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, author of No Period. Now What?, Dr Nicola Rinaldi 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 stressful enough on 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. Heidi 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.

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 to 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, gently 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 thats 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 its 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, its 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.

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

• No Period. Now What?
• ESPN article:Why Tina Muir retired from running, at the peak of her career
• Runners World article: After 9 Years Without a Period, I’ve Stopped Running
• Dr Nicola's Guest post on my blog
• The 5 factors involved in amenorrhea
• Heidi Twitter
• Heidi Instagram
• No Period Now What? Instagram
• No Period Now What? Twitter
• No Period Now What? Facebook

Thanks for Listening! I hope you enjoyed today's episode.