Complications of Athletic Amenorrhea in Powerlifting – Part 2

drawing of a woman squatting

drawing of a woman squatting

Complications from Athletic Amenorrhea in Powerlifting

Powerlifting 4 Women

New Series of Four Articles on Athletic Amenorrhea

Part 2

Welcome back to our series on Strength Sports or those sports that involve cutting weight in general and the problem of athletic amenorrhea in women.  But since this is Powerlifting4women forum, we will focus on Powerlifting.

In the last article, we presented a general overview of amenorrhea or menstrual inconsistency. Today we are going to focus on how it comes about.

The first thing to note is that, historically, athletic amenorrhea isn’t something that has been talked about much in powerlifting. Some female athletes don’t actually know what it is, or the dangers that are associated with it, or the behaviours that they might be taking part in that puts them at risk for it.

Lack of awareness in strength sports about athletic amenorrhea in women.

powerlifting4women the masculine male coach
‘The Masculine Male Coach’

This lack of awareness is often made worse by the fact that as a new lifter we are guided into our weight class usually by our brilliant coach. But many powerlifting coaches are males, and, most of them won’t even know what amenorrhea is, and honestly, they probably would rather not know. This situation is not ideal given the direction they’re pushing their female lifters in. Such programs can have long-term effects on a female athlete’s overall health.


Why do powerlifting athletes cut weight?

Unfortunately, too many coaches, because they want their lifters in lower weight classes, insist their athletes cut powerlifting4women cartoon woman doing bicep curlsweight. The reason for this is typically that they want to increase the chances for a higher IPF score.  Also, many think the ‘shredded look‘ is a better look for their coaching.

The reality, however, is that the behaviour associated with many weight cuts, particularly extreme weight cuts, is dangerous, especially when one is constantly on a calorie deficit and not getting enough fuel in the body, and not eating a balanced diet. Such behaviour can lead to serious complications for women like amenorrhea.


What issues can extreme weight cuts cause in female powerlifting athletes?

Disorders of the hypothalamus can affect menstruation, causing amenorrhea. For many women, the cause of irregular or absent menstruation is functional hypothalamic amenorrhea (FHA). FHA is a hormonal imbalance related to stress, exercising too much or consuming too few calories, or a combination of it all.powerlifting4women cartoon woman squatting

Physical stress affects the functioning of the hypothalamus which connects the brain to the endocrine system. When under stress the hypothalamus goes to sleep, halting the production of gonadotropin-releasing hormone (GnRH). GnRH is what signals the ovaries to produce estrogen, amongst other things. Without estrogen, ovulation and menstruation stop.

powerlifting4women cartoon woman standing in front of the scalesWhen a woman eats too little and overtrains the body perceives this as a massive stress. This lack of menstruation in elite athletes, bodybuilders, and others who do sports that involve weight cutting. These athletes describe irregular periods or even the total absence of menstruation for multiple months.

But sometimes, the diagnosis of amenorrhea is made after a female athlete experiences a bone break or injury that is seen to be more severe than it ought to have been given the circumstances, or when female athletes experience a trauma from circumstances that wouldn’t normally cause one because amenorrhea affects bone density.

Hypothalamic amenorrhea is confirmed by ruling out other possible diagnoses. Conditions such as pregnancy, benign tumours of the pituitary gland, or thyroid gland disorders are a few other conditions that may cause similar symptoms.

Sports isn’t about building a better body, it’s about building a stronger mind and more robust life. 

How do low levels of body fat affect women athletes?

Lower levels of body fat for women, unlike for men, can be dangerous especially if they want to have a family in the future– the female body cannot menstruate below a certain percentage of body fat.

Exercising makes the body release certain hormones, such as beta-endorphins and catecholamines. High levels of these hormones are thought to affect how oestrogen and progesterone work.

powerlifting4women cartoon woman measuring tape around her waistThe combination of all these can be dangerous for female athletes. This is not to say that weight cuts are bad and should not be done. To be realistic, if you want to be the best in your sport you will most likely need to weight cut a bit, but this can be done smartly and in a way that empowers you and does not have long-term physical or mental health implications.

What can I do if I am a female athlete concerned about extreme weight cuts?

If you are struggling with weight cuts, reach out and we can refer you to a dietitian.

