Periods.
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 which I knew because my clothes still fit. 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 modifications. 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. And health care providers are so limited on time due to insurance reimbursement and other barriers. 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, other body systems suffer. bone health deteriorates leading to osteoporosis (leading to lots of injuries) in addition to infertility, atrophy of the vagina and breast and an increased the risk of cardiovascular disease 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 have very low body fat, yet healthily menstruate. There are also women whose run marathons and regularly menstruate. 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.
This is fantastic information. It’s got me thinking. I’ve had HA for around 6 years and for the last year have been on the pill (prescribed by my doctor). If I didn’t, my bone health would keep deteriorating (I was diagnosed with osteoporosis 3yrs into my anorexia). I’m definitely within a ‘healthy weight’ range nowadays, have been for 2 years; but am continually stressed, anxious and (as a result) fatigued. I exercise regularly, but not super excessively…. I honestly think the issue is just managing my stress… but that’s the thing. Realising that I can’t seem to control my stress levels makes me so stressed! Haha.
Turning to prayer and the Word.
Thank you Robyn!
I know it can be a frustrating road but practice self care and trust your body that if it’s taken care of that is the best you can do! Truth and prayer is so good for the soul 🙂
Dang, this was a big eye opener for me. Do you know anything about the IUD in relation to the menstrual cycle? I’m on Skyla and my NP said that I would likely not get any period because I’m a runner and have a history of missing my period in the months where I am more active. Obviously I shrugged it off and trusted a Ob/Gyn NP but this post is making me reconsider. I know you’ve got a lot on your plate but I’d love to hear your thoughts.
Depending on the IUD you might not get your cycle each month – but I will say if you’re running and have a history of skipped periods even off the IUD you could be dealing with exercise induced amenorrhea. Of course I don’t know your history so that’s a general statement 🙂
Great post. I think it’s also important to try and get your body back on track sooner rather than later, even if you aren’t planning for children right away. I missed periods for years, but didn’t consider it an issue because I wasn’t actively trying to get pregnant. Fast forward to when my husband and I were, and it was a long road of doctors appointments, and mentally struggling to accept what I needed to do to get my body to a healthy place.
Happy to say I am now 5 months pregnant 🙂
Thank you for sharing Courtney – women need to hear that!
Congrats on the sweet babe!!!!
This was so informative! I struggled with an eating disorder in high school and stopped getting my period for 10 years. It only just came back this year, at the age of 26. I had several doctors who totally blew me off about it, tried birth control, etc. One even said “no worries, when you want to get pregnant, we will reduce your running and have you put on a few pound.” I think my doctors took a different approach to yours – once they heard “marathon runner,” they assumed it was just my running and never asked about my food intake.
Changing my eating and upping my fat intake has been huge! I feel so much healthier.
Thank you for this. Thank you for sharing your knowledge and passion. Thank you for being objective and thoughtful. I always learn and grow from your posts <3
thank YOU for reading!!!
Very helpful! I finally found a ob/gyn NP I LOVE who stressed how imperative it is that I get it at least 4 times a year – not just for fertility, but she also said it put me at an increased risk of (endometrial – i think) cancer years from now.
I had lost my period for 4 or so years. I had just lost 60 lbs (slowly, over a year), but it wasn’t until I picked up running – stress that my body clearly wasn’t used to – that I lost it. I stubbornly refused to believe it could be b/c I was training for marathons and eating low carb that caused my period to go MIA, because, again, I was at a healthy weight and I wasn’t exercising for hours on end daily.
I think it’s crucial that women do not compare themselves to others – just because a girl weighs 20 lbs less than me and still gets her cycle, doesn’t mean that I can!
Fortunately, I’m back on the carb train and for the past five months, have gotten it like clock work. I’ve also cut out one day of running and replaced it with strength training.
And I’m with you Robyn – despite it being somewhat annoying and inconvenient, it is such a good feeling to know that my body has the energy to function normally!!
Great post. In my sports nutrition class my professor talked a lot about how it’s a false belief that it’s “normal” for females to not have a period. Sadly, a lot of coaches tell that to their athletes. I had a gymnastics coach tell me that before. Thanks for sharing.
I LOVE this! I’m still in the middle of all of this… I’m in college and every doctor I have gone to hasn’t even blinked an eye when I tell them of my lack of period for over 2 years!! They assume it’s just the stress of college. But I’m like– other people are getting their periods!! Ugh. Now I’m not excercising at all and eating ALL the foods… Still waiting! I think I reallyyyyy need to take the relaxing thing to heart. I stress about everything.. Thanks for the super helpful post!
