Back in my early 20s when I was just starting my career as a dietitian I knew very little about my lady hormones. Aka my reproductive system. What I did know is that I never got my period except when I was taking the birth control pill. What I also knew is that after a slew of blood tests, ultrasounds, and multiple rounds of the Provera challenge that didn’t induce a period, doctors didn’t know why I wasn’t getting a period on my own. I was told, “this is normal” and the solution was to take the birth control pill.
I trusted my doctors and so off I went to go pick up my prescription. Looking back I know my doctors had the best intentions and they truly were trying to help. I’ve never been to medical school, but I have been through nursing school and we receive very little, if any education on treatment for missing or irregular periods outside of medications and birth control. So I don’t blame the doctors or nurses. I just think as a healthcare providers we’re undereducated. I was too.
It wasn’t until I acted on my gut that had been telling me for years this wasn’t normal…that I began to dig into the research myself and was pretty surprised by what I found. I by no means know everything and there are many, many physicians and healthcare professionals out there that could teach me a whole lot. Amenorrhea (not getting a period) and other reproductive hormonal issues are areas we just don’t get enough education on and in order to truly understand what’s going on in the body and how to treat the root cause…it takes some a comprehensive understanding.
After a lot of digging I realized the solution to my period problems would not be found in a birth control pill. The solution was taking a honest look at my lifestyle and how I was treating my body. What I thought was healthy living – eating “clean” foods, never missing a workout and being productive and go go go every day – wasn’t healthy for my body at all. It was scary and uncertain and uncharted territory for me at the time to let go of these engrained “healthy habits” but it was worth it. Having a natural period and being more in tune with my body’s needs was worth every ounce of anxiety and fear.
I’ve only been able to learn what I now know about fertility and hormones because of my healing journey with hypothalamic amenorrhea and through helping other women with reproductive issues heal too. And along the way, there have been many things I realized weren’t actually true when it came to female reproductive health.
Weight can certainly play a role in our reproductive health. But it’s certainly not the bottom line. While being underweight for your body puts you at greater risk for losing your period, you can definitely lose your period or have irregular periods at a “normal” weight. Weight fluctuations play a key role here too. If you have a history of weight loss (as little as 10 lbs) that can impact your periods. It’s easy to get stuck on the thought (maybe because your doctor or someone else told you this..), “I’m at a healthy BMI, so there’s no way my weight is a problem.” and that just simply isn’t true. Adequate energy intake regardless of weight plays a huge role here. Plus BMI isn’t an accurate measure of health either. There are a lot of other factors that contribute to menstrual abnormalities than weight itself so we have to look at weight and weight history but also look beyond weight to figure out the problem.
PMS that impacts how you participate in your life is not normal. Sure, we are going to experience different sensations throughout our cycles as hormones fluctuate throughout the month. We might be a little more tired. We might have some mild cravings. We might experience some skin changes. We might have some mild discomfort or bloating. Those are normal. Your body is doing it’s thing. Symptoms that leave you out for the count or significantly impact your life like painful cramping, heaving bleeding, mood swings, migraines etc ….these are not normal.
There’s something going on and we have to figure out what that is. While there is still room for a lot more research, there is a good amount of research that suggests PMS is correlated with high levels of estrogen. Every month progesterone and estrogen wax and wane to prepare the uterus for a potential pregnancy. More noticeable, impactful symptoms occur when these hormones fluctuate dramatically. I think it’s helpful to note as well that neurotransmitters (like serotonin) may play a role in addition to genetics too – something we have no control over. The important thing though, is figuring out what is causing the PMS symptoms that are impacting your daily functioning. That can take some time and digging, but if that’s important to you I think it’s well worth the effort versus jumping straight to birth control or other medications. Medications have a time and place and can be a very helpful tool…but they aren’t always the solution.
This is something I actually thought to be true up until about 3 years ago when I began nursing school and starting looking into the research more. And I found it wasn’t that conclusive. Some studies showed birth control might help prevent further bone loss, and some showed some small increases in bone density over various time frames. Overall though, the evidence for birth control’s role in bone protection is pretty underwhelming. Actually, oral contraceptives are not recommended to protect bone health in the presence of amenorrhea (not getting a period). BUT supporting your body in finding it’s healthy set point weight and restoring your natural period does do wonders for your bone health. You won’t be able to reverse the bone loss completely, but you can replace significant amounts of lost bone.
I never really fully understood how the whole body intertwined together and the effect one system could have on the other until I started nursing school. I understood some surface level concepts, but hadn’t done much reading or learning to really understand what was going on in the body. It makes total biological sense though that if your body is physically stressed out from disease or other health conditions, it’s going to take the energy it does have coming in and use it for survival versus using that precious energy on non vital systems like your reproductive system. Take a look at your overall health…are there areas of physical stress your body is under that could be affecting your reproductive health?
