Five Health and Diet Factors that Can Lead to a Lost Period
One or All of these Factors can change your menstrual cycle
Remember the post I wrote about having no period? If not, let me remind you of some of the key points that lead into the discussion about the factors that can lead into this.
What is Amenorrhea
The lack of a period is known as amenorrhea. One potential diagnosis is hypothalamic amenorrhea (HA) but very few women get this diagnosis. Amenorrhea refers simply to a missing period and there can be many contributing factors to this which are discussed in this article.
HA is when the hypothalamus is involved and signalling becomes confused or damaged due to hormone imbalances and chemical mix-ups. The cause of this may be a combination of the five factors involved which are:
- energy imbalance
- over exercising
The exact combination and degree of causes will look different for everyone. It is also important to note that other medical causes such as polycystic ovarian syndrome (PCOS) or endometriosis are not included in this article. We also do not discuss the size of your body. Let me elaborate… you do not have to be underweight or have a low BMI to experience HA. Even larger bodies experience HA from these factors. This shows that extreme weight loss, low calorie diets and excesses exercise are dangerous for EVERYONE!
5 Factors that Can Lead to a Lost Period
The amount and type of exercise among women that experience HA can vary widely. Some commonalities include exercising more than 4 days a week for an hour or more at a time and the intensity of the exercise is higher. ATHLETES EXPERIENCING A LOST PERIOD IS NOT NORMAL (unfortunately I have heard too many athletes be told by their physician, coach or trainer that this is normal)! It is very possible to exercise 4+ days a week for longer than 1 hour at a time, as long as the other factors are considered (stress and energy intake).
Energy Imbalance (calories in vs. calories burned)
Under consuming food leads to low energy availability. Low energy availability does not mean you are underweight or have an eating disorder. It means that you do not have enough energy coming to sustain your menstrual cycle, on top of your other physiological functions and possibly exercise. According to a survey done by Nicola Rinaldi of women who have or are experiencing HA, the average consumption was 1481 calories/day. Unfortunately, this is a factor that very often gets missed in today’s medical care. If a woman looks to be a ‘normal’ weight, they do not question how much they are eating. Severely restricting the amount of food consumed has both short term and long-term consequences, including lost period. Diet culture has made calorie restriction all too common. Every body needs energy in the form of calories to maintain normal healthy functioning.
Putting fertility aside for one second (as this is definitely one of the negative health effects of no period), the absence of a period means estrogen, progesterone and testosterone have dropped. This will also affect athletic performance. The other short-term effects include thinning or loss of hair, brittle nails, low libido and skin problems. Long term, it leads to weak and brittle bones, cardiac disease, increased risk of early dementia and earlier cognitive problems (estrogen is highly protective of brain cells, which we covered in our Menopause series).
Weight and weight loss
Weight and weight loss are both included here as it is a misconception is that only women who are super-skinny experience a loss of period. BMI under about 21 or 22 is a risk factor for HA when combined with some level of food restriction and exercise. Low body weight is certainly a major player in maintaining reproductive functions but looking at the survey done by Rinaldi again, they found that 82% of the respondents of women with HA had lost more than 10 lbs at some point in the past. This leads to the point that weight loss and caloric restriction also is a crucial factor to consider. Diet culture has us believe that weight loss, no matter the cost, is ‘healthy’. This demonstrates why it is important to be careful when considering how you want to lose weight.
Mental stress alone is enough to mess up a normal cycle. When I was 18, I travelled to New Zealand for 8 months. First time on my own, in another country, all the way across the world. I did not get my period for the entire 8 months I was gone. I was stressed and my body responded. Both acute and chronic stress are factors to consider especially when paired with the other factors.
In Rinaldi’s book, No Period, Now What, she references a few studies that have found mutations in the proteins down the pathways that control the menstrual cycle. These studies suggest that there are some women that have a greater predisposition to HA than others. Other genetic factors such as estrogen or progesterone production, luteal phase length, body size (specifically body fat %), and more are also important.
Multiple factors can lead to a lost period
Many women who experience HA can point to at least 2 of the above factors that may have led them to where they are, some may have all 5 factors. The hope I have is that this can bring awareness to the issue and what may be going on with your body. Often women are told to start birth control to regain their cycle but this is NOT the solution. It is a band-aid that will mask the problem. Hope is not all lost, regaining a lost period is VERY possible but it will take work and commitment. Support is also critical! Getting support from loved ones, teammates and coaches is greatly important, but you may also need support from a health care team that can include a registered dietitian, therapist and doctor.
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Disordered Eating, Emotional Eating, Sports Nutrition, Fertility/Women's Health
Empathy and kindness are two things you will notice about Alison, oh, and her love of good food and sport! Alison is known for her client-centered approach that looks at a person as a whole in all aspects of physical, mental and spiritual health. She specializes in eating disorders, emotional eating, sports nutrition, fertility and women's health.