I get it - you’ve been doing all the hard work to try and support a normal menstrual cycle, and you’re not seeing any changes. At. All.
And while I think some doctors are great and know exactly how to integrate the science of medicine with the art of bedside manner, there are definitely some out there who might brush this off with a, “it’s not a problem until you want to get pregnant”. Ouch.
There can be a variety of reasons why your period still isn’t back – many of which can be addressed through a combination of nutrition, medicine and other amazing wellness modalities.
1. You’re still undereating. If you’ve been navigating eating disorder recovery, or a period of restrictive and disordered eating, you might have already been working towards eating a more appropriate amount to restore your health. I like to use the analogy of a bank account in this context: you’ve spent some time taking lot of withdrawals from your energy balance, and you had some overdraft protection for a while. Once you start putting energy back into your account, you’ll have to pay some interest on the overdraft before the energy contributes to your typical balance. It’s entirely possible that for a period of time you will need more energy than you think to support the production and function of healthy hormones.
2. You’re going through puberty, pregnancy or menopause. The first one catches lots of folks off guard. When the body is undergoing the puberty transition, the brain and the ovaries are learning how to communicate with each other and how to produce the various hormones involved with a menstrual cycle. This can mean that periods may start and stop, or they are a little more irregular for some time – it can be worth tracking to make sure that periods gradually find a pattern. If you’ve been participating in sexual activities without a barrier method, and sperm are involved, there’s also a possibility that you could be pregnant (early pregnancy sometimes feels like the start of a period!). And the menopause transition is often associated with an increasing irregularity of cycles, meaning longer chunks of time between periods until they stop for a full 12 months.
3. You’re not ovulating yet. Ovulation comes before menstruation, and if you’re experiencing conditions such as PCOS, there’s a possibility that you’re not ovulating. There can be occasions of anovulatory bleeds, or bleeding without ovulation, but these may not be as common and are related to a drop in hormone production versus actual cycling. This can be where working with a reproductive endocrinologist can be useful, to assess whether ovulation is occurring or if it needs support via medication. You may also see this in fertility care through assisted cycles or treatments such as intrauterine insemination (IUI) and in vitro fertilization (IVF).
4. You need more body fat. Similar to #1, if you’re working towards health and weight restoration you may need further nutrition support to achieve a body fat percentage that facilitates menstruation. If you’re a competitive athlete or engage in frequent, high intensity activity, this can also be a concern for you – working with an experienced dietitian is critical to ensure your body is safe and functioning well to support regular periods.
5. Your stress level is too high. Elevated levels of cortisol can negatively impact ovulation – your body doesn’t think it’s safe to have a baby! By working to reduce or manage stress levels, the brain and ovaries can communicate more appropriately to allow regular ovulation and therefore regular periods. Working with a professional can be a privilege, but where accessible having a therapist or counsellor can be a great tool alongside nutrition and medical care.
6. Your thyroid is under or over-functioning. Both hyper- and hypothyroidism negatively impact the patterns of reproductive hormones, and this can be where medical treatment is important. From a nutrition perspective, there are considerations for foods that may play a role in thyroid hormone production as well as managing negative side effects from both of these, such as constipation or diarrhea. It’s also important to ensure adequate energy and nutrient intake overall, as restrictive eating can trigger the thyroid to under-function as a means of protecting metabolism!
Getting periods back can be a challenge, but having a strong healthcare team can be an asset in promoting your best health along the way.