They’re annoying (because hiii monthly bleeding from down there), yet amazing all at the same time. I never appreciated my period until I didn’t get it regularly for over three years. And I was told by doctor after doctor to do a progesterone challenge or go on birth control. Really, I was just nuts about running and needed to gain a little weight and boom. Period. No drugs required.
Nowadays, when I’m regularly getting cycle I’m like…actually, authentically excited because it tells me things are working right in my body. And if it doesn’t come, because there has been a month here and there when it hasn’t, I take a step back and look at what has changed in my life. Am I stressed? How is my sleep? Am I eating enough? (that’s actually now never really the problem) Have I increased how much I’m running without being mindful of that?
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.
My BMI was lower than my natural set point. Note on BMI –> women menstruate with a whole range of BMIs, what’s most important is that your body is at weight that is healthy for YOU. My senior year of high school and into my sophomore year of college I was on a spring break diet or simply trying always lose a few pounds (that sounds so exhausting now). Then I started to learn about the body and how it works so I ate more, but even though I was eating more responsibly, I still stayed around the same weight, still on the lower end of a “healthy BMI,” not once was I asked about exercise or what I ate by any physician.
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.” WHAT?!
I don’t want to sound like I know more than doctors or other health providers because I most certainly have so much to learn and there are incredible providers out there. 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. I was at a dinner hosted by Monte Nido with a bunch of RDs who work in eating disorders and we got on this topic, and the passion surrounding this was palpable. I loved it because passion fuels change.
I could go on and on because I get so fired up about this topic. 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 cortisol – a natural and normal response to exercise. But these are the same hormones the body releases during the “fight of flight” response to any stressful situation (from you forgetting your wallet to you running from a burning building). Everyone’s body has a different threshold of when stress starts interfering with your hypogonadal pituitary axis to keep your menstrual cycle flowing regularly.
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 an NP…this is a big freaking deal. When your period goes missing, there’s an altered production of reproductive hormones and women often are estrogen-deficient (there are other reasons as well).
Estrogen is like the queen of female hormones and when there’s not enough of it, bone health deteriorates leading to osteoporosis (leading to lots of injuries) in addition to infertility, breakdown of the vagina and breast tissue and there is even research to show prolonged exercise-induced amenorrhea may increase the risk of heart attacks later down the road. I don’t say that to scare you, but instead to perk our heads up and be like ok…this is not normal and not okay.
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. That is what research shows. That is not the end all be all. But I hope it puts perspective on how having little body fat is usually not healthy.
In light of all the above though, every woman is different. There are women who run marathons and have very low body fat, yet healthily menstruate. There are also women who have an exercise threshold that 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 rhythmic pulse of hormones 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 foods 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. With intuitive eating, your body will tell you what it needs when, we don’t have to track or overthink things. We need foods that nourish our body and foods that nourish our souls too. Because stressing about eating healthy and avoiding all processed foods, well that’s a big point of stress and that’s not good either.
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.
Seeing clients get a period for the first time in a long time or the first time EVER is my favorite thing, even better when they get pregnant naturally after being told they needed infertility treatment.
Our lady health is so so important.
Want more on this? Here are more posts I’ve written on this very topic <3