No Period – A sigh of relief or a cry for help?
This post was written by Brooke Robinson, UCSD dietetic intern and recent nutrition graduate from Bastyr University. Her goal is to become an expert on women’s health and have her own private practice one day. Being new to San Diego, her spare time is spent exploring different neighborhoods and new restaurants.
Menstrual cycles are often associated with a long list of negatives including mood swings, painful cramps, and fatigue. Because of this, it might initially seem like a good thing if your period were to suddenly stop. However, loss of your menstrual cycle is a red flag that something is physiologically off-balance and is cause for concern.
A missing period often represents deeper health issues. Some short-term consequences of missed periods include infertility (no period = no ovulation), dry brittle nails and skin, low sex drive, and increased vaginal dryness. If lack of menstruation persists, it can result in increased risk of cardiac disease, early cognitive decline such as dementia, and low bone density, which increases risk for bone fractures.
Some potential causes of missed or irregular periods include polycystic ovarian syndrome (PCOS), Turner syndrome, anatomical abnormalities, type 1 diabetes, and hypothalamic amenorrhea (HA). Properly determining the cause will require help from your primary care doctor.
Polycystic Ovarian Syndrome (PCOS): a condition in which a woman’s hormones are out of balance.
Turner Syndrome: when an X chromosome is missing or abnormal.
Anatomical abnormalities: an absent uterus or excess tissue that prevent bleeding.
Type 1 Diabetes: An autoimmune disease in which very little or no insulin is produced in the pancreas.
Hypothalamic Amenorrhea (HA): a lack of period that is brought on by improper signals from the hypothalamus.
Hypothalamic amenorrhea (HA) is the one that will be discussed in this post. “Amenorrhea” means missing period, and “hypothalamic” designates the cause of the condition- the hypothalamus. The hypothalamus is the portion of the brain that maintains the body’s internal balance. It controls the stop and start of hormones throughout the body. Typically, the hypothalamus keeps a tight regulation of your hormones. However, sometimes things go haywire, and some hormones become too high or too low. One consequence of this is the disruption of your natural menstrual cycle.
What causes the hypothalamus to malfunction?
Energy imbalance
Food restrictions
Weight loss
Intense exercise
Stress
Genetics
You don’t need to check off every box to find yourself with HA. Some women can develop HA through one factor such as food restriction, and others through a combination of factors such as weight loss and stress. Each body is different with its own set of genetics and reacts differently to the environment. HA is more common in women with low body fat percentage, insufficient caloric intake compared to daily activity, psychological stress, and/or physical stress through exercise. When there is one or more of these factors present, it causes an alteration in hormone levels and a disruption in the communication with the hypothalamus.
The hypothalamus is largely responsible for regulating appetite. Combine this with food restriction, and the hypothalamus will react by reducing communication to the reproductive system and causing an imbalance in hormone production.
Energy imbalance & Food Restriction:
All cells, organs, and body processes require a sufficient supply of energy. When there is a low supply of energy (i.e. calories from food), the available energy is directed to the mechanisms essential for survival such as your heart, brain, and other vital organs. Systems not needed for immediate survival won’t be given as much energy to thrive, such as hair and nail growth, skin and bone maintenance, immune cell production, body temperature regulation, and your reproduction cycle.
To keep these systems working, you need enough energy to meet your essential needs for survival and additional energy for the other body systems and processes. Your body needs to be able to use fuel all day every day. When it comes to adding in additional physical activity like sports and exercise, your body requires additional fuel (food). Low energy availability is more common in people that limit certain food groups such as carbohydrates or fats, or those who practice intermittent fasting or other restrictive diets. By cutting out core food groups or restricting “allowed” eating times, it can be more difficult to get adequate calories.
If you are feeling hungry, fatigued, or even hangry often, you may not be meeting your caloric needs throughout the day. If you are not feeling your hunger cues, it may be a sign that you have been ignoring your hunger cues for an extended time. Restricting certain food groups also increases your risk for unmet nutritional needs. Any limitation of nutrient sources (certain foods, food groups, or rules around eating) can lead to a restrictive mindset and the development of an unhealthy or disordered relationship with food.
