My Struggle with Hypothalamic Amenorrhea (HA). How I got my period back.

If you follow me on Instagram you may have noticed my post last week where I welcomed back my monthly visitor (this is what my grandmother would say) after a 10-year absence. I’ve kept pretty quiet about my struggle with HA. To be truthful, admitting my illness made me feel like an imposter and a fraud. How could someone whose job and life revolved around helping women find and nourish their own fertility be infertile and unhealthy herself?

I’ve helped countless women in my nutrition practice regain their cycles and balance their hormones. I’ve also supported hundreds more in my job as a midwife though their pregnancies and in the early months postpartum. Yet here I was, no period, no cycles, in fact, I had hormones in general (aside from cortisol). Sick, tired and at my wits end something had to give.

 

How did I lose my cycle?

 I lost my cycle 10 years ago directly following the sudden death of my fiancé. I was in a busy midwifery residency, which on it’s own was stressful, but when I lost my partner I had to find ways to cope that would allow me to feel like I had some sort of control over my life and simply keep going.

IMG_2975.JPG

I’ve always loved mountain activities like rock climbing, backcountry skiing and trail running. So, while in the final years of my residency, I took it upon myself to stay as “fit as possible” ,  to enable myself to enjoy the sports I loved and be fast and strong enough to keep up to all my mountain guide and professional athlete friends. The thing was, I wasn’t a professional athlete, I was staying awake for 30+ hr stretches regularly catching babies and instead of sleeping and resting to recover I would run 15- 30km. While this genuinely did feel GOOD, it resulted in over exercise, under fuelling and a general lack of relaxation in my life.

Some people call what happened to me a “female athlete triad”, but essentially what it means is you are sending your body the signal that all is not well. You force it to go into a state of self-preservation. With a lack of fuel and an abundance of stress hormones (like cortisol, which is produced during excessive exercise and a hard job where you often don’t sleep), your body prioritizes survival and shuts down reproduction because it fears that a pregnancy would not be able to be sustained.

Sometimes tragedy can be a blessing in disguise 

Sometimes tragedy can be a blessing in disguise 

            In October 2016 I had another terrible climbing accident that left me in a cast for 8 weeks and kept me away from midwifery for almost 8 months. Although I tried to exercise during this time, being in a cast and in terrible pain forced REST on my body. I also experienced regular predictable sleep, for the first time in 12 years. I ate the same but overall, my calorie deficit was reduced and my body’s hormonal systems WOKE UP! I started to have all the symptoms of PMS (sore breasts, cramps, bloating). My body was starting to grow ovarian follicles, which produced precious ESTROGEN. This surge of estrogen stimulated my body to start holding onto body fat again.

Get psycked to buy new clothes...and belts:) For the record, I'm now ANOTHER jean size larger than I was here and I give zero fucks about it. 

Get psycked to buy new clothes...and belts:) For the record, I'm now ANOTHER jean size larger than I was here and I give zero fucks about it. 

Over the course of 8 months I gained about 15lbs and went from a body fat of 16% to 24%. My body did this despite any modifications in my diet and despite my resumption of a high level of activity. My body wanted to survive and heal. For most women to regain their cycles they need to overshoot their previous weights and body fat percentages by an average of 5 lbs and 3-5% hitting a new “set point “ of sorts. It’s worth noting that a fertile BMI ranges anywhere from 21-24 and fertile body fat % ranges from 22-26%. If you’re below this, I’m sorry to say, but 90% of you will have to gain weight to regain your cycle.

Recognizing that my body was taking charge of it’s own health and fertility, I finally decided to pay attention and support my body’s valiant efforts to recover a cycle, hormonal health and my own precious fertility.

How did I do it?

There are lots of ways to get your period back. Some things will work better for others but these are the things that worked for me.

Get properly diagnosed

Hypothalamic amenorrhea isn’t something you should “self diagnose”. It could me a symptom of a much bigger issue. Approach your primary care provider and find a good functional medicine specialist to work with you to diagnose the cause of your lack of period. Here are the tests you should be asking for:

1.     Blood Hormone Levels: Estradiol, progesterone, LH, FSH, testosterone, cortisol, prolactin and b-HcG. Most women who have HA have: Low estrogen, low to absent progesterone, low LH, low FSH, low testosterone, high cortisol.

2.     Thyroid hormones: TSH, T3/T4, TPO antibodies, Reverse T3

3.     Blood nutrient levels: B12, Vit D, Iron and ferritin

4.     DUTCH urinary hormone panel. This is a GREAT test that I did and I now offer to patients. It helps diagnose problems with hormone pathways and tests for not just hormones but also hormonal metabolites

5.     Ultrasound: To check for excess cysts (when combine with high testosterone this may indicate PCOS) and test for uterine thickness.

 

Diet:

1.     Move less and eat more: Reduce and aim to eliminate your caloric deficit. If you need help calculating your calorie and nutrient needs you can use an online calculator.

Never restrict when recovering. This organic vegan chocolate ice cream (with magic shell) was a key part of my recovery :) 

Never restrict when recovering. This organic vegan chocolate ice cream (with magic shell) was a key part of my recovery :) 

2.     Don’t restrict any macronutrient: You need carbs, fats and proteins to be healthy and produce hormones. Trust me I tried everything (low carb, high carb, keto, high protein)  but in the 3 months preceding my period returning I found that I was intuitively eating a balanced diet of about 33% fat 33% protein 33% carbs

3.     Eat clean, well-sourced, organic and nutrient dense foods: These are better absorbed and will cause less stress in your body. An anti-inflammatory diet is best. If you need help finding the best diet for you, send me a message. 

