For individuals with a uterus, a consistent monthly menstrual cycle serves as a crucial indicator of overall health, often regarded as the fifth vital sign. The absence of menstruation signifies abnormal estrogen function, impacting various bodily functions beyond reproductive health. If you're experiencing a missing period, consulting a hormone health specialist, such as a reproductive endocrinologist, is essential. Pairing this with a Health At Every Size (HAES) dietitian specializing in women's health and eating disorders can provide comprehensive support.
Understanding Amenorrhea
Amenorrhea, the absence of menstruation, can lead to significant health issues and fertility challenges if prolonged. While an isolated missed period might stem from a stressful event, persistent absence for over three months warrants deeper investigation. This article primarily addresses hypothalamic amenorrhea (HA), frequently triggered by weight loss, excessive exercise, or stress, and briefly touches on period loss related to Polycystic Ovary Syndrome (PCOS).
Hypothalamic Amenorrhea (HA): The Impact of Weight Loss
Despite the common perception of weight loss as a positive health outcome, it can disrupt hormonal balance, leading to HA. This condition arises when the hypothalamus, a critical brain region, reduces or ceases the release of gonadotropin-releasing hormone (GnRH), which is essential for initiating the menstrual cycle. Reduced GnRH levels result in decreased estrogen, disrupting menstruation.
HA can affect individuals of all body sizes, often overlooked in larger bodies and misdiagnosed in thinner ones. It is diagnosed when a previously regular period disappears for three or more months, even without reaching a low BMI. Extended HA can lead to high cholesterol, reduced bone density, fertility issues, anxiety, and depression.
Causes of Amenorrhea Due to Weight Loss
- Low Energy Intake: Over time, insufficient calorie consumption alters GnRH release, suppressing the hypothalamic-pituitary-ovarian (HPO) system and hindering normal follicular creation, ovulation, and estrogen production.
- Hormone Reduction: Reduced levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) can lead to anovulation, infrequent periods, and eventually, amenorrhea.
- Decreased Body Fat: Adequate body fat is crucial for maintaining reproductive functions, including menstruation. Maintaining a lower body weight can cause amenorrhea, even without recent weight loss or intense exercise.
Polycystic Ovary Syndrome (PCOS) and Menstrual Irregularities
PCOS is a complex hormonal condition characterized by abnormal hormone function, metabolic issues, hair growth, and mood changes, all affecting menstruation. Cysts on the ovaries disrupt the regular release of eggs, leading to irregular or absent periods. Insulin resistance and inflammation, common in PCOS, can worsen these irregularities. It's important to note that women in smaller bodies can have PCOS, while those in larger bodies can experience HA, highlighting the need for accurate diagnosis through blood work, irrespective of body size.
Read also: Weight Loss and Missed Periods: What to Do
Other Potential Causes
Uterine fibroids, noncancerous growths in the uterus, can also cause hormonal imbalances or physical obstructions, leading to irregular, missing, or heavy menstrual cycles. While their exact cause is unknown, they are linked to hormonal changes, genetics, and growth factors.
The Role of Diet Culture and Disordered Eating
The pervasive culture of thinness and perfectionism significantly harms women, leading them to pursue restrictive diets with detrimental physical and mental health consequences. The wellness industry often promotes "healing your hormones" through restrictive diets and supplements, which can be harmful and based on pseudo-science. Obsessing over perfect eating and restricting food intake can trigger health issues, including period loss.
Nutritional Strategies to Regain Your Period
Restoring menstruation typically takes around six months with proper nutrition, requiring patience and commitment. Whether pregnancy is desired or not, regaining a regular cycle is vital for overall health. Key nutrition and lifestyle tips include:
- Adequate Calorie Intake: Consuming enough calories is crucial to restore energy balance. According to experts, a minimum of 2500 calories daily is essential, with potentially more needed for those who exercise, are underweight, or have recently lost weight.
