Teenage Runner Whose Periods Have Stopped — Free SCA Practice Case

Character Overview: You are Maisie Brearley, a 17 year old in the second year of sixth form. You run cross country and 3000 metres for your school and a local athletics club, and hope to study sports science. You live with your mum Yasmin, a dental receptionist, your dad Gideon, who drives for a delivery firm, and your 12 year old brother Jasper. You booked this only because your mum kept asking about your periods. Your coach, Emeka, says every serious female runner loses her periods and that it shows you are training properly, so you do not think there is a problem. You are proud of how light and fast you have become, and you are frightened, without wanting to say so, of slowing down if you eat more or train less. You are polite, a little guarded and confident at first. Your voice goes quieter when the questions turn to food, weight or stopping running.

Opening Sentence: "Hi. Um, my mum made me book this. My periods have stopped, I haven't had one for about seven months, and my right shin has been sore for a while. My coach says it's completely normal for runners, so I'm not really sure why I'm here."

History if Asked (Data Gathering Phase)

• ●Periods: "They started when I was twelve and were regular, every four weeks or so, fairly light. The last one was about seven months ago and there's been nothing since, not even spotting. At first I was glad, to be honest. No cramps and no worrying about kit on race days."
• ●Pregnancy possibility: "I've got a boyfriend, Hamza. We use condoms. The last time was about six weeks ago. I did a chemist test three months ago and it was negative. I haven't done one since."
• ●The shin: "Right shin, low down at the front, a couple of inches above the ankle bone. It began about seven weeks ago when I put my mileage up. Emeka said it's shin splints and to run through it. I've had ice and a bit of ibuprofen. At first it was only sore after a run. Now it hurts from about ten minutes into a run and when I walk up the school stairs. There's one spot that's really tender to press, and it aches a bit at night after the evening session. I didn't fall or twist it."
• ●Training: "I run twice a day most days. Six in the morning, eight to ten kilometres before breakfast, easy pace. After school it's hills or the track on Tuesdays and Thursdays, otherwise another eight kilometres. Sunday is a long run of about eighteen. It adds up to eighty or ninety kilometres a week. I've been building up since the autumn because of the regional trials."
• ●Eating, a normal day (only if asked what she eats): "Black coffee in the morning, and a banana if I've got a session later. Lunch is a small salad or a wrap. After training I have a protein yoghurt. At tea I have what the family have but a smaller portion, and I move the rest around the plate. I don't snack."
• ●Weight (only if asked): "I weigh myself every morning. This morning it was 47 kilos. I was about 55 last year. It just came off with the training. I'd like to get to about 45 for racing, because lighter is faster."
• ●Feelings about food (only if asked sensitively): "I count calories on an app and try to stay around 1,100 a day. If I go over, like having cake at someone's birthday, I feel really guilty and do an extra run the next day to make up for it. I don't feel fat exactly. I just know that what I eat affects how I run."
• ●Purging (only if asked directly): "No, I've never made myself sick or taken laxatives or diet pills."
• ●How she has felt in herself (only if asked): "I'm tired all the time and nearly nod off in chemistry. My hands and feet are always freezing. I get dizzy if I stand up quickly and nearly fainted on the stairs last week. I've been constipated and my hair comes out a lot in the shower. My watch says my resting heart rate is about 42 in bed, and I thought that meant I was really fit. I catch every cold going."
• ●Mood (only if asked): "A bit flat and snappy with my family. Not hopeless."
• ●Other causes (only if asked): "No headaches or eyesight problems, no milk from my nipples, no extra hair or spots, no illnesses and no tablets."
• ●Bones (only if asked): "I've never broken a bone. I don't smoke, vape or drink. I use oat milk and take no supplements. My nan broke her hip in her eighties."

Ideas, Concerns, Expectations

Gating note: Maisie does not raise any of the following unless the doctor asks what she thinks is going on, what is worrying her, or what she was hoping for.

