AFTER HYPOTHALAMIC AMENORRHEA: ONCE YOU ACTUALLY GET YOUR PERIOD BACK the tricky balance of trying to maintain a regular, healthy menstrual cycle after you've conquered hypothalamic amenorrhea.
I’ve been putting off writing this for awhile. But, I’m finally taking some proactive measures and coming to terms with a few thoughts that have been incessantly swirling around my head. If you’re here, you’ve likely had your own experiences with hypothalamic amenorrhea, or perhaps, you are a female and you have a menstrual cycle in general (because it’s actually that widely applicable). Or maybe you even know a female who has a menstrual cycle. So, basically, you could literally be ~anyone~ and this information is valid– the more I research independently/learn about my body (the female body as it were), the more I am astounded by the lack of information we were simply not taught, and if anything, we were encouraged not to ask questions about. Ahh, my post-hypothalamic-amenorrhea world.
To be clear, the discoveries I’ve made are not new, it’s simply my personal discovery of them that is. I’m talking about how the menstrual cycle works. Like nothing crazy you guys, the basic facts about our biology– like the fact that you *biologically* can’t get pregnant “any time,” a myth we seemingly all (?) believed growing up. I’m talking about the very basics of feminine wellness and being. Let me back up a bit.
Last I had written an update on my HA recovery progress, it was just over a year ago, in April. If you want to start at the beginning of my issues with hypothalamic amenorrhea, you can read here, then here, then finally, here. Or, to quickly bring you up to speed and paint a picture: In April of 2020, I thought I was well on my way. I had a “bye bye HA and no-more-period-issues-for-meeeee, hello regular menstrual cycle and now let me get back into my regularly scheduled programming!!” type of attitude (it’s a very specific attitude as you can see, but I am sure many HA people can relate).
Regularly scheduled programming = “healthy” things, like exercise and morning routines and productivity and to-do lists and perfection blah blah blah. I knew I couldn’t do as much as I had been doing, exercise-wise– I still know that– but in my April 2020 blog update from last year, as I re-read it now, I pretty much sound like I was starting back up an exercise program (I’m actually also quite sure I used those exact words too)– and that’s that. Only, that’s not that.
It’s actually never just “that” when you are a woman and you have a cycle and that cycle has certain demands of your body, and certain hormone requirements in order to, well, cycle. And on that note, one of the other promises I had made to myself post-HA-recovery, was that I would introduce more starchy carbs into my life– I had promised to try sweet potatoes, chickpeas and white rice (three items I had mentioned specifically in my last update), but ultimately I never tried any of these things because “my period was back” and so why should I??? I told myself at the time that I didn’t want to divert from the SCD diet since I had my cycle back now, and things seemed OK. Only, I’ve realized since that time that I truly lost sight of my carb intake, or perhaps more apt, I stopped necessarily even trying to get that minimum quota of starchy carbs that all women need to cycle. My natural inclination on the SCD diet is quite low carb (minus fruit and honey, but those are not the type of carbs that help regulate your cycle, my friends, so I am not referring to those here!) because I’m not a fan of lentils and beans (as much as I’ve tried), and that really relegates me to things like plantains and squash, which, as much as I do love, I am not eating enough of, regardless (slash, clearly).
It’s safe to say that I’ve lost my starchy carb maintenance and, on top of that, I had rather recently increased my exercise load to three times week. The exercise included 1-2 mile runs as well as some strength training and yoga. It might have been fine, if I had actually given extra thought to the once-again-lacking carb-loaded vegetables in my life. Somewhere along the way, I sort of lost sight of this piece of the menstrual cycle puzzle, and I believe it’s a component that will truly help to regulate my cycle (more on this, and what exactly this all means for me personally, later!)
what in the world have i been doing since last year?
I’ve been tracking my cycle in the app Clue, at a very basic level, though. I tracked when I was bleeding (duh), and symptoms leading up to it (things like cramps, PMS, breast tenderness). I also always track what I eat daily for my Crohn’s disease/SCD diet management, and at what time I eat — the latter being more important to my cycle regulation than to anything SCD-related. Energy deficit, as I’ve explained in my previous blog posts, is a big factor as to why HA happens– leaving your body without sufficient calories for a prolonged period of time (i.e. putting off eating in the morning with intermittent fasting, or in my case, fasting + high-intensity cardio for an hour + fasting some more). I also track how much exercise I’ve been doing or not doing.
