Should I cut out dairy if I want to get pregnant?

Will dairy negatively affect your fertility? Should you cut it out if you’re trying to get pregnant?

Short answer? No, you should not.

There seems to be a trend lately toward demonizing particular food groups. “Sugar is toxic.” “Gluten is a hormone disruptor.” “Dairy is very bad for fertility.” And the solution is to remove as much as possible of the offensive food from your daily fare. However, when you look at the scientific literature, there is rarely evidence to back up these claims, or if there is, it is MUCH less black and white than what gets spread online. Let’s look at the claims on dairy. “VERY BAD for fertility” according to a recent podcast a member of my Facebook support group listened to. “In this article we will examine the link between milk and infertility and why this beloved, popular food can be so detrimental to your fertility.” from natural-fertility-prescription.com. Oh, and how about this gem, “Dairy can actually hurt everyone’s fertility because of the fertility harming toxins it contains, and for people who have lactose intolerance, or a casein (milk) allergy or sensitivity, it can actually cause infertility” from tomakeamommy (emphasis mine).  And you can find a ton more if you google “is dairy bad for fertility?”

What all these sources have in common is an almost complete lack of scientific support for their claims. Or they take studies in mice or that find hormones/chemicals in milk and then make all kinds of assumptions to translate the studies to humans, or hypothesize the downstream effects of the hormones/chemicals – but this gets reported as FACT, not the speculation it actually is (hello, pseudo-science.)

There aren’t actually a lot of studies on the role of dairy in fertility, so let’s take a look at those that are out there. (I searched on Pubmed using “dairy infertility not cow not cattle” because most of the articles that came up initially when I used “dairy infertility” were related to cow physiology and menstrual cycles which is not super relevant.

Dairy intake and IVF outcome – no effect

The most relevant article, IMHO is this one, “Dairy intake in relation to in vitro fertilization outcomes among women from a fertility clinic.” The study population was women attending the Massachusetts General Hospital fertility clinic and enrolling in the Environment and Reproductive Health (EARTH) study, an ongoing prospective cohort started in 2006 to identify environmental and nutritional determinants of fertility among couples. There was no criterion for cause of infertility, meaning that the study group should be a representative cross-section of infertile women in general.

The findings? The researchers divided 232 women into four groups based on amount of dairy products consumed. After adjusting for possible confounding factors there was not a statistically significant difference between the group with the lowest dairy intake and the group with the highest. Of note, prior to adjustment there was a 21% higher live birth rate in those consuming the most diary (significant with a p-value of 0.02), after adjustment, there was a 16% higher live birth rate among those consuming the most dairy, but not significant, with a p-value of 0.10. One can definitely say there is no detrimental effect of dairy consumption in this group.

The researchers looked at other intermediate outcomes during the IVF cycle and found no relationship between dairy intake and uterine lining thickness, estradiol levels at retrieval, or number of eggs retrieved. They also looked at different age groups and found no association between dairy intake and live birth rate in women under 35, but to their surprise, there was a positive association in women older than 35 (meaning higher pregnancy rates in groups with more dairy intake). Again, no evidence for a detriment to fertility – if anything suggestion of a positive effect.

It’s possible that women who are infertile have different characteristics from those who do not have difficulty conceiving, and that in the latter population dairy does cause higher rates of infertility (those women would then likely attend fertility treatment centers like this one and increased dairy would thus show a negative effect…) but I would surmise that women who are having trouble conceiving would be MORE sensitive to dairy than the general population, if in fact dairy was causing infertility/trouble conceiving.

Changes in reproductive hormones with dairy consumption

The  next study, Dairy Food Intake Is Associated with Reproductive Hormones and Sporadic Anovulation among Healthy Premenopausal Women” tested hormone levels at four times during two menstrual cycles (eight tests in total) in 259 healthy, regularly menstruating women and assessed correlation with overall dairy intake, high fat, low fat, different individual types of dairy (e.g. milk, butter, cream, yogurt, ice cream), as well as looking at ovulatory versus anovulatory cycles (assessment based on hormone measurements in the luteal phase). In this study, a ~5% decrease in estradiol was found for each serving of dairy consumed, but also a 3% increase in luteinizing hormone (LH). I’m not in the least convinced that either of these changes is meaningful given the wide range in inter-woman hormone variability as in the figure below (from https://en.wikipedia.org/wiki/Menstrual_cycle), and also the very wide ranges given. I looked at the supplementary data where hormonal changes were broken down by menstrual cycle change, and the only time when the range of decrease in estradiol did not include “no change” was during late luteal phase and menses. (and then the range was from  -10 to -3.2% during late luteal phase, to -8.3 to -1.2% during menses). Of note the decreases were larger with low-fat dairy than full fat.

https://en.wikipedia.org/wiki/Menstrual_cycle

The researchers also assessed whether there was an association between consumption of different types of dairy and anovulatory cycles. Their model which adjusted for various factors found that cream and yogurt were both associated with an increased likelihood of anovulatory cycles, but… with cream (7.5% anovulatory cycles with no cream consumption versus 9.8% with cream), the 95% confidence interval includes 1.0 which means the statistical significance is marginal (i.e. if they were to do another study, they could very well get a different outcome). With yogurt, there does seem to be a difference (6.1% anovulatory cycles with no yogurt consumption, 13.2% with).

