Can Maca help restore periods?

This week’s topic in our series on supplements to potentially help with missing periods is maca, aka Lepidium meyenii.

A little while back I did a survey of women in my facebook support group and found that among 53 women 63 supplements were being taken with the idea of helping to restore missing periods. (The overview of the topic can be found here, other posts in the series include Vitex and Acetyl-L-Carnitine). 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 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

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

 

 

Femara or Clomid for Ovulation Induction?

Summary: If you are not ovulating naturally even after working on recovery, and want to use medication to induce ovulation for pregnancy, Femara (letrozole) is preferable to Clomid (clomiphene)*.

letrozol3d

 

 

Letrozole, By MindZiper – Own work, CC0, https://commons.wikimedia.org/w/index.php?curid=15991603

 

In No Period. Now What? (NPNW), our book on hypothalamic amenorrhea recovery, Chapter 21 covers the oral medications that can be used to encourage ovulation. We discuss how soy isoflavones, Femara, Clomid, and tamoxifen reduce estrogen levels to encourage an increase in follicle-stimulating hormone (FSH) that in turn leads to growth and maturation of eggs. These medications can be used when pregnancy is desired, but also to “jump-start” menstrual cycles*. It is really important to note that these meds are unlikely to work without progress having made toward recovery in the form of increased eating, reduced exercise, and reduced psychological stress – all of which you can read about in earlier sections in our book.

clomifene_ball-and-stick

 

 

Clomiphene, by MarinaVladivostok (Own work) [CC0], via Wikimedia Commons

 

 

We also cover research comparing pregnancy rates, likelihood of a multiple-gestation pregnancy, uterine lining thickness, and other metrics between Femara (letrozole) and Clomid (clomiphene citrate) to help women decide which choice is optimal for them. (Tamoxifen is an alternate that is rarely used, so there is not a large body of research to reference, although in many ways it is preferable to Clomid based on fewer effects on the uterine lining.) We also discuss dosing recommendations, what to do if the first cycle doesn’t work, and much more. 🙂

Our conclusion in NPNW is that if one is trying to get pregnant, 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 FertileThoughts.com, 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