When Greta Jarvis was 16 years old and on her high school lacrosse team, her menstrual cycle completely stopped. When she went to an OBGYN to discuss the issue, doctors told her this symptom was completely normal for female athletes.
Nearly 10 years later, she learned that her period loss, or amenorrhea, was abnormal and actually dangerous. In fact, it’s the body’s response to too few calories, too much exercise, and extreme stress. It’s also extremely common among young female athletes, and intensified by scarce targeted education on nutrition, body image and hormone health within women and girls’sports.
Now, Jarvis coaches the same team she played on in high school, and she wants to provide the education that she didn’t have when she was growing up. She founded the Center for Active Women, where she organizes workshops for teams, schools and sports organizations to equip women and girls with the skills to develop healthy relationships with body, food, and exercise. She joins us to discuss her work.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. When Greta Jarvis was 16 years old and on her high school lacrosse team, her menstrual cycle completely stopped. An OBGYN told her this was completely normal for female athletes. It was years before she learned that period loss, or amenorrhea, is actually dangerous.
Jarvis is now the founder of the Center for Active Women, where she organizes workshops for teams, schools and sports organizations to help women and girls develop healthy relationships with food, exercise and body image. She also coaches the same team she played on in high school, where she’s now providing the education she did not have when she was growing up.
Greta Jarvis, welcome to the show.
Greta Jarvis: Thank you so much. I’m excited to be here.
Miller: You became interested in these issues because of your own experiences as a young athlete. So I want to start there. When did you start playing sports?
Jarvis: Oh, I think as long as I can remember, I was outside in some way – soccer, gymnastics. But sixth grade was when I started to play lacrosse and that very quickly became my focus. So that was my sport [in] sixth grade, high school, middle school and even in college. So I always say I’m a bit of a one-trick pony, lacrosse is where my heart lives. But I still love being active in all sorts of ways.
Miller: When did you first start experiencing symptoms that you now know were tied to your athletic life?
Jarvis: It’s hard to parse that apart because, as you mentioned, I was 16 when my period went missing. And for so long I thought that’s just part of being a competitive athlete. And now, since I started learning about this, the technical term I always like to equip people with is “relative energy deficiency in sport,” and essentially that is what happens to health and performance when you are not eating enough to meet your body’s needs. And now looking back, I can say there were other elements of that that I noticed, of feeling cold frequently, or even needing to pee all the time is one of them. Menstrual loss is the biggest one that I noticed in my own story.
RED-S [Relative Energy Deficiency in Sports], the shorthand, is a very helpful framework to say how your body might respond to undereating. And if we can equip women with that at younger ages, it can really prevent a lot of harm.
Miller: What did you hear from doctors or other experts at the time about what you were experiencing?
Jarvis: The word I remember was “exercise-induced amenorrhea.” It was something that I heard, [that] once you get to a certain level of competition, it’s just part of the game. “Come back when you want to get pregnant, don’t worry.” And I always like to very much emphasize too, this is no individual health care practitioner’s fault. This has been normalized for decades. At every point along the way, dietitians, OBGYNs, I played in college so we needed to be cleared by that physician, either they didn’t ask or they assured me it’s nothing to worry about. And we’ve, we’ve seen the link between undereating, menstrual disturbances, and bone loss is the big health related issue we’re concerned about, since the ‘80s. The research is there. But for whatever reason, it’s become so entrenched and normalized in sport and medicine that a lot of women slip through the cracks.
Miller: How did that end up impacting your life?
Jarvis: Well, I was 24 when something inside of me – I don’t know what it was – I just couldn’t quite accept it as normal anymore. I had wrapped up my career as a college athlete and wanted to train for the Portland Marathon, and went back to my doctor and said, I really want to run this race, but just wanting to check in, my health is my top priority. And she gave me the green light. She said, “you’re strong, you’re young, you’re healthy, go ahead.”
That’s when I started to research it for myself and found out – again this is a well established connection – bone health is happening your whole life. So adolescence is when you’re actually building up that bone density that will support you for a lifetime. And so when I was 24, I pushed my doctor for a bone scan, and unfortunately they found osteoporosis in my hips and spine.
