Amenorrhea after fat loss

[shesprints]

My body has always been prone to this since my anorexia at age 13, right after I got my first period.

But now I'm at a healthy weight and body fat percentage and eating at maintenance for 3 weeks after I cut 20 pounds. I only gained them in the first place due to some antidepressants that seemed to do something odd to my aerobic capacity and metabolism. Perhaps the antidepressants also threw off my hormones? Or is it work stress, because I have been extremely busy, perhaps combined with hard training?

I do work out a lot, and intensely (TDEE is 3,000+) but I've always heard that training doesn't cause amenorrhea: negative energy balance does. And that there is no overtraining, only undereating. I am also not doing nearly the cardio amounts I used to do (I used to run 40 miles a week and now run 20).

Should I wait this out and let my body settle at this new weight for awhile? I am also getting sick a lot (twice in the past month).

If it helps, I got bloodwork done and everything is optimal, except slightly low estrogen, which I have had my entire adult life.

[oregonchick76]

What's your height and current weight?

[shesprints]

I'm 5'6" and in the low 140s.

[oregonchick76]

I'm 5'6" and in the low 140s.

How many periods have you missed? Forgot how old you are - I'm almost 42 and my cycles are wonky. Stress definitely makes mine worse.

[shesprints]

How many periods have you missed? Forgot how old you are - I'm almost 42 and my cycles are wonky. Stress definitely makes mine worse.

I've missed 2, and I'm 29.

[oregonchick76]

I've missed 2, and I'm 29.

See your doc.

[Echo814]

I have never experienced amenorhhea but I have seen some interesting studies. I follow Lyle McDonald on his FB group page and he has addressed this issue and will have a pretty decent section in his upcoming Women's Training book.

From what he's posted, it's energy availability, hormones and stress/psychological factors. It usually takes about the same time frame of losing it to get it back. Always check with your Doc of course but that is what I've seen posted on that group.

Here is an interesting studying on it being just as much physiological as low energy availability.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941235/

[shesprints]

I have never experienced amenorhhea but I have seen some interesting studies. I follow Lyle McDonald on his FB group page and he has addressed this issue and will have a pretty decent section in his upcoming Women's Training book.

From what he's posted, it's energy availability, hormones and stress/psychological factors. It usually takes about the same time frame of losing it to get it back. Always check with your Doc of course but that is what I've seen posted on that group.

Here is an interesting studying on it being just as much physiological as low energy availability.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941235/

That IS interesting! I think you meant psychological? But either way--I finally got my period back, after roughly 1.5 months of increasing calories to only a 250 kcal/day average deficit and working on stress, and also eating more intuitively i.e. not ignoring hunger for as long as I often did in the past.

Am very relieved. I want to hit 18% body fat or so this year and I was worried that might be too low for menstruation (for my particular body) but now I think I've figured this energy balance thing out and might make it.

[tina722]

I've read that some in the medical/research field believe that it's low dietary fat intake that is the problem not the low bf%.

Also. since this validates my thought and is directly relevant for you https://jissn.biomedcentral.com/arti.../1550-2783-5-1

I am biased since this fits with my experience/history as a runner/calorie/weight obsessive individual. I lost my period for over a year while in the worse mind-set. (at age 27, 25ish bf%) It came back regularly after consistently following better macro intakes.

[Echo814]

That IS interesting! I think you meant psychological? But either way--I finally got my period back, after roughly 1.5 months of increasing calories to only a 250 kcal/day average deficit and working on stress, and also eating more intuitively i.e. not ignoring hunger for as long as I often did in the past.

Am very relieved. I want to hit 18% body fat or so this year and I was worried that might be too low for menstruation (for my particular body) but now I think I've figured this energy balance thing out and might make it.

Ugh, autocorrect strikes again. Yes psychological lol.

Glad it came back!

[shesprints]

I've read that some in the medical/research field believe that it's low dietary fat intake that is the problem not the low bf%.

Also. since this validates my thought and is directly relevant for you https://jissn.biomedcentral.com/arti.../1550-2783-5-1

I am biased since this fits with my experience/history as a runner/calorie/weight obsessive individual. I lost my period for over a year while in the worse mind-set. (at age 27, 25ish bf%) It came back regularly after consistently following better macro intakes.

Hm, interesting that the study suggests 36% of calories from fat??? I don't think that could work for me--that's a LOT of fat given my TDEE is around 3250. I tend to hover between 65 and 90g per day, which is well under 30% of my calories. I do get plenty of vitamins A, D, E, and K, and always eat a fat source with a meal for better absorption, though.

Thoughts on this?

[tina722]

I read that as speculation from the authors. The data shows 36% is the upper end of intake from non-injured runners. 30% as the average. (upperlimit of 130g and average of 80g fat).

