I get it periods aren't exactly fun or really anything that any of us women actually want to spend a week every month dealing with but they are a sign that your body is healthy and working properly and are actually something that should be celebrated! I never appreciated my period until I lost it, and I'm now going into my 7th month with zero signs of a menstrual cycle and I feel like I have tried EVERYTHING to try and get it back and to say that I'm tired of not having one is an understatement.
When you get your period every month it means that you aren't pregnant (duh), but it also means that your body is healthy enough to get pregnant if you wanted to and that your fertility is normal and healthy. So I'm sure you can guess that when you don't get a period every month it is not a good sign. When you don't get your period regularly (regularly is every 28-30 days) it means that something is off and for some reason your brain is sending signals to your body telling it to hault ovulation. Basically no menstrual cycle = something is making your body think you are not healthy.. which is obviously bad news.
The amount of times that I have been told by my doctor and other practitioners over the last 7 months that it's "no big deal" that I don't have a menstrual cycle is shocking. I have had multiple blood tests done, a stress test, a pap and still NO ANSWERS and no concern from anyone other than me. My doctor even suggested that I go back on the pill to try and regulate things, which I immediately shot down so his next suggestion was a round of 10 days of progesterone to try and get my body to withdrawal bleed after I come off of it in a hopes that this would kickstart my period. Again, it's a hard no from me on the whole putting synthetic hormones in my body thing. The only thing that either of those options would do is pump me full of synthetic hormones which I'm not into and put a small and (very) temporary bandaid on the actual underlying issue. As a society we are way too quick to prescribe and take medications instead of actually investigating the problem, getting to the root cause of the issue and treating it with dietary and lifestyle changes and I know that it's because the pharmaceutical and medical industry is a massive business and that's how they make money but as a soon to be Registered Holistic Nutritionist and Certified Nutritional Practitioner prescription meds will never be my chosen route for myself or my clients.
Okay now back to the period stuff. I know that not getting your period might seem super convenient but aside from not having to carry tampons around in your purse or make frequent trips to the bathroom it actually isn't awesome and comes with a pretty extensive list of seriously concerning long term health consequences. There is actually a legitimately diagnosed condition for not getting your period - Amenorrhea is the absence of a menstrual cycle for 3+ months. And let me just tell you now, it is no joke.
Amenorrhea can be caused by a number of things like; coming off of the birth control pill, taking certain medications, chemotherapy, a drastic increase or drop in body weight, certain medical conditions, etc. But the main thing that all cases of Amenorrhea have in common is a lack of sufficient estrogen in the body.
Estrogen is the hormone responsible for sexual and reproductive development in women, increased estrogen levels cause the lining of the uterus to grow and thicken which causes your body to release an egg into one of the ovaries, if the egg is not fertilized estrogen levels will drop and your body will shed the lining of the uterus (this is your period). When estrogen levels are too low the reproductive cycle is halted, no egg is produced, no uterine lining will be shed, fertility is turned off and other body systems will start to suffer. Bone health will start to deteriorate which can lead to osteoporosis and an increase in injuries, risk of atrophy of the vagina (thinning, drying and inflammation of the walls) is increased as well as the risk of cardiovascular disease later on in life. On top of all of that there is also the risk of permanent infertility which even if you're not currently thinking about having a family one day, is still something that should not be taken lightly.
There is also another type of Amenorrhea, called Hypothalamic Amenorrhea which is very common in athletes both competitive and non, in women with a history of eating disorders and/or restrictive eating, in frequent dieters, in women who follow a low calorie, low carb or ketogenic diet and in women who are chronically stressed or who have extremely high cortisol.
Hypothalamic amenorrhea (or HA for short) is the absence of a menstrual cycle for 6+ months due to a problem involving the hypothalamus (the reproductive control center in the brain) caused by low body fat, over exercising and restrictive or inadequate calorie intake.
If energy and nutritional intake are not sufficient enough to support energy expenditure, the body will recognize that it is in a negative calorie balance and will start to shut down organ systems that are not necessary for survival – and guess what the reproductive system is generally the first to go. Think of it like this, if your body isn’t getting enough energy or nutrients to support it's own needs, then it’s definitely not going to think it’s in a healthy enough state to be able to conceive and grow a baby.
And you don’t have be a crazy cross-fit junkie or extreme dieter to have hypothalamic amenorrhea.