And again, I had no idea. I’d never gotten a stress fracture. We typically aren’t giving bone scans to young women. So, I have since then dedicated my career to this, going back to graduate school and learning this is a huge challenge in sport. I always thought it’s just me, but we see this very commonly. And it’s something you can’t see by looking at someone, so it’s hard to know exactly the scope.
Miller: I want to zoom forward a little bit. I mentioned you’re now the coach of the high school lacrosse team that you played on 15 or so years ago. How much has changed in that time?
Jarvis: Unfortunately, not much. So when we talk about these issues I’m focusing on – undereating, disordered eating, body image – especially at the high school level, these are everywhere. Almost every young person struggles with this in some way and yet we don’t have screening, we don’t have education. Since I am a coach, I’m familiar with the required trainings, and again, there’s nothing on this.
Miller: So what are the required trainings for, as a coach?
Jarvis: Coaches wear so many hats. I am amazed at coaches, it’s a labor of love and a very important job. We need to take trainings on things like concussion. One example I like to use is heat illness – that’s one we need to take every other year. That is important, we should know how to manage that. That happens about 1.6 every 100,000 practices or games. And then when we look at these issues we’re talking about earlier, it’s everywhere, every team, every sport. So this is one area I would love to see added to that requirement list because as of right now, there’s really nothing.
Miller: You have focused on the connection between undereating or problematic body image issues and athletics. But they obviously exist, eating disorders and other problematic eating, outside of athletics as well. But what happens when you add athletics to the mix? What’s the connection, I guess, between this kind of disordered eating and athletics in young people?
Jarvis: I think anyone who grew up in this culture, to your point, probably has some understanding of what body shame feels like, or stress or guilt around food. With athletics, there’s an added pressure. Typically there’s this idea of what an athlete looks like. We also see athletes are incredibly driven, detail oriented, and they want to be the best at their sport. So if they see something [like], “this is how an athlete should eat, no sugar,” fill in the blanks … we need to spend two seconds on social media to see all the noise that athletes can encounter. It’s really easy to fall down this rigid, all-or-nothing slope, especially if you’re really wanting to do whatever you can to be the strongest athlete you can be. But there’s a lot of misinformation and unhealthy pressures out there.
Miller: You mentioned social media there. How much does that play into the issues that you’re reckoning with right now as a coach?
Jarvis: It is everywhere. And when we talk about disordered eating, it’s multifactorial, there’s not one thing we can point to. But social media is huge. So a concrete example is every other week where I coach lacrosse, we practice from 7 to 9 p.m. Almost every year I have a player come to me and say, “Well, I saw on TikTok you should never eat past 7pm.” And if we zoom back the lens, these young women are growing, they’re studying, they just worked hard for two hours, and they’re going home and not eating anything, missing the opportunity to start the recovery process, to come back stronger the next day.
So things like that I see all the time, these soundbites of what you should or shouldn’t do. And it can be hard to let go of those or see, “hey, this might actually be getting in the way of me fueling my body.”
Miller: So how do you respond? You said that this happens every year, and that’s just one example of what your young athletes come to you, what they’ve been exposed to and what they’re saying to you. What do you say in response?
Jarvis: I like to be proactive. Every year, we dedicate a whole practice to starting this conversation and really being clear about what are the unique pressures that athletes face. Why is disordered eating, body shame so common? And how can we make our team a space where we’re recognizing those and pushing back? Once we set that as the expectation, I find it’s easier during the season to have those little check-ins. “Diet culture” is a key term we talk about, a catch-all for these pressures that push us into an unhealthy space. “Might that be diet culture talking? How can we think about this in another way? You are growing, your body is working so hard. Food is what fuels you to do that. So it’s really important that we stay focused on eating enough rather than falling into these rules or restrictions.”
Miller: I want to go back to what you’re saying earlier, that you get required trainings in all kinds of things, but basically nothing in these questions about menstruation, healthy eating or hormones. Why do you think that is? Why do you think this has not been required?
Jarvis: This is a question that keeps me up at night. I wish I had an answer. I think there’s this idea that athletes are strong, they’re resilient, that disordered eating or body image challenges are something you can see. Probably every viewer can have that stereotypical presentation come to mind, but these are not issues that you can see. Athletes are a high-risk group. I’m curious if that’s part of it, we see athletes as somehow immune to these challenges.
