Amenorrhea: Where has my Period Gone and How do I get it Back?

“That time of the month.” Period. Menstrual Cycle. Aunt Flo. Bloody Hell. Whatever it is you call it, your period is such a beautiful part of being a women. Your body is fucking amazing: every month it knows to shed the lining, while providing your body with hormones to keep you healthy. Whether or not you want children of your own, your period prepares your body for the possibility of pregnancy (in more grand terms: YOUR own body can create a home for another tiny little person to live within. Can we all just stop for a second to think about how miraculous that is?)

And yet, in all honesty, most of us sort of dread our period. Often times cramps, irritability, appetite changes, fatigue, and acne can come along with it. Oh, and “period underwear.” Don’t pretend like you don’t know what I’m talking about. Personally, I hated getting my period; until I didn’t get it anymore at all. It was about 6 months into my eating disorder, and my body already responded hormonally to the lack of nourishment I was giving it. And so I developed amenorrhea (AKA: loss of your period).

This meant a couple things for me, on both a physical and emotional level.

Physically, I was at risk for a number of health consequences. Some that could effect me immediately, while others were “hidden” and would come up later in life (especially if I continued on the path of malnourishment I was on at the time).

Emotionally, I started to feel less connected to my body. I knew internally that my body wasn’t functioning at it’s optimal level. But until amenorrhea developed (and gave me hard facts that I was unhealthy), I was living in blissful ignorance. I was under the impression that “everything was fiiiiiine, I’m doing fiiiiiiine.” Amenorrhea made it real: I was suffering from a very severe eating disorder, and something needed to be done about it.

Doctors immediately put me on the pill. No other options offered. I was put on birth control at age 15, and have actually been on it since. Now, for reasons of having sex and wanting to reduce any risk of getting pregnant. Ten years ago, just for the sole purpose of getting back on a normal menstrual cycle.

So, WHY AM I SHARING ALL OF THIS?

  1. Because amenorrhea is part of the “Female Athlete Triad.” This triad is a syndrome of three interrelated conditions of health risk factors: amenorrhea, bone loss/osteoporosis, and disordered eating.
  2. Because amenorrhea can be a result of VARIOUS things going on, both internally and externally (which ultimately influence one another).
  3. Because there are other ways to gain your cycle back that doesn’t rely on birth control.

The risks

Okay so maybe we all dream in a perfect world we’d never have to deal with bloody underwear, buying tampons, and forgoing sex for a week. But, it’s actually not all that great when we think about the health consequences associated with losing your period.

Ovaries

Anovulation: this is the fancy (or medical) word for the inability to produce viable eggs from the ovaries. No ovulation means there is no conception. In other words, amenorrhea can increase the risk of infertility.

Ovarian cysts can also form due to estrogen deficiency (and the over production of testosterone). PCOS (polycystic-ovarian syndrome) is one condition that can result. In this case, cysts form on the ovaries because no eggs are being produced. PCOS can also directly impact insulin levels, meaning that those diagnosed can experience weight gain, insulin resistance, excess hair growth, and are at a greater risk for the development of type 2 diabetes.

Bone health

Like I said, lack of your menstrual cycle means a decrease in estrogen production. The bad news? Estrogen has a HUGE impact on bone health. Let’s break it down here as simply as possible. Estrogen stimulates the actual formation of your bones, inhibits the breaking down of your bones(osteoclast activity), and suppresses bone resorption (minerals from one bone are released and transferred from bone to blood).

So without as much estrogen presence, our bones suffer. There is a direct association between the number of missed periods (or length of time of amenorrhea) and reduction in bone mineral density (BMD). As BMD decreases over time, we unfortunately are at a greater risk to develop stress fractures, osteopenia, and osteoporosis.

Other impacts

Acne due to hormonal imbalances, altered sex drive, and breast milk secretions.

The why

Primary amenorrhea

When we look at the “why” behind loss of your menstrual cycle, we first need to break it down into primary and secondary amenorrhea. When I say “primary,” think genetics here. During fetal development, some or all of the normal internal female organs fail to form normally, or fail to function.

Diseases of the pituitary gland and hypothalamus can also cause primary amenorrhea, as they both play a very significant role in ovarian hormone regulation. Another condition, gonadal dysgenesis can result with premature failure of the ovaries (due to a lack of egg cells, ococytes, in the ovaries).

Women who lack all or even one part of the two X chromosomes are not only diagnosed with Turner Syndrome, but also experience amenorrhea. In this case, ovaries are replaced by scar tissue and production of estrogen is significant decreased.

Secondary amenorrhea

Thyroid

Something may be off with your thyroid if you’re experiencing amenorrhea. Your thyroid is a powerful little gland: it regulates your metabolism, places a role in hormone production, and helps to regulate body temperature (among many other things). So when it’s over or underactive, ovulation can get disrupted.

Excessive weight loss

Excessive weight loss (sometimes in the form of an eating disorder) means that your body isn’t receiving enough nourishment to maintain normal menstrual cycles. Weight loss itself can cause elevations in ghrelin (a hormone), which has an impact on the reproductive system.

