So this week I became a Registered Nurse.
It still feels a bit surreal.
I took the NCLEX on Thursday morning and then had to wait the entire weekend before I found out the results on Monday morning. To say I was relieved was an understatement. I’m typically a sad crier and laugh or scream when I’m happy, but I ugly cried when I saw “pass” on Monday. PRAISE THE LORD.
So 14 months after moving to New York City and going back to school, I can now write:
Robyn Coale, RD, RN.
WIAW breakfast // two pieces of whole grain bread with PB and J + a post run green smoothie made with 1 scoop Vega Sport, 1 frozen banana, frozen spinach and almond milk
I think I had so many emotions when I found out Monday because it meant so much more than just being a nurse. The past three years of doing Nutshell has heavily influenced my decision to be a Nurse Practitioner, so officially becoming an RN was tangible solidification that this is happening. I’ve always been super passionate about helping women find food freedom and true health and healing, but over the past couple months, the client interactions and conversations I’ve had have made my heart explode with excitement and an uncontainable passion to care for women more comprehensively.
I’ve worked with clients from all different health backgrounds and even worked with men, but over time I’ve seen more and more women who come to me with a history of restrictive eating and overexercising asking the question, “Why am I not getting my period?” Some have never had a period at all and they are now in their 20s. The more women I’ve worked with, the more frustrated I’ve become at how medicine and healthcare has addressed this issue. Amenorrhea is not something you just slap a birth control prescription on and call it a day. That’s not the solution and all that’s doing is masking an underlying cause of why women aren’t menstruating.
Having walked through hypothalamic amenorrhea myself, I too have walked out of a doctor’s office enraged and thinking, “Really?! Birth control is your only answer?” What typically happens is health care providers run a bunch of lab tests, which usually includes your female hormones and a thyroid panel, among others. Then when the results come back normal and if your weight is within the “normal” BMI range, you get a prescription for progesterone to jump start your cycle and/or birth control to keep it regular and off you go. Hearing this story time after time from clients enraged me. The issue nine times out of ten is not a hormone deficiency, the issue is lifestyle.
lunch // Ezekiel bread with baba ganoush + olive oil + tomatoes, salad with brussel sprouts + tomatoes + cucumber and TJs champagne dressing, and an apple
afternoon snacks // TJs raisin bran with almond milk and some mixed nuts
Hormones are the leading role in the regulation of a woman’s reproductive health. They regulate menstruation, fertility, menopause, and your sex drive [which is why when your restricting food/overexercising and have low estrogen, the last thing on your mind is sex…unfortunate, but true.] The hormonal cascade that causes our menstrual cycle starts in the hypothalamus. Gonadotropin-releasing hormone triggers the pituitary gland to release follicle stimulating hormone [FSH] and luteinizing hormone [LH] and FSH and LH then start the process of ovulation in the ovaries. The ovaries produce estrogen and progesterone, both which help get the uterus ready for pregnancy. So if pregnancy doesn’t happen, we shed the lining of our uterus and get our period. If any of these hormones are out of whack, it can cause you to miss your period all together or have irregular periods.
If you think about it very basically, our woman bodies can grow another human being. Besides that being absolutely AMAZING, it’s also a lot of work for the body. So if your body isn’t getting enough calories, enough nutrients, enough sleep or it’s exerting too much energy through exercise, that is going to cause stress. Any sort of emotional stress is also taxing on the body. So if the body is too stressed in any way and especially if it’s lacking in calories and nutrients, the body says, “Ok girl, this is not a healthy environment to grow a baby…so we aren’t menstruating this month.” And that’s when our cycles become irregular or stop altogether.
happy hour Chardonnay + dinner at Tres Carnes
Addtionally, fat cells produce estrogen so if we don’t have enough body fat, we won’t produce enough estrogen and therefore not get a regular period. Furthermore, when cortisol is high, the body is also less sensitive to estrogens. So in that case, it’s not an estrogen deficiency, but rather an altered biological response. So your lab results might come back normal because there’s enough circulating hormone, but there’s still a problem that no amount of synthetic hormone like birth control will fix. Actually, adding more will likely make the problem worse.
