My Struggle with Hypothalamic Amenorrhea

I have always been active and I have always loved food. I have never "dieted" but I have always tried to eat healthy - especially starting around when I began cross country in high school. It turns out that by trying to watch the types of food I ate while also running several miles a day caused me to not get my period during each cross country season. I didn't think much of it then. I was just trying to be healthy by eating well and exercising.

I used to avoid sugar and anything processed and "unhealthy" at all costs. It was never a weight issue with me - just an obsession with trying to be as healthy as possible. As for my workouts - I never missed one. I always wanted to do more - more strength training, more running, more daily movement...because the more activity the better, right? 

When I got married and moved to Maryland I started making everything from scratch to be even healthier. I would write down what I was eating and how many calories everything was and I would try to get the proper amount of nutrients each day - but it became obsessive and made eating stressful for me. I wanted to eat "perfect" so I could be as healthy as possible.

It all changed when we moved to Nashville in 2014. I don't know why but I told myself when we moved that I was over it. I didn't want to count calories or macros or nutrients anymore. I wanted to go out to eat and order what I wanted and not worry about it. I chose to listen to my body and my needs and ended up feeling better than ever. This is when I discovered balance. I realized it was okay to eat processed carbs and sugar in moderation. It was okay to go out to eat and order something special. I started adding in the little things I used to avoid along with my normal healthy diet. So for the last several years I have felt good and have been in a great mindset - I found my balance with food and exercise. Or so I thought. 

Enter October 2018. I decided to stop taking my birth control pills with the intention to let my body regulate itself for a few months without hormones before trying to start a family. I had been taking birth control pills for about 10 years and from prior research I knew it could take a few months to adjust. I was excited to get off of them because I always hated that I was taking synthetic hormones. After finally stopping the pills, I lost a few pounds, I had extremely dry skin and hair, my face was breaking out all over, my anxiety was high and I was having problems sleeping. I also didn't get my period. 

The next several months tested my patience as it required a lot of waiting. Waiting for appointments, waiting for results, waiting for answers. My gynecologist was not super helpful so I eventually switched to a new one (who is great) and I worked with her and my primary care doctor to figure out what was going on. I had my hormones tested in February and the rest of my blood work was done in August. Everything came back normal. This process was so frustrating because it took me so long to get help and to get answers. I had a feeling what the problem was because of what happened to me during cross country season. All signs were pointing to FHA (a diagnosis of exclusion after making sure there wasn't a bigger issue). 

Functional Hypothalamic Amenorrhea (FHA). I never knew I would Google this word so many times. 

Hypothalamic amenorrhea is a condition where your period stops due to increased stress usually due to over-exercising and under-eating. Most women don't realize they have a problem until they stop birth control and then never get their period. It occurs when the hypothalamus, a gland in the brain that regulates body processes, slows or stops releasing gonadotropin-releasing hormone (GnRH), the hormone that starts the menstrual cycle.

Common characteristics of women with hypothalamic amenorrhea include:

• Low body weight
• Low percentage of body fat
• Very low intake of calories or fat
• Emotional or physical stress
• Strenuous exercise that burns more calories than are taken in through food
• Weight loss (usually 10 pounds or more)
• Deficiency of leptin, a protein hormone that regulates appetite and metabolism
• Some medical conditions or illnesses 

The good news is that it can be reversed with lifestyle and behavior changes and you can still get pregnant once you get your period back (or receive fertility treatment). Yes, you DO need to still get a period for your health EVEN if you don't want to get pregnant. Hypothalamic amenorrhea is a serious health issue. It can cause bone loss/osteoporosis, dry hair and skin, digestive issues, exhaustion, poor sleep, anxiety and increased risk for long-term diseases.

While for 6 years now I have had a healthy mental attitude towards balancing food - I could see where a new problem might have begun with exercise. Ironically, I was aiming to get as healthy as possible before trying to have a baby. I had been in a great place mentally and didn't feel like I was exercising too much (because I love it) and I felt like I was eating enough (because I sure can put food away) but I guess I was still overdoing it. On top of that, 3 years ago I lost 10 pounds in a month from the stress of buying our newest house and renovating it. I never gained all of that weight back until recently. So that, partnered with increasing my running to be more competitive (I had gone from 2-3 days a week of easy running to 5-6 days a week of intense running + weight training + just being an active person that moves around a lot + the stress of starting my own business) and still having a hard time fitting enough food in for my amount of activity = no period.

I'll be the first to admit, this was depressing and frustrating. I felt defeated because I thought I had been doing well and I was happy with where I was at. Unfortunately the birth control pill masked this symptom so I don't know for how many years my hormones were actually thrown off. It could have just been in the last year or two when I started increasing my activity levels, or it could have been all 10 years on the pill. Whatever it was though, I wish I would have been able to tell earlier so I could have fixed it all sooner. I was angry that I needed to cut back on my exercise. Angry that I needed to eat more (everything I read recommended more carbs and fat and more "unhealthy foods"). Angry that my body wasn't working as it should. Most articles I read said to give up all types of exercise and eat a lot of unhealthy food. That wasn't how I wanted to go about doing this though. Could an "all-in approach" have fixed things sooner? Maybe, but I would have been miserable. I also chose to ignore all other complementary therapies that were recommended (acupuncture, acupressure, special teas/supplements, adaptogens, etc.) I wanted to get to the the heart of the problem: too much physical stress on my body and/or not enough food.

