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Eating Disorders, Featured, Reproductive Health, Self Care

More Reasons Your Period Is Irregular or Missing

February 8, 2018 By Robyn 34 Comments

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.


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Filed Under: Eating Disorders, Featured, Reproductive Health, Self Care

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Comments

  1. Jazz says

    February 8, 2018 at 7:44 am

    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?)

    Reply
    • Robyn says

      February 9, 2018 at 12:33 pm

      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!

      Reply
  2. Megan @ A Continual Feast says

    February 8, 2018 at 8:11 am

    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 😉

    Reply
    • Mary says

      February 8, 2018 at 1:29 pm

      Haha I agree!

      Reply
      • Robyn says

        February 9, 2018 at 12:34 pm

        🙂

        Reply
    • Robyn says

      February 9, 2018 at 12:34 pm

      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!

      Reply
  3. Courtney Glausi says

    February 8, 2018 at 1:05 pm

    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!

    Reply
    • Robyn says

      February 9, 2018 at 12:34 pm

      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!

      Reply
  4. Amber @ Bloom Nutrition Therapy says

    February 8, 2018 at 2:31 pm

    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!

    Reply
    • Robyn says

      February 9, 2018 at 12:35 pm

      Hope you enjoy them! Every Thursday at 5pm EST!

      Reply
  5. Emily Frigon says

    February 8, 2018 at 5:07 pm

    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!

    Reply
    • Robyn says

      February 9, 2018 at 12:35 pm

      It depends on your history, any other symptoms, labs etc. I’d encourage you to talk to your GYN!

      Reply
  6. Julie says

    February 9, 2018 at 1:11 pm

    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.

    Reply
  7. Jordan says

    February 9, 2018 at 10:31 pm

    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?

    Reply
    • Robyn says

      February 12, 2018 at 5:29 pm

      email me! just because they saw cysts on your ovaries doesn’t mean you have PCOS, so don’t get too concerned yet 🙂

      Reply
  8. Meah Konstanzer says

    February 10, 2018 at 9:41 pm

    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!

    Reply
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Trackbacks

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A non-diet dietitian and nurse practitioner helping women find peace with food, accept their natural body size and heal from hormonal issues and period problems.

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women's reproductive health

Women’s Reproductive Health 101

I have yet to experience postpartum myself, but I've had many clients and readers that have been through that season of life. Or perhaps you are currently living through the postpartum period. Every woman's body is different, therefore every woman's experience after giving birth will be different. What works for one woman, might not work for the next. While one woman might go through postpartum and adjust to newborn life quiet seamlessly, another woman might find it much more difficult. She might need the support of medication, therapy, extra help and many other things. One way is not better than the other - they are simply two different ways of navigating the postpartum period. I hope this post helps you better care for yourself, whatever that means for you. There's no right or wrong way to care for yourself as a mom or your new baby.

Postpartum Hormones: what’s happening in your body and how to care for yourself

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I talk a lot about moving, eating, and living intuitively so you can be well hormonally and live a fulfilling life in line with your values