- Balanced Meals and Snacks: Eating regular, balanced meals and snacks throughout the day helps maintain energy balance. This typically involves three meals and snacks, each containing approximately 50% carbohydrates, 20% fat, and 30% protein, consumed every 2-5 hours.
- Unrestricted Eating: Avoiding restrictive mindsets, such as limiting food groups or calories, is important. The body needs sufficient carbohydrates, fats, and proteins to produce hormones and maintain regular menstruation.
- Intuitive Eating: Practicing intuitive eating, which involves giving yourself unconditional permission to eat what you want when you’re hungry, can help break free from harmful food rules.
Lifestyle Adjustments
- Prioritize Sleep: Aim for 7-9 hours of sleep per night to support hormone regulation. Establishing good sleep hygiene practices can improve sleep quality.
- Manage Stress: Reducing stress levels is crucial, as stress can disrupt the HPO axis and affect menstruation. Relaxation techniques, such as meditation and deep breathing exercises, can be beneficial.
- Modify Exercise: Adjusting exercise routines is essential. Excessive exercise can contribute to energy deficits and hormonal imbalances. Reducing the intensity and duration of workouts may be necessary.
Addressing Weight Bias and Misdiagnosis
Weight bias in healthcare can lead to misdiagnosis, with larger-bodied individuals being incorrectly advised to lose weight and smaller-bodied individuals being misdiagnosed with HA. It's crucial to recognize that weight is not always an accurate indicator of health, and restrictive diets can worsen HA.
The Importance of Professional Help
Seeking professional help from healthcare providers, registered dietitians, and therapists is essential for individuals experiencing amenorrhea. Registered dietitian nutritionists (RDNs) can assess your nutritional needs and provide strategies to restore your period gradually. They can help you understand how much energy (or calories) your body needs to run optimally, ways to boost nutrient intake, and strategies to make changes to restore your period gradually. Professional counseling can address underlying behaviors such as excessive exercising, stress, or untreated eating disorders. Therapists can help address disordered eating patterns, body image issues, and emotional stressors that contribute to HA.
Read also: Keto Diet & Menstrual Cycle
How to Get Your Period Back After Weight Loss
Lifestyle changes are the first step in getting your period back after weight loss. Since low energy intake leads to amenorrhea, increasing how much you eat and reducing how much energy you use from physical activity and exercise will help restore the energy balance within your body. A common recommendation is a one to two kilogram (or 2.2 to 4.4 pounds) weight gain or a 5% increase in body weight, resulting in getting a period back within 6 to 15 months using an intensive education and managed exercise program. Each person is unique and may need to gain more weight to regain their monthly cycle.
Monitoring Your Progress
Restoring your period is a multi-faceted process spanning across your whole lifestyle. These changes will take time to implement and regain balance in your body. Set daily, weekly, and monthly goals. Track goals and progress on paper or by phone. Little steps each day will help you restore your health and period. This week’s goal could be to prioritize breakfast five days this week and then come up with three or four breakfast ideas to make that week.
Potential Long-Term Consequences of Amenorrhea
- Infertility: Anovulation, a basic feature of weight loss-related amenorrhea, can lead to infertility.
- Bone Loss: Prolonged hypoestrogenism can diminish bone mineral density, leading to osteopenia, osteoporosis, and an increased risk of fractures.
- Cardiovascular Issues: Long periods of hypoestrogenism can lead to cardiovascular disease due to endothelial dysfunction, reduced nitric oxide bioactivity, and altered lipid profiles.
- Mental Health: Hypoestrogenism can affect mood and increase the risk of mental disorders, such as anxiety and depression.
Lifestyle Changes to Promote Menstrual Health
- Adopt a Balanced Diet: Prioritize fruits, vegetables, whole grains, low-fat milk products, and lean protein sources. Limit added sugars and processed foods.
- Incorporate Strength Training: Strength training builds bone density and content, helping to offset bone density reductions from hormonal changes.
- Prioritize Self-Care: Make time for activities that help you function well and feel good, such as preparing nourishing meals, spending time in nature, and connecting with friends.
Read also: Keto Diet Effects on Women's Hormones