Secondary amenorrhea - the loss of 3-6 consecutive menstrual periods, according to HealthLine.
From August of 2014 through January 2016 - about 18 months - I lost my period as a result of all that my body suffered during my eating disorder. Of all the negative side effects - the aching knees, the abnormal blood tests, the fatigue, the extreme weight loss - amenorrhea scared me the most. This fear wasn't like most others, though. It didn't want to be talked about (I kept it to myself and tried to shrug it off whenever someone asked), but rather wanted to just pinch away at my insides until what remained was just an immiscible lump in my throat.
Immiscible for two years. Will I have children someday? Will my body change because of the lack of hormones? So many questions tore up my mind and I prayed and prayed and prayed that God would humble me enough to let Him take control (and therefore help me embrace weight gain and recovery) so that I could find real sustainable health for the first time.
Since August 2016, I've been seeing my period once every month! Though I still can't pinpoint exactly when it will come or for how long, I know I can expect it at some point. Besides just prayer, I took a few intentional steps in order to regain it and I want to share those with you. First, though, I should note that in my research, I came across TONS of information, tons of possible causes and effects and this and that with which eating disorders and amenorrhea play a role. To narrow down what therefore could become a days-long post, I'll just discuss the relationship between anorexia and amenorrhea, and concluding with some of the steps I took in conquering both those obstacles and some I've found via my research.
Now, bear with me as I take you through a brief science lesson explaining a little bit more about what happens to the body during a period. The sympathetic nervous system is responsible for the "fight or flight" response and controls hormone release (specifically adrenaline, norepinephrine, and cortisol). By producing gonadotropin releasing hormone, the sympathetic nervous system manages the female menstrual cycle. Like most mechanisms in the body, certain things (substances, situations, foods, etc.) can alter the body's ability to produce GnRH. New research shows that high levels of cortisol - also known as the stress hormone - can inhibit GnRH production. Similarly, "stress also increases brain levels of a reproductive hormone named gonadotropin inhibitory hormone, or GnIH...", according to researchers at UC Berkeley. All this to say, stress plays a huge role in human reproductive ability.
To touch on what exactly "stress" is - well, it could be mental stress from those upcoming exams, that job presentation, the financial weight on your shoulders, or the daily strenuous workouts, the constant worrying about and fearing of certain foods, the dangerous calorie-deficit characteristic of eating disorders. All of those situations fall under the category of "stress",one of the main causes of amenorrhea, especially in younger women. I'm not here to freak you out about the effects of stress, but these possible outcomes of extremely high, prolonged levels are nothing to shrug off.
Maybe you are working to regain yours or maybe you know someone else who is. Either way, take these into consideration:
- EAT MORE: Think about the main cause (as it pertains to this post) - calorie deficit/low energy intake. Our bodies run on calories for energy to regulate everything from simple arm movements to hormone production. Guess what happens without enough calories? Our bodies have to prioritize the most important bodily functions and send as much energy as needed to those areas, and in the process, some functions are sacrificed. In the case of hypothyroidism, our bodies leave the thyroid gland without enough energy to produce hormones that regulate the menstrual cycle. How to solve that? Eat more! Ahhhh, but it's not that simple, Haley. Oh, believe me - I know! I've been there.
Now, when I look back at my previous portion sizes I'm like, "Um, yeah I'm still hungry just looking at that...". I learned to increase my portion sizes when I went vegan. A plant-based diet is naturally low in calories, so I had to adjust to filling bigger plates with more rice, potatoes, beans, or whatever it was I ate. Of course, eating more doesn't mean an extra cupcake or scoop of ice cream or even a slab of fatty fish. No, eating more means more of those high-quality, nutrient-dense calories from plant-based foods like avocado, brown rice, tofu/tempeh/soybeans, etc. - STRESS LESS - I'm in college and sometimes - no, like 94.7% of the time - "stress" might as well be my middle name. Now, that isn't totally just college's fault because I play a role in regulating my own stress levels, too. If you're currently a student or if you've been one before, you know what I'm talking about when it comes to exams, studying, working outside of school, and managing all of that plus a social life. Now, throw in a high cognitive dietary restraint into that mix. High cognitive dietary restraint is the act of constantly trying to limit "food intake to achieve or maintain a healthy weight" (check out This Girl Audra's YouTube video for a better understanding of the term). Research shows that this mentality in college women can likely cause menstrual irregularity. In fact, women with high cognitive restraint levels are more than 2x as likely as those with low-medium scores to report irregular menstrual cycles.
