Amenorrhea - the abnormal absence of a woman’s menstrual period
There are two types of amenorrhea: primary and secondary. This blog post will be addressing my reversal of secondary amenorrhea, not primary. With that being said, please keep in mind that every person’s body is unique, so what worked for me may not work for you. Also, it’s important to note that I was under close medical supervision throughout this process to ensure that my body was responding well to the changes I was making. I highly recommend to anyone who is trying to naturally reverse amenorrhea to consult your physician before, during, and after your period has been restored.
What Causes Amenorrhea?
Secondary amenorrhea can be caused by a handful of things - gynecological disorders, serious illness, physical stress, or because a woman is severely underweight. For me, it was exactly that. My body was so severely malnourished that it couldn’t function properly, my hormone levels were completely out of whack, and my percentage body fat was dangerously low. Because of this, I hadn’t had a single period in over three years. My doctors told me that my struggles with anorexia were the direct cause of my amenorrhea diagnosis, but I didn’t understand just how detrimental that diagnosis was. I brushed it off for years, thinking that this was an achievement. My sick and irrational mind was proud - I had actually proven to myself, ED, and my doctors that I was finally skinny enough.
“Keep it up,” ED would whisper into my ear.
The scariest part of this condition is that many girls struggling with eating disorders use it as standard to hit. “If I am still getting my period, then I must not be sick enough/skinny enough.” That thought absolutely shatters my heart. So before I continue, let me set something straight - if you are struggling with your food, weight, or body image in ANY WAY, you deserve help. You don’t have to “achieve” any standard that ED has set for you. You are worthy. End of story.
How Can It Be Reversed?
Despite what many people think, restoring your period is not as simple as “just gaining weight.” Starvation, as well as extreme exercise and stress, can trigger an effect that suppresses the hypothalamus. Typically, a healthy woman’s ovaries produce progesterone and estrogen after getting certain cues from the pituitary gland and hypothalamus, but for women who are severely underweight, the hypothalamus becomes suppressed, and the cues stop. When the cues cease to fire, the production of estrogen also ceases. Additionally, the lack of fat doesn't allow cells to convert cholesterol into extra estrogen.
For a woman to restore her period, the primary goal is to increase her percentage of body fat. But let’s be honest, asking someone who is battling anorexia to gain fat is like asking someone who is terrified of heights to go skydiving...it doesn’t go well. So while this may sound like a quick fix, this takes time, accountability, medical supervision, and support. For me, this seemed not only impossible, but also unnecessary. I thought I could just go the rest of my life without restoring my period and I would be fine, but that was until my doctors reminded me how crucial it was to restore my hormone levels before reaching an age where I would want to start a family. I had dreamed of being a mom my entire life, but unless I got my body back into a healthy state, that dream would no longer be within reach. Not to mention the higher risk of developing calcium deficiencies, stress fractures, and osteoporosis. So even though I couldn’t find the motivation within myself, I used the motivation of my future family to light my spark. I had to find something to hold onto, and that was it.
To increase my percentage of body fat, I obviously had to make a number of changes to my diet and exercise habits. ED hated every second of it, but I was done succumbing to his demands. I worked hand-in-hand with a certified eating disorder nutritionist to increase my overall intake, with a main focus on increasing my lipids. Lipids are just a fancy word for fats, but even though it sounded like a simple task, I didn’t know what normal eating looked like anymore without the help of someone else. So needless to say, my nutritionist was my saving grace.
In a very general sense, the daily goal for the average person is to consume about 15 calories per pound of body weight for “available energy”, not taking into account the calories you may expend during exercise, or the fact that you may have a higher resting metabolic rate than the average person. But for me, in order to make this process possible, eliminating exercise was the only option (for both mental and physical reasons). I eliminated all forms of exercise until I was cleared by my medical team. I highly recommend anyone going through this process to do the same. Although it may seem scary, I promise you that conquering your exercise dependency will open thousands of doors for you. Put away your sneakers, hide your headphones, and lock up your gym clothes for a little while. I promise they will still be there when you’re ready for them again.
Utilizing an Exhanges-Based Meal Plan
After completing a number of assessments and evaluations, my nutritionist formulated an exchanges-based meal plan specific to my body’s resting metabolic rate and nutritional needs. This would be my baseline. From there, we tweaked the plan every so often in order to continue meeting my needs as my body adapted. Eating was my main priority. My meal plan was structured around a high lipid, moderate protein, moderate carbohydrate framework.
I didn’t count a single calorie or track a single macro throughout this entire process. Instead, I gradually grew familiar with the exchanges on my meal plan. A meal plan based on exchanges is an approach often used for people going through recovery due the fact that it avoids tracking, counting, and calculating food based on its caloric composition. It rather focuses on food as fuel, made up of energy that our bodies will break down to give us strength. I would say this is one of the main reasons I was able to overcome my calorie obsession, and therefore one of the main ways I was able to stop looking at food as “good” or “bad” - it all became neutral.
From there I was able to independently pick out adequate and well-balanced sources of fuel, eyeball portion sizes, and get creative with my meals based on the exchanges my nutritionist structured for me. I would return to my nutritionist on a weekly basis to check in, get my vitals taken, and discuss how I was feeling. The mental aspect of this process is just as (if not more) important as the physical, so taking time to sort through the thoughts in your recovering brain is vital to the success of restoring your body’s natural rhythms. Whether that means sitting down with your therapist, talking with your doctor, calling your mom, journaling before bed, or a combination of all of the above, DO IT. Without support, this journey can be a very scary one. Lean on those around you.
I relied on my exchanges-based meal plan for a while. Not in an obsessive or dependant way, but rather as a way of knowing that I was doing what I needed to do in order to overcome this condition. For roughly the next two years, meeting my meal plan was my number one priority. That meant bringing food to class if it overlapped meal times, staying on top of my grocery shopping, creating a schedule that allowed for breakfast, lunch, dinner and snacks, and most importantly, focusing on my own needs rather than comparing my intake to those around me. This was what my version of health looked like. I needed to embrace that.
From the time I actively began working to restore my period, it took about one year for it to resurface. But please keep in mind that restoring your period to its normal monthly cycle does not magically happen once you hit a healthy percentage of body fat. Just like a machine, your body has to work out some kinks before it can run smoothly. After about one year of working toward my goal with my nutritionist, I got my period roughly once every three or four months. From there it began to return on a more regular basis, but you have to allow it some time. Restrictive eating takes a major toll on the body, so we must be gentle and patient as it tries to heal. As always, be kind to yourself and be grateful for your body’s ability to mend. The human body is a beautiful, beautiful thing - let’s continue treating it that way.