Just because you menstruated at xyz weight or size when you were xyz age does not mean that is the weight your body is going to turn back on it’s reproductive system now. Especially if you’re thinking about the weight you were when you got your first period in your teenage years – if you’re now into your 20s and 30s or 40s ..your body has done a lot of maturing since your teen years and that weight is very likely too low for you now. Additionally, the body is dynamic. Weight and body size change and fluctuate throughout our lives – I know this is hard, but learning to trust your body is so freeing (although hard – I know!) Every woman’s body is different. Also keep in mind weight is not the end all be all. There are many factors that contribute to your period going missing. If you can, see if you can create some space to use this as an opportunity for some body image work. Positive body image doesn’t mean you have to love your body, but can you focus your time on building a fulfilling life outside of your body?
If my own story resonates with you or if you’ve had any of these similar questions or thoughts, I have created an e-course on healing your hormones and getting a healthy, natural period back. It’s been years in the making as I’ve compiled the work I do one on one with clients into a video course that walks you through the healing process in a realistic, easy to digest way. Beyond talking about what’s going on in your body and how to heal, I also walk you through cultivating healthy body image and developing self care for long term health. If this resonates with you, you can read more here.
Robyn, I so appreciate your passion for this topic, because it’s something I feel pretty passionate about too. I’m so thankful that I have been able to have normal cycles for over two years now. But that’s after taking a long hard journey to eat more, exercise differently, and really take care of my health (both mental and physical). As annoying as periods can be, they are an amazing indicator of our overall health, and for that I am thankful. I’m planning on going into the healthcare field (as a PA!) and this is something I’m so excited to learn more about, and also to teach and learn from my future patients about!
That are an annoying yet beautiful thing 🙂 So excited you are pursing a PA career! Best of luck to you – you will be wonderful!
Thank you so much for this article. I too have struggled with this and continue to struggle. After a series of stress fractures I found out that what I thought was my “healthy” lifestyle too was impacting my period and my overall health. My body was literally shutting down from the inside out. I am still finding the balance and continuing to work to gain control. It’s often something we don’t think about so I am so happy you shared your experience!
I’m so glad this has been helpful for you Christina! Thinking of you in this journey!
So so happy that you’re talking about this and educating others! I have a degree in health sciences and spent a good 2 years taking classes on how to read research papers (even helped write on!) and even then it takes me a good amount of time and effort to read papers when I am doing my own research on things like reproductive health. And touching in what you said about getting your period at different weights. I was a good 25 pounds lighter than I am now (22 years old) when I was a freshmen in high school and getting a normal period. Back then I was super underweight by medical terms but also super healthy and ate whatever I wanted (think two personal sized pizzas covered wit ranch for lunch daily – oh public school lunch programs 😜) but through high school I developed a severe ED and have since recovered by if I were to get back to my pre-ED weight I would actually have to starve myself again and definitely wouldn’t get my period. Not to mention just be miserable, hangry all the time, and not have any energy. Just goes to show that I grew up in the last 8 years (wow time goes by fast) and my body/set point changed!
I remember being so bored in my research classes but now I’m like OH YEA THIS IS WHY haha.
Thanks for sharing how “menstruating body size” has changed over the years – mine too!
Also, just thought you might find this interesting but there is some new research that may link the copper IUD with reduced cervical cancer rates! It’s a good read.
Oh wow would love to read that if you can link!
Life got real crazy this week and totally spaced on getting back to you Robyn! Here’s the citation for the study: Cortessis, V. K., Barrett, M., Wade, N. B., Enebish, T., Perrigo, J. L., Tobin, J., … & Natavio, M. (2017). Intrauterine Device Use and Cervical Cancer Risk: A Systematic Review and Meta-analysis. Obstetrics & Gynecology, 130(6), 1226-1236.
It’s a meta-analysis of 16 or so studies, all but one conducted in the 80’s and 90’s so while the studies don’t implicitly say that copper IUDs were used, hormonal ones were not available yet at the time. It’s a cool study to read and author does give a few mechanism that may explain why IUDs help prevent cervical cancer, but also this was a time before the HPV vaccine was available so the whole socioeconomic idea that women who have access to IUDs also had fewer partners/were in monogamous relationships and access to better healthcare also come into play. Nonetheless, interesting read. Enjoy!
Oh my goodness thank you for this post!
