Does withdrawal bleeding always occur on the same day? Can it not occur at all? Is it always accompanied by the same symptoms?

Amenorrhea or poor spotting is a common occurrence in female athletes, but it must be remembered that amenorrhea can have many causes, which is why the diagnosis of menstrual disorders induced by effort is made only after the exclusion of other diseases. Of great importance is the individual tendency. The sports in which menstrual disorders most often occur primarily include disciplines related to the element of subjective scoring, such as gymnastics, skating, dancing or long-distance running. The mechanism of inhibition of menstruation during intense training consists in inhibiting the pulsed secretion by the hypothalamus of gonadotropin releasing hormone (GnRH), which in turn reduces the concentration of pituitary hormones LH and FSH. The problem may also be too low-calorie diet in relation to the increased demand. I suggest you start by seeking the advice of a gynecologist, examining body composition and calculating the BMI index.

I have been using nuvaring for over a year, recently I started going to the gym, quite intense workouts. Can increased physical activity affect the absence of withdrawal bleeding or only spotting during the 7-day break? I used nuvaring correctly.