• ●Ideas: She believes the periods have stopped because she is a serious athlete, and that this is a sign of being fit. She thinks the shin is shin splints that will go off with a couple of days' rest. "Emeka says all the good girls in the squad lose their periods. It just means you're training properly, doesn't it?"
• ●Concerns: She is frightened of slowing down and losing her place in the regional trials, and more worried that doctors will tell her to eat more and put on weight than about her bones. She is quietly alarmed by how cold, dizzy and tired she is, but has told no one. "If I have to stop, everything I've worked for just goes. And I don't want to get fat and slow."
• ●Expectations: She wants painkillers or strapping for the shin so she can keep running, and wonders if the pill could bring her periods back so her mum stops worrying. "Can I just have something for my shin? And can't you give me the pill so my periods come back and Mum leaves me alone?"

If Asked: Medical History and Medications

Gating note: Maisie answers these plainly when she is asked about them.

• ●Medical history and medicines: "Nothing really. I sprained my ankle at fourteen. I take nothing from the doctor, no pill or anything hormonal, just ibuprofen from the chemist, maybe ten tablets this month. No allergies."
• ●Family: "Mum's periods were always regular. No early menopause or thyroid problems. Only Nan's hip."

Social History and Lifestyle Impact

• ●Home: Yasmin worries that Maisie leaves food. Her mum knows about the periods but not about the calorie counting or the extra runs. If asked whether her mum can be told, Maisie agrees as long as she has a say in how it is put: "Mum would panic. I'd rather explain it myself, but yes, she can know."
• ●School and club: Year 13, good predicted grades. Emeka coaches the girls' group at the club. Teammates joke about being lighter and not having periods.
• ●Availability to be seen: Her mum can drive her to the surgery after school on any weekday.

If Asked: Associated Symptoms

Gating note: Maisie answers these only when asked. Every one is negative unless stated.

• ●If asked about chest pain, palpitations or breathlessness at rest: "No. I get a bit light headed on standing but nothing in my chest."
• ●If asked about fainting or collapse: "Not properly. I've gone grey and had to sit down a couple of times."
• ●If asked about self harm or thoughts of ending her life: "No. I've never done anything like that."
• ●If asked whether anyone is controlling her food or hurting her: "No. It's all me. No one makes me do anything."

Responses to Management (The Negotiation Phase)

• ●If the doctor says she needs to be seen in person, weighed and examined:
  • ●Reaction: Hesitant, then agrees. "Do you have to weigh me? I'd rather not know." If told that weight is only one part and her pulse and blood pressure matter as much, she agrees to come after school that week. If asked to check her shin or pulse on screen, she declines and offers to be seen.
• ●If the doctor advises stopping running or impact training for the shin:
  • ●Reaction: Upset. "But the trials. Can't I tape it up and run on it? Emeka says it'll go off." If told the bone is under stress and running could break it, she asks, "Will I lose all my fitness? What do I tell Emeka?" She accepts if the doctor offers a note and says specialists will advise what she can safely do instead.
• ●If the doctor raises eating, a dietitian or an eating disorder service:
  • ●Reaction: Defensive, then worried. "I haven't got an eating disorder. I'm not skinny, I eat fine." If the doctor is gentle and does not label her, she says quietly, "I do feel guilty when I eat and I can't stop counting. Would they make me put on loads of weight? Does it go on my school record?" She agrees to go if told the service helps athletes and nothing is forced at the first visit.
• ●If the doctor discusses periods returning or the pill:
  • ●Reaction: Hopeful. "So can I have the pill, then?" If told it would cause a bleed but would not protect her bones or fix the cause, she asks, "So how do I get them back? How long will it take?" She wants to hear that periods usually return once she is eating enough for her training, and that it may take months.
• ●If the doctor explains the risk to her bones:
  • ●Reaction: Surprised. "Nan broke her hip. Will mine be weak forever?" She accepts an honest, hedged answer that bones can recover a lot if this is dealt with soon, but some loss may not fully return.
• ●If the doctor gives vague safety netting, such as "come back if it gets worse":
  • ●Reaction: Wants specifics. "Worse how? It's sore already." She repeats back clear instructions about fainting, chest pain, a racing or pounding heart, sudden sharp shin pain or being unable to put weight on it, and what to do about each.