Also, they only followed women for two cycles and do not report the number of women with 0, 1, or 2 anovulatory cycles, nor did they confirm ovulatory cycles before the study commenced. So… grain or two of salt on this one. Regardless, given a (non-significant) decrease in anovulation upon consumption of cheese (11.6% in those consuming no cheese versus 7.9% in those who did eat cheese), butter (9.3% vs. 6.8%), and only a miniscule increase in those consuming ice cream (8% versus 9%), and no difference in ovulation based on overall dairy consumption, low-fat or high-fat dairy consumption, one cannot say unequivocally that “dairy causes infertility” or “dairy is bad for fertility.”

Dairy products and anovulation – high fat dairy seems to be protective

Since the previous study brought up anovulation, the next study I want to look at is the one we refer to in No Period. Now What?, “A prospective study of dairy foods intake and anovulatory infertility.” Researchers evaluated questionnaires from participants in the Nurses Health Study II, and found 18,555 women who were attempting to get pregnant. Within the eight years the subjects were followed, 3,430 women reported infertility of more than a year’s duration, with 438 of those reporting “ovulatory disorder.” Unfortunately the authors do not report an analysis of dairy intake with general infertility. The researchers do examine correlations between dairy intake and ovulatory disorders, and overall find no association.

They go on to further examine association of low-fat (skim/low-fat milk, sherbet, yogurt and cottage cheese) or high-fat (whole milk, cream, ice cream, cream cheese and other cheese) dairy with ovulatory disorders. In this case, they find an 11% increased risk of anovulation per serving of low-fat diary, and an almost 50% decreased risk with one serving of full fat dairy per day versus <1 per week. Interestingly, they also find a strong correlation between yogurt and anovulation (as well as sherbert and frozen yogurt), with a 30-60% higher risk (depending on the statistical model) with an increase of 1 serving yogurt per day. I assume that they put yogurt into the low fat category as most of what is available in stores is fat-reduced. I would suspect that full fat yogurt would not show the same association. I do find, after looking at the data, that their assertions of effect might be a little strong… with low fat diary ovulatory disorder occurs in 1.1% of women consuming <1 serving per week, 1.6% of those consuming 2-4 servings per week, 2.3% of those consuming 5-6 servings, 1.9% of those consuming LF dairy once per day, and 1.4% of those consuming more than one serving low-fat dairy per day. Adjustment for confounding factors makes the differences more significant… but in general you can see that the percentages are quite low.

Once again, one cannot draw the conclusion that “dairy is bad for fertility.” As far as anovulatory infertility goes, it seems that there might be a correlation between consumption of low-fat dairy products and ovulatory disorders, but high fat dairy seems to be protective (and why we encourage women with HA to consume high fat dairy products!!)

additional studies

Phew! Time is getting short here, so I’m going to throw out a few other things I’ve come across without going into quite so much detail.

In 1994 a study was published ostensibly looking at correlation between dairy intake and fertility on a global scale, “Adult hypolactasia, milk consumption, and age-specific fertility.” The authors compare rates across countries of hypolactasia (lacking the enzyme lactase that digests the sugar galactose in milk), amount of milk consumed per person in each country, and number of births across age groups, using that as a proxy for fertility. They state that “decline in fertility with aging is steeper in populations with high per capita consumption of milk” and suggest that might be due to the effect of galactose on ovarian function. There are so many reaches in this paper I don’t even know where to start (for example using number of live births per age group as a proxy for fertility). I will point out that when they restricted their analysis to European and North American countries where economic development is similar, “the correlation between milk consumption and decline in fertility is not present.”

Just to throw in a little something on the male side, this study, “Impact of men’s dairy intake on assisted reproductive technology outcomes among couples attending a fertility clinic” likewise found no effect of dairy intake on live birth rates in couples based on the males’ dairy intake.

Finally, this study, “Low Starch/Low Dairy Diet Results in Successful Treatment of Obesity and Co-Morbidities Linked to Polycystic Ovary Syndrome (PCOS)found improvement in some hormonal measures of PCOS when women diagnosed with PCOS were put on a low starch/low dairy diet… but A) hello, you obviously can’t assign that improvement solely to low starch or low dairy, that would require another study where the two factors are separated, B) there is no evidence in the paper that this leads to improvement in fertility and C) even if it is the case for women with PCOS, no reason on earth to then go and say that dairy is “very bad” for *everyone*. PCOS is a specific hormonal condition, so in the absence of a similar study in women without PCOS showing that dairy harms fertility (which in fact we have the opposite of, see above), one simply cannot make that claim.

conclusion

In conclusion, if you like dairy, eat/drink dairy without fears of it affecting your chances of getting pregnant. If you do want to consume dairy, it seems that the full fat versions are probably better for you, especially if you are already missing periods. If you don’t like dairy, or are allergic, don’t have lactase, then don’t consume them (although Shanta in my facebook support group says, “I eat LOADS of lactose free dairy and full fat yogurt and cheese, in fact i go through more than a liter of yogurt a day, and it REALLY helped my recovery, so you can always go the lactose-free route.)

