Reader Questions

I thought that now that my kids were back in school I’d have all kinds of time to post here – but somehow between being PTA president, starting a PTO at my youngest’s preschool, getting involved in local politics, reading a bunch of books and starting to lift weights again (because I was feeling weak NOT for body sculpting purposes), and yes, getting a little mired in the national election coverage too… not so much. But hopefully this will start a new routine!

I asked in my facebook group for questions people would like answered. If you have anything else you’d like me to address, pop it in the comments and I will do so on another post!

1. What do you think about soy and other estrogen increasing foods?

Many people think that the issue when one has HA is low estrogen. This is not the case. The issue is that your hypothalamus is not sending the signals to your reproductive system. Once your hypothalamus turns back on again, your estrogen will rise appropriately. So as far as foods go – I advocate moderation on all fronts. It’s fine to eat some soy but I see no need to specifically increase the amount you’re currently eating. If you’re eating a “lot,” I’d advocate cutting down and substituting with other protein and fat sources simply in the interests of eating as many different types of foods as possible.

2. Does color and length of your period indicate anything?

This one actually comes up a lot! Many women are afraid that their period is “too light” when they start cycling again. My ‘normal’ post pregnancy has been one heavy day (which I define as filling a regular tampon every 2-4 hours), a medium day (filling a tampon every 6 hours or so), two light days (a tampon every ~12 hours) and then a day or two of spotting. Something around that seems to be reasonably common. Some women obviously have much heavier periods, some have significantly lighter periods – but anecdotally I haven’t noticed a correlation with ease of getting pregnant. Also, interestingly, it seems that not all the lining is shed as “blood” but some can actually be resorbed into the uterus. So I think that really what is important is what is normal for you. If your periods after recovery are much lighter than before, that may indicate a need to relax a little further on the exercise, eat a bit more, or see what you can do about relaxing (all of which we cover in our book :)). If they’re much heavier, you may want to check in with your doctor, just in case there is another issue at play like endometriosis. If they’re normal for you, however heavy or long that may be – chances are excellent that everything is fine. If you are trying to conceive and not getting pregnant, you can discuss with your doctor, but barring that – go with the flow. (yes, pun intended ;))

3. How long will it take to recover?

In a previous post I discussed whether time to recovery was associated with length of time without a period, and the answer in that case seems to be no. The median time to recover is about six months – some shorter, some longer. In general, the more quickly you are able to go “all in” the more quickly you will recover your cycles. I wish there was a formula I could plug your information into that would spit out an answer – but unfortunately life doesn’t work like that. Your particular recovery formula will depend on what your BMI was/is and how quickly you’re able to increase that to a ‘fertile’ BMI of 22+, how much exercise you did and what you’re doing now, what your food intake looks like (hint: the more variety the better, assuming sufficient energy), and what your daily stress and anxiety levels are (and unfortunately this is a vicious circle because stressing out over how long it will take to recover can make it take longer!).

4. I can’t go all in. I don’t trust the process.

From my experience what really helps here is seeing other women recover. (Read the success stories in our book and join my facebook group!) When you find someone just like you and read about what they did to restore cycles or get pregnant, it makes it that much easier to believe that it can and will happen for you. Keep reading the successes, keep listening to the other amazing resources that are out there (I cannot recommend Meret Boxler’s podcasts enough, she will introduce you to everyone you need to know in this arena), do as much as you can to work toward recovery (fake it ’til you make it) and one day it will click for you too. I have seen it countless times. It will come.

5. How do you track food while in recovery and know you’re eating enough?

This is a tough one because really, tracking is a big part of the problem. So it’s hard to see it as part of the solution too – but I know that when you’re starting on this path from a place where you are tracking it is hard to let that go. What I did initially was to increase the amount of calories I was allowing myself each day (“allowing”…that’s a whole different topic) and I continued meticulously tracking as I had been. I’m a numbers person so that was hard for me to let go. But there came a time when I’d skip a day… and that quickly grew to two and three and then to not tracking at all anymore. At that point I had a good sense of how much I needed to eat each day and I was much better at listening to my hunger signals. If you’re not tracking now I wouldn’t suggest starting unless *maybe* you log your food intake for a day just to see where you’re at. Really the best way to know you’re eating enough is two-fold: 1) if you’re under a fertile BMI to make sure you are gaining, and 2) notice your fertile signs (chapter 16) and obviously return of your period. And yes you often have to go beyond what feels comfortable for you, both in the amount you’re eating and in how much weight you gain… but I *promise* you, the return of your cycles and your fertility is worth that discomfort. Again – seek out success stories and read about how little women care about what their body looks like when they see that first sign of red, or get their positive pregnancy test.

