No period or irregular periods? Flax seed might help

There are multiple benefits to consuming flax seed, that I’ve discovered as I research the seeds used in seed cycling. 1) Fewer anovulatory cycles in normal cycling women, 2) longer luteal phase with higher progesterone/estradiol ratio, 3) reduced stress hormones and perception of stress, 4) a number of more general health benefits including improved lipid profile, reduction in risk of cardiovascular disease, decreased A1c in type II diabetics, and potentially cancer prevention. I will discuss the first three in this post – for an excellent review of the other health benefits, please see this article.

There are three major components in flax seed that are thought to have health benefits – the fiber (6% of dry weight), the lignan alpha-linoleic acid (20%), and the phytoestrogen precursor secoisolariciresinol diglucoside (SDG, 1%). One can consume either whole (ground) flax seed or lignan or SDG extracts. If you’re trying to recover your period I would recommend ground flax as the relevant studies were mostly performed with that rather than extracts. For other health benefits, I would suggest looking more closely at the studies (in this review, for example) to determine whether they used extract or whole flax (many used specific extracts).

Flax seed and menstrual cycles

Hormone levels and menstrual cycle parameters in women consuming 10g flax seed per day were examined for the duration of three menstrual cycles (comparing with three menstrual cycles in the same women where no flax was consumed but diet remained otherwise the same). For each woman, the second and third cycles were examined.

There were two important findings. First, there were no anovulatory cycles (0/36 cycles in 18 women) in women consuming flax seed compared with three anovulatory cycles during the control phase (3/36 cycles in 18 women, anovulation occurred in three different women).

Second, luteal phase when consuming flax seed was 1.2 days longer than with no flax seed consumption. I loved that this paper actually graphed the change in luteal phase between the flax/no flax cycles rather than just reporting averages: 1 woman had a shorter LP by 1 day, five women had no change, one had half a day longer LP, five had a 1-day longer LP, two had a 1.5-day longer LP, and one each had 2, 2.5, 3.5, and 4.5 day longer LPs! Both of these results suggest that daily flax seed consumption might be beneficial for women trying to regulate periods, and those with short luteal phases (another tool to add to the short LP arsenal!)

When hormone levels were examined, there were no significant changes in any hormones: estradiol in the early or mid-follicular phase, or progesterone or estradiol during the luteal phase. Testosterone levels during the mid-follicular phase were about 10% higher, a significant difference. The researchers speculated this might affect the luteal phase length. There were also 25% higher progesterone to estradiol ratios during the luteal phase (non-significant 10% higher progesterone and ~15% lower estradiol combined to give a significantly higher P/E2 ratio under flax seed consumption). This could potentially explain the longer luteal phases.

flax seed and improved stress perception

Another set of studies seem to show positive effects of flax seed consumption on hormones associated with stress response, and this is where I think that flax seed might help those who are working toward recovering missing periods, but not there yet.

The first study I want to tell you about looked at stress markers in mice fed either a control diet, or one that contained a commonly used anti-depressant (imipramine), pomegranate peel extract or flax seed extract. After 50 days various hormones were measured – cortisol, epinephrine, and norepinephrine. Flax seed extract and imipramine showed similar levels of decrease in each of these hormones, which is great for someone trying to recover from hypothalamic amenorrhea / no period, as each of those hormones help suppress the hypothalamus – decreasing levels will only help get the hypothalamus going again!

35 postmenopausal women consumed different varieties of flaxseed containing varied levels of two active components SDG and alpha-linoleic acid. Blood pressure was used as a marker of stress, and all three types of flax seed reduced blood pressure during a frustrating cognitive task, in comparison with the same task without flax seed consumption (the study was a crossover design so some women took the test with flax seed first and without second, for others the order was reversed so the reduction in blood pressure was not due to having taken the test before.) All three varieties reduced plasma cortisol as well, but the Linola 989 variety with the highest SDG showed the highest reduction.

flax seed recommendations

I started researching the effects of flax seed in the context of seed cycling. As I read the scientific literature I noted that there was not a single study that alternated seed types – all the medical literature I could find had people (or animals) taking one seed type consistently. I will present the evidence on the other seeds included in “seed cycling” shortly (pumpkin, sesame, and sunflower seeds) but I have not found any evidence to suggest value in changing between seed types.

Studies show flax alone has the potential to reduce stress hormones, and have positive effects both on the follicular phase (including ovulation) and the luteal phase of a menstrual cycle. Based on the reduction in stress hormones and perceived stress, along with other health benefits and no adverse consequences, I see no reason not to add flax seed to your arsenal as you work to restore missing menstrual cycles or to potentially help with normalizing menstrual cycles that are wonky for other reasons. Instead of making yourself crazy trying to figure out what seeds to take when, as one has to do with “seed cycling”, simply eating ground flax seed every day (the other seeds could be added as you like) might be beneficial. Note that as with other supplements, it is unlikely that taking flax alone, without increasing food intake, reducing high intensity exercise, and reducing stress will be successful. Check out No Period. Now What? for evidence and recommendations on how to do all this.

This is the ground flax I use, from BJs . My mom started adding flax seed to the yogurt she had for lunch every day ages ago, I tried it and liked it, and started adding it too (along with chia seeds, ’cause I like the crunch).

I’d suggest 10g/d as a reasonable amount based on the study finding fewer anovulatory cycles and longer luteal phases. For other health benefits, again, please examine the specific literature to find the optimal form of flax to use and what dose.

Also, note that there have not been any detrimental effects found with flax seed so far for most people, but the recommendation is not to consume flax in large quantities while pregnant as studies in rats do show some negative effects (included in this review). I wouldn’t stress if you’re pregnant and have some, but probably best not to have daily.

 

 

 

 

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

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

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?