Signs you may not be consuming enough food:
Your period is no longer occurring, or it is occurring irregularly when it was previously regular.
You feel cold all the time – This can happen because your body is using more energy keeping vital organs alive and less energy on regulating body temperature.
Your hair and nails are dull, brittle, and/or break often.
Your skin is dull.
You get sick often.
You experience digestive problems such as indigestion, gas, bloating, constipation – If you’re regularly not consuming enough food, your body will slow down your metabolism and the digestive process to conserve energy & nutrients.
You experience some degree of weight loss.
Weight loss:
Women with lower body fat, or with recent or history of weight loss predispose any woman to losing her period. While it is possible to lose your period at any weight and without the presence of significant weight loss, it is more common to see HA in women that are under their normal weight.
Exercise:
Exercise can affect your menstrual cycle in two ways: by not eating enough to refuel your body and increasing your cortisol levels (the stress hormone). Exercise is a form of stress. A little bit of stress has a positive effect on the body, but too much of it can be detrimental to health. It is more common to see HA occur in women who do moderate to high intensity exercise, but HA can be seen at any intensity level, especially when it is paired with under-nourishment. If you’re not replenishing the energy expended during exercise through proper nourishment and rest, you can alter the balance of your reproductive hormones quickly. Even if you think you are refueling properly, there’s a chance you are underestimating your needs.
Sometimes high-intensity exercise alone without caloric restriction can lead to an imbalance in reproductive hormones due to increased cortisol levels. Exercise can also cause mental stress. If you find yourself organizing your life around exercise, feeling irritable when you can’t exercise, or feeling compelled to exercise when you don’t want to, this can lead to increased stress levels even if you don’t realize it.
Stress levels:
Stress is an inevitable aspect of life, whether from normal day-to-day stressors, traumatic events, pressure to achieve, or even exercise. However, if the stress becomes chronic and is partnered with overexercising and/or under-nourishing it can lead to changes in your brain that suppress the function of the hypothalamus and the menstrual cycle.
Birth control pills & HA:
Hormonal contraception such as birth control pills or injections can mask the absence of your period. You may think “I’m fine because I bleed every month.” However, birth control pills or injections provide synthetic hormones that stimulate an artificial period. So you may bleed, but it is not due to the regulation of your natural cycle. If you were not having a regular period before you got on birth control and currently resonate with the symptoms listed above, then you may want to consider further investigation with your medical provider.
Identifying the difference between disordered eating and an eating disorder:
Many times, women with HA engage in some degree of disordered eating behaviors, which are often normalized in society. This can look like eating only “healthy” or “good” foods and avoiding “junk” or “bad” foods in the name of health. It can also look like avoiding certain food groups all together in order to lose weight or working out extra hard to burn off last night’s dessert. These behaviors, while normalized, are not a part of normal eating and can be a slippery slope to harmful behaviors and thought patterns. The way diet culture portrays health tends to be too restrictive and have negative side effects, including disruptions in your reproductive cycle.
If some of the behaviors resonate with you but you are not sure to the degree disordered eating is engrained in your thoughts about food, take Eating Attitudes Test (EAT-26) here and calculate your score yourself, or visit the Eating Attitudes Test website to take the exam online and it will calculate your score for you.
A score of 20 or above indicates an eating disorder but you can exhibit disordered traits even if your score is lower.
If score is close to 20 or high, you may need to seek professional help.
It’s important to remember that everyone’s genetics react to their environment differently, so each body tolerates a certain amount of exercise, stress, and/or food intake differently. It is important to not compare your situation to someone else’s. The main takeaway here is that the amount of food you consume, exercise you do, your weight, weight loss history, stress you experience, and your genetics all strongly affect your reproductive system. If your period has stopped, it is your body’s way of saying, “something is wrong here.” It’s your sign to start evaluating your daily routine, stress levels, food intake, and exercise routine to see if your body is receiving enough fuel and rest. When your food is plentiful, exercise is adequately fueled, and psychological stress is managed, you can find your way back to your natural cycle.
If you are experiencing any of the struggles discussed in this post or feel you need additional support with nutrition or disordered eating, email us at hello@SDNutritionGroup.com or call us at (619) 289-8131. You can also find our contact information here.