6. If a period was lost with no exercise, will adding exercise while eating more calories, fat, carbs delay recovery?

Abso-freaking-lutely yes. I was over in a different facebook group today and a women commented on how she had just started a new exercise routine, going five days a week instead of the one she had been doing, and how her ovulation was six days late (and still nowhere to be seen). Especially if your body isn’t accustomed to it, the increased cortisol from exercise can do a number on your hypothalamus. Walking and yoga, *light intensity* are probably okay but I would add even those slowly. Also, I noticed a big effect of exercise on my own cycles (p. 162 in our book) even while gaining weight.

I hope you found this helpful, and if there’s anything else you’d like to know, drop a comment!

Embracing the New You

I just went to see the movie Embrace with my new friend and fellow HA warrior Kate. It was lovely meeting her in person and we spent a lot of time over dinner before the show bemoaning how our society has encouraged us toward the predicament of treating our bodies so harshly in an attempt to be healthy – and also how much more common hypothalamic amenorrhea is these days with the latest trends in “clean” eating and strength and endurance training for women.

embrace_showing

Anyway, the movie was utterly fantastic and I cannot recommend it enough. Whatever your personal situation is, I can pretty much guarantee that Embrace will speak to you. I love the idea that is becoming more and more commonplace: that we should love ourselves and others for what we accomplish and *think* instead of what we look like (and heck, let’s do our best to pass this idea on to the next generation!). I know, not really a newsflash anymore, but at the same time it’s an idea that is easy to give lipservice to without truly believing. Embrace took me even further than I was down the path of believing. Find a way to see this movie! #ihaveembraced

Along the lines of switching your outlook, a woman recently posted in a facebook support group of which I am a member (join mine here) about how she was struggling with feeling frumpy and not hot when she went into a fashionable store to try on some new clothes. The responses were amazing, insightful, and inspiring, which is why you should join too if you’re working on recovery. Who doesn’t need an army of HA warriors at their back?

Lindsay said, “I’m so sorry you’re having a rough day. I understand; I had MANY of them. The next time you go shopping and you don’t like how something looks when you try it on, try to shift your mindset from “This fabulous shirt doesn’t fit my body” to “My fabulous body doesn’t fit this shirt“. There is nothing wrong with your body; it’s the shirt that doesn’t work. Take it off, and try on a different style. Do you remember the show What Not to Wear? I like to think of that show every time I go shopping, because Stacy and Clinton could always make ANY person look fabulous, no matter how big/small/short/tall. It’s just a matter of finding clothing that really flatters you. Body love and acceptance takes time… you’re just getting started here, and the changes are fresh and new. Over time, you’ll get used to your new self, and you will grow to love it as much as you did your old self. Maybe even more. Remind yourself daily that you are a multi-dimensional person… you are not just a body. And truly, the other aspects of your being – your personality, your sense of humor, your wit, your charm – are what people are most drawn to. Don’t let any perceived ‘imperfections’ of your physical body spoil the rest of that.”

Yes, yes, YES!

<3

How long will it take to recover???

One of the unique aspects to our book on recovering from hypothalamic amenorrhea is the data we include from our survey of over 300 women who have experienced missing periods. I also love having the data set because when people ask me questions that I didn’t address in the book I can go and get the answer pretty quickly.

A question that was recently asked was Is there a difference in time to recovery depending on how long one’s period has been missing? The range of time for which periods were missing for the women who took our survey was from three months to over twenty years!

However, I found that there was hardly any difference in time to recover based on length without a period. Note that the start of working on recovery was defined as the time at which eating more / weight gain commenced. The data are shown below (note that the scale is logarithmic, not linear):

MonthsWithoutCycleVsTimeToRecovery

Each point represents one woman, with the amount of time she was without a cycle on the Continue reading

What to do if you’re a competitive athlete with a missing period?

