Solutions for Runners with Serious Periods

Obstetricians and gynecologists who run will happily chat about the pros and cons of tampons, pads, and even menstrual cups during races and training. But ask how they manage their own heavy flows while running, and most have the same answer: They don’t have to.

You could say these doctors harbor secrets to slowing or even eliminating their periods, except they’re more than happy to share them—especially with runners whose heavy or painful cycles have limited their distance. “As a gynecologist, I try to whack down the whole flow from the start, which makes everyone’s life a lot easier,” says Wendy Conway, an obstetrician/gynecologist who’s run 15 marathons.

From pills to IUDs to minor surgery, doctors have a range of tools at their disposal to stem the tide of heavy flows. To learn more, we talked with Conway and another expert—Kelly Wright, M.D. an obstetrician and gynecologic surgeon who’s about to run her eighth marathon. Of course, you’ll want to talk to your own medical team about the best method for your body and lifestyle, but read up beforehand for a clear picture of your options.

Q: What exactly counts as heavy bleeding, anyway?

Technically speaking, shedding more than 80 milliliters of menstrual fluid per cycle qualifies. But unless you’re using a menstrual cup or weighing soaked tampons and pads, you probably don’t have a hard number—and your doctor won’t require one.

If you worry about leakage on the run or feel like you should buy shares of a feminine hygiene company for all you spend on their products, don’t hesitate to call your gyno. “Anybody who comes in and says ‘I have heavy bleeding,’ or bleeding that’s bothersome or painful in any way, can discuss options to control it,” Wright says.

Q: That’s totally me. What can I do about it?

Often, your doctor will suggest oral contraceptives (that is, birth control pills). When it comes to your cycle, chemical messengers like estrogen and progesterone run the show. Hormonal peaks and valleys trigger ovulation (the release of an egg), thicken the endometrium (the lining of your uterus), and start the flow of menstruation. Low, steady doses of both hormones in pills block ovulation, making the rest of the process unnecessary.

Many monthly packs contain placebo pills during the last week. You might bleed when you take them, but that’s a “false period” caused by hormonal withdrawal, Wright says. You can safely skip them or buy packs with continuous active pills to reduce bleeding or eliminate it altogether—Wright’s personal method of controlling her cycle. But busy or forgetful runners beware: You do have to take oral contraceptives at the same time each day.

Q: Pills seem like a hassle. Are there methods that don’t require a daily commitment?

Other, longer-lasting hormone delivery systems—such as patches, rings, implants, and injections—work in similar ways to control heavy bleeding, Conway says. However, they haven’t yet been approved for this purpose. Your doctor might recommend them for what’s called off-label use, provided you can work out the details with your insurance company.

An increasingly popular option that has earned the FDA stamp of approval is the levonorgestrel-releasing IUD, sold under the brand name Mirena. As the name implies, this implanted device delivers a steady low dose of levonorgestrel, a type of progesterone, directly to your uterine tissue. “Imagine you have a little guy with a lawnmower in there making that endometrial lining really thin, so you don’t have to worry about heavy bleeding,” says Conway, who has one herself.

This isn’t your mother’s IUD—unlike the Dalkon Shield, blamed for serious infections and other complications in the 1970s, modern devices have a strong safety record and prevent pregnancy 99 out of 100 times (compared with 91 for pills). Rare but potentially serious complications include ectopic pregnancies, which implant outside the uterus, and perforation or infection when your doctor places the IUD. Insertion can also cause short-term cramping and fainting, especially in women who haven’t given birth; popping an anti-inflammatory or a drug called misoprostol to dilate the cervix beforehand can help, Conway says.

As with continuous pills, some women bleed lightly with a Mirena while others stop having periods altogether. In part, this depends on how heavy your flow was beforehand, Wright says. (Note: Another type of IUD, made of copper, works by creating inflammation and can make your flow heavier—so it’s not recommended for women with heavy bleeding.)

Q: Wait a second—skipping periods, like, completely? That sounds unnatural! Doesn’t it cause health problems?

Well, if you’re going to take birth control pills to begin with, you’re already manipulating your cycle, Wright points out—research suggests there are no harmful effects from skipping the placebo pills. Manufacturers included them to ease women’s minds and because early pills had much higher doses of hormones than today’s versions. Now, most doctors believe lower, steadier doses of estrogen and progesterone not only control bleeding and prevent pregnancy, but also keep women’s moods and energy levels stable, Wright says.

Evolutionarily speaking, we’ve strayed far from “natural” anyway. “We were designed to start our periods in adolescence, become pregnant pretty much right away, deliver and breastfeed, then repeat every couple of years,” Wright says. Our early grandmothers likely only went through a few menstrual cycles in a lifetime; “Now, we have 40 years of periods every single month,” she says. This can actually increase the risk of health problems like endometriosis, a painful condition in which uterine tissue grows outside the uterus.

And regardless of what you read on Facebook, your risk of endometrial or ovarian cancer actually decreases when you don’t have periods. “Cancer is usually triggered by abnormal cell division,” Conway says. “So the less cell division—the less your endometrial lining grows and sheds and grows and sheds—the less chance you will have for a mutant cell to form.”

One note of caution: If you’re not using one of these options and your period stops when you start or ramp up your running, consult your doctor. He or she may evaluate you for what’s called the female athlete triad, a combination of disrupted menstrual cycles, poor nutrition, and thinning bones that places you at risk for stress fractures and other health problems. This represents a totally different biological pathway to halting periods, Wright says—in fact, women who show signs of the triad usually start taking the pill, because estrogen protects and strengthens bones.

Q: I get it, I get it—but I just don’t want to mess with my hormones. Other ideas?

Birth control pills do have downsides, including increased chances of clotting and stroke. For some—including older women and smokers —the risks may outweigh the benefits. Some can use the Mirena, but others should, or prefer, to steer clear of hormones completely.

If you fall into one of these groups but need help for heavy bleeding, you can consider:

Taking high doses of non-steroidal anti-inflammatories, such as ibuprofen or naproxen, the first two days of your cycle. This contracts the uterus and decreases blood flow, Wright says. Runners doing long runs or hard workouts should use caution, she notes—NSAIDs can increase the risk of gastrointestinal bleeding and also of hyponatremia, a potentially serious electrolyte imbalance. Consider shuffling your schedule or at least taking the medications at night if you run in the morning.

Taking a prescription medication called tranexamic acid, which has the brand name Lysteda. Approved by the FDA in 2009, it reduces your flow by stabilizing a clot-forming protein in your blood.

A procedure called endometrial ablation, which involves burning away some of the lining of the uterus. You shouldn’t choose this option unless you’re done having kids, Conway says—unlike the pill or IUDs, which are swiftly reversible, ablation permanently affects your fertility. But when you’re ready, this procedure can stop bleeding or at least reduce it by 80 percent.

The bottom line, the physicians say, is that you don’t have to settle for soaking through your shorts. You might have to try a few options, but with time and patience, you can usually bring cumbersome periods under control. “In some women, treatment really works after three months; in others, it takes a year” to lighten or stop bleeding, Conway says. “But if women are patient and willing to work with me, I can get them there.”

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