They’re annoying, yet amazing all at the same time. I never appreciated my period until I didn’t get it regularly for over three years. Nowadays, I’m pumped when she shows up each month relatively on time, give or take a couple days. Like…actually, authentically excited because it tells me things are working right up in there and overall, my lady parts are doing pretty well.
I can’t even count the amount of times I was told “don’t worry about it” by multiple physicians and NPs throughout my late teens and early twenties when it came to not getting a menstrual cycle. I had blood work done, DEXA scans, and probably other tests, but not once did a health care provider ask about my exercise or eating habits. I went through a diet-y phase at the end of high school and into my first year of college where I was restricting my food intake. I’d guess I was about twenty pounds lighter than I am now. Then I started to learn about the body and how it works so I ate more, but even though I was eating better I still stayed around the same weight, give or take a few pounds. Still on the lower end of a “healthy BMI,” not once was I asked about exercise or what I ate.
Then, when I graduated from my dietetic internship in 2012 and took things into own hands and really started educating myself, I was absolutely baffled when I went to an endocrinologist specializing in women’s health and her solution was to prescribe birth control. I was also once told verbatim when I asked about exercise and its relation to amenorrhea, “There is no medical indication for stopping exercise. It is also not dangerous or unhealthy to skip periods.”
I don’t want to sound like I know more than doctors or other NPs because I most certainly do not. But I do think, as a health care profession, we are far undereducated about how lifestyle relates to reproductive health, and way too quick to prescribe a medication rather than getting back to basics with some lifestyle modification. And the business of healthcare plays a huge role in this – there is way more money in prescribing birth control or other meds than there is in telling somebody to change their diet and exercise. So I get it, the business is against us.
I could go on and on because this area of women’s health fires me UP. But instead, here are five things I didn’t know, but think you should know about your period and lack thereof.
You don’t have be a marathon runner to have exercise-induced amenorrhea. If energy and nutritional intake are not sufficient enough to support energy expenditure, the body begins shutting down organ systems that are not absolutely essential for survival – including the reproductive system. If your body isn’t getting enough energy + nutrients to support your own needs, then it’s certainly not going to think it’s in a healthy state to grow a baby.
But even if you do eat healthily and adequately, amenorrhea is still a common occurrence since exercise causes the release of stress hormones – a natural and normal response to exercise. But these are the same hormones the body releases during the “fight of flight” response caused by any stressful situation (from you forgetting your wallet to you running from a burning building). Everyone’s body has a different threshold of these stress hormones in which they start interfering with the brain’s production of reproductive hormones to keep your menstrual cycle flowing.
Sure, not having your period is convenient, but it has long term health consequences. So when I was continually assured that not having my cycle “was no big deal,” I began to wonder…how is a process that reproduces other humans no big deal when it goes absent? For me as a patient, as an RD, as a nurse, and as a soon-to-be NP…this is a big freaking deal. When your period goes missing, there’s an altered production of reproductive hormones and women are most commonly estrogen-deficient (there are only reasons as well). Estrogen is like the queen of female stress hormones and when there’s not enough of it, bone health deteriorates leading to osteoporosis (leading to lots of injuries) in addition to infertility, atrophy of the vagina and breast and there is even research to show prolonged exercise-induced amenorrhea may increase the risk of heart attacks later down the road.
Just because you’re at a “healthy BMI” doesn’t mean you’re at a healthy weight for YOU. Typically, women need about 17% body fat to have their first period and about 22-23% to maintain a healthy menstrual cycle. In light of that though, every woman is different. There are women who run marathons and have very low body fat, yet healthily menstruate. There are also women whose exercise threshold is much, much lower. That’s okay. You are YOU. Looking at a woman’s BMI and shrugging off an irregular or absent period because she has a “healthy BMI” is ignorant and shoves the body and healthcare into an algorithm when every single patient is different.
The body’s hypothalamic pituitary gonadal (HPG) axis is super sensitive to changes in the environment. This chain of events happens on a regular schedule that is precisely timed. That means lack of sleep or insufficient energy intake or emotional stress or other environmental factors can effect this cascade of hormone release that causes a woman to menstruate. Which is why it’s so important to focus on appropriate sleep, stress management and self-care. Nobody ever mentioned those things to me or asked me about them for years.
FATS FATS FATS ARE SO IMPORTANT. We need fats in our diet to synthesize hormones. And eating enough calories AND nutrients is just as important. Now, any and all foods are part of a healthy diet. Any and all food are part of a healthy diet. Any and all foods are part of a healthy diet. But we would become nutrient deficient if we ate McDonald’s all day. So we need a balance of nutrients AND calories in order for our body to not be under nutritional stress. We need foods that nourish our body and foods that nourish our souls too. Because if you’re always stressing about eating healthy and avoiding all processed foods, well that’s a big point of stress and that’s not good for you either.
My point here is that not having a period isn’t normal. And we can’t just ignore it’s absence. But instead of just taking a pill to slap a band aid on the problem, we have to take step back, look at the overall picture, and get down to the root of the problem.
Because our lady health is important.