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Why wait for three periods after amenorrhea recovery?

Updated: May 16, 2023

In No Period.Now What? I recommend waiting for three periods before altering the amenorrhea recovery lifestyle you have adopted. I’ve gotten a number questions recently about why this is, so I thought I’d go further into the rationale.


Picture of three hearts crafted from tampons, with the text "why wait for three periods? I have seen too many people get that first period, think, "Yippee, I'm recovered," add back exercise or stop recovery level eating, and their second period is nowhere to be found. #HArecovery

Reason #1

The first reason to wait for three periods before making any changes as far as eating, exercise, or stress go (obviously stress is least in our control but we can try!) is because after just one period you have no understanding of your normal cycle parameters, so you have no way of knowing how your body is responding to any changes you’ve made. You don’t know how long a typical cycle might be, you don’t know what “normal” is for your luteal phase, you don’t know when to expect ovulation… all of that information can be extremely useful going forward as you can use it to assess the effect of exercise or eating changes. (Particularly if you want to be pregnant.)


Chapter 18 in NPNW talks about how to monitor when you ovulate, some other good resources are Lisa at Fertility Friday who has an excellent podcast (I would avoid the episodes with guests talking about how to eat for fertility because those recommendations are not appropriate for women with HA and can be rather triggering) and also teaches courses on fertility monitoring, and the book Taking Charge of Your Fertility (Amazon US, Amazon UK, Amazon CA, Amazon DE).)


As I’ve discussed in previous blog posts, it is quite common for second cycles to be long anyway, so it’s great to use this time to get to know your body a bit better – what signs of ovulation is it giving you?


Reason #2

The second reason is I have seen many women get that first period, think “Yippee, I’m recovered,” add back exercise or stop recovery level eating, and not get a second period. That situation can then necessitate working on recovery all over again which is a real bummer. If you stick with your recovery lifestyle for three months / cycles (which can be longer than three months) your body is much more likely to be settled with the new hormonal patterns, and more resilient to changes.


Making changes…

I do want to caution you that even after three cycles, your system is likely still quite sensitive, and if you want to make changes, you should do so gradually.


For example, if you’re a runner who has stopped for recovery, I would suggest only adding 15 minutes running twice a week after your third period. If your body seems to handle that okay (i.e. luteal phase is the same length, you’re ovulating around the same time), you could move to 30 minutes twice a week for the following cycle, then the cycle after that, maybe go up to 3-4 times a week. Definitely monitor your luteal phase and ovulation, and if the level of exercise you’ve added seems to be affecting that, keep it the same for another cycle or two to allow your body to adapt.


As far as any eating changes, I do not recommend intentionally cutting calories or starting to restrict food groups again. Hopefully you have learned during recovery that your body can get nutrients from all types of foods, and that if you eat what you desire and enjoy, your body can find it’s own natural and comfortable balance. You may have had to force yourself to eat in the beginning of recovery – we often have overridden natural hunger signals, and possibly even shrunk the size of our stomach, so that we have to eat more than is comfortable when we begin recovery…. through your recovery journey you will likely have found that your hunger signals are now more appropriate, and you are no longer feeling uncomfortable with those food amounts.


What you can start moving toward is more intuitive eating. I recommend Evelyn Tribole and Elyse Resch’s books Intuitive Eating and the associated workbook (Amazon US, Amazon UK, Amazon CA, Amazon DE (including a version in German)) if you want to learn more. Also, check out Evelyn’s recent series on instagram about the TRUE principles of intuitive eating, as the work has been coopted and misunderstood by those still sending diet messaging.


In essence this means following your body’s hunger and fullness cues more, rather than focusing on making sure you are eating X amount per day. I do still encourage fueling throughout the day – breakfast close to when you wake up to make sure that you are not starting off the day in an energy deficit, snacks and meals through the day. But if you have been eating at a certain time just because you want to ensure you’re getting enough energy for recovery but you’re not actually hungry then, you could experiement with honoring those hunger cues more.


I will caution you that exercise does seem to blunt our natural hunger signals as we discuss in NPNW, so fueling your exercise probably needs to be more intentional, e.g. if you’ve run four miles, eat an extra 400 calories beyond what you normally would for a day. This fueling of your exercise is what will allow you to continue while maintaining your cycles.


Kathrin’s story

I want to share Kathrin’s story with you – she had two recovery periods then decided her body was “too big”… the weight loss she undertook was too much and she lost her period again. We worked together to change her mindset, I reassured her that she could recover once again, it might take gaining a bit more than she had before but her body would trust her again… I’ll let her share the rest…


”My journey with HA started in May 2017 when I felt uncomfortable with the weight I had gained over the past few years. When I think about it now, my body was actually perfectly fine but unfortunately I didn’t see it then. My boyfriend just got into fitness and was using an app to track his calories and macronutrients (fortunately he doesn’t use it anymore these days), so I was like: “Hey, let’s try this too. Maybe it will help me lose some weight.” So I made one of the worst mistakes of my life and downloaded the app. It calculated a calorie requirement for me which I know now was way too low, but I followed it nevertheless.