Our hypothalamic amenorrhea / female athlete triad recovery book No Period. Now What? describes the causes of HA, many of the short- and long-term effects, and offers a Recovery Plan that has worked for hundreds of women. We also offer support throughout in the form of our own experiences, anecdotes from other women in similar situations, and advice we have gleaned over our years working with women to restore menstrual cycles.

There are two major components to recovery, both of which are covered in great detail in our book, but simply put, they are to eat more and cut out high intensity exercise.

Easy, right? Except, really, not at all. It is incredibly difficult for most of us to relinquish the food myths that we have been taught over the years, to let go of the rules that we have placed on ourselves, and particularly, to gain weight. For many it’s even more difficult to stop our cardiovascular exercise, whether it be running, biking, classes, or being a ‘gym rat.’ That’s why we spend more than a hundred pages on the rationale for the recommendations, ideas to implement them, and support for all the mental work that needs to happen.

While it’s hard enough for a recreational athlete to cut out high intensity exercise, for a competitive athlete this might truly be impossible. If you’re in high school and hoping for a college scholarship, or already in college being provided funds to attend, or a professional athlete – you might not be able to just quit for a few months. There is so much riding on your ability to perform.

relay Pole_vaulter Division’s_own_earns_Camp_Pendleton_Female_Athlete_of_the_Year,_runner_up_in_Marine_Corps_award_140313-M-PC317-003 Women 60 m final during Doha 2010 World Indoor Championships, by Erik van Leeuwen

(Photo credits, L to R: Erik van Leeuwen, Atitaya Kongkaew, Sgt. Timothy Lenzo (https://www.dvidshub.net/image/1189561), Erik van Leeuwen http://www.erki.nl/pics/main.php?g2_itemId=33469, all via Wikimedia Commons)

And yet.

Continue reading

Some new reviews

I am so utterly thrilled by the reception of our hypothalamic amenorrhea/female athlete triad recovery book so far – we seem to have met our goal of providing a resource that can help women to recognize what habits might be less than healthy, and encourage and support them through making the necessary changes. I’ll let other’s words speak for themselves.

Ashlee, in an HA support group on facebook:

Nicola Rinaldi I just wanted to tell you how much your book settled all my feelings towards HA. I bought it last night and read the whole thing already. I have to say I’m in the medical field and felt silly that I didn’t know much about the science behind HA. Now I feel good about going to my first RE appointment coming up and what to expect. I can’t express how thankful I am to have all you wonderful role models in this group. I am continuing to gain weight and reduce exercise. Normally when I get stressed I eat less and run more. I now am doing the opposite and doing really well. So since this post is getting super long in conclusion I just wanted to thank everyone for being amazingly strong. I hope to not only have success in pregnancy in the future, but just as important to focus on actually living life and not focusing on and obsessing over what I “think I need to look like”.

V, in response:

Ditto to Ashlee! My husband just read the chapter for partners last night, and we both can’t stop talking about it. He said it feels like you (Nico) know my wife so well, and it gives him such encouragement to know we can get through this!

Amanda, in a different facebook group:

Loving chapter 11, Nicola Rinaldi! So many heartfelt nuggets of understanding, motivation, and inspiration! LOVE it! And just what I needed to read this morning.💜💜

Lauren, via email:

I’m only a little way in, but it’s making me feel better already… I’ve had HA since coming off the mini-pill three and a half years ago. (Plus no periods for eight years whilst I was on that pill, since the docs said that was a “normal” side effect… Plus wonky cycles even before that — in hindsight, probably due to constant dieting.)

I genuinely didn’t realise it could have anything to do with my food intake/exercise until less than a year ago… No doctor ever mentioned it as a possibility, and I thought I was super “healthy”… Anyway, I’ve gained 20lbs over the past few months and have been really struggling with keeping up my resolve, so I feel like I stumbled on your book at just the right time!

Thank you so much for helping me feel like I’m not alone… And giving me hope that I still might get my period back!

Marcy, via facebook message:

Just finished your book, it is amazing, as I read I identified with so much of it, thank you for guiding me through making changes to my lifestyle and essentially starting to get my life back. I am only at the beginning of my journey to recovery but I feel so inspired, in fact I think I will read it again to reconfirm and keep me on track, thank you so much, I look forward to feeling better about myself, my health and all the wonderful times that lay ahead for me!!!