A lot of the research I did led me to see that I probably needed more carbs and should aim for AT LEAST 2500 calories a day (plus more on workout days). I definitely don't restrict carbs or calories at all BUT I realized since I eat gluten-free I always aim to decrease the amount of "unhealthy" gluten-free replacement options I eat. So, starting in April I finally started making changes. Honestly the biggest food changes I have made are: I try to eat a gluten-free bagel for breakfast most days (it was an easy way to get in a few hundred extra carby calories) with coconut oil and on a big activity day I add an egg, avocado and fruit, I eat a bigger afternoon snack (like homemade banana bread with peanut butter) and I just ignore portion sizes and eat what feels right according to my hunger, especially on days when I am more active.

I was probably eating around 2000 calories most days before I made these changes and more on my super intense activity days, but it appears I still didn't come close to what my body was needing for the energy I was spending each day. After the changes I made I would say it now ranges from 2500 - 3500 calories a day (I still don't count calories but I will check in every once in awhile to make sure I am eating enough). I aim to keep 2500 calories as my minimum and then I try to eat around as many calories as I burn depending on the exercise I do - which is still hard when I train for longer races.
 
For the activity portion of my recovery - I mainly cut back on my running. This was the most frustrating part for me. I don't exercise because I feel like I have to but because I like it! I love running and how it makes me feel, I enjoy running hard and doing well in races. Starting in April I cut back from 5-6 days a week of intense running to 3 days a week (1 day hard, 2 days easy-ish) and 2 days a week of strength training/yoga. I even kept training for a few races and trained well enough that I was able to place in them. In fact I feel like I have been running even better and faster since I haven't been killing myself every day like I was before. I now make sure to take more time off after each race to properly recover too. I also used to "have" to get to 10,00 steps each day - so I got rid of my Fitbit watch. 

It's interesting because looking back now I can see that I was being a little too intense with my workouts, yet at the time I just felt like I was being a good, competitive runner. I am now picking this up from others doing the same thing around me and I get it...it is easy to get pulled into the thought that more is better. Guess what though? It's not. Recovery and balance are everything. I think I even went through the 5 stages of grief through this whole process. Denial: I didn't think that I was exercising too much. Anger: I didn't want to stop competing, I loved it. Bargaining: I thought if maybe I only starting eating more but continued running just as much it would still come back. Depression: I felt like I lost my identity by forcing myself to eat more and run less and I did not like how it made me feel. Acceptance: I realized running less and eating more wasn't such a bad thing and I was starting to feel even better and healthier. 

It took 6 months for me to figure out something was wrong and to start making changes when I realized what the problem was. It took another 6 months of implementing these consistent changes to finally see results. After a full year of not having my period after stopping birth control - I finally got my first period again in October 2019 and have been having it regularly ever since (just kind of long cycles - 40ish days or so)! After 6 months of less running and more eating I gained about 5 pounds and I am back at the weight that my body has always been comfortable with.

While I was annoyed with the food portion of this recovery, the hardest part has definitely been the cutting back on exercise part, but I am finally at a spot where I feel good with what I am doing. I just have to hold myself back from continually signing up for races (which is hard when I am in a running group and everyone is always talking about races, lol). 

After 3 months in a row of getting my period I feel like I am doing well and I have learned A LOT. Listening to your body is so important. While mentally I have been in a good spot for years, I guess my body still wasn't physically there yet. But it is now. The anger and frustration is gone. The changes have been made and it is up to me to keep them going. The good news is that I plan to never take birth control pills again so I can at least tell if/when I start getting too intense with exercise in the future. Another plus - my skin is cleared up (mostly), I am sleeping better, I have WAY less anxiety and no more dry skin and hair! 

It's actually pretty crazy to see first hand what all affects your hormones and what all your hormones affect. Hint: Extremes are rarely ever a good answer. 

If you are going through something similar - don't give up! Instead, ask yourself if you are doing enough. Are you actually eating enough? Are you actually cutting back on your exercise? It is hard not to fall back into your "normal" ways. Stick with it. You WILL recover but it is up to you to make these changes and keep them up! If you feel like you are being "less healthy" with these changes, just remind yourself that getting your menstrual cycle back is actually the healthiest thing you can do at this point. If you are going through this and want to talk, please reach out to me!

The moral of this story is to stop trying to be perfect. You don't have to push yourself every single day to always complete your workouts, to always be better, to always be faster. Sometimes it's okay to take a break. Give yourself a little grace. Listen to your body. Focus on recovery. Focus on restoring. There is no perfect diet. There is no perfect way of eating. Find what works for your body and mind. A healthy relationship with food is a good start. Your body needs food. So does your mind. There is no "bad food". Get in plenty of vegetables, fruits, complex carbs, dairy (or non-dairy options), healthy fats and lean protein. Make space for the less nutritious options as well. Eat enough but don't over do it. If you do, forgive yourself and move on. Practice stress relief techniques and don't be so hard on yourself.

​Live your life balanced.