I have been dealing with irregular/absent periods for the past 3-4 years ever since coming off of hormonal birth control. I was given the fear tactics of bone loss and cervical cancer risk by doctors refusing to actually listen and look at me and just wanting to put me back on the pill (which, by the way, I don’t tolerate anymore anyway and ended up getting breakthrough bleeding DAILY).
I asked myself the same questions – my weight is higher than it was when I lost it, why isn’t it back!? I exercise less and eat more, so why isn’t it back!?
By working with a functional medicine doctor, we think it’s come down to my liver not detoxing correctly – b-glucaronidase levels were OFF THE CHART so my estrogen levels were probably being kept too high to allow for the natural cycle of estrogen/progesterone – not that my estrogen was HIGH per se, but progesterone never got the chance to dominate and initiate ovulation/a cycle.
We have brought down my enzyme levels and I’m having some periods here and there now, so progress after 1.5 years without ANY! Still pretty sure I’m not ovulating yet, but progress is progress!
So glad to hear you are finding some solutions Ellen!! Excited for you and admire your patience and persistence in this journey <3
My OB mentioned that birth control can lower your risk for breast and ovarian cancers (I think it was those two…). Can you comment on that? Is there data to support it?
Research does show bc can lower risk for ovarian and endometrial cancer. The research tends to be still mixed on breast but leans more on the side of increasing risk in addition to bc increasing risk for cervical cancer. There are pros and cons of all medications so I think the side effects and risks of birth control itself have to be considered alongside the effect on cancer risk. I hope that’s helpful! Here’s a great article by the NIH with accompanying research studies https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet#q2
Thanks so much for bringing up this topic. I think you’ve reached a lot of people who have been told that the quick fix for not having a regular period is birth control… but the reason for not having a period was never explained. When this happened to me it really bothered me. I knew something wasn’t quite right with my body. I started taking birth control like they said and started having regular periods, but then everything else went out of whack, including horrific mood swings for almost a year. When I stopped the birth control those awful mood swings went away but my periods were irregular again. I still knew something wasn’t right, but couldn’t put my finger on it. Until I had a friend who was diagnosed with anxiety and depression did I start to see what may be going on with me. I was having similar feelings of prolonged sadness and I always felt on edge. After multiple doctor appointments and eventually being hospitalized, I was diagnosed with bipolar disorder. Once I started medication to treat bipolar disorder, everything else fell into place and I had regular periods too. I was amazed how these two problems were connected. It’s so important to find the root cause of the problem—thanks again for bringing light to this topic.
Not getting a reason why I wasn’t getting a period was a big stumbling block for me too Colleen. I’m so glad you brought this up as other underlying illnesses can certainly impact your cycle. Thank you for bravely sharing – I know other women will be able to relate!
First, a belated congrats on your move to our now shared city!
Second, I have been a long-time reader but admit this is my first comment! Like many of your readers, I have struggled with a long history of eating disorders, exercise addiction, and amenorrhea and appreciate and value the balance you have found in your own life and also seek to help others find. Intuitive eating has been a life saver for me and helped me get to a place of health and mental stability for the past 6-7 years!
All that said, while I can tell many readers love and value your posts about female hormones, birth control, menstrual cycles (and I love your transparency about these sometimes taboo topics!), I want to play the devil’s advocate here and caution you on these posts – as much as you try to provide disclaimers that reproductive health is not one size fits all, you still come across with an all or nothing mentality on what is the right way to manage your hormonal health. And I found myself getting affected by your posts in a way that really messed with my head to the point where I asked my gynecologist this week to remove my IUD this past week in my annual exam. He asked me, “Are you trying to get pregnant?” No. “Are you having bad side effects from your IUD?” No, in fact, I love it. I mentioned my concern about not having a “natural period” – and I was so mad at myself for even bringing it up based on a blog – I have RELISHED not having a period for the past five years – and while a cycle is a great indicator of health, it is NOT the only one! My doctor, who I cherish, had no concerns about my hormonal, reproductive, or otherwise health, including my history of lost periods, and thankfully talked me off a ledge.
I caution you to be respectful of choices that work for others that may not be your choice – you are an amazing resource and a wealth of knowledge, but I think I personally need to step back from your blog and let myself pass by your posts on hormones and reproductive health and instead only read your intuitive eating posts. I hate that I even second guessed what works for me (and so many other healthy women) because of the way you proselytize about natural periods as the be all end all to female health.
Hi Hannah, After reading your comment, I wonder if you have misunderstood Robyn’s intentions for mentioning a “natural period”? When I have read her posts related to a natural period, I take it that she is trying to convey for women who are searching for answers about menstrual health and then their doctor prescribes a birth control to “normalize” periods. This also happened to me with my doctor. I explained to my doctor my intense exercise schedule at the time and asked if this could be part of the problem. My doctor quickly dismissed it and just prescribed me a birth control. It was nearly a year later after scaling back on my intense exercise that my period returned to normal on it’s own.