Hormonal issues can be so complex, and medication most of the time, is not the solution. It can often mask an underlying cause, and can even be more detrimental in the long run. Birth control almost always is not the answer for amenorrhea, but rather looking at a woman’s entire lifestyle to see where the stress is coming from and making changes to reduce that stress is the answer.
What does nutrition look like? Are you getting enough calories and nutrients?
Is exercise too intense in either quantity or quality?
Is your body weight and/or body fat too low? And that does NOT mean just falling in a normal BMI range.
Is there emotional/mental stress going on?
Is there stress from lack of sleep?
There is so much that goes into a woman’s reproductive health. So I blab on and on about all of this because I think it’s imperative that we as women know about our bodies, so instead of trying to “fix” something with medication, we can take a step back and look at our health as a big picture with so many moving parts and address each part individually.
Health is so much more than your weight and just because you’re a certain BMI, doesn’t mean your body is at a healthy, sustainable weight for you. And once we step into that realization and let our body be the size it’s suppose to be and take care of ourselves, there is so much freedom and true health to be found.
Congratulations on adding a few hard-earned letters to your name 🙂 That’s so exciting! Thank you for writing this post. I have been so frustrated by doctors telling me that I am “normal” because of my blood work and weight when I know that there MUST be a way to get my period back that doesn’t involve birth control. This was exactly what I needed to read to keep pursuing full recovery and get my body to the place where it needs to be. Thanks again!
thank you!! I know how you feel being so frustrated and the body can do amazing things to heal if we simply let it! Thinking of you as you find true health 🙂 xoxo
I just became an RD a few weeks ago- I know your feeling of exaltation! Thank goodness we didn’t have to wait a week for test results, though. That would have killed me! Congrats on becoming an RN! My question for you is: What are your thoughts on using birth control for the sake of pregnancy prevention? I originally got on birth control because (like all the other women you’ve referenced) I didn’t have a period for years.
Now I’m on birth control because I got married and just am not quite ready to become pregnant. Thoughts? If you’ve already written or spoken about this elsewhere, feel free to just direct me to that link!
Megan King says
Savannah, I too was on birth control originally for “acne” and then because I wasn’t getting periods. I too got married and thought birth control would be a good idea but knew underneath that it would mask normalcy. I knew in order to be healthy I had to go off it and eat enough in order to “earn” my period. My husband and I use condoms and it works just fine. 🙂 I just knew I needed to be off it to monitor whether or not I am getting my period on my own to keep myself in check.
I don’t use birth control but use condoms with my long term boyfriend. Also, there is a non-hormonal copper IUD option out there.
I switched to the copper IUD and it’s great!
Last year I finally got the copper iud (paragard) for all the same reasons everyone else mentioned. I love it!!!! Doesn’t interfere with hormones or cycle and its the most effective form of bc out there. After having no period for over a year, I have slowly managed to regain a pretty regular cycle by eating more (and more frequently) and exercising less (not necessarily intensity but definitely quantity). For me it’s peace of mind knowing what’s going on with my body each month rather than masking this with a fake hormonal bc period. If you decide to try the iud make sure you go to a doc who has plenty of experience placing them. Some Drs don’t feel comfortable placing them if you haven’t had a baby bc I think it can be more difficult. My experience was completely fine and only moderately uncomfortable for a short period of time. Good luck!
That’s a question I get quite often Savannah! Like the other ladies above, I highly recommend the copper IUD. I haven’t had it myself, but have several friends who have and they really love it- or old school condoms work too! But I always say, hormonal BC is the last, last resort I’d recommend. Hope that helps!
Congratulations and welcome back!
Your post speaks to me, as in June I had my first period in 12.5 years!! (unfortunately it was while I was on a family holiday in Portugal – how’s that for bodily payback?!) I knew I’d probably lost my period when I suffered an eating disorder while at University; but I kidded myself that it never came back because of birth control (implant – which in 70% of cases stops menstruation) rather than hypothalamic amenorrhea. After gaining back some weight and cutting back on the intensive exercise I was shocked at how much I’d hurt my body. I’m glad my body has started to forgive me.
p.s. what’s on that salad – it looks like mushy peas 🙂
So overjoyed for you regaining a cycle after so long! The body is truly amazing at what it can bounce back from!
