UPDATE: Since writing this article, I have taken EVERYTHING I learned in my journey to get my period back, and wrote a book on the topic, so you have everything I know about amenorrhea in one place. This book is written for runners who have lost their period, but regardless of what sport you do, if you don’t get your period, Overcoming Amenorrhea: Get Your Period Back. Get Your Life Back will help.

Missed, delayed, and irregular periods are often pushed aside, even by medical professionals. Doctors and other medical professionals are not taught about hypothalamic amenorrhea and the five factors that cause a loss of a menstrual cycle.

An energy deficit is the biggest one, and can cause significant damage to bone health in both men and women, but it is not the only cause. Running, stress, weight loss, and genetics can all play a role in why running causes periods to stop.

In this episode, Dr. Nicola Rinaldi, author of No Period. Now What?, is on the podcast to talk about why this is more common than we realize, and how our desire to be healthy has caused the reproductive system of many women to shut down. As running is a high intensity activity, it can be so stressfulon the body that it feels it needs to reserve energy to keep moving.

Birth control pills can mask a deeper problem, and today we talk about how even if you are having regular periods on the pill, you might still have an issue, which will go undetected until you come off the pill.

We also have Heidi Greenwood, former professional runner, on the show. Heidi shares her story of transitioning away from running to start a family because of her amenorrhea. She shares her powerful and heartbreaking story of how she had to say goodbye to her daughter Jules at 28 weeks because of anencephaly.

This is a long episode, but so important to discuss and bring attention to.

You or someone close to you could have struggled with missed, irregular, or complete loss of a menstrual cycle. This episode shows just how prevalent amenorrhea is, and how birth control pills may be masking the problem for many seemingly healthy women.

Today’s Guest

Dr. Nicola Rinaldi is the author of No Period. Now What?, researcher and driving force behind the awareness of hypothalamic amenorrhea. Heidi Greenwood is a 2:42 marathoner who ran in the 2016 US Olympic Trials for Oiselle.

Dr Nic and Heidi will teach you about why it is so important to ask questions and seek further information, especially when it comes to your health and fertility.

What You Will Learn About

  • How difficult it is to get your menstrual cycle back once you have lost it.
  • How much weight a female needs to gain and what BMI a females body should get to for the best chance to restore cycles.
  • Why it is so important  to find other ways to manage stress as the psychological side of stress is more important than initially thought.
  • Why if your doctor prescribes birth control as the solution to amenorrhea, you might want to reconsider.
  • Why Dr Nicola does not recommend birth control pills regardless of whether you have periods or not.
  • Why hypothalamic amenorrhea research is lacking and what can be done in the future. Why you play an important part in growing awareness.

“Help prevent future daughters from hypothalamic amenorrhea, share this podcast episode.”

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Inspirational Quotes

The hypothalamus is one of the master regulators in your body and when it senses a lack of energy or too much stress, which can be either physical or psychological, it will shut down your reproductive system and other systems to try to conserve energy…it will use the energy for the things you need to stay alive.-Nicola

I feel like there is a huge stigma, that if you don’t get a period, you have an eating disorder, so what does the person do who doesn’t get their period? Stay quiet, because they don’t want people to think they have an eating disorder.-Heidi

There are 4-5 factors involved in HA. You can be extreme on any one of those factors, and shut down your hypothalamus and menstruation…for most of us, it is not just one of those aspects, but a whole bunch of things together.-Nicola

It is important to be eating freely, not restricting any food groups, definitely eating enough to support whatever exercise you are doing.- Nicola

Women, especially young women, don’t realize that we need to ask questions. -Heidi

I have not seen any impact on fertility from having HA. Once you ovulate and get your period, you have the same chance of getting pregnant as anyone else; in fact in some ways, it might even be better. -Nicola

High intensity exercise has been demonstrated to increase cortisol, and an increase in cortisol shuts down the hypothalamus, so I really recommend people do walking, gentle yoga, and maybe easy biking and elliptical. -Nicola