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🙌🏻🙌🏻🙌🏻🙌🏻💃🏻💃🏻💃🏻 two babies are asleep at the same time in their beds (and not on me) for the FIRST TIME IN 7657 DAYS and dear lord I could cry tears of relief straight into this latte and bowl of chocolate chips bc I woke up this morning exhausted and weary and told Nick I didn’t want to parent today 🤣 Not even calling this self care. It’s sanity right now. And even if it lasts 5 minutes it will be 5 minutes of freaking glory. p.s. yes that brick is crooked bc v uneven floors are part of the charmed package of this old house
Learning over and over again in this season that f Learning over and over again in this season that feels unsettled and chaotic and longgggggg that sometimes, you just need the viewpoint of a toddler to remind you that the seemingly insignificant things & moments really are....straight up magical. And that yes, these mundane days are packed full of goodness & beauty if I keep my eyes fixed on what actually matters.
Spent two hours at Lowe’s this morning and wow, Spent two hours at Lowe’s this morning and wow, wowww 🤯 Asked at least six people where to find something and their opinion on all the options bc holy decision fatigue. Nursed my newborn on the floor of the paint aisle. And BLESS my new contractor friend Matt I found in the lumber section that pushed my cart around and helped me avoid the mistake of buying exterior wood for some DIY bathroom shelves.
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I’m giving all our bathrooms a DIY makeover and I couldn’t be more of a rookie. So shoutout to all my Lowe’s buddies and YouTube 😜 You’re making this happen.
We are now officially homeowners. WUT? We didn’t We are now officially homeowners. WUT? We didn’t plan to close on a house 10 weeks after having a baby, but here we are. And we are so, so grateful.  And I’m also terrified. We’ve moved three times and lived in three different states since we got married three years ago. After six years spent living in New York City and Boston, moving back to Charlottesville was really, really hard for me. I cried a lot those first six months because my heart ached for the northeast and for city life. I wanted to pack up and go back to Boston ASAP. It felt so different and so quiet here and at times, very lonely. Even though it felt like the next right step, I second guessed our decision A LOT.
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But here we are 10 months later ready to continue investing in this neighborhood we’ve come to love. And this community of people that have become so dear. Ten months later and it feels so, so right. And although committing to settling down here for a good bit feels really scary to me, it also brings so much peace to know we aren’t moving again anytime soon. We are here to plant and grow. And raise our babies in this house as we make it a home. It’s also really fun to have one of your best friends be your realtor. We love you @kelli.teter.nesting 🤗
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Now, to see if we make it out of this kitchen renovation all in one piece 🤪
my go-to breakfast these days is two fried eggs in my go-to breakfast these days is two fried eggs in ghee with sautéed spinach (also in ghee) and an english muffin with more ghee + some sort of jam on half for that sweet & savory combo. we discovered these local english muffins (from The Bread Basket) and they are doughy and delicious and we are obsessed.
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I’ve found that I need a solid source of protein and lots of fat for breakfast to keep me full while breastfeeding this time around vs with Cal, I was so into big bowls of pb & chocolate chip banana oatmeal. just goes to show our bodies know what they need and change cravings accordingly. also, just a psa: go pick up the maple butter from @traderjoes bc it is bonkers 🤤 and lastly, shout out to my husband bc a lot of mornings he is making this bfast for me while I nurse & try to pull myself out of bed - don’t for a moment think I’ve got it together 🤪
I’ve had many thoughts rolling around in my brai I’ve had many thoughts rolling around in my brain of if/how to use this platform in a way that aligns with how I want to live my life. I’m finding it tricky to discern that when 90% of my use on this app is for professional purposes. But I’m not sure if even professionally, it makes sense for me. Because I feel more aligned with what matters to me when I’m not regularly present here.  I’m not really sure what things will look like moving forward, but for right now I’m here to share with you that I somehow found some spare minutes between newborn & toddler life to write a post with some semi-coherent thoughts on life lately. 🤪 You can head there by clicking the link in my profile.
I’ve been completely disconnected from social me I’ve been completely disconnected from social media and that’s been vital for me during this tender postpartum period of transitioning from a mama of 1 to 2. But today, I’m bopping on briefly to share how Teddy entered this wild world with you - if you’re into a lengthy, detailed birth story, the link in my profile will lead you to the blog post 💙
Theodore “Teddy” Lars Nohling joined our famil Theodore “Teddy” Lars Nohling joined our family at 12:48am on Wednesday after a quick and swift labor & birth at home 💙 Thank you Father for another healthy baby boy & your abundant, tender love for us. What an undeserved gift.
Very grateful to be carrying another baby past his Very grateful to be carrying another baby past his due date, but also....LET’S GO DUDE. Still over here eating dates (check out the @ebbirth article on the research showing dates can help ripen (aka soften) your cervix, reduce the need for medical intervention in labor and can overall, improve birth outcomes) drinking red raspberry leaf tea and sleeping as much as possible with a 19 month old running around. And also trying to survive July in VA without public pools or splash pads bc it is BLAZIN HERE (and I’m a wuss with the heat 🤪)
#AlignPartner A huge plus of transitioning from ti #AlignPartner A huge plus of transitioning from tiny-apartment-city-living to house living is this screened in porch. This little oasis sold me on renting this house when we moved from Boston to Virginia back in November. I dreamed about this becoming our outdoor living room for at least half the year (because also, summer comes earlier and stays later down here - which has a its pros and cons 😆)  During Cal’s afternoon nap, I set up shop out here with my computer + something refreshing to drink and get a little bit of work done before my brain turns to mush and/or a find myself napping instead of working. 🤷🏻‍♀️ I can only drink so much water during the hot months before I’m over it so I’ve been mixing it up with either seltzer + juice, iced tea or @alignprobiotic’s new Kombucha On-the-Go powder sticks - all you do is mix one of the packets into ice cold water and stir. Then sip!  With quarantine life, we aren’t on-the-go much these days, but it’s still nice to have a nonperishable drink option always around. Flavor wise, it’s like a fizzy iced tea with a zingy, refreshing lemon ginger flavor.  I think it’s important to know that not all probiotic supplements are created equal. They all aren’t backed by evidence, but the Align brand is and could be something helpful for you if you feel like you need some digestive support - but talk to your healthcare provider first. I try to incorporate probiotics into what I eat - and that mostly comes in drink vs food form. Tell me how you’re staying hydrated in the comments ...because these days, it’s the little things 🤪 #AlignProbiotic **Use as Directed
Lunches for the past month or so have been some re Lunches for the past month or so have been some rendition of a sandwich + chips + fruit. SUMMERTIME 😎I’ve switched to open faced only bc there just ain’t much room left in there for food at 38.5 weeks 🤰🏻90% of the time at the end of a meal, no matter how “small” the portion, I’m feeling stuffed and like the food is in my throat (just what you wanted to read on this lovely Tuesday afternoon 🤪) but my point here is...intuitive eating doesn’t mean find-the-perfect-fullness and eat-only-when-hungry. Sometimes it means eating when you’re not hungry and feeling overly full often and trying to eat foods lower in fiber and higher in calories.
Found this photo on my camera roll today from a wa Found this photo on my camera roll today from a walk I took a month or so ago. Between quarantine and spending my days with a toddler, life is much less hurried and a lot more mundane these days. But those two things are helping me to stop & notice and to chill out on checking things off my to do list and instead just being present with whatever is in front of me. I want to have the curiosity & wonder my 18 month old has as I go about my day - with my surroundings and people I encounter and really, everything. Life is way more meaningful that way. Ending my evening with that reminder and a white chocolate chip cinnamon blondie covered in vanilla ice cream before I go take an Epsom salt bath and read.

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