Amenorrhea and Heart Health
Amenorrhea, or missing periods, is associated with a large number of eating disorders. When we think about the risks of amenorrhea, we most commonly think about the negative implications on fertility and bone health. However, missing periods could actually be causing cardiovascular damage.
What Is Amenorrhea?
Amenorrhea is defined as the absence of a menstrual period. Missing your period when it is not caused by pregnancy, breastfeeding or menopause is an indication of a larger health problem. When a woman has missed multiple periods and is not pregnant, estrogen has been shut down. This is referred to as hypothalamic amenorrhea and is caused by excessive exercise, undereating, stress…or a combination of all of the above.
The Connection Between Estrogen and Heart Health:
Amenorrhea leads to low estrogen levels. Estrogen is extremely heart protective. More than two thirds of young women with heart disease have abnormally low estrogen levels. 69% of young women with coronary heart disease have low estrogen levels caused by losing their periods because of over exercising, undereating, stress, or a combination of all of the above.
That is a staggering statistic.
Slipping Through the Cracks:
At The Holistic ED Recovery Center, we work with individuals struggling from eating disorders and amenorrhea every day, and from the lens of an eating disorder, we know to ask and assess accordingly, and recommend regular medical follow ups for our clients. The problem is, however, that contrary to popular belief, eating disorders are often an invisible illness. Yes, some who struggle with an eating disorder look incredibly unwell visually speaking, but many..most actually…do not. And so unless they disclose to their doctors that they are missing their periods and are struggling with an eating disorder and/ or compulsive exercise, their doctors will not know.
Another layer to this is the distorted lens through which the individual with an eating disorder views health and wellness. They are often looking at their health by how much they weigh, how “clean” their eating is, how much they exercised, how much they have improved their fitness, etc. While they of course know that they should be menstruating, and that this is important to their health, they most often will not see it as a primary concern compared to rigid and restrictive eating and excessive and intensive exercise. And when it comes to our health, we are our own best advocates. If we do not go to our doctors to voice concern about a missing period…or even share it at all… and we look perfectly well (often even society's picture of health ironically), then our doctors cannot know and cannot test and support accordingly.
Your Menstrual Cycle is Your 6th Vital Sign:
Something I tell clients all the time (those who are menstruating women), is that their menstrual cycle is a vital sign of health. Yes, vital! And no, that is not an exaggeration. I believe very strongly that inquiring as to one's menstrual cycle and cycle regularity should be part of regular medical questioning for women. A consistently missing period is not to be taken lightly.
Many of us view the menstrual cycle from the lens of reproduction. However, our cycles are also an indicator as to the general health and well being of women, just like your other vital signs (temperature, heart rate, blood pressure, respiratory rate and pain).
I share about the connection with heart health and missing periods, because not only is it lesser known, but also because many youth we see in eating disorder recovery do not consider fertility to be of serious concern at their age and stage in life. It is not cognitively enough of a negative impact to make them worry about their actions in regards to the eating disorder…but serious risk of heart disease gives one moment to pause and hopefully incentive to take steps to wellness and recovery.
…which brings me to the next question many individuals have:
How Do I Regain My Period?
Of course, the approach to healing and recovery from amenorrhea and eating disorders is layered, nuanced, and individualized. That said, here are some places to begin exploring your healing and next steps to take towards wellness.
Explore what is the cause of your missing period:
For many, it is a combination of stress, excessive exercise and restrictive eating. But for some it may be one or two instead of all. For example, perhaps you eat a very sufficient and balanced diet, but are a distance runner. Or perhaps you don’t exercise and you eat well and enough, but are under chronic stress. Or perhaps you think you eat “enough” but if you are being honest with yourself still are quite controlled and “careful” with your food intake. And then of course, for many there is a full on eating disorder such as anorexia or bulimia, that is the main contributing factor.
Work with a team accordingly:
Once you know what is the cause of your missing periods, you can work with the correct practitioners to support your health and recovery. At The Holistic ED Recovery Center, we believe in an integrative team and working holistically in a circle of care so that you can heal mind, body and soul. This includes working with a registered nutritionist, a certified recovery coach and a naturopathic doctor, as well as regular check ups with your medical doctor.
Ensure you are eating a balanced plate, and enough food:
Of course if you are working with a nutritionist, this is work you will do together. If you do not have a team of support in place yet, a good place to begin is assessing whether or not you are consuming enough of all of your macronutrients: carbohydrates, fats and protein. These days, diet culture is currently favoring protein and so many individuals I work with lately seem to be more fearful and avoidant of carbohydrates (namely grains) and fats. But of course, each individual and eating disorder is unique and what is safe/ unsafe in regards to foods varies from one person to the next. Others will do quite well at eating foods from all sources, but by no means are eating enough of any.
Please keep in mind that in eating disorder recovery, we have elevated nutritional needs and as such, you will likely need more nutrition than you think in order to heal your mind and body, recover from your eating disorder and regain your period with consistency and regularity.
Take a break from exercise:
This one is the kicker for many. But the truth is that if you are trying to regain your period, physically stabilize and recover from an eating disorder and are still engaging in exercise…the you are chasing your tail. This only makes recovery and health harder to achieve, makes the process take longer than it needs to, and honestly sabotages your recovery to some degree as you will never have the experience of eating without compensating.
Exercise, especially compulsive and intensive exercise, continues to put stress on the body, use up essential nutrient reserves, and increase the caloric needs one will need to show up to to regain regular menstruation.
Work on tools to support and manage stress:
It can be helpful to take some time to journal and explore where your stress is currently residing:
-Are you feeling overworked? Are you not taking adequate days off or proper study breaks?
-Are you taking on more in your life than is kind to your mind and body?
-Are you struggling with sleep?
-Do you need to implement rituals or routines into your morning or evening to support stress reduction? How is your self care?
-How are your relationships?
-Is there anything you can let go of? Is there anything you can prioritize?
You can also check out THIS blog I wrote all about tools for anxiety management.
What About Birth Control Pills?
Many clients we have worked with over the last decade have been prescribed birth control pills in response to missing their periods. I have to be very clear here that this is absolutely not the answer but rather just covers up the issue.
On “placebo” days when taking the pill, we do bleed but it is not a true period. The hormones in birth control pills mask the absence of those hormones required to naturally menstruate.
There are risk factors to making this choice:
It masks the continued and ongoing problem which means possibly a delay or absence of any further medical and nutritional interventions to restore the health, weight and lifestyle factors (stress, exercise, etc) needed to regain regular menstruation and health.
The individual with an eating disorder may believe themselves to be weight restored even when they are very much not, since they are getting a period.
The good news here is that although there are many risks associated with hypothalamic amenorrhea… it is 100% reversible. Through working with a care team towards recovery and health, you can absolutely regain your period, recover from an eating disorder, heal your relationship with exercise, and make choices each day in your life that support more calm, more health and more happiness.
If you are looking for support and are curious what working together would look like you can contact us to book a free discovery call here. We take an hour with you to talk, assess, and share what next steps would look like and we are always happy to connect and support.