As a female athlete, it is up to you to ensure your coach understands these issues and has your best interests at heart. Powerlifting may be a hobby for you, but the consequences of bad preps can be serious.

Great lifting coaches for females come in all genders but ensure that they understand what they are asking of you.  


About our Expert: Who is Hannah Altman?


powerlifting4women Hannah Altman squatting at a powerlifting competition at BNB Brisbane North Barbell
Hannah Josepha Rachel Altman      BHS|BCOM| MPHIL

Exercise Scientist, Strength Coach, Powerlifting Coach & Precision Nutrition Level One Accredited Nutritionist

Coaching Available at Below Parallel Barbell Club, Effectus Physio/Active Matters Or Online

Get in touch with Hannah Altman

Complications from Athletic Amenorrhea in Powerlifting

drawing of a woman squatting

drawing of a woman squatting


Complications from Athletic Amenorrhea in Powerlifting

Powerlifting 4 Women

New Series of Four Articles on Athletic Amenorrhea


The Dangers and Complications of Athletic Amenorrhea, or menstrual inconsistency, are especially prominent in any weight-based sport, including powerlifting, weightlifting, bodybuilding, and boxing.  Weight manipulation, even when done under the guidance of a nutrition professional, can result in this condition.


Athletic amenorrhoea can be caused by a range of factors related to over-exercising and weight manipulation, which include the following:


  • Low levels of body fat – the female body cannot menstruate below a certain percentage of body fat (many male coaches don’t actually understand this and push female athletes into striving for unhealthy body fat levels).
  • Exercise-related hormones – exercising makes the body release certain hormones, such as beta-endorphins and catecholamines. High levels of these hormones are thought to affect how oestrogen and progesterone work.
  • Emotional stress – strong, negative emotions can affect the hypothalamus as can stress in training and dieting with balancing life.
  • Disordered eating – which in this case includes crash dieting and skipping meals trying to make weight for a competition.

cartoon picture of a woman thinkingA risk directly related to athletic amenorrhea is musculoskeletal injury, particularly in the latter stages of a comp prep when the load is getting heavier and the body is breaking down more. Research done in the US has stated that, athletes who reported menstrual inconsistency sustained a higher percentage of severe injuries when taking part in high-level sports than athletes who did not suffer such inconsistency due to their weight cuts.  

cartoon picture of a woman standing in front of scales



Research has also found that female athletes who take part in weight cuts are 3x more likely to suffer a competition ending injury days out from a competition when they develop athletic anemia.



cartoon picture of a woman crying

The long-term complications of untreated athletic amenorrhoea include:

  • High levels of blood cholesterol –caused by an oestrogen-related fall in the ratio of good cholesterol (high-density lipoprotein or HDL) to bad cholesterol (low-density lipoprotein or LDL).
  • Loss of bone density – this may cause osteopenia (low bone density, but not low enough to be osteoporosis) or osteoporosis (brittle bones that break easily), especially if peak bone density has not yet been reached because of age.
  • Premature aging – the skin loses its flexibility because of low levels of oestrogen


That’s why it is key that coaches understand the whole process of weight cutting, and that female lifters are different than male lifters, particularly when it comes to weight cuts.



Treatment options for athletic amenorrhoea depend on the person, but these can include:

drawing of a woman flexing her bicep

  • Exercising less often or choosing sports that are not as intense. 
  • Putting on two or three kilograms of body fat.
  • Starting the combined oral contraceptive pill or hormone therapy if dietary changes and reduced exercise do not result in regular menstruation returning.
  • Making dietary changes such as increasing calcium and daily kilojoules.
  • Taking calcium supplements to increase bone strength and prevent osteoporosis.
  • Seeking counselling if an eating disorder is an issue.


About our Expert: Who is Hannah Altman?

Hannah Josepha Rachel Altman

Director Infinite Strength & Rehabilitation



Precision Nutrition Qualified Sports Nutritionist & Elemental Nutrition Institute 

Qualified Body Transformation Specialist and Blood Analyst  

Qualified Powerlifting Coach and Referee

3X PA National Record Holder Top 20 Women’s Lifter PA 2019, 2020 and 2021 Top 10 Bench 2018, 2019, 2020 and 2021 425kg @ 68kg BW  


Get in touch with Hannah Altman