And that would be lots of guac 🙂
I got my period at 20 years old and at the time I thought it was because of all the chemo I had when I was young but in hindsight, maybe it was simply because I was restricting/binging and my body wanted nothing to do with periods. My doctor put me on medication to kick-start it when I was 16 which didn’t work and she then put me on the pill so I could be “normal”. I stopped it a couple of years later as had no need for it and got my period the year of my 21st birthday. Thankfully after coming off the pill again a few months ago I’ve had one every month although my cycle is not quite regular yet.
Thank you for enlightening us all such crucial information!
Clare @ fitting it all in says
I am SO PROUD OF YOU!!! You are already doing and will continue to do AMAZING things girl .xoxoxoxo
thank you so much!! so excited for the years ahead for you! 🙂
God is so so good- all the time.
So happy for you and your future endeavors. When I was hospitalized for anorexia, the doctors suggested BC, but when I went to treatment they refused the idea. Gaining weight was the only way.
Now I am on BC, b/c my husband and I aren’t ready for kids, but I sometimes wish we used another method. I believe our periods are such an important way to be in touch with our bodies.
Again- so happy for you. We are all rooting for you!
you are so sweet! thank you for all the support and encouragement!
email me if you’re ever interested in chatting more about non-hormonal options 🙂 xo
Alison Z says
Robyn, I’ve been doing the progesterone and birth control thing for several years now, so draining! I’m getting married in the fall and will be off the birth control and praying for the best. In the meantime, I just wanted to say a big congratulations! What an enormous accomplishment! You should be so incredibly proud of yourself. You are already doing so much good and this new calling will only expand your impact. I hope you do something awesome to celebrate with the people you love!
Thank you so much Alison! Your support means the world!!
laura @Sheeatswell says
Robyn, Congratulations! You continue to be an inspiration to me, as a post-bacc RD student. Loved this post and the message it has.
I think that an interesting topic (not sure if you’ve covered this yet) for a future Q and A would be the topic of PCOS. I don’t have it, but know many young women that do (and none of them are overweight/have visceral abdominal fat). I feel like tons of young women have PCOS and diet and lifestyle can play a huge role in helping/managing it. Just a thought!
Yes, I’d like to hear your thoughts about PCOS. I’m affected, but I’m healthy, not overweight, don’t have diabetes or any of the symptoms usually associated with it. Thanks! And congrats on becoming an RN!
Thanks for the post idea! I’ve talked about PCOS in Q&A videos, but never addressed it in a post but would love to the best I can without interfering with Nutshell since I do have several clients with PCOS- look out for that soon! 🙂
Thank you sooo much for posting this! I’ve been in HA recovery for a year and I needed to read this today! I’ve really struggled with coming to terms with gaining weight. I’ve already gained about 20 pounds and still no period on my own. I had been on fertility meds but my husband and I decided to stop that. Learning that each body is different has been the biggest hurdle for me lately. So thanks for posting!
I am so glad to hear you stopped fertility meds to treat HA and are going the natural route- I’m thinking of you and remember that our bodies are simply a shell and people love you for your heart. XOXO
Congratulations on becoming an R.N, that’s awesome! Thanks for the great discussion on being kind to our bodies. I couldn’t agree more with you about how important it is to be in tune with our bodies and to really listen so that we can rest when we need it, workout when we need it, and eat when we are hungry. Thanks again 😀
She Rocks Fitness says
So I haven’t gotten my period in a while and I know what the problem is, but I want to tell you that my OB wanted to recommend a medication that would force me to get it and then proceeded to tell me that there would be no side effects…SERIOUSLY? How is that possible? I know what I need to do and what I need to work on. I love these educational posts that are also inspirational too. CONGRATS to you and as always your eats look DELISH! XOXO
I know your OB had good intentions but I am with you in saying NO! The body is amazing at what it can do to heal – rest, good nutrition and some good self care 🙂 Thinking of you!