In the time since I got my first cycle back, at the end of January 2020, until now, according to Clue, my cycle length is an average of 37 days, with a cycle variation of 16.6 days (this number being how much it changes in length from one cycle to another). I guess, looking at these numbers here– they don’t appear too crazy — however 37 would definitely be considered ‘long’ for one cycle. And my issue is, that I do not think it is representative of my cycle, either. When everything seems to be running “normally” my cycle is typically 30-32 days. The variation in my cycle this past year came from a few times in particular, where my period went M.I.A. again, for a month or two, and had me scared AF and generally confused.
On top of this, I began to notice a specific trend, where, my cycle would ‘start’ in the 30-32-day range, and then each month it would get longer and longer– from 34 days, to 43 days, to 49 days, to 76 days plus, before finally re-setting back to 30 days. I won’t get into too many more details here as they are unnecessary in the grand scheme of things, the point is that I did not (do not) have a regular cycle still post-HA– it’s not always that simple.
In this realization, I began reading and listening to more podcasts about menstrual health in general, and I was no longer hyper-focused on the HA side of things (but if you do want a good HA podcast rec or two, definitely feel free to ask me!). While I did have HA, I wanted to explore more about maintaining a healthy menstrual cycle because now my cycle was back, despite being irregular.
I ended up at the Fertility Friday podcast, hosted by Lisa Hendrickson-Jack, and let me just say she is THE BOSSSSSS when it comes to your period and knowing your own fertility, and she makes you realize just how silly it is that we are not actually informed on these topics. We can and should be aware of our own ovulation, and by extension, fertility — both as a matter of birth control and as a means to get pregnant– yet we are not taught about this from an educational sense, at all. It’s unbelievable the wealth of information that Lisa provides in her podcast series as well as her website and her book, The Fifth Vital Sign, all of which I highly recommend.
Now getting back to my initial point: it is thanks to Lisa’s podcast really, that I have grown to not only become interested in my menstrual cycle, but I’ve come to actually understand it more from a biological sense, all of which has encouraged me in this post-HA journey, as I attempt to now regulate my cycle.
I should now warn you, Lisa’s podcast has led me to a natural way of tracking my cycle that centers around the Fertility Awareness Method or FAM. This is considered a natural form of birth control (I personally will never go back on birth control or any type of man-made birth control). I am no FAM expert, in fact, I am just getting started, however this particular method of charting your cycle appeals to me because it allows you to understand and know more about your own body. It literally requires you to be in tune with yourself every single day.
what is the fertility awareness method?
I will provide my off-the-top-of-my-head explanation for FAM (lols, I’ve said it before and I will say it again, I am no doctor).
The Fertility Awareness Method (FAM) means you are basically paying close attention to your body day-in and day-out and tracking specific elements, either on paper or in an app (there are apps such as OvaGraph or ReadMyBody specifically designed to chart for FAM, while Clue also has the ability to add in all these options to track).
Typically, you would be tracking:
- cervical mucus (cervical mucus, yes, I am so used to these words they no longer gross me out — your CM looks different depending on the phase of your cycle, and your CM can actually tell you if you are in your fertile window or not. CM would be egg-white-like leading up to ovulation, whereas it might be sticky/tacky/lotion-y at other times of the month– you need to be checking every day to really know)
- basal body temperature (BBT) (basal body temperature is your temperature at-rest, basically, and if you are tracking your BBT, it needs to be done first thing when you wake up, before you get out of bed or do anything else. When progesterone rises, and estrogen drops, right after ovulation, your BBT rises by .5 to 1 degree. Thus, BBT can confirm ovulation)
- cervical position (often times checking your cervical position is considered optional, however, if you were checking, you would notice whether the cervix is high and soft/open – approaching ovulation, or lower and firm – post-ovulation).
- and perhaps other personal symptoms/indicators within your cycle that point to what phase of the cycle you are in (for example, breast tenderness always occurs right after ovulation for myself, personally.)
