Two Readers On Losing Their Periods
On Monday night we heard from Dr Grace Ross on the topic of women losing their period, a condition otherwise known as “amenorrhea”.
Tonight we hear from two readers who developed amenorrhea under different circumstances and what they’ve done to reclaim their natural cycle.
I had my first bleed when I was 13 years old and it was a “normal” period that never gave me too much grief, other than being an inconvenience.
When I was 16 I started taking Roaccutane to treat acne, and decided to start taking oral birth control, Levlen, as a precaution. I got into a bade habit of skipping the sugar pills when I didn’t want to worry about a period that month, and then every few months I’d take the sugar pills to have a “bleed”. I stayed on Levlen until September 2019 when my partner and I decided we wanted to start trying for a family.
I’ve always loved to stay active – whether that meant being at the gym or moving my body outside – and I get such a rush from the endorphins and energy. I’ve always been someone who puts up my hand to try something new. But this passion evolved into a compulsive need to exercise, and when paired with a diet that wasn’t sufficient in terms of quantity for the amount of exercise I was doing, I believed this is what lead to my period disappearing. As I increased my exercise (scaling up the weights I was lifting, increasing my daily step count, adding in a hike or a bike ride etc.) I didn’t think to increase my calories to make up for what I was burning – in fact, I probably did the opposite as I didn’t like to eat before I worked out in the morning as I was led to believe that intermittent fasting was “good” for our bodies. I have a degree in science and a keen interest in health and nutrition so I’ve always promoted others eating a wide variety of healthy wholefoods, I just didn’t realize that by doing this I wasn’t leaving any room for “fun” foods.
I started getting concerned about my cycle when I got to January, four months after stopping Levlen, and realized there was still no sign of my period. I had friends say, “Oh don’t worry! It will start to become more regular with time.” But when I told them the issue wasn’t it being “irregular” it was that I wasn’t bleeding at all,they were shocked.
I decided to visit my GP who sent me off for some blood tests to check my sex hormone levels (LH, FSH, oestradiol, progesterone) as well as prolactin, TSH and AMH. I also sought guidance from Dr. Nicola Renaldi, who is based in the US and has a popular book called No Period. Now What?, which outlines a plan for overcoming hypothalamic amenorrhea. Her work has helped thousands of women reclaim their periods (and get pregnant, if that’s their goal!). During this time, I also went to a fertility specialist who put me on a 5mg cycle of Letrozole (an ovulation induction drug). When this failed, she wanted to go straight to IVF which I didn’t agree with so I discontinued under her care.
I’m now on the “All In” protocol laid out in No Period? Now What. The protocol includes eating a minimum of 2,500 calories a day and reducing exercising to a minimum (ideally only light yoga and walking). I’m also on a slightly higher dose, 7.5mg, of Letrozole. This season has been a huge adjustment for me, and I’ve found it challenging to deal with the inevitable weight gain. Six months later, after truly resting and listening to every hunger cue, I have not only had recent blood tests showing that my hormone levels have double, plus my hairdresser noticing so much new hair growth, I can also say that I have just had my first period! It is such a relief and I’ve never been so happy to get cramps and chin breakouts.
I urge anyone who is on birth control and participating in strenuous exercise to check with their GP that everything is cycling normally. I’d also recommend looking into the work of Dr. Stacy Sims; she provides awesome information for women who train, and has created a hashtag #WomenAreNotSmallMen to highlight our different needs and requirements.
I first went on the oral contraceptive pill, Levlen, when I was in high school because I was experiencing excruciating period pains. That pain all but disappeared when I started taking Levlen, and I loved being able to control the timing and frequency of my periods. I was on the Pill for roughly three years, and often got in the habit of running the Pill packets together so that I could skip the “chore” of a monthly bleed as it was always something I dreaded. After three years I switched to the Depo Provera injection as my main form of birth control and I stayed on that for close to ten years. I loved that the injection meant that I didn’t have to worry about a monthly bleed – that was, until I realised I couldn’t get my cycle back at all.
My sister, who’s three years older than me, had trouble conceiving her third child, and after a long period of trying to conceive naturally it was discovered that she had an extremely low ovarian reserve (egg count). This became the catalyst for me coming off the Depo Provera – to assess my own fertility. I was almost 30 and I didn’t have a partner, so my thinking was that I wanted to know if there was something “wrong” now, so that when I was in a position to start a family it wasn’t too late to address any reproductive problems. I also wasn’t sexually active at the time so it felt like a safe time to come off birth control and let my cycle return to normal.
I knew that it could take anywhere up to six months for my cycle to return, but when eight months had passed and I still hadn’t had a bleed, I decided to visit my GP. She explained that in some cases periods can take longer than six months, but wanted to run some blood tests (which came back relatively normal) and a vaginal ultrasound just to rule out that there wasn’t an underlying issue. Her reasoning behind the vaginal ultrasound was that because I hadn’t had a period in so long, I might be experiencing a build-up of my endometrial layer – however the ultrasound came back clear. Our next step was to start me on a course of oral progestogen; a drug routinely used to stimulate a withdrawal bleed and kickstart a woman’s natural cycle. Sadly, this didn’t work, and this is when my GP referred me to Fertility Associates. I’m lucky to have health insurance so I felt comfortable exploring all my options here.
About a year before I came off the Depo Provera, I was in an incredibly stressful job as a lawyer; looking back on that time, I was in a constant state of panic, and working in a very unhealthy work environment often plagued by conflict. Because I was on the injection and not getting a monthly bleed, there was no way to know if I “lost” my period during that time, and my fertility specialist believes that my absent period, 12 months later, was likely a hangover from that stress – something she called “recovering functional hypothalamic amenorrhea”.
After being diagnosed with amenorrhea, my specialist requested I undertake monthly blood tests over a six-month period to monitor my levels of Oestradial, LH (luteinising hormone) and FSH (follicle stimulating hormone), and I was given strict instructions to not lose any weight (I was a healthy, stable weight), always eat before exercising, and be more diligent about managing stress.
In a lot of ways, my diagnosis gave me the validation I was looking for that the stress I endured at my old job was not normal, and not sustainable. My amenorrhea showed me that just because we have the capacity to work at such a fast pace in our twenties, doesn’t mean that we should. And that if we run on empty for long enough, eventually something’s got to give – and in my case, it was my monthly cycle. I also felt an element of guilt that I’d put my body such a state, as I hadn’t perceived my stress to be “unhealthy” or anything different to what my peers experienced. As a lawyer, like many other professions, being stressed is a badge of honour.
Six months after visiting Fertility Associates, and fifteen months after first coming off the injection, my period has finally returned.
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