Stress isn't limited to only the mental aspect, though. Workouts are "stress", too, just more along the lines of the physical aspect. Too much physical activity can and will contribute to that calorie deficit/low energy intake discussed previously because the body burns calories in order to push through that workout. During a workout, the body uses calories to fuel jump squats, bicep curls, and uphill climbs. After a workout, the body uses calories to REfuel, replenish, and restore broken down muscle tissue. Again, the thyroid's hormone production function is not prioritized, resulting in a missed period.
I used to workout 6-7 days every week. HIIT, weight lifting, and running were my go-to's, but I set aside 1-2 days each week for lighter exercise, like walking and practicing yoga. My strict workout regimen - though motivating to many - combined with my low energy intake to inhibit my body's thyroid gland function. Only about a year ago (which seems both long and short at the same time, somehow) did I finally just how much I induced on my body on a daily basis. After a series of eye-opening, heart-softening conversations with God, I wrote a love letter to my own body (also in the spirit of Valentine's Day), apologizing for all I'd put it through and thanking it for pulling strength from places in which I didn't even know I had any in order to fight for life. Last January, I took an entire week - which may not seem like much, but for me it felt like years - off from workouts. I walked, but that was it, and guess what I saw for the first time in almost 18 months? That little red dot most women dread, I finally embraced and thanked God for. - PRAY - Of course, these aren't in particular order of importance, because if they were, this guy would bump up to the top immediately. Anyway, a fellow blogger asked me the other day if all I did was pray and magically my period came back. At first, I second-guessed myself - why does that sound so simple, even though it was such a challenge? Is that really all I did? Well, yeah, I guess. Of course, I still had to fight - I had to punch that voice in my head constantly telling me to eat less and workout more, despite my absent period. And I used prayer as my weapon during those battles. I prayed not only for a regular period, but most often for actual, sustainable healthy habits. My eating disorder (my not-so-healthy, definitely not-sustainable habits) caused my amenorrhea, so I knew I needed to rid my life of such destructive behaviors and adopt ones that will last a lifetime because I want my period to last a lifetime. Makes sense, huh?
Prayer made all the difference in this whole battle. Through it, God brought me peace in gaining weight, trust in the waiting period (6-7 months of waiting before it became regular), and inexplicable gratitude when it finally did set in every month. So, no, I didn't only pray for my period to come back. However, prayer was at the root of every step I took in order to regain it. Looking for some scripture about prayer? Here are some of my favorites: Philippians 4:6-7, Matthew 11:24, Romans 8:26, Acts 2:42, 1 Peter 5:7.
YOUR QUESTIONS, ANSWERED
"How were you feeling mentally and physically?" Over a span of about 12 months (from the time I began focusing on healing my amenorrhea until now), my emotions flew everywhere. At first, I was stoked to begin the journey because the only thing in sight was the end result - a regular menstrual cycle. However, I was considering every bump I'd face along the way. Since last December, I've gained weight. How much? I don't know, probably around 5-7 pounds. While that may not sound significant, it was enough to pull me way down low emotionally, convincing me that I'd lost everything I once worked so hard for (i.e. my slim thighs, my flat stomach, etc.), and then lift me so high on the pure joy of seeing red for the first time in almost two years. Gaining weight was, by far, the hardest part of it all. BUT I'm now even more stoked than I was to begin with because I see that red every single month and I know that I'm healthy. I know that my body is doing what it's designed to, as a woman. Now, physically, hmm... Well, I'm currently on my period, so I'm dealing with the cramps, moodiness, lower back pain, and breakouts I definitely didn't miss. On the other hand, I'm so grateful for the muscle AND FAT - yes, I'm grateful for the "fl(abs)" lol - I've allowed myself to gain. My body amazes me everyday, as it survived all that it endured during those disordered two years. Again, I couldn't be more grateful :)
"Were you hungry and tired all the time?" During my eating disorder? Yes. During my regain-my-period mission? Not really. Though I wasn't working out as much, I didn't feel as lazy as I'd expected, which is probably because I was finally consuming sufficient calories to meet my body's high energy needs.
"I've gained the weight, but where's my period?" Oooooh, I actually don't know. I tied my returned period to my weight gain, so if you've also gained enough weight (key word = enough) but aren't seeing yours again, I'd ask what your stress levels are like - are you feeling overwhelmed in work or school or any other areas in life? If you've come this far in this post, you know how stress can affect the menstrual cycle. I would also consider the quality of your diet - vegan? vegetarian? paleo? low-carb? You may have gained weight, but you may still be low in some essential nutrients and/or vitamins/minerals. I suggest tracking your food intake using an app, analyzing your nutrient amounts, and fixing what's too low or too high. If you've still got some questions, head to your doctor or dietitian for serious deficiencies. When I went vegan, I made sure to increase my vitamin B12 intake via supplements and nutritional yeast. And YES a vegan diet provides enough protein, sooooo don't get me started.
