Hypothalamic amenorrhea: On the road to recovery

It’s been almost a month and a half since our wedding and since I’ve made a conscious effort to cut back on exercise and to stress less in hopes of starting a family.

Who knew that would be so hard to do?

For someone whose identity is wrapped up in being physically fit, I knew it might be uncomfortable at first. But I didn’t realize how uncomfortable it needs to get.

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After another blood test and still no real improvements on the fertility front, I kept scouring the internet for answers, searching for stories that are similar to mine. I’ve blogged before about suspecting my lack of a period was due to my level of physical activity, but thought surely there must be something else going on because I’m a normal, healthy weight and I’m not an elite runner. My naturopath diagnosed me with subclinical hypothyroidism, put me on thyroid meds and told me to gain some weight and manage my stress levels, but deep down I knew that wasn’t the whole problem.

After not coming up with much online, I finally decided to buy a copy No Period. Now What? by Dr. Nicola Rinaldi, a book that I heard about when Tina Muir’s story was published to further investigate the possibility of hypothalamic amenorrhea, or HA as it’s known for short. HA is basically when your hypothalamus stops releasing hormones that signals the production of other hormones needed for the egg to mature and for ovulation to happen (no ovulation, no period) due to over exercising, under eating and constantly stressing. I don’t know why I didn’t look more into it before – I think because I thought Tina was a competitive runner and not like me, so maybe it wasn’t HA. I wasn’t super lean, so I figured it must be something else.

So on Thursday I finally bought the PDF of the book. When you purchase the book, you get to join the supportive Facebook group… and it was like I’d discovered a lost tribe of women who were quietly here all along.

Almost everyone’s stories were very similar to mine: got into health and fitness in their early twenties; loved to workout and/or run; put fitness and health first; counted calories at one point or another and/or followed meal plans for training or to look a certain way; stressed about food and eating too much or felt the need to exercise to compensate for extra calories; restricted certain food groups or avoided carbs and/fats; were always in a healthy weight range or the lower end of their BMI; and were on the birth control pill since they were teenagers and went off it to start a family only to discover that their reproductive system stopped working somewhere along the line.

I’ve blogged here before about my struggles with ED-NOS, and noticed old habits and behaviours coming back earlier this year when I was training to get “wedding ready”. As soon as the wedding was over, I stopped measuring my food and following a 5-day-a-week training plan, but continued to wake up early to do a shorter and less intense workout, packed the same pre-wedding lunches and snacks for work, and stressed about how quickly all the weight I’d lost in the six month before the wedding came back in only one month.

Many women in the group have either had eating disorders in the past or struggle with these same behaviours, which seems to be a main factor in getting HA. The constant stress and worry you place on yourself over food and body image is compounded by all the exercise and calorie restriction. Even if you are at a normal weight and body size, this all adds up over time and can put your hypothalamus to sleep, so to speak.

“Keep in mind that the levels of body fat, food intake, exercise and so on do not need to reach extreme lows or highs in order to affect the communication between the hormones and the hypothalamus. Because each of us is unique and has different sensitivities, any marked changes for an individual
can have an impact on menstrual cycles,” writes Dr. Rinaldi.

It makes sense. Your body is telling you this is not the right time or environment in which to bring a child into the world, so it shuts down until conditions are better.

So how do you wake it up again?

“Eat more. Exercise less. Do your best to reduce emotional stress,” says Dr. Rinaldi.

I’ve only just started to read the book, but already know I need to make some major lifestyle, mental and emotional changes to bring my cycle back. This includes going to therapy again, deleting MyFitnessPal and other apps that might cause me stress, unfollowing any triggering fitness Instagram accounts, only going for walks/hikes and doing yoga for activity, prioritizing sleep, and eating. Lots of eating. Dr. Rinaldi recommends eating at LEAST 2,500 calories a day. I don’t even think I ate that much when I was marathon training.

I’m not sure where my body’s “happy place” is, so I’m going to have to get comfortable with gaining weight. It’s going to be hard for me to let go of this size I’ve been working hard to stay at since high school, but I know it’s what my poor body needs. I know I need to do this if I want to hopefully avoid fertility treatments, or at least it will make it easier when and if I do go down that route. As Dr. Rinaldi says in her book, “Many women with HA are driven, perfectionist overachievers. Take that energy and use it toward building a new, healthier body for the rest of your life—a five-star baby hotel instead of a run-down, tired, overused side-of-the-road motel.” I’m definitely feeling more Bates Motel than the Fairmont these days, so I’m going “all in” on the book’s advice.

By now you’ve also probably noticed I’ve changed the name of my blog. I’ve been thinking about rebranding for awhile, and thought it would be a good thing to do now to unravel that part of my identity from myself. I will always be a runner and will come back to it again one day, but need to put it on the shelf for awhile. Same with personal training and writing about fitness. Just until I’m healthy again and in a better place to bring it back into my life in a healthy way.

It seems fitting to share this all on my blog today; it’s Canadian Thanksgiving and the day of the Victoria Marathon, and the second year in a row I’m not toeing the starting line after running this race every year since 2009 and always following it up with a turkey feast (I used to joke I ran the marathon so I could feel less guilty indulging at dinner — this will be the first Thanksgiving where I haven’t tried to “exercise away” the extra calories). I’m proud of all the races I’ve done, and know I’ll be back at it again one day. But for now, I’m trading in my running shoes and Garmin for my yoga mat and all the pumpkin pie I can stuff in my face at dinner tonight.

So that’s what’s going on with me right now. I’ll keep you posted with how it’s going <3