A Nutritional Medicine Practitioner’s approach to Amenorrhoea
Warning… I can get a bit 'ranty' on this topic! Through my own life experiences this is a passion of mine and I want to help you from being led astray and educate you on your hormones.
Do you miss the occasional period or 3 or 4 or perhaps you don’t have a period at all but are still in your reproductive years… well you may have Amenorrhoea!
Amenorrhoea is defined as the absence of menstrual bleeding for more than 3 months in females of reproductive age.
There are two main types:
Primary – which is where periods do not commence during puberty however other secondary sexual characteristics changes have occurred, e.g., breast development and pubic hair growth. This is caused by several factors, such as no reproductive organs, genetic anomalies or functional issues with the hypothalamus, pituitary gland or ovaries; and
Secondary - periods stop after having a regular cycle for a period of time and you are not pregnant. This is known as Hypothalamic Amenorrhoea (HA) however prior to treatment other causes need to be ruled out.
Here is a quick overview of what happens to your hormones each month during your cycle.
Your body makes:
oestrogen to help grow an ovarian follicle (which then releases an egg, i.e., this is when you ovulate); and
progesterone to build up the uterine lining which is then shed when you get a period.
Production of both hormones is controlled by a part of the brain called the hypothalamus, which is like the body’s hormonal control centre. The hypothalamus usually sends hormones (called FSH and LH) down the hypothalamic-pituitary-axis to the reproductive organs, aka the ovaries, to make oestrogen and progesterone, which initiates your menstrual cycle.
HA occurs when the hypothalamus “switches off” the supply of FSH and LH to make oestrogen and progesterone, resulting in no ovulation or periods. Phew I hear you say!
Maybe you are thinking that having no period sounds great, but there are some health challenges which are not so good including infertility, bone health, bladder issues, sexual health, cardiovascular health, and mood changes.
Some of the most common causes of HA are:
Being underweight for your body type
Excessive exercise
High anxiety and stress
Disordered/restrictive eating;
A combination of all the above!!!
Whilst you can recover from HA, there is NO magic food, diet or supplement that is going to get your period back. HA involves many factors, with some being food-related but there are also psychological and emotional aspects to consider.
Correct medical diagnosis and management
Firstly a correct medical diagnosis (and ongoing management by supportive professionals) is essential. Amenorrhea can occur for different reasons, so it is very important to establish the reason for your Amenorrhea. This means going to see your doctor, having blood tests and physical examinations, and potentially being referred to a specialist doctor like an endocrinologist. Other causes of amenorrhea, like PCOS (polycystic ovary syndrome) need to be ruled out.Nourishment
Nourish your body, find food freedom, and honour your hunger. Eat regularly, eat what you truly like and don’t jump onto any dieting trends. Just don’t!
When you have HA, you do not need any kind of restriction on when, what, and how much you eat. You need to convince your brain that you are “safe” and energy (that is kilojoules!) is readily available. If you restrict your eating, you risk putting yourself in a negative energy balance where your body senses there isn’t enough energy available to support regular periods.
Exercise
Keep exercise gentle. Yes it’s good for us but intense/extensive exercise is a form of “stress” on the body and may be an obstacle to the return of your menstrual cycle. High intensity workouts or extensive cardio like long distance running can be especially demanding. Mix it up and try introducing Yoga, Pilates or even just a good old gentle stroll (plus you get bonus points for getting some sunshine and walking outdoors).Stress/sleep management
Speaking of stress, are you a stressed-out person? Consider what could be done to make your days run a little easier and make some tweaks so you get more chill time and good quality sleep. High stress levels are not good for periods! Your hypothalamus is connected to both your nervous system and your endocrine (hormone) system. It goes like this - you are under stress (and this can include perceived stress) your body sends signals to the brain through your nervous system to register this stress this message reaches the hypothalamus which thinks it is not safe this negatively affects female hormone levels and your menstrual cycle, which then may cause you stress and so the cycle goes on!Support network
Make time to hang with friends and family - whoever your support network is. Hang out with people who respect and understand that you’re making changes. Doing something fun with someone fun is one of the best ways to de-stress! Your network might also include professional support like a psychologist or counsellor, if you’re struggling with disordered eating or worried about the recovery process in any way.Self-love and patience are important
Remember to love and care for yourself too. That might feel difficult at times, especially if your body is changing - many women with HA need to gain weight to restore their periods and that can feel uncomfortable. We live in a world that talks non-stop about dieting and applauds weight loss - going up against that can be one tough fight… but you can do it! Patience is also part of the process. Sometimes changes to hormone levels can take quite a while, and the initial changes going on inside your body might not really be visible to you. Don’t get frustrated by the process (easier said than done I know but keep going)!Don’t forget your bone health
And finally, just one last health-focused point - stay on top of your bone health! This is something to be discussed with your healthcare provider as well because a doctor can send you for the right examinations to check your bones. HA is associated with poor bone health (osteopenia or osteoporosis are some of the long-term consequences of HA). This is because oestrogen deficiency affects the lifecycle of our bone cells, and we lose bone more quickly without oestrogen. The way to stop this is to start producing oestrogen again, that is by restoring your periods. In the meantime, eating a balanced diet, adequate calcium, and vitamin D (from those strolls in the sun!) intake is essential.
What can you do?
The web that creates hormonal imbalances is multi-layered, complex, and highly individualised to each woman. At Pretty Simple Nutrition we specialise in investigating and identifying all the possible contributing factors which may be leading to your hormonal imbalance. Our specialised knowledge allows us to create a personalised treatment plan that will address not only your symptoms but begin to tackle the underlying causes of them.
To find out how we can help, contact us …
References:
Briden, L. (2021). Hormone Repair Manual (1st ed.). Pan Macmillan Australia Pty Ltd.
Pape, J., Herbison, A. E., & Leeners, B. (2021). Recovery of menses after functional hypothalamic amenorrhoea: If, when and why. Human Reproduction Update, 27(1), 130–153. https://doi.org/10.1093/humupd/dmaa032
Phylactou, M., Clarke, S. A., Patel, B., Baggaley, C., Jayasena, C. N., Kelsey, T. W., Comninos, A. N., Dhillo, W. S., & Abbara, A. (2021). Clinical and biochemical discriminants between functional hypothalamic amenorrhoea (FHA) and polycystic ovary syndrome (PCOS). Clinical Endocrinology, 95(2), 239–252. https://doi.org/10.1111/cen.14402
Roberts, R. E., Farahani, L., Webber, L., & Jayasena, C. (2020). Current understanding of hypothalamic amenorrhoea. Therapeutic Advances in Endocrinology and Metabolism, 11, 1–12. https://doi.org/10.1177/2042018820945854
Vickers, H., Gray, T., Jha, S. D. (2018). Amenorrhoea. InnovAit, 11(2), 80–88. https://doi.org/10.1177/1755738017737101