Relaxing and practicing self care to help you destress is so important! Thinking of you!!
Thank you for posting this! I kind of have the opposite problem – before I went on the pill a couple years ago I had pretty regular and normal periods. But since I’ve been on the pill I often don’t get a period at all. I’ve tried a few different pills and all eventually have the same result of no period. My doctor says this is normal, but I still don’t feel like it’s right. Not really sure what I can do about it though other than going off the pill.
Love this post and it’s something I have questioned about myself the last 6 months. I have been on the same birth control for 5 years. I have always had a regular period on it until I started strength training. THe last six months I have become in love with Orangetheory and noticed that my period hasn’t come at all. I have a healthy BMI and body fat %, and was not sure if its my BC that prevents my period (I’ve been told that being on the same BC can cause periods to not come) or something else. Do others have this experience?
It sounds like it might be the orange theory – doing that intense exercise too often can be too stressful onto body – thank you for reading!!
Perhaps trying a non hormonal copper IUD would be helpful – a thought to run by your doc!
Thank you for this post! Every time I travel for more than one month, my period just dissapears. I even missed my period for the whole year when I was studying my Masters degree in another country. I went to two doctors in the UK and in my home country and they both told me it was probably just stress and not to think about it. It was such a dissapointing answer. During that year I was doing exercise at a daily basis to keep the stress away but I think I only made it worse. The last month of the Masters I had a nervous breakdown, so I stopped my routine and took a nice trip with my husband and then my period returned.
I feel like I could have written this exact post myself! Thanks for all you say! It’s so informative and encouraging! You have really helped changed who I am as an RD and my own nutrition philosophy!
So needed to read this today. I’m recovered from anorexia and got my period back but it recently went missing again. I know resting and eating more and gaining some weight is necessary but that’s scary, particularly for someone with an eating disorder past.
Thanks for giving me a little nudge in the right direction. You’re such an inspiration to me! <3
This is so perfect. I went through a very similar problem in college and know how tough it is to have doctors tell you that birth control is the answer or there isn’t anything to worry about. I, like you, am always so happy when I get my periods now each month because it’s a sign that I’m taking care of myself and can run and do the workouts I love while remaining healthy. Thank you so much for continuing to spread the word about such an important topic! Have a fabulous day!
This post was so helpful! Thanks for sharing! 🙂
Omg I JUST got my period back after 3 years too! I was thrilled when I lost it, but at the same time I knew I wasn’t healthy. Thank you SO much for sharing this. I’m always inspired by your blog Robyn and I am definitely looking into nutrition school or becoming an RD. 🙂
I needed to read this. I have had *really* long cycles (like ten days + longer than normal) the past three months after usually very regular periods and no problems.( Except when I had an ED and missed my period for over 9 months – restored 6 years ago though now.) I have taken up running consistently for the first time ever and suspect this is the culprit and/or not adequately eating.
Questions: Are suddenly irregular/delayed cycles (talking 35+ days) indicating lack of ovulation or just that my cycle is slowly dying off? And, could a history of anorexia and losing my period precipitate my body shutting off menstruation more quickly?
Thanks so much for this! I needed a wake up call rather than burying my head and telling myself it’s fine.
Hi Jessica!
Happy to answer your questions the best I can! Since I don’t know a full history on you go ahead and email me and we can chat more 🙂
[email protected]
AMEN!
Hey Robyn!Awesome post. Question- what if your period is very light? Personally, I have never skipped a period, but there are certain months where it really only lasts 2 days! Could this also be an indication of not having enough energy intake as well?
I am wondering this too. I am pretty thin (5’5″ 110 pounds) but my body has always been this way. I do run a decent amount and eat very healthy, and have never skipped a period even at my lowest weight. They only last about 2 days though.
The flow of your period can indicate things going on — if it’s super light then you’d want to take a step back and see if there are lifestyle things you could improve. If that has always been your baseline though, then that could just be your body!
Hi Robyn,
Thank you so much for this post. I’ve not had my period for 5 years now (due to an eating disorder) and I’m in the process of reworking my brain to pull myself out of it. One issue I’m having that’s killing my self confidence if my hair. It’s terribly brittle, balding and flat. Although I’ve gained weight, I still need more. I was just wondering if the issues with my hair are due to being underweight, or not having my period? Is there any correlation between lack of a menstrual cycle and poor hair health? I’ve been reading your blog for ages, but I’ve never commented. Forgive me if this isn’t where questions are meant to be asked!