I understand birth control to be just that – birth control. So I’m puzzled, if you were using the IUD as a method of preventing pregnancy, then why would Robyn’s posts about having a natural period convince you otherwise? The need to use birth control to prevent pregnancy is a SEPERATE issue from being prescribed birth control to normalize the menstrual cycle. I would imagine if you’re trying to prevent pregnancy, then you would use whatever method works best for you and that your doctor recommends for you. If that method, as a result, causes you not to have a period, but otherwise you were having a period, then I don’t understand why that would be a problem. I don’t think Robyn has ever said don’t use birth control AT ALL.
Just some thoughts. Again, I don’t mean any of this to be disrespectful. I just think perhaps you’re misunderstanding the purpose behind these posts.
Amber, I think your post definitely captures a level of my confusion and I appreciate you highlighting that! I do agree that Robyn has highlighted a big time problem of doctors prescribing hormonal BC to women struggling to have a period – and while I’m glad I don’t fall in that category, I do think part of me (internally) felt “less than” in Robyn’s/this blog’s lens because I don’t have a “natural period” and while I like that fact, found myself worrying there was something wrong with what I was doing!
Perhaps this more of me adjusting the frame work I read her posts in or more of a request for the clarity you provided in her posts!
I think it depends on your goals – your cycles and periods can tell you more about your health than you realize. If you are curious about your body and your fertility because you hope to get pregnant one day, for example, your menstrual cycles can provide a wealth of information if you pay attention. I appreciate that Robyn recognizes this too. There is a difference between proselytizing and raising awareness about an important issue, which has opened the eyes a of lot of women like myself. Please do not feel attacked by women wanting to understand their bodies.
Hi Cait – I’m glad the posts/info have been helpful for you. I didn’t know much of these even five years ago myself. I hope it’s empowering and educational. Have a great weekend!
Hi Hannah!
Thanks for your welcome to Boston 🙂 Amber got to a response before I did and echoed my thoughts in her comment. I talk about not having a natural period without the help of birth control a lot and how not getting a period on your own is not normal and shouldn’t be brushed over but rather addressed since it can have a lot of negative health impacts.
I think in your comment you’re referencing not getting a period while on an IUD which is actually quite normal. I’ve written a lot about how using birth control for contraception is what it’s for and can be a fitting option for a woman not trying to conceive. I myself subscribe bc to patients for this reason after they know all their options and choose what’s the best fit for them. It seems that the IUD is a good fit for you – you aren’t having any side effects and aren’t trying to get pregnant. Using birth control to prevent pregnancy (which is what its intended for) vs using it to normalize periods or for symptom management (PMS, heavy bleeding etc) is where I feel passionate about because it doesn’t address the underlying cause but rather masks symptoms.
Reading the information in the context of the entire post might help clarify this? I’ve written often about how birth control IS for contraception and can be a good fit for women. But using bc as a solution to a lot of women’s hormonal and reproductive issues is something I feel really strongly about raising awareness around. That has nothing to do with using it as contraception. My hope is to empower women to be their own advocate and feel empowered in their health care decisions – whatever that decision is. Which I think is different than proselytizing. I hope that’s helpful for you!
This is SOOO exciting about your ecourse!! I just know it’s going to help hundreds of women out there. I can definitely second what you’re speaking on here about “normal” weight and fertility. During the time in my life that I experienced irregular periods, I was also living what I thought to be a “healthy” lifestyle. I was eating “clean”, working out most days out of the week and doing all the things. I was also VERY stressed from all the things. I was doing too much physical exercise and eating too little. Ironically, I wasn’t at my lowest weight, but my body was definitely giving me lots of signals that something was wrong. Irregular periods, constant fatigue, hair loss and others. It was actually by reading your blog that I FINALLY was able to honor my body and CHILL OUT. I scaled back on exercise. Instead of running, I began just walking (imagine that). I began listening to my body for hunger cues rather than micromanaging everything I ate. My period returned to normal and has been regular and consistent ever since. I FEEL so much better! Thank you for this information, I know it’s going to be great for so many!
I’m so glad you’ve found healing through this! I can certainly relate to your story Amber. I’m so glad you are feeling better 🙂 Thanks for sharing!
