Amenorrhea

When I was 16 years old, I stopped menstruating.  This was a result of over-exercising and not eating enough.  I had not started out with the idea that I would lose my menses.  It all began with my wanting to lose some weight.  I thought I would start exercising and cut back on some of the junk food I was eating.  This spiraled quickly into an unhealthy pattern of losing weight, exercising more, losing more weight and then losing my menses.  I looked in the mirror and did not understand why I had lost my period, because to me, I didn’t look too thin.  I had what psychologists call body dysmorphia.  No matter how much weight I lost, I thought I needed to lose more.  

As this article is not about how I arrived at amenorrhea, I will stop my story here.  The point I wanted to make was that I have been there and I was able to resolve this issue for myself.  The way I did it was simple, I started eating again.  I actually ate quite a bit, allowing myself to eat whatever I wanted, and within a couple of months, my menses returned.  Now, I am not advising you do the same, but it was effective.  

My experience with anorexia, the clinical term for what I was doing, starving myself, taught me about the relationship between the body and the mind.  It taught me that the mind can be so powerful that even when the body is saying, “hey, there is something wrong,” the mind can continue to tell you otherwise.  This is called self-deception.  We can deceive ourselves for long periods of time, causing more and more damage to our bodies.  

Some time between the age of 10 and 16 years old most young women will start menstruating.  If you have never had your period by the age of 15, you may have primary amenorrhea.   If you have had your period and it has since stopped for at least 3 consecutive months, you have what is called secondary amenorrhea.  If you are not menstruating, then your body is telling you that something is wrong.  There may be some more serious structural issues that need to be ruled out, especially with primary amenorrhea.  And we always want to consider pregnancy.  If you have had sexual intercourse, even once, even if you have never had your period, you can get pregnant.  But once these have been considered, then we want to look deeper into how your diet and lifestyle may be influencing your amenorrhea.  And if you are reading this article, I suspect you want to come to awareness about a better way of living.  And I want to help you find your way back to your womanhood.

First, become aware of what led you here.  The awareness can help you to not repeat the cycle.  Have you been eating enough?  Have you been exercising too much?  Are you using laxatives?  Are you under a lot of stress? What are the underlying emotional issues?  Are there hormonal issues?  Just because you read somewhere that a specific diet or exercise routine was good, does not mean it is good for you.

You can talk to a counselor who is educated in disordered eating or eating disorders.  Many athletes do not have a defined eating disorder, but have some level of disordered eating.  The difference is that an eating disorder has a very specific definition.  Many young women do not meet the defined guidelines for these diagnosis.  Disordered eating is more about not meeting your bodies nutritional needs.  Many young women follow a food plan based on something they read or some ideals, like being a vegan because you don’t believe in killing animals.  These ideals may not allow you to give your body what it needs nutritionally.  There is something called Orthorexia, a disordered eating pattern where the person is addicted to “healthy eating”.  This is a very common issue.  

Second, get some lab testing.  There are places where they will do metabolic testing.  This testing uses a machine to assess your utilization or deficiencies of fat, carbohydrate and protein.  Other testing that can be useful are hormonal testing, such as TSH, Free T3, Free T4, FSH/LH, prolactin, estradiol, progesterone, testosterone, DHEA-sulfate, androstenedione, cortisol (both saliva and blood).  Some doctors utilize these tests for diagnosing conditions such as hypothyroid, PCOS (polycystic ovarian syndrome), or low adrenal function.  I like to use this tests to look for imbalances in hormones.  I use a test called a DUTCH hormone test that gives me a good picture of what is going on hormonally for women.   I don’t need to see elevations or deficiencies in hormones that clearly fit the parameters for a specific diagnostic criteria.  If a patient is having symptoms, such as amenorrhea and they have a relative imbalance in their hormones, I can utilize nutritional supplements and herbs to try to re-balance their hormones.  

Some tools to help your menses return: 

- Nutrition:  As stated above, you will need to get enough fat, calories, and protein to make the hormones necessary for menstruation. Women need fat!  

- Seed Cycling:  Seed cycling is a very simple naturopathic therapy where you use specific seeds in order to simulate a natural menstrual cycle. This is very gentle.  If you do not have enough calories, fat, and protein in your diet to make hormones, seed cycling will not be enough to return you to menstruation.  The seeds are rotated based on the follicular and luteal phases. The follicular phase of your cycle starts with “Day 1,” which is  the first day of your menstrual cycle and the day that you begin to bleed. The luteal phase is from ovulation, or about day 14 or 15, to day 28.  If you are not menstruating, then you will use the moon cycle to “create” a menstrual cycle.  You will make Day 1 of your cycle on the new moon and day 14 will be on the full moon.  Day 14 would be when you ovulate, and when you are most fertile.  

Follicular Phase: Day 1 (new moon) to Day 13, or until ovulation: 1 tablespoon each freshly ground raw flax seeds and pumpkin seeds daily.

Luteal Phase: From Day 14 (full moon) to 28, or until menses: 1 tablespoon each freshly ground raw sunflower and sesame seeds daily.

- Biphasic herbal tincture:  A biphasic tincture uses phyto-estrogen herbs and  phyto-progesteronic herbs in order to simulate a menstrual cycle.  You use the phyto-estrogenic herbs during the first half of the menstrual cycle from day 1 to day 14, or starting on the new moon,  and phyto-progesteronic herbs during days 14 to 28, or starting on the full moon.  There are various phyto-estrogenic and phyto-progesteronic herbal tinctures on the market.  Or you can work with a naturopathic doctor who will create a formulation specific to your needs.  Again you will need to have enough fat, protein and calories in your diet in order to begin menstruation

- Nutritional Supplements: Depending on the lab values I see, I will use various nutritional supplements to support the body to initiate or re-establish menstruation.  Some of these include, mayo-inositol, NAC (N-acetyl-cysteine), lipoic acid, chromium, vitamin D, magnesium, iron, omega-3 fatty acids and others. 

- Bio-Identical Hormones: These will need to be prescribed by a naturopathic physician or another physician.  Once you have done hormonal testing and established a deficiency,  you can use bio-identical hormones in the same way your body would use it’s own hormones.  You can adjust dosing of estrogen and progesterone to create a cycle.  This would help your body to recognize what it needs to do.  

- Prescription Medications: It is always my goal to support the body to return to a normal menstrual cycle.  At times, I need to use things like Metformin or other prescription medications to help in this process.