First Steps to Recovery

Today I received an email from a beautiful young girl who wanted some advice. I realized that the questions she asked are likely questions that a lot of other lovely ladies may have, so I wanted to share my response.

So, you think you have Hypothalamic Amenorrhea, and you have NOT been on the pill, so you don’t think this is the cause. What should you do?

First Things First

Congratulations on commencing your journey to recovery – acceptance is the first step. I recommend that you start by seeing your primary care provider and having blood tests done. The doctor will check your Estradiol, LH, and FSH levels. You may also want to ask to have your thyroid function checked via the blood tests to make sure that thyroid issues are not the root cause of the amenorrhea. Vitamin D levels would also be good to get checked. Vitamin D helps our bones absorb calcium. In women with amenorrhea, the low levels of estrogen can prevent our bones from absorbing adequate calcium, making us more susceptible to osteoporosis.

What’s The Cause?

It is important to know that Amenorrhea can be at 4 levels:

1. Hypothalamic

– This is where my amenorrhea is rooted. Excessive exercise and restrictive eating cause our hypothalamus (the part of our brain that regulates hormone function) to panic. It essentially enters ‘survival mode’ due to lack of nutrition, and shuts off all ‘unnecessary functions’ in order to make sure the body survivors. Unfortunately, reproduction is not a function that is essential to our survival, so my hypothalamus just told my body to stop producing Estradiol, LH and FSH.

2. Pituitary / Thyroid

3. Ovarian

4. Uterine
Start With Your Doctor – Blood Tests
Starting with a blood test will help your doctors confirm that your amenorrhea is rooted in the excessive exercise and restrictive eating. I don’t want to scare you at all, and just want you to be aware, so it’ important to get the blood tests done to make sure that nothing else is the root cause – does that make sense? Honestly, when I went in, my doctor just checked for everything:
– Vitamin D 25 Hydroxy
– Estradiol
– Follicle Stimulating Hormone
– Luteinizing Hormone
– CBC and Platelet Count
– Lipid Panel
– Prolactin
– DHEA Sulfate
– Testosterone Total Free
– Hemoglobin A1C
– TSH with Reflex FT4, FT3
– Comprehensive Metabolic Panel
If you’re scared of blood tests, don’t worry, all of these tests were conducted with one sample set i.e. I did NOT have to get my blood drawn multiple times.
What You Can Do
Nutrition
Caloric Intake
If you have been restricting caloric intake, I would start by slowly increasing. I know a lot of HA blogs say “increase to 2500+ per day,” and as someone who has been so conscious about their weight, I know that’s hard. For example, i am about 5’7, and weigh between 125 – 129 lb. I was restrictive at 1200 for the longest time. I started by increasing by 150 per day, every week, so that after about 4 weeks I got close to 1900. I now eat between 1800 – 2000 (I still log, because it makes me feel less stressed) and I try to LISTEN to my body and hunger levels.
Macro-Nutrients
It is really important to make sure you are getting at least 60g of healthy fats per day. Incorporate nut butters, avocados, and seeds in to your daily intake. I also started taking a few supplements, which you can find on my blog. 🙂 I did NOT take a calcium supplement, because some research indicates that these can increase your risk of heart-disease. Instead I increased my intake of greek yogurt and dairy, and tracked my calcium intake using My Fitness Pal.
Estrogen-Boosting Foods
I wrote a post on my blog about this, so feel free to reference that!
Your doctor will likely refer you to a nutritionist or nutritional therapist. The one my doctor referred me to was SUPER EXPENSIVE, and basically did not tell me anything I did not know – limit exercise; eat 1800-2000; increase fat intake. However, what she did tell me is that I DON’T have to worry about gaining weight – I just need to maintain. She has also helped me transition towards being a normal eater. I plan to share these insights on future blog posts because I don’t want other girls to have to worry about paying $160 / hour like I did.
Keep in mind, don’t scare yourself, or let anyone scare you in to thinking that you “HAVE TO GAIN WEIGHT.” Let’s not worry about the weight part for now – I certainly have not. Getting your period back is about showing your brain what ‘balance’ means, and so for now i am focusing on maintaining my weight, and incorporating healthy fats in to my diet, along with an increased caloric intake.
Exercise
I would suggest taking a few weeks off from exercise. If this is really hard – you mentioned just walking has been really hard – then limit exercise to 3 times a week. I have a post on my blog about what exercises I do as well. Definitely lay off high-intensity cardio.
This journey requires patience. I should also let you know that it is COMPLETELY normal to have emotional fluctuations and breakdowns – in fact, this can be a sign that your hormones are kicking in. Don’t let your emotions scare you – let them out!
Happy healing!Lots of love,

Girl Guilt-Free

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