If there are others studies you’re aware of that support diary as detrimental, please let me know, I’d love to take a look.

<3

Nico

Can Maca help restore periods?

Can maca help restore a missing period?

A little while back I did a survey of women in my “No Period. Now What?” facebook support group and found that among 53 women 63 supplements were being taken with the idea of helping to restore missing periods. Maca was taken by 10 of these women, so I thought we’d investigate it next. Thanks to Eryn for digging up some references!

Overview of Maca

Maca, aka Lepidium meyenii, is grown in the central Andes. The part that is eaten is the “hypocotyl”, a tuberous root-like structure that is a storage organ for nutrients. Maca has been cultivated and used for food and medicinal  purposes for hundreds of years.

From https://doi.org/10.1016/j.phytochem.2015.02.030 Creative Commons License 4.0

Maca and period restoration

Our question is whether maca can be useful in a woman trying to restore menstrual cycles. I was rather surprised after reading some abstracts to find that there were hints of potential usefulness of this supplement – but after reading the full studies, my conclusion is that while maca is not going to hurt recovery, it is unlikely to help either.

In the first study, rats were fed dried maca powder as 5%, 25%, or 50% of their diet. Seven weeks later, during the “pro-estrus” phase (like the follicular phase in humans) hormones were measured, and in the rats consuming 50% maca, a 4.5-fold elevation in LH levels and 19-fold elevation in FSH levels were seen. This elevation was dose dependent (meaning elevations were seen at lower amounts consumed as well, in proportion to the amount of maca). However, there are two key points missing from the abstract, which is where that info comes from. One is that there was essentially no elevation at the lowest dose, 5% of feed, which is about 3g/kg/day.  The second point was that these elevations were very transient, seen only at the time of the pre-ovulatory surge. There was not an overall increase in LH levels.

The huge elevations in LH are clearly not reproducible in humans, because 50% of our diet as maca powder is not feasible. Even 3 grams per kilogram, i.e., 180 grams per day in someone weighing 60kg (about 130 lb) doesn’t jibe with the dosages normally prescribed. A website selling maca powder indicates that a serving is about 9 grams. In the Andes, people will often eat 100-200g of the root 2-3 times a week, a much higher amount than what is realistically available to those of us outside Peru.

https://www.themacateam.com/raw-red-maca

There are a few other studies in rodents, but unfortunately not much in humans to support or refute these results. A study performed in men (due to positive effects on sperm parameters) showed no change in FSH, LH, estradiol, prolactin, or testosterone while taking 1.5 or 3g of maca for up to 12 weeks.

These two results, an elevation in the levels of LH and FSH *only* during the pre-ovulatory surge in mice, and no change in reproductive hormones in males in response to maca suggest that maca is not going to help with no periods based on a hormonal mechanism.

MACA TOXICITY

As I was researching the toxicity of maca (which seems to be zero), I came across an article where they did a double-blind, placebo-controlled study looking at a number of health outcomes after consuming maca (3g/day) for 12 weeks (197 subjects across all groups). The health outcomes were assessed on a weekly basis, giving a really nice data set. There were no adverse events reported which is great, and they reference another study that found no toxicity in rats at up to 17g/kg, which is an enormous amount, so maca seems to be very safe to eat.

GENERAL HEALTH EFFECTS OF MACA

Some of the health outcomes that were measured in the study I just mentioned and found to be significantly different from placebo (on top of a placebo effect!) may be of interest to readers – improved libido, energy, mood, and “Health Related Quality of Life” score. The “HRQL” is a 36-question survey that contains “five items related to general health, five items related to physical activities associated with current health status, two items related to limitations on work or other regular daily activities as a consequence of reduced physical health, two items on bodily pain, one item about vitality, and five items on mental health [].”

This study suggests that there may be other reasons to take maca than period restoration per se… it may help with overall quality of life while you are working to recover. And in someone who is at a “fertile BMI,” not doing high intensity exercise, but still stressed and anxious… maybe something like maca could help with the mental stress part.

MACA for Missing periods?

My ultimate conclusion is if you like maca, go ahead and have some (after checking the sourcing, see below), but don’t feel like this is something that you need to go out and get to help you restore your missing period. It may have some mood boosting effects that could be helpful during recovery in other ways though.

I will leave you with a quote from a recent review of maca,

To date, the health claims of maca cannot be fully supported from a scientific standpoint and more research is needed. It appears that the indigenous local knowledge about the health benefits of maca has been dragged out of context to fit the demands of a growing market for herbal remedies. This globalisation (or hype esp. in China) also has had serious consequences for the local producers in Peru. The lack of protocols to regulate the production and marketing of maca during this rapid expansion, poses a threat to both the safety of consumers and the sustainability of supply.