"I'm vegan... help!" Heeeyyyyy I'm vegan, too! It's been over a year since I made the switch, and my period disappeared before I became vegan. I truly believe filling my diet completely with plants made a huge difference in battling not only my ED, but also amenorrhea. Because a vegan diet is packed with low-calorie plants, it's important to be sure to eat more. Sound familiar? During the first few months of my transition, I played with the high-carb, low-fat lifestyle, which required MUCH larger portion sizes as the main foods (fruits and vegetables) are so low in calories. Though I didn't stick with HCLF, those portion sizes - bigger than any I've eaten before - stretched my stomach and proved that I really CAN and NEED to eat more, despite the branch of veganism I follow.
"Did you consider birth control?" No. A few people suggested trying it, but my gut told me to stay away for a few reasons. 1) I don't really believe in relying on pills. If I have a headache, I take a nap, drink water, and eat a snack if I'm hungry. If I've got period cramps, I use a heating pad or take a relaxing bath. Joint pain? Rest, ice, stretch. A cold? Rest (again), eat well (as always), supplement lysine and zinc in tablet form, and then maaaaaaybe turn to medicine if nothing else succeeds/my doctor suggests. That being said, birth control is last on the list of pills I'd take if I needed to. 2) So, let's say I take birth control to regain/regulate my period. What happens when I stop taking it? Doctors have found that my period could again disappear for several months, so then what? I have to find another solution to the same problem - I've just made a circle back to where I was. Bottom line: it doesn't seem sustainable, and that's why I haven't tried it. My prayer in this journey was that, not only would I regain my period, but that God would heal my broken relationship with food and form a healthy mindset, one that will sustain me for the rest of my life.
"Can I still workout while I'm trying to regain my period?" My answer: yes. Last year at this time, I'd been following my friend Amanda (@applesandamandas) for months and we were both struggling with amenorrhea. Her advice and her method of healing was cutting out exercise, but I didn't feel that I needed to completely stop working out. Instead, I took a week off - I walked and stretched, and I ate and relaxed. By the end of the week, my period showed up! Of course, I'm not attributing its return solely to my decreased exercise for that week, but I took it as God's way of comforting me in my choice to continue exercise, but simply change my routine up a bit. Since then, I've decreased the amount of cardio session per week and replaced them with either time for rest or more anaerobic workouts, like weight training, barre, and yoga. However, simply changing your workout routine might not solve the problem. Athletes everywhere suffer from secondary amenorrhea - runners, gymnasts, even bodybuilders - because of their extremely low body fat content. Without enough fat, the body cannot produce estrogen, and without enough estrogen, the body cannot regulate or produce a menstrual cycle. So, is it okay to exercise while trying to regain your period? Talk to your doctor to discuss your body fat content and seek help in designing a fitness plan geared towards achieving and maintaining a healthy body composition.
Wow - I feel like I could go on for days with this post. It was, by far, the most demanded and the most rewarding post I've written yet, simply because of how many of you guys reached out to me asking for help and thanking me for taking the time to post. Honestly, your support means SO MUCH to me, guys.
Please please please remember that I'm NOT a doctor, and I always recommend you see your health professional first, and then take my advice. That being said, all of this information stems from research backed my health care professionals themselves, so this is all still worthy advice.
And lastly, if you're struggling with anything - amenorrhea, eating disorders, or school, boys, faith, whatever - I'm here. I cherish the time I spend on my blog. This is my passion and I can't thank God enough for lighting this fire in my heart :) I hope you've found what you were searching for here, and I hope you keep coming back! Thank you to everyone who contributed questions and read all the way down here. I know it's a long one, but I needed to cover tons of information in order to make this post as effective as possible.
Alright, I'm done I promise! Love you guys!
RESOURCES:
Robyn, The Real Life RD, created a whole series of posts dedicated to this topic. Also, she is ahhhhhmazing and I always open up her blog when I'm in need of some intuitive-eating inspiration and body-positive encouragement.
Here's one from Rachael, aka Avocado A Day Nutrition, which discusses the sheer importance of a woman's period. You need it for more than just making babies, people!
I'm new to the name Dana Magee, but she is an RD who specializes in non-diet approaches to health - woooo! - and she, too, has an extensive informational post about periods and bone health.