I love your posts, esp. this one helping women get to the truth of our problems! I know you eat mostly plant based, but one of the biggest ideas behind a paleo/primal diet is to eat for gut health because gut dysbiosis/inflammation can cause us not to absorb the nutrients in the food that we eat (no matter how well we eat!) Regardless of beliefs on the “right” way to eat, I think another very relevant question worth exploring is: Are you absorbing the nutrients in your food or is your hormonal health negatively affected by improper digestion? The link b/w “IBS” symptoms (another medical cop-out) and hormone imbalance/irregular cycles is SO real in my case. I would love to hear your thoughts on this topic sometime.
A HUGE congrats on the RD!
I would love to research this more and address it in an upcoming post or Q&A video! Thank you for bringing this to light! And thank you for the congrats 🙂
I was diagnosed with anorexia in my mid twenties. I’d been on birth control since I was 18, so I had no idea how my ED was affecting my cycle and my reproductive health. A few years into recovery, my husband and I decided we were ready to have a baby. I stopped taking the pill and just assumed everything would fall into place. Looking back now, I know my weight was still too low and my exercise was still too intense. We finally went to a fertility doctor after two years of no period. She didn’t seem concerned about my lack of cycle and we got started with treatments. Thankfully, my body responded to the treatments and I have a 14 month old son. I haven’t had a period since he was born, but that could also be due to the fact that I breastfed him for 13 months. We will hopefully be able to have another baby very soon. I am willing to go through treatments again to have a baby and hopefully, we will be successful. After that, I am going to put forth my best effort to get my period back on my own. I know that I have done so much damage to my body over the past 7 years and I hope it will forgive me.
And congrats on becoming an RN!
so happy to hear about your precious son 🙂
take care of yourself as you go into this next pregnancy and because I’m so passionate about it, I’d definitely recommend healing your body before this next pregnancy and even being able to conceive naturally! XOXO
Brittany @ Barr & Table says
Congrats lady!! So proud of you for all of your hard work. I absolutely love your posts and just want to thank you for sharing your knowledge with us.
You are such an inspiration Robin. After battling HA for 2 and a half years and finally overcoming it when I got off the pill and stopped exercising so much, I think this message is so important to get out to everyone. Our bodies are amazing and deserve to be treated that way. Thanks so much for sharing your message. You’ve helped more people than you’ll ever know!
Wow, this is so perfect. After I regained my happy weight, I realized that it wasn’t just weight that affected my period. Stress was probably the 2nd biggest factor, and I’m so glad you’re writing about this. I still have to really be conscious about the stress I undergo everyday. Living life on a slower time schedule has and is making all the difference for me.
Yes! Stress management is SO important!! Thanks for sharing. XO
First off, congratulations!! Secondly, what is your opinion on using metformin to deal with androgen excess?
I would need to research that more, but my gut instinct is against it simply because that seems to be a quick fix and not getting to the root of the issue. Hope that helps!
Emily @ Sinful Nutrition says
God IS good indeed! You are speaking exactly what I am going through right now. Just got back from the doctor’s with normal labs, and her telling me maybe it’s just how my body is. Riiiiggghhttt. I am going for a pelvic ultrasound to rule out PCOS and then to endocrinology if that comes back normal. I refuse to be put back on the pill until I know the real reason I haven’t had a period in almost 2 years.
Thanks for all your passion and support for women’s health, and a major congrats on all your accomplishments!
Keep fighting for the real issue and feel free to reach out via email anytime! Thinking of you! xo
Kate @ Kate Lives Healthy says
Congratulations! From a fellow RN welcome to the profession! I remember how nervous I was when writing the NCLEX and huge relief that I felt after having it over with.
Congrats! That is so awesome! Love this post. Our health system loves to medicate anything and everything! Sad, but true.
Amy @ UpearlywithAmy says
First of all, CONGRATS on getting that RN behind your name…that is no small accomplishment! Second, I want to let you know you have truly inspired me over the last couple of months (since I discovered your blog). I’m an RD and I just started an MSW program to get an LCSW, RD, after my name and reading about how you balance school, work, blogging, counseling, and a social life has empowered me to strive for that healthy balance in my own journey. Thank you 🙂
So exciting about pursuing your LCSW! My roommate is doing the same thing!