<3

Nico

Acetyl-L-Carnitine and Restoring Missing Periods

Continuing my series of posts on supplements and recovery of mising periods… overview here, and post on Vitex here 🙂 I am going to review acetyl-l-carnitine next as it is a supplement for which there is evidence for effectiveness in restoring missing menstrual periods from controlled clinical studies. Thanks to Addie for helping with the research!

Here’s a table of contents for this post, as it ended up being super long!!

Alright, let’s get started. First, acetyl-L-carnitine, also known as L-acetylcarnitine, ALC, or ALCAR, is a derivative of the amino acid L-carnitine (aka levocarnitine). L-carnitine acts as a recipient of an acetyl group in a reaction that releases CoA for use in the Krebs cycle that generates energy (ATP) in the mitochondria. ALC is naturally synthesized in our bodies on an ongoing basis, and crosses the blood/brain barrier, therefore potentially affecting brain hormones, chemistry, or brain function. Studies have been performed examining the effectiveness of ALC in a number of indications, ranging from diabetic neuropathy to Alzheimer’s disease.

Chemical structure of Acetyl-L-Carnitine:

By Ed (Edgar181) - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=31705679

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Missing period recovery story!

Just about every day there is a new post in one of my facebook groups about someone getting their first post-hypothalamic amenorrhea period, or their positive pregnancy test. It is so inspirational and truly helps those who are still working to recover to stay the course. I wish that everyone struggling with missing periods, thinking about maybe doing something about it but perhaps too scared, afraid of “losing everything they’ve worked so hard for” could read each of these stories and see how much there really is to gain. (We did include a lot of recovery stories in our book/ebook 🙂 ) I’m going to start sharing some here, in hopes that others will be motivated to start or continue their own journey toward true health.

Gemma wrote:

“I have always been a fit and active person ever since I was young. And my weight had never really fluctuated. I went on BCP when I was about 16 years old until I was 28. I came off the pill because my partner and I wanted to try for a baby.

Before making the decision to try for a baby I had a job for about five years that had become very stressful, 10 hour days with minimal rest, and I was commuting to and from work on my bike, which came to about 9 miles a day. Weight-wise I had always been a healthy weight for my height, but from cycling everyday my BMI had gone down a couple points and it had been there ever since. I never questioned it because I was never fussed on my body shape, big or small, but looking back these were all signs that I chose to ignore. Weight loss, stress, and for the amount of activity I was doing I was not eating enough.

I don’t know for sure that this is when I lost my period because I was on BCP but after reading Nicola Rinaldi’s book I think that could have been my significant HA moment.

When I came off the pill I went to the doctors after 3 months because I wasn’t having a period. I was told that it was normal, coming off the pill can take a while for your body to adjust, come back in a year. So, a year later I went back, the doctor tried to put me back on the pill so I could have a ‘period’. I refused, I don’t know why but I knew that my lack of period was a symptom of something and I needed to find the cause.

The past 5 years have been very hard for me, both emotionally and physically, with a lot of medical poking and prodding, blood taking and a lot of mental exhaustion, confusion, anger. The doctors decided that It was just a case of unexplained infertility and the only thing that might help would be IVF.

Strangely enough my next GP appointment is next week, this was going to be my opportunity to discuss fertility treatments.

I really had lost all hope, I just wanted my period back, I struggled with my friends, those who do know about my condition try really hard to understand it but they don’t really get it, and I would be an awful person to expect them to but It is just something that unless it is happening to you it is a very difficult concept to comprehend.

I felt so alone and so lost but then one night, completely by accident i came across Nicola’s book No Period. Now What?. I read the book from cover to cover in about two days, everything in it was so true to me and I just knew that this is what I had. It was such a leap of faith, I never doubted the process for a second but I was scared of It. Scared because this conditions forces you to face your self head on and admit things to yourself that you have maybe been denying. Recovery is giving me such a feeling of freedom, freedom from exercise, freedom from anxiety which was a huge thing when I was doing too much, not eating enough or resting enough.

My husband thought I had gone temporarily crazy when I told him about this adventure I was about to embark on, stopping all the things that I loved like mountain climbing, surfing, cycling and eating 2500-3000 calories a day but he has and continues to support me, he has seen me re-emerge from myself like a flower. I didn’t know how much of a shell of myself I had become but having this condition and finding the tools that I need to rebuild myself has helped me come back to life.

I have gained 17 lbs so far, I started recovery on the 25th November 2016 and every pound is a pound that I am so proud of and so grateful for. At first, it could’ve been 6 weeks, I hardly put on any weight which made me realise just how much damage I had caused to myself. At this point I decided I was literally just going to walk to and from work and anything beyond that, that was un-necessary activity I would just have to stop. So, since January I have been parked on my bum, not even doing yoga but still walking to and from work. Then about 2 weeks ago I injured my neck, all my muscles had seized up and the pain was radiating down my shoulders and back, I literally couldn’t move for a week and I think that was the final kick start my body needed, just complete bed rest.