Sarah, in another facebook group:

The knowledge and women in this book helped restore my health and bring this little beauty into my life. “No Period. Now What?” continues to save me because honestly with breastfeeding I wasn’t eating enough and after reading a few chapters I changed my ways to keep HA at bay. So inspiring to be reminded that food is fuel and when given what it needs my body can be a baby-making machine. Thanks Nicola, Lisa, and Stephanie!!!

Nico’s story

I’ve had quite a few people ask about my story; my experience with hypothalamic amenorrhea, recovery, getting pregnant, and what led me to writing my HA recovery book. So here’s the full tale. At this point, I’m recalling events of 10 years ago which in many ways has lessened the emotional sting. If you’re interested in reading about what happened at the actual time I was going through it, you can start here, on my old blog. Anyway…

My journey to hypothalamic amenorrhea (HA) and back was a long time in the making. In high school I was relatively carefree; I had a group of close friends, thought exercising was for the birds, and maintained a ‘normal’ weight without issue. I had participated in softball in middle school but wasn’t particularly good, so my high school sporting career consisted of finding the least unappealing gym classes; volleyball, squash and badminton were my favorites. My competitive urges were mostly satisfied by my flute playing.

In college I took a few ice skating lessons (I had ice skated as a kid but never competitively) and started becoming more active; joining a gym, running, playing tennis – much of it encouraged by my boyfriend of the time. I still mostly ate what I wanted to, again maintaining a ‘normal’ figure – was somewhat proud of the fact that there was no ‘freshman fifteen’ for me.

The next stop on my journey was the company where I’d worked as a summer intern while in college. An up and coming biotechnology company in the Boston area. It was a fantastic place to work as a 20-something; lots of company activities that I now joined in on, like volleyball (still one of my favorites) but I also tried softball and soccer again, among other pursuits. After I met my to-be-husband (at the company-sponsored social hour on a Friday evening), he got me hooked on playing ice hockey. He organized the company’s weekly “pick-up skate” where a group of guys would get together and play a friendly game. I told him one night as he was heading out that it looked like fun and asked if I could join. Mark got his gear from when he was a teenager out of the attic for me. It fit relatively well and off I went. The guys were super nice, no-one ever made me feel like I didn’t belong, and I was totally hooked. I started participating in clinics to improve, and playing on some local teams.

Nic hockey

After four years I went to MIT for graduate school. Mark was gone each week from Monday through Thursday on business. That meant I had a lot of free time on my hands, during which I occupied myself with various forms of exercise. I had grown to love my sports and played ice hockey, volleyball, squash with my labmates, lifted weights a few times a week, would bike from home to campus (about 7.5 miles each way), and then we’d golf on the weekends, walking the course instead of riding a cart. All well and good.

Until the labmates I hung out with most of the time decided they needed to lose some weight and were going on a diet. I figured “Hey, I’ve got some love handles I could stand to lose” (and although I didn’t think so at the time I realized afterwards I was also influenced by media images, like Natalie Portman’s abs in one of the Star Wars movies, sigh). Natalie Portman Star warsSo I joined them. They were limiting to 1500 calories a day, I thought that would work for me too; as a female I needed fewer calories, but I exercised more so the equation in my head suggested the same amount would work out well.

 

Eh, not so much. Well… in the short term I lost a lot of weight. I thought I looked great. I thought I was healthy–after all, you read all over the internet to “lose weight to have a better chance of pregnancy.” I also danced around with obsession. I was tracking all my calories in a spreadsheet, and ended up aiming for a net of around 700 calories a day which I know now is incredibly unhealthy. I was getting a high from seeing the number on the scale go down. I was pulled back from the brink through reading the story of a friend of mine who was going through a very similar experience. She posted about the Minnesota starvation experiment and as I read about the experiences of the men in the study I saw a bit too much of myself. Particularly one night when I woke up at 5am starving. I “allowed” myself a bowl of cereal, and that was a turning point for me.

A little more pullback from my restriction occurred over the next few months as I went off birth control pills with the idea of getting pregnant. Unfortunately, no period resulted.