Essentially, a lack of body fat means a lack of estrogen and lowered cholesterol levels. The decrease in both means decreased ability to support the normal menstrual cycle.

Excessive weight gain or obesity

Sensing a theme here with weight? Your menstrual cycle can be directly associated with your weight! Those who are medically obese are also typically highly inflamed. When there is an accumulation of too much visceral fat, inflammatory cells from the immune system start to infiltrate our bodies. Cytokines (little messengers that send the message that there is an infection to fight, even though there isn’t one) are secreted from the inflammatory cells. When this occurs, insulin levels raise, while also increasing the ovarian production of testosterone. The end result? Ovulation is impacted.

Over-exercise

An interruption in the hormonal signals from the hypothalamus gland to the ovaries may have some impact on the loss of your menstrual cycle. Why? Because rather than the hypothalamus sending signals for your uterus to shed its lining, it is actually directing much of its attention to simply providing your body with energy to get through the physical activity you’re putting it through.

Stress

First off: stress can be both physical AND mental. In terms of physical stress, we’re looking at over-exercise again as a potential cause of amenorrhea. Your body is not meant to be overworked or over trained – and it WILL tell you that it’s burnt out!

In terms of emotional stress, we shift our focus over again to the hypothalamus and pituitary gland: which both play a role in the thyroid, adrenal glands, and the ovaries to manage hormones. When experiencing significant stress, estrogen doesn’t quite function as it normally would. Uterine lining then isn’t fully preparing – and also doesn’t shed.

Structural problems

A condition called Asherman’s syndrome can cause scar tissue build up in the lining of the uterus. Scarring prevents the normal buildup and shedding of the lining of the uterus.

There also may be just a lack of reproductive organs! Sometimes during fetal development, problems arise that leave a female to be born without some major part of her reproductive system, such as the cervix or uterus.

The vagina itself may have structural abnormalities that prevents menstrual bleeding. For example, there may be a membrane present in the vagina that simply acts as a wall to any outflow of blood.

Treatment

It may be helpful to seek out professional support in the form of a dietician, physician, and mental health counselor or therapist. A loss of a normal menstrual cycle can have a deep impact emotionally on a girl. There can be shame, embarrassment, confusion, and body image issues. Having a period is such a “normal” part of being a women, that it’s likely some conversations around sexuality may come up, and probably need to.

A therapist can also help to unravel the areas of stress in your life that are inevitably impacting your physical health. Reminder: the mind and body connection is HUGE, and REAL! What happens to us mentally is most likely going to impact us physically, at least to some extent, and vise versa. Where in your life are you getting the most external stress from? What about internal stress? Can these stressors be reduced or managed independently? It’s okay to say no, and it’s even more okay to ask for some extra support.

In the case of amenorrhea due to weight loss, it is definitely recommended to increase your daily intake, while decreasing the frequency and intensity of the exercise you’re doing. Restoring weight doesn’t guarantee your period will just come back like magic. It may take time. Your body is an amazing “vessel,” but it needs some patience on our end, and some time to rebuild itself and restore your normal menstrual cycle.

In the case that ovarian function can’t actually be restored, hormone replacement therapy can be used.

Can certain food help?

ALWAYS. Come on now, you know how much I love talkin’ all things mind-body connection. So yes, food plays a role.

  • Iron: women who do not get sufficient sources of iron can experience a loss of menstrual cycle, and difficulty with pregnancy. Sources of iron include grass-fed beef, wild caught Alaskan salmon, eggs, elk, sunflower seeds, and quinoa.
  • Vitamin C: directly related to iron, vitamin C is actually required for proper iron absorption. It also helps to improve hormone levels and increases fertility in women. Red bell peppers, oranges, and strawberries are all sources sufficient in vitamin C.
  • Essential fatty acids: these are so crucial for hormone production! And yet many women are actually deficient in fatty acids. Think flaxseeds, walnuts, salmon, chia seeds, and halibut.
  • Zinc: this mineral helps keep hormone levels stable throughout your period, and is needed in certain amounts to produce mature eggs for fertilization. Lacking in zinc? Get some more oysters, pumpkin seeds, and tahini in ya.
  • Fiber: excess hormones can cause hormonal imbalances in your body, and fiber actually helps remove them. It also helps to regulate blood sugar levels, which helps to reduce fertility issues like PCOS. Fiber rich foods include fresh fruits, veggies, beans, and oatmeal.

Reminder: you are no more or less of a women because of your menstrual cycle

The lack of your menstrual cycle says nothing about you as a woman, but can serve as a way to check in with our bodies.

Have we changed the intensity and duration of our workouts?
Have we changed the amount of nourishment we’re giving our bodies?
Are we feeling stressed or burnt out?

Your body WILL tell you: your job is just to listen.

 

 

Nicole

Nicole

Nicole works as a life and wellness coach through Nicole Leigh Coaching (www.nicolenessLPC.com) Nicole strives to empower women with similar struggles to redefine and re-identify themselves, separate from their eating disorder. Through her work, she empowers women to use balance in every aspect of life to maintain lifelong recovery. When Nicole isn't blogging or counseling, she loves spending her time traveling, eating burgers, and surrounding herself with positive people.