Energy Balance and No Period…

Why is it that some women have no period, where others, in seemingly the same situation with exercise and energy consumption continue to menstruate regularly?

A possible explanation for this difference was recently offered by researchers in Sweden. Instead of looking at energy balance or availability for a whole day, as is the standard in energetic research, they computed energy balance on an hourly basis.

Before we get into the meat of the paper, it’s results, and my analysis, a few terms that might be helpful to understand:

  • energy balance: Total energy intake (kcal) minus total energy expenditure, i.e., resting metabolism + daily living + exercise.
  • resting metabolism: calories burned to fuel involuntary processes: pumping blood, fueling brain, building muscle and bone
  • glycogen: stores energy in the liver for short term use, ~300 kcal worth (Farenholtz et. al, 2017)
  • kcal: short for kilocalorie, measure of energy. In the US we usually say “calorie” instead.
  • negative energy balance: more calories expended than consumed; during small deficits, liver glycogen can make up the difference. During larger deficits (e.g., < -300 kcal), fuel is obtained from other body stores, for example, fat and muscle (called catabolism).

Alright – getting back to the paper. The findings were remarkable; the average time with a negative energy balance of < -300 kcal for athletes with regular periods was 17.6 hours (Interquartile range (IQR) 3.9 – 20.8 hours), versus 21.8 hours in athletes with no periods (IQR 17.8 – 22.4). Athletes with no periods were in a catabolic state (negative energy balance) for four more hours per day than athletes with regular periods.

What I found really interesting was a diagram the researchers included, illustrating how hourly energy balance was calculated. This example shows a period of significant energy deficit at night, with no positive energy balance until the middle of the day (presumably lunchtime). Thinking of energy balance on an hourly basis like this rather than simply the amount of energy consumed in a day leads me to wonder if this might be part of the reason some women can be “all in” for 6+ months without period restoration, where others resume cycles within just 6-12 weeks. Continue reading

Getting the word out!

Helping women with hypothalamic amenorrhea / female athlete triad / missing periods to recover–regain their cycles and realize how much needless energy has been spent on food, exercise, and appearance–has been my passion for the last ten years. For many years I helped women on the HA forum at, but since 2012 my posting there slowed down as I worked on the book.

Now that the book is done… it’s really time to get the word out. We’ve gotten so many positive reviews and comments on our work, like what Amanda said recently,

I want to take a moment to thank you from the bottom of my heart. I’m almost done your book and can see that you’ve poured years and years of your life, heart and soul into that book and raising awareness around HA. I can’t tell you how much I’ve learned and how motivated I’ve become to continue to work on my health and hormonal integrity and to incorporate BALANCE into my life. Not to mention that this book will spearhead an increased awareness of HA and hopefully a new understanding of the importance of maintaining female health……THANK YOU!!!

Meret Boxler, whom I met on a hypothalamic amenorrhea support group on Facebook, has been working on being compassionate with herself, redefining her view of what healthy is and looks like, and focusing on the positives in her life. As a former radio DJ creating a podcast series seemed a natural next step – and she wanted to interview ME!  So I am super excited to share that interview with you. Take a listen, and if you enjoy, please subscribe to her feed, give her lots of likes, and reviews would be fantastic.

LU 003: Nicola Rinaldi – No period. Now what? Health issues from overexercise and too little food.

Subscribe on iTunes (Apple), or on Stitcher (Android)

Shortly thereafter, having gained some confidence from the interview with Meret (on top of which it was a really enjoyable conversation), I was directed to a video on YouTube that contained misinformation about HA and its causes. So I immediately thought that doing my own video would be another fantastic way to get the word out about our hypothalamic amenorrhea recovery book along with basic information about HA that it’s important for people to understand. That video is below – and again, if you could like and comment that would be stellar – the more likes, the more people will be able to find it and educate themselves about missing periods and the effects on our health.

Thanks so much!!! xox Nico