I in no way think I am recovered, I am still at the very beginning and I fear that this gift I have been given could be taken away from me at any moment but time will tell, regardless of the outcome I am recovering, my body is reacting to rest and nourishment and I never thought my body would ever feel strong enough or trust me enough that it felt it could try to bring another life into this world. I think my body is a miracle.

We are all incredible, we show incredible strength by facing our fears head on and not running from them but I wouldn’t be on the path to recovery if I didn’t have you all supporting me, I hope I give back to you what you give to me.”

<3

Nico

Does Vitex Help Restore Missing Periods?

why would I use vitex, and WHAT IS it?

To determine what supplements women might use to try and restore missing periods, I did a quick survey of women in my “No Period. Now What?” facebook support group. The most common herb/supplement mentioned  was Vitex, taken by over a third of those who responded to my survey (21/53). Vitex is a shortened name for Vitex Agnus Castus also known as Chasteberry.  Most women reported taking “vitex’, but some said “agnus castus” or “chasteberry” – as far as I can tell they are synonyms. It’s a small, bushy plant, with pretty purple flowers and small brown berries.

Vitex-agnus-castus-foliage

RESEARCH METHODS

I did a search of the medical literature using the following queries in pubmed to find research relevant to understanding whether vitex can help restore a missing period.

Vitex fertility
Vitex amenorrhea
Vitex oligomenorrhea
Vitex luteal phase
Vitex follicular phase
Vitex progesterone
Vitex estrogen
Vitex osteoporosis

RESULTS

The searches came up with between 5-25 results, many overlapping between searches. I read through abstracts where available (a few articles were in languages I don’t speak, or had no abstract available) and the full article if the abstract seemed relevant and I wanted to learn more.

My conclusion is that Vitex Agnus Castus does NOT lead to restoration of cycles in someone experiencing hypothalamic amenorrhea (unless that amenorrhea is due to elevated levels of prolactin), and may in fact be hindering the return of a missing period.

Continue reading

Supplements to Recover Missing Periods?

I recently asked in my Facebook support group what supplements women had used while trying to recover from hypothalamic amenorrhea / no period as I wanted to look further into the science behind each of them. I was astounded at the range of answers – 53 women used one or more of 65 different supplements!

Can pills help recover missing periods?

By Root66 (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

How do I restore missing periods?

Unfortunately, many women are prescribed supplements instead of what we all know works – eating more, exercising less (particularly less high intensity exercise), and reducing stress. A common refrain was captured well by one poster:

Ellen: Oooh, I’ve tried so many supplements in hopes of sidestepping real lifestyle change! I’ve dabbled with vitex, maca, soy, estroven, bulletproof diet recipes, acupuncture…while some (acupuncture) really benefited me in other aspects like stress level, none served as proxies for eating bravely and resting bravely- which I am finally giving a go.

It is really important to take heed of what Ellen says – there is no way around making lifestyle changes. If you have no period due to HA, while you might (possibly – success is not guaranteed!) be able to get pregnant using injectable gonadotropins or IVF, those are not going to restore your system to balance or bring back that missing period / cycle. In the words of another wise woman: Continue reading

Positives of Recovering from Hypothalamic Amenorrhea

I asked women in my new facebook support group to tell me about one thing (or more) positive about recovery or working toward recovery, which they did not expect. Some responses are shared below…

Lindsay: a sense of freedom and ease and ability to go with the flow that I had been missing since I was a teenager and that I never thought would come back.

Oh, another one: when my husband says, “Doesn’t a burger sound good tonight?” not having to make things difficult and try to convince him to go somewhere healthy and insist that I don’t really like burgers … and just get to enjoy the freaking burger together! With a side of fries!

One more, because there are so many: when I first get home after being on a long flight, not having to go on a run before I even unpack my bags and instead just collapsing on the couch and ordering takeout.

Florence: Less anxiety, babies, ice cream, support from all of my fellow HA ladies into motherhood, boobs and poops, not waking up hungry at night, my hair growing back, feeling like a normally functioning woman, saving my bones, sleeping better, spending more time with my family and friends, holidays without a single workout, not going round with my tupperwares, eating socially, finally using my time for something i love & aiming to save the world, discovering a more fun, more balanced person inside of me.

Nicole: Not having to worry about when to eat, what to eat, and listening my body tell me what it wants. My eating used to revolve around an IBS and paleo diet as well as my workout schedule – no more of that taking up space in my head.

Oh, and my laughter is so much deeper now. Happiness feels amazing, like its own high.

Louisa: Realised that restricting myself and stressing around food/exercise was 100% the reasons behind my gut issues. Since eating everything I’ve actually been pretty ok!