I lost weight pretty quickly and along with it I lost my period. Before I had HA, I was tracking my cycles, so I know that I started to diet around the time of my ovulation. My luteal phase was shorter than usual that first cycle, and then I didn’t ovulate again. At the beginning I was a little concerned but I thought that my body just needed to get used to my new “healthy” diet, so I kept doing what I was doing. I soon slipped into an awful restrict-binge cycle, was thinking about food 24/7 and couldn’t keep focused in my classes anymore because I was so hungry all the time.


When about three months had passed and I still hadn’t gotten my period, I became worried and went to my ob-gyn who prescribed me chaste tree (vitex [not recommended for HA recovery, see this post]) without doing any blood work. I was skeptical and after doing some research I found out that chaste tree only works for some causes of amenorrhea and can actually be counterproductive for others. So I stopped taking it and went to an endocrinologist who did blood work and so I got diagnosed with HA.


The endocrinologist didn’t talk to me about my diagnosis but just gave me the lab results, so I did my own research. I quickly found NPNW and immediately bought it. Its content really resonated with me and I went all in shortly after I finished reading it in February 2018.

I was gaining weight pretty quickly but it didn’t bother me that much because I was still at a weight I felt comfortable with during that time. It only took me about two weeks to get my period back. I couldn’t believe that it had happened so fast. I had a LP of only three days though but still a period after over nine months of nothing!


About the time when I got my second period and was still gaining, I was slowly reaching a weight I didn’t feel comfortable with, so I subconsciously started to restrict again thinking I would be safe after two periods. But I was wrong. I didn’t get a third period and after a few weeks without one, I became angry and stubborn and started to exercise again. Another six months passed without a period and I fell into a deep hole of depression and self-pity. I knew what I had to do to get my period back again but I just couldn’t bring myself to gain more weight and that made me hate myself even more.


Eventually I got so fed up with living in limbo that I joined the No Period.Now What? support group because I felt so lonely. I have my boyfriend and my close friends who are really supportive but they just can’t get it the same way the awesome ladies in the group do. And all the doctors who told me that my weight was “normal” and perfectly fine didn’t help either. I read so many posts from other women who had the same worries, struggles and fears I did and suddenly I wasn’t so scared of gaining weight anymore. Unfortunately my mom wasn’t supportive at all with this and fed into my fears of gaining weight again, so I just couldn’t find the courage to go all in again.


Finally I reached out to Nico who gave me the affirmation I needed so much and then I finally took the plunge and went all in again which undeniably was one of the best decisions of my life ever! I gained some more weight and became “overweight” by BMI standards which I really struggled with. But after about three weeks I got my period back again and this time my LP was even eleven days long! This time I didn’t only heal physically but also emotionally because I finally felt like I had a somewhat normal relationship with food and with myself again. Of course there’s still much work to do but it’s getting better and better. And guess what? My weight has been stable since getting this first period even though I’m still 100% all in.


To all the women who think that they can’t have HA because they have a “normal” BMI: You can and so did I!


To all the women who got their first period: Please don’t make the same mistake as I did! Wait till you got three recovery periods and then you can SLOWLY add in changes.


The danger of relapse is just too big at the beginning and I can tell you that there’s nothing more frustrating than healing from HA and then having to do the whole recovery process all over again. I never had to go all in for a long time but the struggle in between was definitely real.


Last but not least I want to thank Dr. Nicola again for her wonderful work and her personal support. Without her I would’ve never realized how much I harmed my poor body with my lifestyle and without her I would maybe still be in the depths of my relapse. I also want to thank the wonderful NPNW support group for always being a safe space for me to share my fears, doubts and worries, but also my victories. I met some awesome people here and can even say that I found some friends.


This journey has been an emotional roller coaster for me but it was all so worth it. It made me love my body for what it does and not what it looks like (though I’m beginning to appreciate how it looks again even though I’m at my highest weight of my whole adulthood), it taught me patience, it made me finally break up with the toxic diet culture for good and it made me realize that I’m worthy no matter my dress size or what the scale says.


I actually think I’m going to stay all in a little longer to make sure that my body knows that it’s definitely safe now because I actually feel comfortable with being all in now.”

-Kathrin


Have you had three periods already? If you added back exercise, how did you go about it? Did you notice changes to your cycle?


I hope that these thoughts, recommendations, and Kathrin’s story are helpful for you as you think about solidifying your recovery and then slowly getting back to movement you enjoy, and a long term sustainable relationship with food.


Nico

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