I went to see my ob-gyn who ran a few tests and suggested that I might want to eat a little more / exercise less, but didn’t give me any solid guidelines. Over the next six months we continued with further tests, and she spoke to a reproductive endocrinologist, finally suggesting that I see her instead. A few more tests and I finally had a diagnosis of hypothalamic amenorrhea.

I did, during those six months, see a nutritionist who gave me caloric target about 700 calories per day more than I had been eating at the height of my restriction. Knowing what I know now, however, I still think that had me at a deficit. She did provide me with some great ways to add calorie and nutrients: switching my daily glass of milk from non-fat to 2% (full-fat is even better, again, hindsight), adding olive oil when I cooked, handfuls of nuts…

When I finally got to see the endocrinologist, she told me that it was highly unlikely that I’d get my period back, especially as I’d been somewhat irregular when I was a teen. So, the plan was that I would start on injections to cause follicle growth and ovulation, after I got back from a three week vacation to my homeland of South Africa.

Well, wouldn’t you know it… during that three weeks I actually had a period! In hindsight, I totally credit my lack of serious exercise during that time (and probably decreased stress). We did quite a bit of walking and played a few rounds of golf, but there was no ice hockey, volleyball, squash, biking, maybe one or two weight sessions when we were staying at hotels, but nothing regular. I *rested*. And ate too. My reward was a bleed, which was particularly thrilling as it came as my sister was announcing her pregnancy to our relatives; we had planned to be pregnant together so the fact that she was pregnant and I hadn’t even ovulated yet was a bitter pill to swallow.

After that vacation I had already scheduled a couple of reproductive endocrinologist (RE) appointments. I went to my first with high hopes, I was on cycle day 13 (right around when you might expect to ovulate in a normal cycle)… they did an ultrasound and I had a 13mm follicles (not quite large enough to ovulate, but almost certainly growing!!!!!!) My second appointment was two days later, so I went in expecting to see that my follicle was growing and I’d ovulate on my own, but no such luck. It was quite the blow, going from the high of “my body rocks, I have an egg growing” to “craaaaaaaaaap, it’s not growing after all.”

So, down the rabbit hole of injectable gonadotropins we went. My first cycle resulted in my period at 10 days past ovulation (dpo) which is early and unlikely to be sufficient for an embryo to implant (known as luteal phase defect, common in women with HA). So we tried again, with progesterone support to avoid the luteal issue. Another BFN. Followed by two more. I was incredibly discouraged – I’d gained weight (to more than where I started), cut my exercise, and couldn’t even get pregnant when my body was made to ovulate. I was convinced that I would remain childless, which I had thought would be fine when I was not staring the possibility in the face. Now? not so much. I was in one of the darkest places of my life. We made the decision to move forward with IVF, despite my convictions that it would just lead to more disappointment.

We had to wait a month for insurance to kick in. In the interim my doctor wanted to put me on the pill but I declined. I thought I might as well give my body a shot in the meantime and doing daily testing of my hormones (using ovulation predictor kits, OPKs) and taking my temperature gave me something to do to pass the excruciating time.

I didn’t expect anything to come of it. It really was just to make the 60 days or so go more quickly and give me something to occupy my data-driven mind with. Well. Come cycle day 42, I went through my usual routine of peeing on my OPK and to my complete and utter astonishment, it was positive. I was afraid I’d missed the window of conception as my temperature was already somewhat elevated, but woke my husband up to make an attempt at pregnancy anyway, just in case. The next day the OPK was positive again, temp was back down, so holy freaking sugar-balls, I was ovulating all on my very own! The third day the OPK was negative, day after that my temperature was way up so my body had come through big time. I had OVULATED! (Note that “normal” ovulation occurs on CD 14, that is 14 days after the first day of your period – this was cycle day 44!!! Actually fairly typical during hypothalamic amenorrhea which is not commonly known.)

I waited and waited, felt some symptoms (like cramping at around 6dpo) that were different from my other cycles, but at this point I was not expecting anything, I was just so stoked that I’d managed to ovulate. At 13dpo I took a pregnancy test I’d bought the night before and to my complete and utter shock, the result was definitive. I was pregnant!!