Ha, its’ messy and often not balanced but somehow it all works at the end of the day 🙂
Best of luck to you!!
Congratulations on your RN! You’re well on your way to becoming a nurse practitioner. Medicine needs more people like you I think once you practice medicine (I am a PA) it becomes even more frustrating to see the advice patients with HA and similar issues are given. I am amazed at how many people are treated with prescriptions when it is glaringly obvious that they’re nutrition, stress and exercise levels need desperately to be addressed.
Any advice on nutrition for women trying to conceive? After being on OCPs for 7 years (which at this point I totally regret) my husband and I started trying to get pregnant last year. I had a miscarriage and subsequent D&C and since then no success :-/ I’ve read a lot online about an alkaline diet and I’m not sure what to think about the science behind that. Certainly the foods on the alkaline list are all healthful. any thoughts?
I love that you are a PA thinking that way!! Keeping being awesome 🙂
Email me to chat more about conceiving naturally after OCPs! [email protected]
Kate @mindfoodly says
I love this, I have so many issues with BMI as I don’t believe it gives an accurate depiction of what each individuals healthy is.
I know for me I am recovering from an ED and am in the weight gain phase. I am not sure where my period is at because I have been put on birth control. I think this is such an important post because so many women think it is ok to not get your period but it is just wrong!
this post is just what I needed to read. No one ever really realizes how much they are affecting their body by what they eat or the lack of proper nutrients. Thank you for this post and congrats on officially becoming an RD! You deserve it!!
Congratulations on becoming an RN! I cannot imagine the relief and joy you feel right now over that accomplishment, it is well deserved! I just wanted to add to the other voices commenting on this post and to say thank you for posting about a topic that personally hits home for me right now. I have been struggling with HA for a little over three years now and ironically have an appointment with my OBGYN tomorrow. This post just reinforces the decision I made earlier to avoid taking birth control, knowing it would only mask the bigger issue underlying my absent periods. Thanks again for speaking such truth to me and everyone else struggling with the same issues, its one of the reasons I love reading your blog!
Thinking of you as you regain your cycle naturally! Rest, good nutritious food and lots of self care to manage stress and the body can do amazing things!! xo
A huge congrats on passing your boards! Yay for becoming an RN!
Great post! Do you have any thoughts or what does research say about women who get their periods too often or for long periods of time with bleeding? I’m a mom and have so many friends with frequent and/or long periods. Most doctors just put them on Bc. Any other advice?
That’s typically a sign that female hormones are off and how to go about healing will differ based on individual circumstances. Email me to chat more! [email protected] 🙂
Erin M. says
Congratulations!! That’s such a great accomplishment!!
Robyn, Congratulations! You have been instrumental in my recovery progress-both in working with you and following your blog. I am thrilled for you and I know you are going to be a wonderful advocate (especially for women) in your life. Many of us do not hear this information so spelled out anywhere else. The article you wrote fits me entirely. I finally have regained my period after over 2 years. It did (and does) take a lot of replaying your voice in my mind and rereading your information. My PMS symptoms seem extreme with bouts of intense irritabily, anger and also spotting almost daily (for about the last 6 months or so). Do you have any information on how long it can take to even things out after a woman has gone an extended time without normal menstration? I want to thank you for sharing your spirituality with us as well. It’s uplifting. Thank you and so happy for your accomplishments!
It’s a joy to work with you! Thank you so much for your support!
It’s not typical to have extreme PMS and daily spotting six months out so I would talk with your doc about that- I’m happy chat further too via email! XO
Ellen C. says
Robyn, Congratulations on the RN! WhooHoo! I hope you have been seriously celebrating. I just wanted to say how much I appreciated your post. I do not have major current issues, but the first thing I thought of was I wish that more people in Medicine (Drs especially) had a background in Nutrition like you do. You understand how food affects the body and how it is much better than a medication. It is sad how others have mentioned that they have been given a medication, when it is something else that can be fixed with something easier and better for the body than a medication of one sort or another. Keep up the great work for Women.