Also, Sleeping in, not having to schedule my week around my workouts, desserts, a pretty much healed digestive system, freedom around food, just food in general, boobs, oh and you ladies!
Also as I’m not yet recovered just knowing there’s more that will improve is all the motivation I need to keep going 💪🏻 x

Sarah: Crying. Like full body weeping. You know that saying, “have a good cry?” I haven’t been able to do this for months and it’s felt strange. In the past week (just went all in), I’ve wept and I feel I’ve been cracked open in a healthy way.

Mary: Resurrection of my libido!

Corey: Realizing how high strung I was, and how my anger was on a hair trigger!! I was ALWAYS planning out the food I was going to eat, or rehashing the food I had just eaten. I still focus on food a lot, but now it’s looking forward to all the great stuff I get to eat, and enjoying it! I also didn’t expect all of the stories and personal growth shared in NPNW to apply to me as closely as it did…man, did I try to fight it! “But that’s not ME…. I’M not like that….” 😐

Liz:  I no longer feel out of control around food. I don’t feel disgusting anymore for feeding my body what it needs or weighing what it wants to (for the most part, there are some bad days). I had a list of “bad” foods I thought were poison to me (because if I had ever binged on them they went on this list of supposed poison trigger foods) much longer than the list of foods that I deemed pure and wouldn’t cause binging (protein veggies select oils). I had to go to the gym every day sort of like paying for an ok day. If I didn’t get to it for some reason I felt like it was an automatic terrible day. I’m definitely not in the best place but so much better and I’m so grateful. I usually am grateful to nourish my body. I try to eat mostly foods that I believe are nutritious for my body and feel grateful for that. If I am hungry or crave something I don’t usually think it’s an urge to binge but maybe that… I’m hungry and my body is telling me. I no longer eat salad for every single meal… I no longer feel like many of the foods I thought were poison are (some I do still struggle with… it takes time and is a journey to completely free myself and don’t know if I’ll ever get there… but the list is def a lot smaller)… I can eat all u can eat sushi sometimes usually no guilt. Chocolate sometimes ❤️… I’m happy to enjoy a treat once in a while and see now that I can have one or two when I want and not have a compulsion to stay up and binge on 20 like I feared)… I can walk some mornings (hope to get back to running sometime bc I enjoy it) and others rest if I don’t feel like it… and it’s not the end of the world and I can function and have an ok day without exercise. So there are a lot. I have a way to go and there are def some weird thoughts about food still but I’m in a much better place and someday if I’m a mom I feel I’ll pass on much better attitudes that I would have.

Oh another very random that i was thinking of recently during a discussion with someone… i used to have major bladder issues for most of the time i had HA. I thought i might have interstitial cystitis as I frequently had infections, and even when I didn’t i often felt burning and sharp pain sensations… very strange another thing no one could quite figure out 🙁 It mysteriously went away around when I recovered from HA. I have never had any pain or a bladder infection since. I can’t help but wonder if it was related to my super low estrogen levels…

Erika: Bladder issues is a symptom of low estrogen. 😊 I had them, too. Mine was more frequency (now if I go in the middle of the night it’s 1X where used to be as much as 4Xs). Also if I had to go, I had to go. Extreme urgency. Some of mine could have also been kidney function just from low body weight, too.

This is just a sampling of the comments. Are you ready to dive into YOUR recovery and discover how your life will change?

<3

Nico

Missing period and hair loss?

Jenny recently joined my facebook support group (now closed to new members, but a new group has just started, so come join us!) and posted about her experience with hypothalamic amenorrhea…

Hey! I’m new here. I just cracked open No Period Now What this morning and got to Chapter 3. I wanted to share a little bit of my story, since I’ve been inspired by reading a lot of yours.

I am a lifelong runner and I’ve been dealing with HA for the better part of the last 10 years. I ran competitively in high school then went on to run at the D1 level, where it was widely accepted to not have a period for months (or years), and I was actually told that this was a normal and acceptable thing.

I’ve been navigating the recovery on my own the last 5 months after finally going to see an endocrinologist to get to bottom of my issues.

The reason I finally decided to go in and get help was not that I’m ready to have a child. I’m 23 years old, and about a year ago, I started losing my hair.

It doesn’t come out in chunks and I don’t find strands on my pillow in the morning. It’s been a slow process of overall thinning, with large thinning areas on the top of my head (the front of my scalp). I never expected to deal with hair loss/receding hair line, especially not at the age of 22.

At first I was panicked, but it was also not noticeable enough for anyone to really see it or acknowledge that I wasn’t crazy. But now, my hair is noticeably gone in areas on top of my head. Here are a couple more photos.

When I went to the endocrinologist last winter, we found that my reproductive hormones were extremely low. We also did a bone density scan to see if my bones had improved since college.

I assumed that they would because I hadn’t been running as hard (but I was “triathlon training” and would exercise 3-4 hours a day with a lot of intensity).

My bone density actually worsened since college, putting me in the osteopenia zone. My doctor urged me to gain weight and lessen my exercise. She thinks that in solving my hormone issues, I will solve my amenorrhea and my hair loss. I’m hoping this is true.

I guess my hair loss is somewhat of a blessing because it has forced me into action. I want to improve my bone density now so I can run later in life, as well as address my issues with gaining weight.

