I’ve had so. much. fun. doing the weekly live Q&As on Instagram. If you’re like….what you talking about? …Every Thursday I bop onto Instagram at 5pm EST (give or take a few minutes because timeliness is hard for me..) and answer your questions about anything. Really, you can ask anything! If I don’t know the answer, I just tell you that. Or if it’s too personal or too detailed/individual where I would need to know you better…I’ll let you know that too. But I’d say, 90% of the time I’m happy to give an answer. I love engaging with you guys and knew this would be a blast, but I didn’t realize how much I would look forward to Thursday evenings. So thanks for hanging out 🙂
We talk about a variety of topics – women’s health to eating disorders to changing careers to RD education to life in general – but I’ve noticed that overall, women’s health and eating disorder questions are the most frequent. Which makes sense given the theme of this space. I would love to only talk to you guys all day and get to all your questions (wouldn’t that be fun?) but since there are so many that come in (such a good thing that I’m excited about) I thought I would answer a handful of the most common questions here in a post. Shall we?
The short answer is yes, it can be. The pill introduces different synthetic hormones into your body and different types of pills have varying amounts of hormones which affect your menstrual cycle. First make sure you’re not pregnant. Second, make sure you’ve been taking the pill as prescribed — even one missed pill can cause irregular bleeding. Continuous birth control can also prevent a monthly bleed — which is the point of taking that type of birth control and an expected side effect. Since birth control was first introduced, the amount of estrogen in the pill has decreased to make the pill safer and reduce side effects. Progestin levels have also decreased. There are now all kinds of pills with varying levels of estrogen and progestin. If you’re taking a low dose birth control, that may result in not enough buildup of your uterine lining to produce a full bleed. So you might experience spotting or no bleeding at all because there isn’t much uterine lining to shed so you don’t experience a full withdrawal bleed.
Of course it’s always helpful to take inventory on your lifestyle. I have found the research on this to be lacking, but there is some suggesting that although birth control might blunt some effects that lifestyle has on your menstrual cycles, how we eat and sleep and exercise and care for ourselves still affects our cycles – birth control or not. Underlying stress affecting your period could be from inadequate nutrition, lack of sleep, high emotional stress, or too much exercise for your body.
It’s not as likely, but yes you can. PCOS stands for polycystic ovary syndrome and is essentially a hormonal imbalance (I hate calling it a disorder) that causes irregular menstruation among other symptoms. Hypothalamic amenorrhea (or HA for short) is when your period stops because your hypothalamus in your brain stops firing a hormone called GnRH like it should. GnRH is the hormones that says “go” for your reproduction system. HA and PCOS can manifest similarly and there is overlap in the diagnostic criteria so they sometimes are confused in the diagnosis process. And less commonly, they can both exist at the same time.
The main physiological difference is that hormonal imbalances seen in PCOS don’t begin in the hypothalamus like they do with HA. That means that you can have PCOS hormonal imbalances while simultaneously having inadequate GnRH signaling from your hypothalamus. GnRH doesn’t work like it because of many factors including not eating enough, inadequate macronutrients, stress and overexercising – read more on that here. If you do have PCOS and HA though, physical and hormonal symptoms will look most like HA. Think missed periods, low sex drive, vaginal dryness, low energy, feeling cold often, dry hair/nails and others. And your LH and estrogen lab levels will likely be low. Once the HA is healed, then your PCOS symptoms will become more pronounced – irregular periods, facial hair, acne, fatigue, mood swings etc. Your labs might shift too where LH is now higher than FSH and your testosterone and/or DHEAS levels might be high. If you do have both PCOS and HA, even after healing from HA you still might not be getting a regular period because of persisting PCOS. I hope I’ve made that as easy to understand as possible. Here’s a good summary of distinguishing the two that might be helpful. Leave a comment below and I’ll do my best to clarify!
You may have heard of something called “post-pill amenorrhea syndrome” which alludes to the idea that you don’t get your period within 3 months after stopping birth control because of the birth control itself. Amenorrhea (a-men-o-ree-ah) just means you don’t get your period. “Post-pill amenorrhea” is not a diagnosis supported by research. There is not a cause and effect phenomenon between stopping birth control and not getting your period. Typically, women regain their cycle after stopping birth control within 2-4 weeks, sometimes a bit longer. But if you haven’t gotten your period and it’s been more than a couple months, that should be looked into further. Often when this occurs, there was an underlying issue that the birth control was masking. What can be helpful is seeing your health care provider to figure out the underlying issue and then working to heal that – which is often the same healing process as women who aren’t getting their period and didn’t just stop birth control.
This will totally vary from woman to woman. There’s not a black and white time frame. From my experience (which isn’t the gold standard) over the past several years working with women both as an RD and Nurse Practitioner I will say I’ve seen a period return in as quick as 3 weeks and as long as about 13 months. On average, women regain their cycles within about 3-5 months with most women regaining within 6 months. Most women who regain quicker have gone “all in” with the healing process. I think we underestimate the healing power of the human body. I was just talking to a client yesterday morning who went from no period in years to conceiving a baby in less than 3 months. I never ever want to sugar coat conception, I know it’s a very sensitive and vulnerable topic – but I say that to illustrate the power of giving your body what it needs to heal and function optimally.
If any of the above resonates with you I’d love for you to check out my e-course that walks you through the healing process, step by step. I compiled all the work I do with clients into a self paced, visual and engaging course that is more affordable than 1:1 counseling. The course covers the same information I usually cover with clients over about 8-10 sessions –  but for a quarter of the cost. I’ll walk you through why you’re not getting regular periods or no period at all, the healing process, accepting body changes and learning supreme self care. Another good place to start is with my free mini course, you can sign up up for where I take you through steps to begin healing your hormones.
