and low bone mineral density. I didn’t know about the female athlete triad until late in my college career, when a big, fat light bulb went off in my head and I thought to myself, “this is what’s wrong with me.” I didn't learn about RED-S until I was halfway through my Master's degree and seeing a therapist for my eating disorder. She was the one who introduced the concept, telling me, "losing your period is only one small part of your condition. You may feel chronically fatigued, have lots of gastrointestinal distress, and you're likely disrupting your metabolism and a host of hormones. That's why your liver enzymes tested so high."

Not only was I putting my body under intense physical stress, but the mental and psychological stress I experienced was hefty as well. When I began seeing my therapist, I thought she would help me learn to nourish my body better. I didn't understand that what I really required was that, yes, alongside psychological help.

For most of my life, I associated losing my menstrual cycle with fitness, and felt a real sense of failure when I did occasionally bleed. This attitude was underscored by the mentality of those around me; coaches and team doctors who validated the sense that my experience was normal.

Menstruation is not a cozy, comfortable subject to discuss over dinner, and growing up, I hated the idea of dealing with a monthly blood geyser. From seventh grade until my senior year, I had only two periods and was relieved that I was able to largely avoid the messy business of womanhood. The first time I tried to use a tampon, I couldn’t figure out where to put it, and sadly turned to Google for step-by-step instructions on how to locate my vagina and where to insert a tampon. The fact that I found periods so horrifying and confusing speaks volumes about how I was taught to conceptualize not only my own body, but women's bodies. Periods were not, and are still not, normalized or talked about enough (especially in athletics), which is another reason my discussion with the Texas A&M coach was uncomfortable.

Looking back, I find it disconcerting that of the dozens of coaches recruiting me, he was the only one who brought up menstruation in relation to physical health. He realized that losing a period is unhealthy, saw the connection to eating disorders, and actively tried to get in front of the issue. Every other coach was speaking my language—how to be fast, and how to be skinny.

This is the dogma so many runners (and athletes) are fed: that to be the fastest you must be the thinnest, that the two are inter-changeable and congruent. This is the largest lie we have been conditioned to believe, and it took me years to unlearn. It is not okay or healthy to lose your period, and it is certainly not an indication of physical fitness.

Below are two pictures of me. The one on the left is from my senior year of college, when I never had a period and was deeply sick with my eating disorder. I also wasn't competing at the time and lost a significant amount of muscle mass. The picture on the right is me shortly after I moved to California. My period is regular, I am at a healthy weight, I can exercise healthfully, and I'm genuinely happy. Health comes in so many different forms, and most of the time, it isn't visible.

P.S. If you or someone you love is struggling with an eating disorder, contact the NEDA helpline at (800) 931-2237, find an Eating Disorders Anonymous meeting near you HERE, or find a treatment center near you HERE.

xoxo

Sarah Rose