By tracking all of these different elements each day, you are then able to make a smart (or dumb 😉 ) decision about whether or not you are fertile, and thusly, whether or not you should be having sex!
There is certainly a lot of learning that comes along with using FAM. Previously, when I was just starting out to get my period back post-HA, I would say I knew very little (or rather, nothing at all) about the phases of the menstrual cycle or what really happens when you menstruate. As I began to heal myself, I began to learn more about the different phases, and while I could eventually name them (they are the follicular and luteal phase, by the way) I still couldn’t necessarily remember the order of them (and I mean, it’s just two of them lmao), or the fine-tuned details about what happens during either phase, and what you might need to support either phase nutritionally or otherwise. I now actually know when estrogen rises, and drops, and then when progesterone rises, and what those effects can look like on your body– and how they can translate to PMS (or otherwise).
Because I ended up taking this fertility awareness approach as I dove deeper into my HA recovery, I know so much more and I also understand a lot more, simply put. It’s frustrating too at times, because I can learn as much as I can learn– but if my body doesn’t follow suit or mimic the standards I’ve learned about, it still leaves me questioning/wondering. However, nobody is textbook-format, in the sense that each of us has our own unique cycle and set of hormones and figuring out that balance of what works for us individually, to allow us to cycle, maintain health, exercise etc.
For me, right now, I am coming more and more to terms with the fact that I do not need to exercise and I do need to eat based on nutrient profiles. It’s kind of crazy I am still a year plus post-HA and I still need to say these words, but that’s how much this mentality has been ingrained in me (more exercise = health), and I know many people can relate.
finally: letting go
Ultimately though, beyond learning as much as I can about my cycle and trying to spot the signs in my own body, in my attempt to now ~regulate~ my cycle, I’ve also come to a few realizations along the way– or perhaps, very recently. And I think this will be one of the most important factors in the next steps to regulate my cycle– that is– letting go.
Letting go is a dooooozy. It’s hard af. I’ve basically only NOW realized, a year post-HA (and I am also now realizing this is the process for many women who fix their HA) that the whole year I “got my period back” I still had these thoughts needling into the back of my head, but ones I would try to suppress of course, or at least, tell myself I wasn’t actually having. These are thoughts like:
“Okay but just three months of this and then I can get back to running and lose this extra weight” (and it’s worth noting last year’s blog update was after my third period in a row, thus I clearly thought I was “homefree”, and this was perhaps the *biggest* detriment to my mentality)
“Gah damn, I look fat/ugly”
“I liked myself better before I gained this weight”
“People liked me better before I gained this weight”
“People will notice this weight gain and judge me”
“I liked having that running thing, I have no thing now”
“I can’t wait til I can go hard again with exercise”
Etc – to each their own negative thoughts – but that’s the idea. These are the thoughts that I did not keep front and center day-to-day to be clear, but they had certainly borrowed holes in the back of my mind. I don’t really know why now is the time that I’ve FINALLY ~accepted~ this is my *new* body, and it’s not changing, and also, I will *never* exercise in that same manner again. I have come to terms with this in the most open and honest way I have since starting this hypothalamic amenorrhea journey at the beginning of 2020. Sidenote: I am also aware that if any so-called “people” judged me for my weight gain they are not so-called “people” I want around– and I don’t have friends like that IRL anyways– but our minds have a unique way of being irrational.
I want to end this super-long update by saying, it’s easy to begin this journey on the surface-level– which is what I think I did initially– but at one point, it needs to go deeper and affect your mindset wholly. It’s not something you can force though; much in the same way you can’t force someone to work on their health, or start the SCD diet, unless they truly want to. You need to be ready for this change in mentality and to be accepting of it. I believe that my mentality has been affecting my menstrual cycle (or lack thereof) just as much as my increase in exercise, my nutrition and perhaps even my weed habit — and ultimately, ALL these elements actually go right back to my *mentality* at the end of the day.
I do want to share my current approach/what I am doing right now as I have done similarly in previous blog updates, however, considering how insanely long this post is already, I will be sharing my current habits and the specific changes I’m trying to implement moving forward, as a separate post to follow up this one, later on this week. I welcome your comments, whether in the comment section below or feel free to connect with me via Instagram DMs, the contact form on my site; the world is your oyster!