Postpartum Injuries: Part 1, Hormones

Hello, mama athletes! I want to make this a multi-part series because OH MY GOD THERE IS SO MUCH TO DISCUSS and, really, I could go on tangent after tangent and climb on every soap box you can find about this topic. I’ll try to restrain myself.

Go with me on this one.

Imagine all the bone density you’ll ever have in your life is like a savings account. It is opened when you get your period in early adolescence and closes by age 30. And 90% of the deposits are made by age 18.

As your bones stop growing, they start to become more dense. As soon as you get your period and the estrogen starts flowing through your system (yay, periods!), you are making deposits into that bone density savings account. When you reach peak bone density in your mid-20s/early 30s, that’s it. Account is closed and you have what you have for the rest of your life. It’s only steady-state or downhill from there.

What else affects bone density? Oral contraceptives (estrogen) and an early period often lead to more dense bone, as does a healthy diet throughout adolescence and early adulthood. But things like eating disorders/disordered eating, amenorrhea (lack of a period), overtraining, and pregnancy can have a negative effect on bone density.

During pregnancy, the calcium bank of the mother’s bones is tapped into for the fetus. Additionally, estrogen levels are very low during breastfeeding and remain so until the new mom resumes regular menses (periods).

So, if you are a female athlete who never got or had irregular periods all her life, struggled with an eating disorder during teenage years, trained at high volumes and intensity through college and early adulthood, and then got pregnant and decided to breastfeed while returning to a high level of training…

…you can see where this is going. It’s a perfect equation for a stress fracture. This fictional athlete never reached peak bone density to begin with and was doing ok. Or maybe she had other small injuries and fractures along the way. But when she got older, became pregnant, and returned to high levels of training IMMEDIATELY after having a baby and WHILE breastfeeding, she was ripe for a stress fracture.

I’m not getting down on mama athletes. NOT AT ALL. I want all moms who want to have babies. LOTS of babies. But in the case of this athlete, she needed more medical attention than anyone was going to know to give her. Regular metabolic panels with her CBC and thyroid screenings should be done. She should have a DEXA scan to asses her current bone density as well as meeting with a registered dietician when all her tests had come back. She needs to see an endocrinologist to keep an eye on her thyroid levels. A pelvic floor physical therapist could help her with the muscular imbalances that happen at the oh-so- important pelvis/abdomen/core that is forever changed by pregnancy and childbirth.

She needs a TEAM approach. She needs a THOROUGH medical history done. She needs to feel SAFE to talk about her past, her pregnancy, her goals. But most importantly, she needs INFORMATION from medical professionals to help her make INFORMED decisions about her pregnancy and postpartum care.

So, my mama athletes out there, advocate for yourself! If you see glimpses of your story in this article, it’s time to form your team.

~Abby