The Pill for Missed Periods: What It Can Hide in Athletes

A period that isn't really a period

If you're an athlete, or the parent of an athlete, who was put on the pill for missed periods, it may be masking the real problem underneath.

Here's how it often goes. An athlete sees the doctor for missed periods. The workup comes back normal for common conditions. Then the pill is prescribed to bring back her period.

But the pill doesn't bring back a true period. The bleeding on the pill is a withdrawal bleed, caused by the medication, not by her body recovering. It can give false reassurance. Everyone relaxes while the underlying problem continues and can even get worse.

Missed periods aren't normal for healthy athletes

Healthy athletes shouldn't lose their periods. When they do, it can be a sign of REDs, Relative Energy Deficiency in Sport.

REDs means the body isn't getting enough fuel to cover both training and its basic functions. Without enough fuel, the body starts to shut down systems it treats as optional, and the reproductive system is often one of the first. This affects more than performance. It can affect bone health, injury risk, and many other parts of health.

REDs can happen in male athletes too. But this post is specifically about periods.

Why the pill isn't the treatment

If the medical team isn't thinking about REDs, the pill will bring back a monthly bleed. But it misses the main pillar of treatment: fueling and correcting the energy deficit. Meanwhile, things can get worse.

Major medical groups agree:

• The Endocrine Society (2017 guideline on functional hypothalamic amenorrhea, the type of missed periods caused by energy deficiency) advises against using the pill just to regain periods or improve bone density. It recommends correcting the energy imbalance as the core treatment.
• The International Olympic Committee (2023 REDs consensus) prioritizes restoring energy availability. When hormone therapy is needed to protect bone, it points to transdermal estrogen (a skin patch) with cyclic progesterone, not the pill.
• The North American Society for Pediatric and Adolescent Gynecology (NASPAG) is even more direct. Its 2025 recommendations state that combined oral contraceptive pills used solely to restore periods or protect bone in adolescent and young adult athletes with REDs are not recommended. They warn the pill can give false reassurance that estrogen levels are normal and that the athlete's bone density is no longer at risk.

Why doesn't the pill protect bone? The pill turns off the body's own hormone cycle. The type of estrogen in most pills is processed by the liver in a way that can lower a growth factor that helps build bone. Studies in women with this type of missed periods haven't shown that the pill protects bone density.

That matters because the teen years are a critical window for bone. About half of peak adult bone mass is built during adolescence. Time lost during those years is hard to make up.

What treatment actually looks like

The real treatment is correcting the energy deficit: eating enough to cover training and everything else the body needs, and sometimes adjusting training for a while.

That works best with a team:

• A physician who knows REDs
• A sports dietitian
• Mental health support

If periods don't return after a real effort to restore fuel, or if bone density is already low, a physician may consider transdermal estrogen to support bone while fueling continues.

When the pill is the right choice

The pill can still be the right choice for other reasons, like contraception, endometriosis, PCOS, or painful periods. NASPAG recommends that every athlete with REDs be assessed for contraception needs and offered it when needed.

But the pill isn't the recommended treatment for REDs. If your athlete is on the pill for missed periods, talk about this with her medical team.

References

This post is for educational purposes only and is not medical advice. Talk with your physician before starting, stopping, or changing any medication.

1. Romano ME, Sass A. Reproductive health management of female adolescent athletes with relative-energy deficiency in sport. J Pediatr Adolesc Gynecol. 2025;38(2):108–116. PMID: 39709115
2. Gordon CM, Ackerman KE, Berga SL, et al. Functional hypothalamic amenorrhea: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2017;102(5):1413–1439. doi:10.1210/jc.2017-00131
3. Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073–1097. doi:10.1136/bjsports-2023-106994