posted on June 4, 2018
At some point in our lives women have heard “Keep the intensity high!” “Eat Clean!” “Exercise 7 days a week and let most of it be cardio!” These are the mantras from health teachers in grade school, sports coaches, social media, TV, health personalities etc. Do these mantras teach us about taking in enough calories to fuel our workouts and provide for our bodies? Do they teach us the importance of rest and recovery? This is an important concept for individuals who exercise on a regular basis, but it is especially important for females.
Why females? They are at a risk of experiencing Hypothalamic Amenorrhea. This is a subject I am passionate about. I have gone through and continue to battle this issue and I want to prevent other women from this experience.
About seven years ago I started going to the gym 6-7 days per week. I did not have much education on what to do. I just knew I wanted to lose some weight for an upcoming vacation to the beach with a large group of friends. I did cardio and weight lifted about 6-7 days per week. I ate minimal calories. I remember hearing most of my life from magazines, tv, etc. that I should eat lots of protein and broccoli. I did just that. Of course, I started to see results. Results of me shedding weight week after week. I could see my abs. It became an obsession. I wanted more. I got down to 104 lbs. For reference, I’m just under 5’7”. This led to years of calorie restriction and over exercise. A year into that lifestyle and I completely lost my menstrual cycle.
Once I realized what I was doing, how terrible I looked, how upset my mother and family were, I started to make a change. It took 3 years to completely slow it down and increase calories to a somewhat “healthier” range (although I believe I was eating in a deficit for 3 years, at least). Fast forward to today, and I am still fighting to get that back. I was diagnosed with Hypothalamic Amenorrhea a few years ago and this is a result of my years of restriction and excessiveness.
What is Hypothalamic Amenorrhea (or “HA”)? This is a condition that is rarely talked about, but is becoming increasingly prevalent in the population of physically active women. HA is a disturbance in the hypothalamic-pituitary-ovarian (H-P-O) axis, that ultimately results in the cessation of menstruation. Your hypothalamus is located in the forebrain and is a MAJOR control center of our bodies. It controls body temperature, thirst, hunger, sleep, emotional activity and other homeostatic functions. The hypothalamus receives input from various hormones and chemical messengers in the body and needless to say, it is highly sensitive. At any sign of disruption, the hypothalamus loses balance and essentially protects the body using some sort of defense mechanism.
The factors that often cause such a disturbance are stressors including, a caloric deficit, low body fat, mental/environmental stress, and excessive physical activity. The hypothalamus cannot differentiate between starvation and a caloric deficit, or the stress of excessive exercise and the stress from a life-threatening situation. The hypothalamus does not recognize these factors as they are but, rather the stress they exert on the body and immediately goes into a “protection mode.”
Why is the reproductive system affected? The reproductive system is considered “secondary” and not a primary need for survival. Reproduction and conception are energy taxing events in the body. This explains why temperate animals do not reproduce or certain animals are infertile in times of famine or low energy availability. In places where food is plentiful in human populations, women can still create a deficit from a higher energy expenditure i.e. strenuous physical activity thus, causing reproductive issues. When in stressful situations or low food availability, the body does not want to “waste” it on non-essential organs and tissues for survival. In the case of HA women, the menstruation stops (Wade & Jones, 2004).
To understand HA better, let’s talk further into how these factors affect our bodies in a negative way.
A caloric deficit can affect the signals that the hypothalamus receives. Eating restrictions can include caloric deficits or the elimination of food groups. “Fad diets” that restrict certain food groups paired with or without intense exercise can cause catastrophic conditions in the body. Not only eliminating food groups, but overall undernourishment of proteins, fats, and carbohydrates creates a deficit and can lead to HA. Food is paramount for metabolic function such as organ function, cell maintenance, and other physiological processes (Wade & Jones, 2004). The hypothalamus knows how much fat, carbohydrates, and protein your body is receiving. The hypothalamus receives input from the entire body and when energy availability is low, the hypothalamus responds. An energy deficit of both micro- and macronutrients are relevant to neuroendocrine dysfunction. Nutrients such as; fatty acids, amino acids and glucose all have a part in the function of the hypothalamus as well as the gonadal axis (Dupont et. al., 2014).
The other variable contributing to the rising prevalence of HA in women is excessive exercise. Let me preface this by saying exercise is important and should not be eliminated however, it is the frequency and intensity that can affect the H-P-O axis. The key here is balance. Exercise activates the stress system, by inducing the release of stress hormones such as glucocorticoids (cortisol). Cortisol plays a MAJOR role in down regulating the reproductive system. To understand this further, Glucocorticoids are anti-inflammatory hormones and are released when stress is sensed. The release of glucocorticoids is the body’s way of protecting itself, i.e. protecting a woman from getting pregnant because the body senses any type of stress as a threat and not an ideal environment for child bearing. I am going to link exercise and mental/environmental stress together, because the body does not discriminate, stress is stress.
To understand this even further, I want to bring light to a study that was done at the University of Pittsburgh where they thoroughly examined the step by step process of strenuous exercise leading to exercise-induced amenorrhea. The study took place at a research lab at the University of Pittsburgh. Sixteen adult female monkeys were involved in the study. Baseline blood was drawn and every other day after. The monkeys had their estradiol and progesterone levels sampled. The monkeys ran everyday on a human sized treadmill to do the testing. They increased running to 12.3 km per day. The monkeys developed a stop in menstruation developing exercise-induced amenorrhea and showed changes in their hormonal blood profile.
Treatment of HA can be complex if there is not an understanding of what variable is contributing to the issue; stress, exercise, a caloric deficit or a combination. HA is often a disorder without direct evidence, but more so a disorder that has many internal and external variables, and with continuous exposure, the hormonal signals begin to adapt to these responses. HA is dependent of these variables and there is no parameter for each individual, instead, a wide spectrum and a matter of person and their own sensitivity threshold. Often, physicians of western medicine prescribe an oral contraceptive (birth control) as “treatment” of HA, due to the influx of exogenous estrogen and progesterone. However, this will only mask the issue and not actually treat the underlying cause…
It is also important to understand what can happen when estrogen is low and menstruation is absent. There is sufficient evidence to prove low estrogen levels from HA can cause many detrimental issues to manifest such as infertility, osteoporosis, dementia, Parkinson’s disease, Alzheimer’s disease and evidence to prove that there is a correlation between cardiovascular disease and HA. Some may think that not having a period is the best news yet, but when we know the long-term effects and how important estrogen is for our brain, heart etc., I think it helps put into perspective the importance of our periods and self-care.
Some of the variables I have changed to see results are reduced frequency of training, increasing my calories by 1,000-1,500, increased sleep, and to focus on rest and recovery on the days I am not training. I slowly implemented this over a period of 2 years, as this was not easy for me, especially lowering my training frequency and intensity. I saw signs of recovery at different stages, but the hypothalamus is sensitive and sometimes requires more efforts to see a change.
If there is one takeaway, just know that food, specifically carbohydrates and fats are necessary not only to survive, but to perform your best in the gym and get stronger. Strong is beautiful and remember that the pressures from the outside world should not influence what you eat and nourish your body with. We also need to remember that balance is the greatest gift you can provide yourself with and to not go to the extremes of any spectrum.
To anyone who has lost their cycle, this is where we need to truly be honest with ourselves and make comprehensive changes to our lives, and truly understand what variables have changed to the extreme. Your life is valuable and you deserve to live at your best.
I want to continue to share this experience with all of you, maybe this will help someone who has not yet shared or discussed their experience with anyone and they are unsure on how to seek help. I was there. This is a process and I want to be as vulnerable and authentic with you as possible. This journey is to be continued.