My diagnosis of Hypothalamic Amenorrhea (HA) has been known for over five years. However, my understanding was limited because as I was fit, lean and an ‘athlete’, I thought not getting a period was simply normal. I knew I was infertile and if I wanted to have a baby I would just have to reduce exercise and put some weight on. Simple, right?
I recognised there was risk to my bone health so I went on the birth control pill and was prescribed Hormone Replacement Therapy (HRT) to provide my body with estrogen – important for calcium absorption. A clinical diagnosis for HA is low estrogen. My hormonal state and symptoms were similar to a women going through menopause.
My attachment to my identity of being ‘Amy the dietitian and trainer’, who was fit, strong, lean, determined, and a triathlete, didn’t allow for me to stop exercise and put on weight. I was good at ignoring the facts, but in reality thoughts of guilt and the feeling of being trapped would often arise.
When a young girl placed a photo of me on her inspiration board as her health and fitness idol as part of a school project, I felt guilty and dishonest. Although I would often post pictures of my ‘six-pack’, use fitness hashtags, and see people comment encouraging words on my pictures, I felt like I didn’t really deserve the compliments.
I recently learned that young girl had also been going through HA and used to look at me thinking “how is she so lean, fit and healthy?”, when little did she know I was not ‘completely healthy’. On my Instagram you will see I now feel it is my absolute duty as a health professional to be open and honest, and share my journey if I truly want to help people.
My recovery started in July this year after returning from a big three-week holiday to the Greek islands with my husband. Months before the trip, we had discussed starting a family and had seen a fertility specialist who seemed confident that with ovulation induction (injections) or IVF we should be able to fall pregnant. She told us to make an appointment after we returned, where she would be able to give us a prescription for the drugs and I would be closely monitored.
I told her I had reduced my exercise and put on weight compared to where I was.
My lowest weight was around 49kg (BMI 17.6) in late high school. I sat around 52kg (BMI 18.6) over the 2-3 years I was training 20 hours per week as a triathlete, and when I went to see the fertility specialist I was 55-56kg (BMI of 19.8). At this stage I was training around 1-1.5 hours per day, every day.
Having that appointment booked in made me realise that although I told myself I had done everything, I was only giving 95 per cent, not my whole 100 per cent. Going through without this five per cent was not the way I wanted to live my life or be a role model to my future children. I knew that the missing five per cent meant ‘letting go’.
I realised I did in fact have restrictive eating habits as I would feel great stress and anxiety when I was unable to eat what I liked. For example, I had porridge every day for five years, even on holidays. It wasn’t just always there; I made it be there.
Although my exercise volume had been significantly reduced, I still felt the need to train every day. It always came first. I had started introducing a rest day and yoga days, in which I found my mood and allowance of food on those days significantly differed.
There were other long standing symptoms of HA I was ignoring – sleeping problems, hair breakage, poor temperature regulation, always feeling cold, and a low libido.
I am now three months into my giving it my ‘all’. Although quality research is limited on this topic, small case studies shows that with a reduction in exercise, cutting out high intensity workouts, eating more to support a positive energy balance, weight gain, and achieving a BMI of 22-23 is when recovery is very likely. This BMI is shown to also be the most fertile weight even if fertility medication is required. Patience is also essential. For me this is a BMI of 61.4 – 64.1kg.
I have openly and honestly shared my journey on my Instagram for four reasons:
1. Keep me accountable
2. Raise awareness that ‘no period is not okay’
3. To help people in a similar situation find inspiration and support; and
4. To be truthful and be a REAL health professional
I am up around 61-62kg, I have cut out all high intensity training and cardio (to reduce cortisol and preserve energy), and I am doing 2-3 strength sessions with 1-2 yoga classes per week along with walking my dog most days. I have challenged all ‘food rules’ and had weeks of no exercise as an ‘exercise detox’. These challenges resulted in immense mental health improvement and freedom.
I may have completely changed my ‘identity’, daily routines, gained weight, had to update my wardrobe, and recognise there is no 100 per cent guarantee that my cycle and fertility will resume for finally being able to let go, but I do know that this journey will still be worth it.
When I look at photos and memories of myself before recovery versus now, I am so much happier, energetic, confident (yep, even with more cellulite and no longer a size 6 or 0!), social, I’ve found so many other activities that I enjoy, I am better able to manage stress, I laugh more and feel so much more ‘free’. Even if I don’t get my period and I do have to resort to IVF or ovulation induction, I know I am at peace with myself, I’m happy and confident, and I will be a great mum one day.
What is Hypothalamic Amenorrhea (HA) and how can we work through it?
HA is the absence of a menstrual cycle for greater than three months due to the body’s perception of stress, and is a condition that is more common in women than you think.
Some of these symptoms include, infertility, lack of libido/sex drive, poor temperature regulation, disturbed sleep, preoccupation with, and the need to control food, exercise and weight, anxiety, social isolation, decreased bone mineral density, and greater risk of bone fracture.
HA is often a result of ignoring your bodies signs and symptoms, and you lose connection with your instinct and instead rely on external ‘diet rules’ and societies pressures to look or behave a certain way.
Your hypothalamus, the control centre of the brain, perceives a threat both in energy availability and ability to reproduce. The result is energy conservation, by switching off non-essential bodily processes (menstruation) to prevent an unhealthy pregnancy due to insufficient energy and/or body fat.
Regular exercise, eating ‘clean’, and maintaining a lean physique is often associated with being ‘healthy’ and societies ideal of what healthy looks like. In fact, these are the three factors that cause HA, when pushed too far, or done too well.
If you or anyone you know need help or support for an eating disorder or concerns about body image, please call Butterfly Foundation National Helpline on 1800 334 673 (ED HOPE).
Amy Giannotti is a qualified Dietitian and Sports Dietitian, Personal Trainer, Strength and Conditioning Coach, Running Coach, Yoga Teacher and Founder of Eating Fit – an online platform offering personalised nutrition and training programs. For more information on Amy, visit her site here, or follow her on Instagram @amyleegiannotti.
For more like this, this is how Jess got her period back after three years, and this is how Instagram sensation Caroline groth got her period back.
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