Birth Control / Hormones / Amenorrhea

Many of the posts that I want to do, I want to keep simple and to the point. I don't want you to feel overwhelmed with information, but rather have practical take home tips for topics that hopefully are relevant to your life. Here are some common themes that come up in female athletes: 

  • Primary Amenorrhea - not having your period by the age of puberty because of a possible issue whether that's anatomical or medical in nature
  • Secondary amenorrhea - due to some stressor your hypothalamus recognizes this and regulates these hormones and in order to conserve energy, you stop menstrating.
  • Secondary is most commonly seen in athletes where their body fat percentage is too low, or they are exercising too much (female athlete triad). You might be someone without a period, but you feel your body fat is high enough. This could mean that you simply have stressors in other areas.
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Amenorrhea is a state of stress essentially on your body so that it conserves energy in that particular area. Make sure that you are taking care of all of those areas.

Make sure that you are getting 7-9 hours of sleep per night. If you say that you need less than that personally, then you need to read the book Sleep Revolution. It is your evolutionary design that you do in fact need that many hours.

If you have a high stress job, maybe start meditating, or maybe quit your job (lol-idk maybe not). If you have a high stress life, make sure that you are going on walks and taking time for yourself.

Also work on your exercise and eating habits. Don't just start binge eating. That's also stressful on your body and raises your cortisol level. Make sure that you are eating quality fats (unsaturated- walnuts, avocados, flaxseed oil, chia seeds, almonds, whole fat yogurt), and that your calories are sufficient for you. If you are maintaining weight, then maybe slowly increase your calories each week in a reverse diet fashion if it's psychologically hard for you to increase calories. Typically, women that are in this situation might have a relationship with food. In order to DECREASE stress, you also have to take that into account and not just throwing caution to the wind and eating ad libitum. 

Let's recap: 

  • Sleep 7-9 hours 
  • Meditate / Practice mindfulness / Take care of mental health 
  • Eat sufficient calories increasing slowly if need be 
  • Eat good quality fats for hormonal health 
  • Slowly decrease exercise or quit exercise entirely if possible 

Potential Medical Issues

The issues that arise from not having a period are predominantly these three issues (THIS IS NOT ALL OF THEM - I AM HITTING THE HIGHLIGHTS): 

  • bone mineral density  
  • increased risk of endometrial cancer 
  • infertility 

Humans by psychological nature and the way that our brains work do not predict well into the future and don't prepare well for it. Here is a LONG paper about the 'predictive brain'. The reason that I bring this up is because all of these issues are not symptoms that you will see on the forefront. They are issues that could come up later. It's possible that as an athlete, you've had a set back of a stress fracture, but for the most part, you won't really know about osteoporosis, mutating cells on the lining of your uterus and the possibility of infertility until you are trying for children, so these may not be things that you find to be of issue. It's the same attitude that is seen in diabetic patients that could develop kidney disease. We all make decisions and evaluations about our health every day based on our predictive brain, which humans inherently SUCK AT, so try to not do that! ;) 

I wrote this article about not panicking if you don't have a period and I got a lot of heat about it. I want to revisit that topic and explain what the purpose of that blog was. WE CAN'T BE AFRAID OF EVERYTHING ALL THE TIME. We have to take our health seriously, and this is a very important issue, but when you don't know the details, you think that you are going to wake up with cancer tomorrow, and that's not helping anyone. It's important that we ease OUT of stress, and not back into it. That's all I meant by that. WE WANT THOSE PERIODS LADIES! 

Hormone Testing

I personally think that this is a good idea because it can give you a good picture of where you are at. Here is a FANTASTICCCC chart on the testing for secondary that a physician would follow, but the four hormones that you want to get checked out to make sure that everything is lined up is FSH, LSH, estrogen, and progesterone. Depending on where you are in the spectrum of values within those can help you to determine how "off" things might be and where to go from there. I highly recommend going to see your OBGYN for this as she will best be able to guide you through this process. 

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If you want to read this article in full, it's great so here is that about ameorrhea analysis and treatment: https://www.aafp.org/afp/2006/0415/p1374.html

You want to understand the process of how your hormones shift throughout the month and how that affects you, your moods, your digestion, and your performance. It really does all tie together, and so I wrote this article in reference to that.

I did however want to explain what happens with FSH, LSH, estrogen, and progesterone. 

When estrogen starts to increase during your follicular phase, your body will also stop producing as much FSH and switch to LH (lutenizing hormone). When your LH starts to increase, you will have a surge and this is the 48 hour window (ish) of ovulation when it's best to try for pregnancy. You will then produce progesterone, which is helpful for pregnancy. When you do not get pregnant, the lining tissue of your uterus will shed, and then your progesterone will decrease, estrogen increasing, and this will start the process again. You can monitor your temperature and your LH throughout one month to get a picture of when you are ovulating, and also the number of days of your cycle as everyone can be different (typically 28 days).

If you have extreme period cramps or symptoms, this could mean that something is off within those hormones as well so it's important to work towards regulation of that and not just accept that your period weeks are the death of you! ;) It is also of note that even if you are not having a period, you can still have period like symptoms, but your body is still conserving energy to not produce the actual bleeding. It is important to get your anatomy and labs checked by your OBGYN to make sure that there is not a bigger issue at hand, and I recommend reading the book "No Period Now What"  which is so extensive and broken down in language that is easy to understand.

Birth Control 

The biggest take home with birth control, as most know at this point in 2018 is that it's a 'false period'. The pro of birth control if you are not having a period is that it can help with the uterine wall thickening and endometrial cancer, however I believe that it's important to work through the other parameters first and foremost and try to get one naturally.

If you just DO NOT plan on doing that, then it's important that you get on birth control. I will relate this again back to my diabetic patients. I wish like everything that dietary and lifestyle changes could be made and we work towards that, but it might be something that the person is not willing to do at that time and in that case, they might need to go on Metformin or start insulin therapy. So, as a clinician, that needs to be evaluated individually with the patient. 

LETS GET TO MENSTRATING ;)

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