So at the beginning of 2017, I tried to change things. I stopped doing cardio and starting weight lifting instead. I started eating way more calories.

But the stress of trying to navigate this change on my own, in addition to rapid weight gain, was so much that I was only able to sleep about 5 hours per night – not great.

I’m a type A sort of person that has to do things perfectly, and I also genetically have low estrogen. Women in my family (if they exercise or not) always have trouble with maintaining a normal cycle, so I assume that my cycle is pretty sensitive to things like over-exercising and under-eating.

It’s only been until the last few weeks when another runner, Tina Muir shared her amenorrhea story and talked about this book that I’m learning what it takes to really recover. Which for me, will include stopping my exercise for now and drastically reducing my stress. (Being 23 is stressful, believe it or not!)

So I’m going doing my best to go “all in” for recovery of my period, my bones, my hair, and my health.

Has anyone else dealt with hair loss or thinning at the top of your head as a symptom of your HA? Any thoughts on addressing this issue aside from my overall recovery?

And now, a few comments from other members of the group:

Erika: Welcome! And Yes. My hair came out in clumps. Looked really similar to what yours looks like. I was misdiagnosed with PCOS at first, but told to bring BMI up to a healthy weight (started in low 17). I think my hair loss mostly slowed or stopped by then. In pictures from that time I have visible new growth around my face. Once I got correctly diagnosed and went all in, my hair growth had been pretty good. It’s not quite back to its full lion status, but it’s getting there. Tried to take a pic, but I just look super creepy in all of them!! My weight also came on quick, but then leveled out. I think it’s really great that you’re doing something at 23!! Here is a before pic. I thought it was mostly around the cowlick, but just sort of looks thin all the way around.

I’d only gained 10 lbs and you can see all the new growth around my face here:

Here’s a better view of my hair. So it’s pretty wavy today and looks bigger just because of that… but you can eat least get a good shot of how the baby hairs filled in on the left side.

Lindsay: Hi Jenny, your story is SO similar to mine. I was a serious runner starting from the end of high school all the way until I recovered from HA last year (at age 30). This issue is SO common among runners and it’s really terrible how normal and acceptable it is perceived for female runners to not get their periods. There is an utter lack of understanding, even among doctors, of how big of a health issue this is, and it needs to change.

My hair came out too. And my skin was dry & dull. I feel like when you have HA, there are some big things in your body that aren’t functioning properly (like your fertility and your bone health!) but also countless small things. Your mood, your energy, your digestion, your “glow.”

I’m really glad that you’re taking action for recovery. I will share that for me, I needed to give up ALL exercise, even weight lifting, in order to recover. This was hard, but remember that during recovery you are trying to add enough body fat and rest so that your body feels like it is safe to ovulate again. Weightlifting is counterproductive towards that goal. The faster you recover, the faster you will be able to return to normal activity!

Oh I forgot to say one thing! At my last haircut, my hairdresser’s jaw dropped open and she said “What in the world have you been doing, your hair looks so much thicker and healthier!” And I was like, “well, I stopped running.”
Natalie: So i am not recovered yet but have gone from bmi 15 in June last year to around 19 currently. Last year a big bit of hair literally snapped off. I have curly hair and atm its the thickest it has been in years 🙂 xxx

Here I am at a BMI of 15

BMI of 19 thick hair 🙂 xxx not particularly long but I’ve found my hair type, i.e., curly, tends to grow outwards not long hehe xxx

Oh and this was the bit that snapped to basically about 1-2 inches that has now grown 🙂

So basically there is hope! I am probably one of a few on here who have been very, very unwell. I still hold out hope for periods to return but little bits like hair growing thicker keep me going because my body IS capable of repairing damage just like yours will be too hun 😍😍😍 Oh and those glasses in the original pic? Yep I haven’t needed them at all in months because my eyesight has improved. Sorry for the waffle and hope it helps 🙂 xxx
Nadia: Great job on taking the steps to recover from HA. I also had A LOT of hair loss from HA. I also had subclinical hypothyroidism but it was directly related to HA. Recovery improved my hair immensely. It takes a long time to grow back, but it does come back.
Clarice: Yes that exactly what my hairline looked like… I would definitely suggest lowering exercise and upping your food as much as you can…. Maybe start looking into the fact you may be holding on to some other emotions around food and exercise… Working with someone can be helpful in the transition! Also maybe check thyroid levels…
Florence: See these weird bangs? This is the hair i was denying myself to have by never eating enough! Pretty much same location as yours right? It took a while but as soon as you’ll start fueling properly, it WILL grow back!
Anna: I have those weird bangs too and never even thought about that being one of the many positive side effects of recovery!!! I used to always have these weird short little hairs on my left side that would never grow. And I just assumed those are non-growing hairs lol But a few months ago I noticed they’re getting longer…
Nicole: Here’s some hair growth after reaching a BMI of 22!!! See those hairs sticking up? I have a few sections of those through my head, granted I didn’t have bald spots, but seems like more follicles (hair and other 😉 are waking up.
 