I typically suggest cutting out high intensity exercise completely.- Nicola

Even if you take 6 months to a year off to restore your cycle, you can always go back to it later.- Nicola

I would have never waited till after the trials to start a family with my husband…time is too precious for things like starting a family, things that bring you joy. -Heidi

Everyone thinks, “oh, I am going to be different, I have read the stuff, but that’s not really true for me”. I hear that over and over again.-Nicola

We have been taught for so many years that you need to be thin, you need to eat right, you need to exercise as much as possible. To recover from HA, you need to do the opposite of that, which is really hard. For many of us, for decades we have been taught this “healthy lifestyle” that turns to not be healthy when you take it too far, even if it’s unintentional. It is really hard to wrap your mind around that.- Nicola

We become numb to the workload we make our bodies do…we train our body to withstand long amounts of exercise, it’s like brushing our teeth, we just go do it, we don’t even think about it. We forget that actually, we are making our body work!-Heidi

When you don’t have your cycle, you are almost assuredly not ovulating because you are not having the monthly hormonal fluctuations.- Nicola

Any more than one period missing, I would be concerned. The sooner you take care of whatever the issue is, the easier it is to do. The longer you let something like that go, the more ingrained you get in the habits that have caused your periods to go missing, and the harder it is to recover.-Nicola

Birth control pills can completely mask this, as you bleed every month. That is not any indicator of a healthy menstrual cycle.- Nicola

Clomid or femera are probably not going to work, unless you have started making lifestyle changes.- Nicola

I have learned so much through the process of recovery. Learning to cope with stress in other ways, other than through exercising and to realize how limiting my food restrictions were. I think that is a common feeling among women who have recovered from HA, they are really thankful for the process and for having to go through it, as hard as it is at the time.- Nicola

We are in communities where this is quite prevalent, but in the overall population, doctors don’t see this that much…for a typical OBGYN, they are not seeing that much of this, they are seeing more PCOS, so it is not on their radar screen, and they were not taught about this in medical schools.-Nicola

Don’t let running determine when you want to start a family. Running will always be there.- Heidi

Don’t have fear foods. Every food can have a place in what you eat. If you have a cookie, it’s not the end of the world. It is really important to avoid any kind food restriction and eat what you feel like, eat what your family is eating, eat what your friends are eating. Let your food be your fuel for the rest of your life, as opposed to feeling like you have to control it.- Nicola

Resources Mentioned

Thanks for listening! I hope you enjoyed today’s episode.

Think we could be friends?

I am always this honest, real, raw. If this article speaks to you, I really believe we could be friends and I could help you as you get your health back. Drop your email below, and I will reach out to you

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Thank you to Nicola and Heidi.  I look forward to hearing your thoughts on the show.

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  • Bobbi Lynn Bolton
    May 19, 2017 12:44 pm

    There is so much I can say about this episode. You are spot on bringing it to a public form. Women do silently deal with this. 1. Doctors do just say, well, it’s normal for athletes, when they stop it will return…it’s “normal” to them because they see it so much but that doesn’t mean that it isn’t a cause for concern. My daughter is only 21 but has struggled with this for 6 years (she started her cycle at 10) so she knows the difference of a real cycle. But she has been seeing a different doctor and just this week got a real cycle and as one of the ladies said, she feels like a 14 year old girl getting excited to get a real cycle! Her BMI hung around 18 for those 6 years. She stopped running, started eating more and now it’s right at 21. All my life my BMI hung around 20 to 21, been a fitness fan since age 16 wouldn’t consider myself high level fitness fanatic as I was just a cheerleader in high school and recreational fitness afterward but always fit and ate well. 2. Took standard prenatal vitamins with her and an over the counter folic acid supplement, she was born at 2 lbs 7 oz with hydrocephalus. I subsequently lost 2 more after her and took the prescription strength dosage of folate like Heidi and ended up on bedrest for 8 weeks to have my son a month early. The 3rd similarity is that I had light periods all my life. I have always suspected it was because I only have a half uterus but after this podcast it might be my low BMI. I did go into early menopause and have osteoporosis now at the age of 50. I am certain it came on in my late 40’s but never thought to get a bone density scan till I had 2 stress fractures from running within 6 months of each other. I hope people take the time to listen to this podcast all the way through. It’s not just for young runners wanting to have a family, it’s important for all of us to better understand why our lives have turned out the way they have, like me. I was obsessed for a while to figure out why I have experienced these challenges in building a family. I am quick to share my story with those having their own challenges so they know they aren’t alone and to keep probing for answers.