I’ll leave you with a little sneak peak into the course, Heal Your Hormones, Get Your Period Back.
I have a question about the PCOS/HA thing. I was dx with PCOS at 15 all the symptoms, showed in bloodwork etc. Was anorexic, lost my period for 3 years, had all the bloodwork and symptoms of HA even after recovery to a min BMI. Gained enough weight to get my period back, still annually get hormonal panels and they don’t indicate either HA or PCOS but my periods are irregular. Basically, I’m asking can you still get irregular periods from PCOS even if your bloodwork is normal? I know PCOS doesn’t go away and I’m managing the symptoms (body hair, thin hair, etc.) but I would’ve thought if the hormonal panel was normal my period would be more regular? Or is irregular periods with PCOS like the other symptoms (i.e. bloodwork may not show it, may not have cysts but can still have irregular periods?)
You can yes…you can even have normal hormone labs and have HA. It’s more than labs – its about your history, physical exam and other diagnostic tests too. Hope that helps!
I really appreciate you being bold and talking about these women’s health topics, Robyn! Loved the preview of your ecourse. I know this isn’t the point of it buuut your hair looks great! Haha 😉
Haha I agree!
🙂
It’s definitely thin glass to skate on but if it helps just one woman I think it’s worth it!
Haha you are sweet – maybe it’s because I never do my hair so it’s all relative 🙂 thank you!
I wish I had this course a year ago when I started facing my missing period reality head on! Even still, all of your resources and support have helped me so much. I know this course will be an amazing way for people to get help with such a real problem. Also, totally off topic… but I’ve been curious and don’t know where else to ask you, where’s your favorite place to get a manicure in NYC??? I need tips 🙂 Thanks!
I’m so glad they have been helpful for you! I didn’t have 1 favorite but I did love Anne’s nails in Gramercy! There are so many places!
This information is so great and needed by so many! By the way, I did NOT know about your Instargram videos! I’m so pumped. Checking it out tonight, for sure!
Hope you enjoy them! Every Thursday at 5pm EST!
Hi Robyn! Quick question: if someone is on a low-dose birth control pill, how can they tell if that’s the reason they’re not getting a period?
Thanks for providing such great insight here!
It depends on your history, any other symptoms, labs etc. I’d encourage you to talk to your GYN!
Thank you so much for sharing your experience and knowledge on the topic. I lost my period in a time of orthorexia and exercice addiction. When I committed to gain back to a minimum healthy weight and then beyond it took me a really long time to get back my period. It took 21 months. I was followed up by an endocrinologist on the matter who was knowledgeable and fair. I got them back for the first time 2 weeks ago. I have maintained my weight, it helps to not care and stress over eating a sweet sometimes, other dealbreaker for me might have been a new boyfriend 🙂 they came very closely after another. Just to say its incredibly hard but incredibly important to relax 🙂 and for who is going through this right now, i have faith that it turn out fine in the end.
Thanks for this post and I’m excited to check out your insta stories! I am struggling with amenorrhea. After a CT scan for digestive issues, I was told I have lots of small cysts on my ovaries, but never given a clear diagnosis. I don’t seem to have any of the metabolic symptoms of PCOS. I’m going to a new practitioner in the coming weeks because I really want to get to the root of the cause. What tests do you suggest I ask for?
email me! just because they saw cysts on your ovaries doesn’t mean you have PCOS, so don’t get too concerned yet 🙂
I definitely can’t wait to learn more about this topic! I hadn’t had it long or very reguarly, so at first I didn’t really pay mind to the fact that my period kept getting later and eventually went away. At the time I wasn’t any more active than sports practives and games during the week and ate totally normal. Three years later and it hasn’t come back and we still can’t figure out exactly why. Obviously, the natural reaction for a doctor seems to be to put a teen on birth control if she’s irregular (although I really don’t support this “band-aid” fix after all I’ve learned from you), but I have Factor V Leiden so I can’t take birth control. Instead they tried putting me on Progesterone twice which was just miserable, but despite the symptoms, still no period. Currently run cross country and track for my highschool, so I’m a lot more active and I did go through struggles with my relationship with food and exercise, but I’ve grown into a much healthier and free mindset with food and exercise. Not I want to FUEL my performance and I exercise because it makes me feel amazing and I love seeing how powerful I am. That being said, it’s so hard to know what to do and how to move forward!
Very nice info and right to the point. I am not
sure if this is in fact the best place to ask but do you folks have any thoughts on where to employ some professional writers?
Thx 🙂
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Hi, I have not seen my period for two months the doctor says I am not pregnant and my belly is growing can you help me.
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Hi! First of all, thanks so much for your posts on IE. They inspire me and educate me as someone who is trying to get rid of the diet mentality.
I’m 14 and I got my first period when I was thirteen. I got it again after two months, the next after three and the next after about two. I haven’t gotten it since–it’s been five months and I’m a little concerned! My mom has PCOS but she’s not overweight and she doesn’t have acne and had no trouble conceiving four kids. I’m naturally slim and don’t have serious acne issues besides for the regular teen pimple here and there. My question is: is it normal? I asked my doctor and she didn’t seem concerned and told me to wait a few more months. I’ve heard that it takes two years to regulate, but I didn’t realize I could go five months without a period. I thought it was more like two or three. Thaknks! Sienna