Ashlee
Hi Ashlee!
Nutrition, diet and stress all play a big role in hair health – so the direct correlation likely isn’t your cycle (although it could be contributing due to insufficient hormones) but its your nutritional status that is likely the cause!
Thank you for this! I have never had my period, and I went to the gynecologist only to be put on the pill without any further questioning. I was extremely confused and upset by this, but I think I need to focus on restoring my weight to its natural theshold and skip the pills.
You’re the best Robyn. I’m forever thankful for your medical wisdom.
Thank you so much for writing this and promoting education and awareness. I lost my period from being under a healthy weight, was told it was not a big deal to lose my period, and was put on birth control. It took me a while to really face up to the root of my problem. Looking back, I wish there had been a conversation with my doctor that could have helped my disordered eating habits earlier.
Absolutely fabulous content, as always! The BMI chart says I’m not underweight until under 107 lbs but I need to be around 115 for a healthy cycle. It’s so important that people realize that there are all individual thresholds for healthy weight.
Any thoughts on periods being late with regards to this type of stuff? I rarely miss my period, but its been both late and early a lot lately, and I’ve been under a ton more stress,life, etc. And was just curious if you had any thoughts!
Yes! An irregular period isn’t “normal” either so something to pay attention to!
You are totally speaking my language here and telling my own story pretty much to a T. Now an RD, missed period for three years in college likely due to restricting, exercise (on an empty stomach), and stress. Shrugged it off, went to doctors for testing, put me first on Metformin (!) and then on the pill. I was always in denial that it was a problem because my BMI was >18.5. It wasn’t until I made some new friends who spoke truth into my life (and also loved dessert and inspired me to enjoy it again too) that change came. I gained 10 lbs and voila, period came back on it’s own a few months later. It was intermittent, but it was a sign that my body was healing. Still not perfect, and still praying hard that getting pregnant will not be an issue, but freedom from that bondage and need for control is the best. It’s amazing to eat freely and exercise because I want to, not out of a need for control. Great post!!
I almost started crying reading this today. I’m going on 7, yes 7 years without a cycle (minus the year that I was on Birth Control). My gynos have never been concerned, and have only offered to prescribe me pills to get it back. This is such a good reminder that what is happening to my body is NOT normal, and I need to act now to get it back on track.
i would love your input on this! about 8 years ago right around the time i started college i began exercising a lot and undereating. i lost my period, but went on bc shortly after. in the past couple of years i have dialed back the exercising but still do so pretty regularly, however my attitude toward food has changed immensely.. i don’t restrict and have gained a few pounds. last summer, i decided i wanted to go off the bc to see if my body would regulate itself. after a few months my period had not returned, so i saw my gyno and she said b/c my estrogen was low, she really wanted to put me back on bc. i also had a dexa scan that showed slight osteopenia (however my vitamin D is normal..) i started taking calcium supplements for this. anyway, i feel like the lack of period issue wasn’t really addressed and i’m getting toward that age where i am considering children in the next 5 years and just want to make sure everything is working right!
Hi there,
I appreciated this article since I was looking for information on if I should expect to have a period after around 7 days of not being allowed to exercise. I have not had a normal period since Janurary 2016, have had Skyla since January 2017, changed my eating and exercise habits in May 2015. I have had about 3 “periods” since Skyla that have all been very light and short.
I have been diagnosed with orthorexia and am working with a dietitian and psychologist, however, I am getting my tonsils out this week. I will be on a liquid diet for some time (around 1 week according to my surgeon), but I am also not supposed to exercise for 7 to 10 days.
Let me know if you have any resources for me please.
Thank you!
I appreciate the information but it would be nice if your wording was more inclusive. Trans masculine and non-binary folks deal with these issues as well. 🙂
Hi !
I lost about 20kg of weight in the past half year or so through a combination of calorie restrictions ton and lots of exercising…..and I haven’t had my period since three cycles…im really concerned about this. I want to increase my calorie intake and reduce exercise but I am so afraid that I will regain weight !! Some guidance would be highly appreciated
hi Erica,
I’d love to help. you can check out my blog posts or if you’d like 1:1 consultation, I have a private practice where you can work with me on an individual basis – head over to http://www.reallifewomenshealth.com too read more on that 🙂