Chidinma's periods stopped when her training ramped up. She assumed it was a sign her body was "efficient." The blood results told a different story — her reproductive hormones had switched off, and without intervention, her bones were already quietly losing density.
Fitness instructor, Yaba. Presented with secondary amenorrhoea (3 months without periods) after a dramatic increase in exercise intensity and a 7 kg weight loss over 4 months. Pregnancy test negative. LH, FSH, oestrogen all suppressed.
Anovulatory AmenorrhoeaChidinma's clients paid her to be lean, strong, and knowledgeable. When her periods stopped in August — right as her competition preparation intensified — her first thought was: "My body is so efficient it doesn't even need to waste energy on periods." A friend with a biology background said: "That is not how it works. Go get checked."
A pregnancy test at a pharmacy was negative. She came to Mascot Healthcare the following week. The doctor asked about her training volume, her caloric intake, and the timeline of the weight loss very carefully. Chidinma answered honestly — including the part about skipping dinner three nights a week to "cut."
The blood results came back: LH, FSH, and oestrogen were all in the low-normal to suppressed range. The hypothalamus — under physiological stress from low energy availability — had dimmed the signal to the ovaries. No signal, no ovulation; no ovulation, no period.
Hypothalamic amenorrhoea (functional amenorrhoea) is one of the most common causes of missed periods in active young women. It is a stress signal from the brain — not a sign of athletic efficiency.
Complete absence of menstruation for 12 weeks — secondary amenorrhoea.
2-a-day sessions for 4 months, preparing for a fitness competition — a major physiological stressor.
Body fat percentage dropped to approximately 14% — below the threshold for regular ovulation.
Eating less than training expenditure demanded — creating a caloric deficit that suppressed the HPO axis.
Absence of menopausal symptoms — helping rule out premature ovarian insufficiency.
Accepted missed periods as "part of training" — no action taken for 3 months.
Increased protein intake — addressed macronutrients but not total calorie deficit.
Home pregnancy tests (negative × 2) — correctly excluded pregnancy.
Blood tests confirmed: LH 1.2 IU/L (low), FSH 3.1 IU/L (low-normal), oestradiol 68 pmol/L (suppressed), prolactin normal, thyroid normal, beta-HCG negative. Diagnosis: functional hypothalamic amenorrhoea secondary to low energy availability and exercise stress.
The management conversation was frank: restoring periods requires reducing training intensity and increasing calorie intake — not a popular prescription for a competitive fitness instructor. The doctor explained the bone density implications clearly. Chidinma was referred for a DEXA scan (bone density measurement) and given a referral to a sports dietitian.
A short-term course of oestrogen supplementation was discussed but deferred pending dietary and training modifications — ideally the reproductive axis recovers naturally with adequate energy availability.
Functional Hypothalamic Amenorrhoea — low energy availability secondary to competitive training and caloric deficit; oestrogen deficiency
Nutrition counselling (caloric surplus target); gradual training reduction; sports dietitian referral; DEXA scan; repeat hormone panel at 3 months; oestrogen supplement considered if no recovery
Period returned at month 3 after increasing caloric intake by 400 kcal/day and reducing 2-a-days to 1 session per day. DEXA scan showed mildly reduced lumbar spine density — calcium and Vitamin D supplementation started.
Chidinma's period returned at 3 months after dietary changes. DEXA showed mildly reduced bone density — actively being addressed with calcium and Vitamin D supplementation. She is now more informed about the cost of extreme training.
Missing periods while training hard is not normal — it is the Female Athlete Triad: low energy availability, menstrual dysfunction, and bone density loss. Each component reinforces the others.
Periods are a vital sign. A missing period in a young woman is a signal from the hypothalamus that something is wrong — not a sign of efficiency.
Missing periods are not a training badge. They are a warning sign that your bones and reproductive health are under threat.
Book an appointment at Mascot Healthcare, Akoka — same-day slots often available, 4.9★ rated.