Shanta: Yes. I kept my hair short because it was so thin. Even so I was getting bald patches.
Thank you for reaching out. This is a very hard process to do on your own. If you can find a counselor or group for eating disorder recovery it may help. Honestly though for me this group was the most effective help.

The journey from type A to type play, the journey from control to love, is often rocky. But it is, ultimately, exactly that: a journey to love, and the end result is as good as that sounds and better then any love story you will ever watch/ read. What is more you deserve that amount of love and joy, you always have, and the world will be a little more right every step you take towards it.Many women here come from an eating disorder background, and we all have each others back.You can do this.
Jenny responds:Thank you so much for sharing. I’ve struggled to reach out to get help but this seems like a great place to do it. It’s reassuring to find others that have dealt with the mental struggle of hair loss. I appreciate the support.
So as you can see, hair loss is not uncommon with HA – but like so much of the other damage done to our bodies through underfueling, overexercising, stress – whatever your personal combination may be – the effects are reversible.
<3
Nico

Can you ovulate but not get a period?

I have heard in quite a few places now that it is possible to be ovulating regularly but not getting a period, or women think they are ovulating but not getting that monthly bleed.

Women who are experiencing amenorrhea will most likely ovulate before they get their first post-amenorrhea period. (A few get an anovulatory period; bleeding without ovulation beforehand). If one happens to have intercourse around the time of this ovulation, it is absolutely possible to get pregnant, therefore getting pregnant without ever getting a period. And that’s where the idea of ovulation without a period arises.

But, monthly ovulation without getting a period is only feasible under very limited circumstances:

  1. On the Mirena IUD. The hormone doses are low enough that they do not affect the reproductive system in general; locally the hormones prevent buildup of the uterine lining and thus many women on the Mirena IUD will ovulate but not get a period. (Note that the manufacturer states the Mirena should only be used in women who have been pregnant.)
  2. A physical abnormality that prevents bleeding, such as Asherman’s syndrome or a reproductive system defect that does not allow for discharge of the uterine lining.
  3. As stated above, if pregnancy occurs on the first post-amenorrhea ovulation.

Barring that…. The mechanism does not seem plausible.

In a normal menstrual cycle, the egg-containing follicle starts growing at the beginning of the cycle and the uterine lining is thin. As egg/follicle growth and maturation continues, estradiol is secreted. The estradiol leads to an increase in the thickness of the uterine lining. The lining thickens as the dominant follicle is selected and proceeds to maturation. When the egg/follicle is mature, the increased estradiol leads to a sharp peak in luteinizing hormone (LH) that causes ovulation.

I do not believe that it is possible to have this LH surge without sufficient estradiol (and therefore a thick lining to shed).

And while it may be true in a small minority of cases that the lining does not respond to estradiol and get thicker (this IS the case with the Mirena IUD), in a normal menstrual cycle the lining will thicken. My suspicion is that if a woman’s lining did not respond to estradiol by thickening, that would always have been the case and she would never have gotten a period – primary amenorrhea.

After ovulation, progesterone is secreted by the cells that surrounded the now-released egg, maintaining the thickness of the lining and causing other changes that prepare the lining to accept an embryo. If no pregnancy occurs, progesterone drops and the lining is shed.

If progesterone levels are lower than normal, the lining is shed earlier.

What do you think? If you believe you’re ovulating but not getting a period, have you confirmed an increase in LH by ovulation predictor kits, or confirmed ovulation through temperature charting?

If you are getting changes in cervical mucus each month that seem to indicate ovulation, but no bleed, it is possible that your body is trying to ovulate but not quite succeeding.  If that’s the case… Look into whether you might have hypothalamic amenorrhea (HA). (Asherman’s syndrome should also be ruled out.)

Nico

Menstrual Cycle Hormones

Whenever someone asks me about levels of menstrual cycle-related hormones during their cycle and the answer isn’t obvious I go to the figure below from Wikimedia (this article). What I love about it is that it shows the average (bold blue line) and then the biological variability around that average (dark blue shaded area)… and then also how much this can vary between cycles and between women.The figure is based on a study performed in 2006 that measured hormone levels in 20 ‘normally cycling women’ not on birth control pills. The data were reanalyzed in 2014 and these figures created.

One example of when I might refer to these figures is if someone tells me that they’ve just had blood drawn, they don’t know what cycle day they’re on (e.g. have not yet had their first post-HA or first postpartum period), and LH was measured at 17 and estradiol at 215 pg/mL. I can check these figures and see that that most likely corresponds to just before ovulation. If LH is 17 and e2 is 85 pg/mL that might mean that ovulation has just occurred. If LH is 17 and estradiol is 30 pg/mL then I might suggest inducing a bleed and testing a hormone panel to determine if PCOS might be in play.

I think what is unique and particularly helpful in these figures is the inclusion of variability so one has an idea of the typical range for these hormones. Let me know if you have any questions!

Nico