HA can be caused by something as simple as having a low(er) body fat percentage, working out regularly or just not eating enough. Having a low body fat percentage decreases leptin a hormone that is crucial in regulating hunger and energy balance in the body and for the proper functioning of the hypothalamus. It's also important for me to note that just because you might be at your usual weight or the standard BMI for your body size doesn't mean that you're at a HEALTHY weight, BMI or body fat percentage. Every woman is different and what your body needs to maintain a healthy menstrual cycle might look completely different on another woman. There is no standard "healthy" weight, BMI or body fat % for everyone, just like there is no set amount of food, calories or energy or a cookie cutter diet that will fit everyone. And since we're already talking about food and energy intake let's chat about that quickly.. Restricting calories, even unintentionally by frequently consuming lower calorie foods like salads, smoothies, fruits and veggies, etc. and maintaining a lean physique with low body fat puts the body into an ongoing negative calorie balance. That alone is not good for hormonal health but when you add in regular exercise it just further increases the imbalance in energy and makes the situation worse.
You might be thinking okay but "I eat enough and I still don't get my period" sometimes the only factor in hypothalamic amenorrhea is over exercising. Exercise causes the release of stress hormones which are the same hormones the body releases during the “fight of flight” response caused by any stressful situation (think forgetting your wallet or running from a burning building). Everyone’s body has a different threshold that it can take of these stress hormones before they start interfering with the brain’s production of reproductive hormones that are essential to keeping your menstrual cycle flowing.
If you haven't clued in by now, I should let you guys know that THIS is what I am currently dealing with, after tons of research and testing I came to the conclusion on my own and have since had my theory confirmed by my doctor that I currently have Hypothalamic Amenorrhea.
I had no idea that I was doing this to my body, I haven't dramatically changed anything in my life other than coming off of my hormonal birth control pill last December. I have always exercised 5-6x per week, I love smoothies and salads and I have always been lower on the body fat % side of things, I've never had any issues at all and I honestly never would have thought that my lifestyle could be the reason I am not getting my period - but it is. All of these factors plus my chronic stress have been causing my body to produce excess cortisol and has made it feel like it is always in “fight or flight” mode which has caused it to shut down the processes that aren’t essential to life like my reproductive cycle for the past 7 months.
SO WHAT DO I DO NOW?
Well luckily HA is completely manageable and reversible with certain dietary and lifestyle changes and a little switch in mentality. The first thing that you need to do if you are currently dealing with HA is to eat more and exercise less - which if you're like me then this probably sounds terrifying to you. I totally get that and I’m honestly with you on it and with a history of disordered eating it makes it THAT much scarier but it’s something that I know I need to do for my health, my body and my hormones right now and if you're currently dealing with HA then it is something that you need to do as well.
To recover from HA you need to be eating more nutrient and calorically dense foods, with a focus on high carbohydrate, high fat and moderate good quality protein. Fats are probably the most important nutrient to increase for HA because fatty acids are the precursor for hormone synthesis and are therefor critical for hormone production. Eating enough calories and nutrients is also equally important because we need a balance of nutrients and calories in order for our body to not be under any energy imbalance or nutritional stress. This means that on top of increasing calories you also need to be practicing zero food restriction, food restriction only causes stress which is exactly what you don't want to do! It's important to mainly load up on nutrient dense foods but also leave room to enjoy yourself and feed your mind and soul with the foods you love and remember that all foods can be part of a healthy diet in moderation!
Exercising less can mean different things for different people when dealing with HA. What stresses your body out may not put the same kind of stress on the body's of others so it's important to remember that everyone's body and needs are different. Figuring out what kind of exercise your body needs to be able to get your period back is going to take trial and error and a lot of patience, for some it might mean just limiting the time they spend in the gym from 60 minutes to 30 minutes, for some it might mean switching from high intensity workouts to low intensity, for some it may just mean lowering the weight they use in the gym for resistance training and for others it may mean cutting out exercise completely. For me it means going from 6 gym based resistance/circuit workouts per week to 3-4 (probably 3), lots of walking and yoga on the other days, more meditation, more breathing and less stress on my body and my mind. I also have to keep in mind that because I do suffer from chronic stress my body is going to need a lot of extra love and help in returning to a state where it feels calm, safe and healthy enough to have an actual cycle so there is a chance that I will have to limit my gym based exercise even more if things don't change in the next few weeks. I will obviously keep you all updated on all of that though as well as this whole journey because I know that so many of you ladies are dealing with or have dealt with the same issues.
I want to make sure that your biggest take away from this is that not getting your period is not normal and isn't something that should be ignored or brushed off. I know how frustrating it is to not have something that other women take for granted and to not know what is going on in your body but I want you to know that there is hope. I also know what it's like to seek help and not find it, so if your doctor or practitioner doesn't take your menstrual health seriously then simply find someone who does. What I'm trying to say is that your cycle is important and your lady parts deserve to be prioritized.
xo - LU