When I was about 25 weeks pregnant I felt some strange tightenings in my stomach that didn’t seem right to me, and they seemed to be coming fairly regularly. I ended up going to the hospital, and it turned out they were “Braxton Hicks contractions” which are not atypical during pregnancy, but they were much closer together than the doctors liked to see (2-3 minutes at some points!) This continued for the next few weeks, ultimately resulting in hospitalization at 28 weeks for a few days to give me magnesium sulfate to relax my uterus and allow time for steroid shots to mature the baby’s lungs in case s/he was delivered early. (We were team green). After that episode I was put on “modified bedrest” essentialy meaning that I could go to work, being as sedentary as possible, and that was about it. No more walking to my doctor’s appointments, no more walking to deliver interoffice mail, no more golf (boo)… which left me with a lot of free time.

It was then I was introduced to the hypothalamic amenorrhea forum on Fertile Thoughts. I Fertilethoughtsbannerjoined, found a community of women going through exactly what I had, and started sharing my knowledge. I’d also do more research as questions came up, advising other women both on what to do to recover as well as fertility treatments. Pretty soon I became the mother hen of the Board, supporting everyone who came through in their journey to recover and get pregnant. I had found my passion. I loved sharing my knowledge and encouraging others to find balance in their lives as I had managed to do in mine. I spent all my free time on the Board, checking and posting multiple times a day. After years of this, the women started telling me that I should write a book; and you know how that story ends. My No Period. Now What? book contains basically everything I know about hypothalamic amenorrhea, its consequences, how to recover (not just recovering periods but also learning to live a balanced life with eating and exercise taking a back seat to actually living), tips about fertility treatments, pregnancy (and unfortunately miscarriage), and continuing to live a fulfilling and balanced life after pregnancy.

Are there any other questions you have about my journey? Or anything else you’d like me to post about?

Setting the tone for your day

Mindset is probably more than half the battle when working to recover your period. Changing your attitude to what you eat, your exercise, and your body takes daily effort, and support from others is huge in sticking with your changes.

Particularly if you’re used to getting up and exercising first thing in the morning, when you decide you’re not going to do that anymore it’s really hard to fill that time with another activity without pining for your workout.

A fellow HA recovery warrior shared a post from tinybuddha.com in support those who have recently decided to go “all in”; cutting out all exercise in hopes that will be the last push needed to recover periods.


The article is well worth a read. But as a highlight, when you wake up in the morning instead of thinking about topics that make you feel stressed or anxious (like choosing not to exercise or running through a totally packed itinerary for the day) rather choose a positive question or two to mull over. Some ideas:

  • What do I have to look forward to today?
  • What’s absolutely perfect about my life?
  • How can I make today absolutely awesome?
  • What’s the best thing that could happen today?

“You get peace of mind not by thinking about it or imagining it, but by quietening and relaxing the restless mind.” ~Remez Sasson

This goes along with our suggestion in the No Period. Now What? book of placing affirmations – positive statements that help ground you and reframe negative thoughts – around your house.

What other ideas do you have for ways to keep reinforcing a positive attitude through the challenge of recovery? (and after too!) What’s been most helpful for you on your journey?

Affirmations

Affirmations

In chapter 11 in No Period. Now What? we suggest using affirmations–encouraging statements that help keep you focused on your goal–to help you get through tough times as you work to recover from hypothalamic amenorrhea. Here are a few more that didn’t make it in to the chapter.

  • The moment you’re ready to quit is usually the moment right before the miracle happens. Don’t give up.
  • My body is a five star baby hotel!
  • The journey is hard, the recovery is worth it, be gentle on yourself.
  • I am not defined by the number on the scale.
  • I have a different body now, but different is OK, even healthy!
  • I am grateful for ________ today.
  • No one is in charge of my happiness except for me.
  • Time heals almost everything…..I will give this time.
  • No matter what my appearance may be, I am going to press forward in faith towards a hopeful future and not relive my past!
  • My happiness is not contingent upon circumstance.

Write any (or all) of the affirmations that speak to you on little pieces of paper, and put them in random spots. They can provide a little pick-me-up throughout  your day. Or if you find yourself struggling with how you look, not being able to exercise as you feel you ‘should’, or eating out of your comfort zone, use these to remind yourself of your purpose and desires. Tape them to your mirror, fridge, running shoes – whatever it takes to remind yourself that what you are doing is helping you to recover and kick some hypothalamic amenorrhea butt.

You’ve got this!