    • Bobbi, thank you so much for sharing your story. I’m so sorry for your losses and struggles. I completely agree that the more we share the more we help other people realize they aren’t alone and to deal with their issues as opposed to hiding them away. Your story also reminds me of a quote from Tina’s episode with Dr. Cindra – “Difficulties don’t happen TO us, they happen FOR us.” And certainly with HA that is true – it opens our eyes to our lifestyle and habits that are not perhaps as healthy as we think. xox

  • Nicola pointed out in the podcast that it’s important to not assume bone density will be normal after having this for a while. I’m different than Tina and Heidi- although I’ve had irregular periods for a similar length of time (an 11 year history of oligomenorrhea, including 3 years of amenorrhea and some shorter episodes or 6-9 months, but also a year of normal periods, and also some short times of being on OCP), my bone density is the biggest causality. I’ve had 3 stress fractures and one stress reaction in the past 18 months, which is what threw all this to light. I definitely had a major energy deficit, a little bit intentional (being a little too strict about my food and lots of running), but a huge bit coming from malabsorption from undiagnosed coeliac disease. So to other women out there- like the girls kept mentioning, ask questions of your doctors! Don’t just accept things when your health isn’t in good shape. If I had persisted in getting answers to my health problems, my bone density might not have gotten so bad. I think it’s also important to note that you shouldn’t ignore these problems even if you’re not planning a family- something that was mentioned in the podcast. Your period is a fantastic window into your health status, something men and postmenopausal women miss out on, we should utilise that information to our advantage! And finally thank you so much to Tina, Heidi and Nicola for all their bravery and hard work in getting this information out there.

    • Thanks so much for commenting Eimar! I think it is helpful for others to see examples of cases where bone density did in fact take a hit (although I’m very sorry that it happened!). I would encourage you still to work on recovering your periods if you have not yet, because I have been seeing bone density gains in women in my FB group into their 30’s and 40’s.

  • Jessica Monson
    May 23, 2017 1:05 pm

    I appreciate so much how much you are bringing this issue into the public eye. I was also a NCAA DII XC and track runner. Actually I took 2nd to Heidi when she won the National Championship in the 1500m 🙂 I suffered from amenorrhea for 6 years. I also wanted to start a family with my husband. My doctor put me on birth control when I lost my period while in college. It did not bring back my period but I was told that was normal. I was fortunate to regain my cycle, and overly blessed that I now have 2 beautiful girls (3 and 6 yrs old) and had 1 miscarriage in between them. I just think that this information needs to be spread as much as possible. I coach high school xc and track and will definitely be discussing this with my athletes. It is just so important to take care of your health. Running is an amazing sport but it is not everything. Again thanks for sharing. I love listening to this pod cast.

  • Nico, Is there research, and what are your thoughts, about starting acupuncture while also going “all in”?

    Thank you for your wisdom and research. I can’t wait to dig into your book.

  • Tina – thanks to you, Heidi and Nicola for the incredible podcast and for bringing attention to this issue. I haven’t had a period in the last 6 years and was recently formally diagnosed with HA. I have 2 children and am beyond child-bearing years, but not menopausal yet. My question is how important is it to get a period back and re-start my cycles if fertility is not an issue? Can birth control pills work for someone in my situation to help simply with preserving bone density? I appreciate your thoughts on this subject as it relates to those of us beyond the child-bearing years. Thanks so much!

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