Great post Robyn! You are such an inspiration to me and so many women.
Ashley P says
Great post! I am currently dealing with HA. I went off birth control in October because I knew it was just giving me a fake period. I’m now trying to eat more food and more frequently. It can be difficult though as I am not always hungry but I am definitely putting in more effort than I used to and eating higher calorie foods. Hopefully I’ll heal my body soon.
Ashley V says
Congratulations!! God is so good.
Thanks for this post. I’m currently recovering (correct word choice?) from HA. I was on BC for about 9 months because I was afraid of osteopenia, and I wanted to be able to keep running (which was certainly a contributing factor to my HA). I finally stopped because I wanted to solve the problem, not stick a band-aid on it. I gained about 15 pounds and am struggling with that fact, even though I have had several periods since I went off of BC. It is still a little touch and go, but the fact that I’ve had any cycles after not having any for a long time is encouraging. You remind me of one of my closest friends who just finished her DNP and deeply loves women’s health. I am so glad to have her and to have your blog in my life!
I wish I had read this post 10 years ago! I was not underweight, I did not over exercise and my diet hasn’t changed all that much. BUT, my mind, oh my mind. I was a binger and a restricter. Not restrictive of calories but rather food choices. I ate a diet close to what you demonstrate, but without your moderation. “Healthy food” was all I could eat. Straying from that path led to binges which eventually led to me trying to get enough “willpower” to get back on it again. This vicious cycle continued for 5 years- as did my lack of period. I too checked out fine at the doctor and was put on birth control. It never felt quite right and I stopped taking it. After one particularly bad episode I hit my knees and asked God for a way out. The next day I found a therapist and at our preliminary appointment her first questions was about my cycle. I was stunned. I never knew the two were related. From that month on I had a regular period. It was as if my body just needed me to know. I’ve been in recovery since that time (another 5 year process) and have come so very far and I haven’t missed a period since!
Thank you so much for sharing your story of recovery!! I know women reading this will relate- keep shining light in a dark place Abby! 🙂
Sara @ Oats & Rows says
Oh my gosh my bloglovin’ feed has not been including your posts- I am so behind! I really look forward to your posts. You are so inspiring and positive and your writing is refreshing. Congratulations on becoming an RN! I am so happy for you!
This is so inspirational. I’ve not had a period for years and have been put on birth control, I’m told until my first pregnancy at least (which, let me tell you, is not on my horizon at the moment!). I am only starting to come to terms with the fact that I need to stress less, exercise less and eat more (and necessarily gain more weight, even though I’m within a ‘healthy BMI range’, which, you know, doesn’t mean a whole lot really). Thank you!!
Remember you are SO much more than your pant size and true health goes far beyond BMI!
Thinking of you girl 🙂
Congrats!! I aspire to be a registered dietitian just like you, adding your RN is amazing! I was wondering if you have a post explaining why you decided to add begin a registered nurse! I am extremely interested in learning about your RD experience (even though that was years ago!) But the reason why I am writing this post is because I have a question on the topic of periods. I am 16 years old and got my period when I was 11 or 12. I was regular for the first 2 years, but after changing to a healthier lifestyle (0 exercise –> now crossfit and from unhealthy packaged food only–> healthy balance of foods,) I have been completely irregular. Two years ago I went 6 months without it, this year it has been a little more regular (recently I got it two months in a row!) I understand that exercise is a major stress (and school/social life- but I am working on that!) but I was wondering how should I know my limits. Can I go to the gym 3x/4x/5x a week? What is too much? I am by NO means under weight and I don’t believe I am underrating. I am actually trying to heal my relationship with food following a similar mentality to you, eating what I want when I want! The way I describe my diet is intuitive eating with a healthy conscious! Thank you for letting me ask so many questions. I would like you to know that you inspire me more than words can explain. I Love reading about your posts and I love that you give scientific explanations/ explain hormones in the posts. I find it so interesting! xoxo, Rachel
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I have never lost my period or been irregular, but I have been on birth control for the past 5 years. I use it not only for contraception but to regulate awful period cramps and acne. Any recommendations for an alternative that would also be useful for minimizing cramps and acne?