I’m curious about what you mentioned about bone health. A friend of mine has been struggling with an eating/exercise disorder for 3 years and she doesn’t care that she’s lost her period. Over the summer, the nurse at her doctor’s office could not find her pulse. Eventually the doctor found it and said her heart rate was 35. They told her that if she has chest pains while exercising she should go to the ER. I was livid when she told me this story because I wanted her doctor to tell her to STOP EXERCISING, but I know it is not my place. Anyways… all of this to say, how does weight impact bone health? I’m worried she might not be aware of those risks to her health.
That HR in the presence of a possible eating disorder is concerning and not a sign of “increased athletic ability” that you see in endurance athletes (that’s a common confusion – a decreased HR comes from a weakened heart muscle) if in fact she is struggling with an eating disorder (I’m not sure based on your comment so don’t want to assume!). There’s research that shows inadequate calorie intake is a possible factor in bone loss independent from estrogen levels (if she’s not getting a period she likely has insufficient estrogen levels. https://www.ncbi.nlm.nih.gov/pubmed/15659278. Hope that’s helpful!
This helps so much. I am very worried about her health, but she is in denial. I’ve had to cut back on my time with her because a) her disorder was not helping me in my journey to get change my own habits and 2) my worry for her was getting in the way of our friendship. She had such significant leg pain at one point this fall that she could not walk (turned out to be an IT band and hip flexor injury)… she went to PT but with the intention of healing it so she could get back to running ASAP. I just wish she could understand that her body needs a break.
Do you have any advice for how I can support her?
This is such a tough situation. I was hospitalized 3 times for a low heart rate due to anorexia/exercise addiction. They would wake me up in the middle of the night to drink a Boost because my heart rate was in the 20s.Robyn is right, this has nothing to do with athletic prowess, but rather a deterioration of the heart muscle. This is serious, but there’s not a lot you can do. She has to get to a place where she realizes there is a problem and wants to get help. I know how hard it is to sit by and do nothing. I hope she gets help before anything happens, but it is not your responsibility to save her. You need to take care of yourself, too. I’m
Thank you Hannah
Really great article! This was definitely my experience- my GP had no idea what was going on with my body, and I was told that this was normal for someone who was running as much as I was. I remember being heartbroken when blood work came back saying that my estrogen was less then the minimum- it was so low that they did not have a measurable value for it!
You and Cody have really helped me through so much and it has been such a blessing to cycle again.
One question that I haven’t been able to find an answer to-
Though I do not plan on getting pregnant any time soon, I have been trying to track my BBT to see that I am ovulating (which in my mind means my body is 100% happy). I haven’t been seeing a sharp temp rise/extended risen temperature that indicates ovulation, and I was wondering if you could touch on (here or in a future post) what the deal is with anovulatory bleeding/if this is something you need to worry about if you’re not trying to get pregnant/the hormonal imbalances that may be at play.
Hi Joelle! I’m so glad you’ve have found the info and work we do so helpful! BBT rises slightly when ovulating so you won’t see a sharp rise – usually less than 1 degree F – just in case you were expecting higher 🙂
I think what you’re asking is what are signs/symptoms or anovulatory cycles, what does that mean hormonally? and what can you do about it to make sure you are ovulating?
Hi Robyn– you are right, by sharp I mean between .5-1 degree haha. But yes that is exactly my question! Particularly what it means hormonally, what to do about it, and if these imbalances have as severe effects as not getting a period entirely.
Hi Robyn,
Do you have any recommendations for a non-hormonal birth control option other than paraguard that will allow you to monitor your true period? I hate being on artificial birth control because you never know if your period is naturally occurring, but my body does not tolerate paraguard. Any suggestions would be great!
Hi Shelby! Paraguard is the only non hormonal prescribed birth control that’s on the market right now – other options could include condoms or fertility awareness methods. I too wish there were other prescribed non hormonal options personally! Here is a blog post on FAMs if you’re interested in exploring that more.
https://www.thereallife-rd.com/2017/09/fertility-awareness-methods/
Another option to consider with your health care provider is that if you don’t have a lot of side effects on hormonal bc and have been getting a natural cycle for a while (9-12 months at least) and stay mindful for caring for yourself (nutrition, sleep, exercise, stress etc) getting on hormonal bc could be an option for you since you’re getting a natural period beforehand. Maybe a different IUD? That’s a totally personal decision and up to you but something to consider if you don’t want to do condoms and put the energy into FAM.
Hi Robyn,
Thanks for the information. The issue is right now I am working on getting my period back, so being on something hormonal interferes with me determining if I am making progress on that. So I am unsure about what to do! Thanks for the resource!
Learning to trust your body even in the weight fluctuations and uppsss and downs is HARD, but you have been one of the most instrumental people in encouraging me to do this every day Robyn!
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