Also, we have a lot of trainings, we have a lot of hats we need to wear as coaches. So just logistically, it can be challenging to add something else in. But again, this is an area where coaches can make a huge change and I would love to see that happen.
Miller: Do you ever run into roadblocks in your work because of a lack of research into women’s health? You were talking earlier about that there is research out there and that goes back to the ‘80s or earlier. But we’ve often heard that a lot of scientific and medical research is done on men or on white people in particular. I’m wondering if you feel like there’s enough data to support everything that you were trying to get the world to pay attention to?
Jarvis: I would love to see more research. I will say, we do have quite a robust body of research on the effects of disordered eating and under-eating in sport. As you mentioned though, we have specifically for eating disorder research, it’s called the SWAG stereotype: skinny, white, affluent girl. That’s the population that most of these studies are looking at. We’re starting to see that expand more. But we really need more. And to your point, when we move into the sports nutrition world, it has mostly been men. Conversations are growing, interest is growing, but the research does have quite a bit of catch up to do.
Miller: There’s a weird flip side of this too, which is that according to a recent study I saw, there’s been a really sharp increase in the rates of hospitalizations for boys with eating disorders. It seems like disordered eating among young men and boys is on the rise right now. How much do you think about that in the context of the work you’re trying to do?
Jarvis: So my business is the Center for Active Women, which of course has that gendered component to it. But we see these challenges across the board. So I do speak at a lot of conferences for whoever’s in the room, not just women, and really want to emphasize that, especially for boys and men, there can be this added challenge of “this is a woman’s issue,” or people assume “this is not impacting the boys on my team.” And then if and when men do get support, they tend to be sicker, have a longer duration of illness, because providers as well have this image of who does and does not struggle.
So this is another huge conversation to shine a light on. This is not a gendered issue, it really impacts everyone. And we’re starting to see more attention specifically on boys and men, to your point. It’s really increased in the past years.
Miller: When you give presentations to educators, to coaches, to organizations, when you share this information with them, what kinds of responses do you get?
Jarvis: I would say it’s been overwhelmingly positive. Especially for coaches, I love having those conversations of “gosh, this is something I’ve been struggling with on my team, and it’s so nice to have an open conversation around it and have some concrete tools.” It doesn’t have to be super challenging or complicated. A lot of time it goes back to, how are we speaking about food? How are we speaking about bodies? What are some of those signs you might see as a coach in your athletes? So, I am always excited to collaborate, connect with anyone in the audience because, I really think in this area, we all have a role to play. So that’s a core message I like to leave my audiences with is, now that you have this information, you can be part of that healing ripple effect. And we really need all hands on deck.
Miller: We’ve been talking about eating and nutrition, but how much do you focus on other sports-related issues and injuries? I’m thinking about torn ACLs in particular, we’ve heard for years about the huge prevalence of them, especially among girls and young women.
Jarvis: I mostly focus on the food and body image piece. And, I will say if someone is not eating enough, that puts them at a higher risk for injury. So there really is a lot of crossover when we’re talking about holistic athlete health and sport, and nutrition is a cornerstone to all of these issues, even if they don’t directly touch the exact presentation I’m giving.
Miller: I want to go back to where we started. What do you wish you’d been told when you were 16, instead of “don’t worry about it, come back when you want to have kids?”
Jarvis: I think a message I would have loved to hear and try to instill in my athletes today is “your body is on your team, working so hard to protect you.” If we think about it evolutionarily, I had no idea how much food I needed to fuel my sport. My body detected some sort of deficiency and instead of shutting down the heart or lungs, it said, “Clearly this is not a great time for reproductive pursuit, so we’re gonna shut down the menstrual cycle.” But that has huge impacts in all other areas of your health. How can you work with your body, how can you understand the signs she might be sending you? This is a huge one, that she’s waving her hand for some little extra support. And you two can work together to be the strongest, happiest athlete you can be.
Miller: Greta Jarvis, thanks very much.
Jarvis: Thank you so much.
Miller: Greta Jarvis is the founder of the Center for Active Women.
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