Average BW was 58kg, so 0.63g fat/lb of BW << pretty sure this is close to what many on this forum or in the nutrition forum suggest (0.4 as a minimum when dieting)

Since your goal is 18%bf, you might consider keeping the fat calories similar between maintenance and dieting periods (65g sounds like the very lowest you should be even when dieting, and 90g sounds better to me ), and that might help avoid period irregularities in the future. You have plenty of room to drop cals from protein and carbs, so this shouldn't be a problem.

I personally eat ~30%+ fat cals, (70-90ish grams at ~2200cals/day) but that is by preference.

[shesprints]

I read that as speculation from the authors. The data shows 36% is the upper end of intake from non-injured runners. 30% as the average. (upperlimit of 130g and average of 80g fat).

Average BW was 58kg, so 0.63g fat/lb of BW << pretty sure this is close to what many on this forum or in the nutrition forum suggest (0.4 as a minimum when dieting)

Since your goal is 18%bf, you might consider keeping the fat calories similar between maintenance and dieting periods (65g sounds like the very lowest you should be even when dieting, and 90g sounds better to me ), and that might help avoid period irregularities in the future. You have plenty of room to drop cals from protein and carbs, so this shouldn't be a problem.

I personally eat ~30%+ fat cals, (70-90ish grams at ~2200cals/day) but that is by preference.

That sounds smart. Yeah, I can't remember the last time I went under 65. I suppose I just felt so good from eating more carbs so immediately that I emphasized those, but I'm seeing the value of all macronutrients now. In the past I've thought, "OK, I can eat high carbs IF I only eat minimal fat" or "I can eat fat only IF I eat minimal carbs," as I feel the nutrition world tends to imply these days... but moderation, it turns out, is likely the right idea.

And yeah, as for dropping some protein and carbs, given that I'm eating up to 200g of protein I can easily sub in some fat and see how I feel. Likewise, I find it almost impossible to reach the number of carbs I require simply to recover from training and rarely meet my goal there, let alone exceed it.

[AddingPins]

That IS interesting! I think you meant psychological? But either way--I finally got my period back, after roughly 1.5 months of increasing calories to only a 250 kcal/day average deficit and working on stress, and also eating more intuitively i.e. not ignoring hunger for as long as I often did in the past.

Am very relieved. I want to hit 18% body fat or so this year and I was worried that might be too low for menstruation (for my particular body) but now I think I've figured this energy balance thing out and might make it.

I have found that regular 2 day refeeds in a caloric surplus have helped a lot of my clients maintain their cycles even deep in prep when in past shows where we did not do this they lost them. Energy balance is definitely a major factor in menstrual dysfunction and regular refeeds (every week if possible) can help the brain stay out of the territory where it feels that food is chronically in short supply and starts messing with your hormone levels like slowing LH pulsality as regulating your reproductive cycle is not a priority in a deficit.

In regard to stress, a number of studies have found that women with amenorrhea have elevated levels of cortisol in their blood (https://www.ncbi.nlm.nih.gov/pubmed/2153693 and here https://www.ncbi.nlm.nih.gov/pubmed/16464944) which turns heads toward psychological stress levels and exercise which are both shown to raise cortisol levels.

One study here compared women normal menstrual cycles put on a running program at a deficit and others at maintenance cals and the majority of them experienced menstrual disturbances, even the ones who were eating enough (https://www.ncbi.nlm.nih.gov/pubmed/3990734)
There were a couple others that showed similar findings. Here https://www.ncbi.nlm.nih.gov/pubmed/23914797
and here: https://www.ncbi.nlm.nih.gov/pubmed/19945961
And again, some of these women were eating enough so if you are sensitive then you may need to look at the intensity or at least the frequency of your high intensity training if you are starting to see things that indicate you may be losing your cycle (lengthened or shortened cycles)

The good news is that even if you lose your period on your diet once you return to maintenance (or surplus if you want it faster) calories for a prolonged period it will likely return, even at your reduced bodyfat granted that you are not at a death's door low. Alan Aragon did a great review that showed that calories are the main determining fact of menstrual regularity and not bodyweight.

[JessRosi]

When I lost my period, the only thing that regulated me was gaining fat, as horrible as it is.
My doctor explained it to me like this, seeing as I originally went to her asking why I had no sex drive.
She said we menstruate so we can conceive. When our body fat is too low, we're stressed or our hormones are out of whack the body doesn't see it fit for us to carry a baby. So those reproductive functions shut down to conserve energy. In my case, my body wasn't bleeding or getting horny because, well, I wasn't fit to have a baby lol
Of course you already know the complications regarding bone density, too.
As another poster mentioned there's evidence that a higher fat intake in the diet can help. I found that eating a lot of carbs helped me but this could simply be down to carbs=body fat=healthy estrogen levels.
Try tweaking your diet but definitely see a doc