4.     Let go of foods and drinks that may cause stress to your body: While I’ve never been a big caffeinated coffee drinker thanks to a CYP1A2 enzyme gene) one of the biggest things I did was give up coffee (opting for organic Swiss water process). If you suspect food intolerances or if your digestion isn’t top notch, I’d encourage you to work with a practitioner to tease out what could be triggering your symptoms. All forms of stress should be eliminated in the body. I recently started working with a woman who lost her cycle and regained it by dietary modifications alone! It’s an important piece to the puzzle.

Exercise:

Move less: You’re going to have to mellow out a little bit or a lot. While some women have to give up exercise 100%, honestly, I didn’t completely. Much of the research I’ve come across suggests that giving up exercise completely (aside from short gentle walks and yoga) may help your period return faster but what really makes a difference is having a higher percentage of body fat sustained and maintained over multiple months. This sends signals to your hypothalamus that there are enough resources available to sustain a pregnancy.

How you choose to get there is up to you. But seriously, have a solid look at your workout routines and ask yourself if they support your body and goals or are causing more harm than good.

Sometimes the best activity is rest and spending time with the people you love

Sometimes the best activity is rest and spending time with the people you love

Supplements:

I’m a firm believer in “smart supplementation”. I don’t like to over supplement and I think that there is no real one size fits all approach to adaptogenic or hormone balancing herbs. If you’d like help finding what may work for you please send me a note. I was continually testing my hormone and nutrient levels using DUTCH testing and blood analysis to ensure smart supplementation. Here’s what I tried and here’s what you can try too.

1.     Vitamin C: Supports your body’s response to stress

2.      Magnesium: Supports progesterone levels and reduces stress

3.     Acetyl L-Carnitine: Supplementing with acetyl-l-carnitine (ALC) restarted menstrual cycles in 40% to 60% of women with HA in two studies. This compound has been shown to affect serotonin, dopamine, and beta-endorphins, reducing the impact of those molecules on the hypothalamus resulting in higher luteinizing hormone (the hormone you need to ovulate). This did seem to help me.

4.     Maca root: This seemed to boost my estrogen levels and accelerate fat gain. For me, I think it caused a state of estrogen dominance and increased my bad estrogen (yes there is good and bad kinds). I’d use this adaptogen with caution. See how it goes for 3 months and re-evaluate.

5.     DIM: I treated my estrogen dominance with DIM. This compound found in gassy veggies like broccoli and cauliflower helps promote healthy levels of good estrogen and clears unhealthy bad estrogen (as long as your liver is strong). This may only work if you’ve already increased your estrogen levels by increasing your body fat levels AND you have maintained a higher body fat for at least 3 months.  Please don’t try this unless you’ve put on a healthy amount of weight.

6.     Calcium diglutamate: This supports your livers processing and clearance of hormones.

7.     Vitex- If you lose your cycles it may be due to an increase in a hormone called Prolactin. If it’s high, Vitex may work for you. This wasn’t the case for me but I tried it anyway ;)

8.     Probiotics: A healthy gut is a cornerstone of a healthy hormonal system. Alternate strains regularly for a robust microbiome.

9.     Sustained Release T3: After years of HA and a high stress job, my Reverse T3 levels were sky-high. Taking a sustained release T3 (prescribed to me by my naturopathic physician) helped me clear my high RT3 and was the final missing piece to getting my period back. Please ladies, have ALL your thyroid levels checked (TSH, TPO antibodies, T3/T4 and FT3). It can be a game changer.

Lifestyle:

1.     Learn to say no:  Over the past year, my blog hasn’t gotten as much attention. I’ve been taking more time to myself to really focus on getting well. Sometimes you just have to simplify. Have a good look at what you can say “no” to in your life and just say “no”.

2.     Sleep your ass off:  Your body is stressed and in a negative energy balance. Sleep is the MOST effective way to recover and rebuild. If you have struggled with insomnia and poor sleep while you’ve had HA, many women find that once you put on some body fat you’ll sleep like a baby again. I certainly did.

3.    Stress less: I’ve taken up a solid meditation practice. It only takes 10 min each day and has changed the way I think, feel and even breathe.

4.    Care for yourself. Get a massage, spend time in nature, Netflix and chill …..if it feels good do it and make sure you do it every damn day.

5.    Acupuncture:  Give it a try, there are several studies that support its use for both stress reduction, hormone balance and fertility. I found it uber helpful.

Coping with your changing body:

1.     Buy new clothes: seriously, tight clothes are such a huge trigger and for me totally ruined my day and made me feel so bad about myself. Sell your tiny sized clothes and use the money to buy some well fitting duds. Most women, myself included, go up 2 sizes when recovering.

2.     Change the way you think about your body.: This one is hard but essential. Your body is trying to survive. It’s trying to get back into balance and be healthy. Resist the urge to pinch your fat or have negative thoughts when you see your body change…..instead, just witness it. Your body is the vessel for your soul. It’s beautiful and dynamic. This is temporary and is the birth of a new normal. If you can’t think of anything positive to say, simply try to witness your body changes without judgment. Be like Switzerland and stay neutral.

3.     Say, “Fuck it” to what people think (including yourself): This needs no explanation. You’re getting healthy; I think you’d be surprised to find that most people, if they understood what you were doing would look at you with admiration not criticism. Often times we are our own worst critics. So perhaps we really need to say “fuck you” to our own self judgment.

4.     Join a support group.:There are countless online forums and FB groups for women coping with the same things as you. Reach out, you’ll be surprised to find that you’re not alone. Ask for help from your loved ones. Reach out. You're not alone! 

This is just my journey. I'm always happy to share. Everyone's journey is their own. If you need support or help, feel free to send me a message