What happens if you don’t recover your period

Aug 14, 2023 | Blog


Join me for a deep dive into what body systems suffer the most when you aren’t getting your period. We’ll discuss the short-term and long-term health consequences of remaining in a low estrogen state as well as the psychological impact amenorrhea can have on your body. If you’re struggling with finding motivation with choosing recovery from HA, this episode will help outline why recovery is worth it for your body, your mind, your relationships, and your future.

In this Episode:

  • The impact of low estrogen on your bones
  • Irregular cycles and risk for heart disease
  • Emotional and financial cost of fertility treatment
  • Why HA and depression and anxiety go hand in hand
  • Amenorrhea and cognitive decline
  • Where to start when recovery feels overwhelming

Podcast Transcript

We are going to do something a little different on today’s podcast.

Something that being in the fertility space, I focus a lot on the ramifications of not having a period on your fertility. But I kind of want to expand on that today and talk about all the other body systems that are impacted and kind of really just talking through like, what happens if you don’t recover your period. And I want to start by like acknowledging that period recovery- while it is a choice- there are always very real and more complex barriers to recovery than just jumping in and doing the thing, right, because if it were that easy, like we would all be doing it. And we wouldn’t need support. And it would just be this quick fix. But we all know that that’s not true. A lot of us are entering into recovery with maybe some very real unrelated stressors, maybe we’ve been through job loss, relationship issues, divorce, trauma, eating disorders. And so I want to, you know, start this podcast episode by saying that, like, I hear you, and I see you, and I’m not here to try to say, like, scare anyone into recovery or like, make someone think like, oh, I should just do the thing. And this is easy, who I’m really talking to here is those of you who are on the fence, and I’ve been this person.

So thinking about you are in this place of recovery, where you are sitting on the fence, and you’re kind of like peeking over into the backyard of recovery, you’re kind of peeking into what this recovered life can look like. But you’ve positioned yourself in such a way that if you were to jump right now, and you would land right back on the side, Where you’ve been Where you’ve been thinking about recovery, but you’re too scared to give up exercise, or you’re wanting to you know, improve your relationship with food, but you’re also scared of how your body’s going to change. Right. So you’ve positioned yourself where when push comes to shove, you’re gonna land back on the other side of the fence. Well, my hope is that with some of the information that I’m going to share in this podcast, that you would position yourself in a different way you would think about recovery in a different way. And that this would propel you to take the next step in your recovery journey, whatever that may be.

Let’s get into it. What happens if you don’t get your period back, one of the most well researched things that is coming up when we talk about period loss not having a period. And how that impacts our body is how it impacts bone metabolism. Research has shown that bone mass starts to decline in as little as six months still six months of not having a period. In fact, it’s been estimated that the average bone mineral density of a woman who has had amenorrhea for six months is equivalent to that of a 51 year old woman (1). So that’s something I want to kind of pause and just like think about with you guys, because I think so often when we think about osteopenia, osteoporosis, these like thin brittle bones, but think about a really old lady kind of hunched over. And you know if you’re in your 20s or 30s, or like, like I hear you but like that’s down the line, y’all I have had more and more people come into my group coaching program in their mid 30s with some pretty severe osteopenia to the point of having back pain to the point of having stress fractures. And so it might feel like it’s like this future thing, but I’m here to tell you that like I see it sooner than later. And it’s one of those silent things that we’re not aware of because most people in their 20s and 30s aren’t having DEXA scans done but those that do this is coming up with regard to how severe bone loss might be for you. It’s important to know that The timing and the duration of period loss is an important factor with respect to the amount of damage that can be done to your bones.

So the more severe cases of osteopenia are going to be seen in women with this long history of hypothalamic amenorrhea, people who are going, you know, 5,10, 15 years without a period, that being said, you know, the biggest impact on bone decline, right. So like the duration of not having a period, like the worse and worse it can get, but like, the biggest chunk that we’re seeing does occur in those first six months. So if you are missing your period, and it hasn’t been years and years and years, and you’re thinking, Oh, it’ll come back, it’ll come back, it’ll come back, you know, this is really important to know that just six months of not having a period can have some really detrimental effects. And so just encouraging you guys to really think about recovery sooner than later. And also to know that like it is reversible, right. So if you’re 25, and you have osteopenia, you’ve got a whole decade where you could regain that bone mass. But there’s a window, right. And so some of the newer research is showing, you know, a little past 30, up until you know, 30 to 33, 34, we’ve still got the ability to be able to regain some of that bone mass, but there is a window that closes.

To dig a little bit deeper on like, why does this happen? You guys might be like, Okay, I don’t get a period, you know, what is kind of the mechanism behind it. And what we’ve know is that estrogen, women’s hormones, in general estrogen and progesterone, there’s more and more research coming out about how progesterone is actually important for building and maintaining bone mass as well (2). But the bulk of the research is talking more about estrogen. And so when our bodies are in a low estrogen state, meaning that we are below where estrogen should be to have a normal healthy cycle osteo class, which are our bones that enhance bone breakdown, they are increased and there’s more and more bone reabsorption or loss. Also, our osteoblasts are cells that helped to build a bone, that activity is inhibited related to estrogen. And it’s kind of this complex thing. But kind of the common factor here, the common thread is the fact that our bodies don’t have enough estrogen. And so when you have no period, your estrogen levels are low. Also to you know, maybe you have your period, but your cycles might be irregular, what we know with irregular cycles, especially if there is a history of a day or a amenorrhea is that estrogen levels are not optimal.

We have research that shows that in athletes with irregular periods, the bone density, bone structure, and bone strength are all altered due to kind of this combination of low estrogen and low energy availability (3). So when it comes to regaining bone mass, I always talk about Yes, the importance of hormones, like that’s key. But the other thing too, when we think about what nutrients make up our bones, so vitamin K, vos, phosphorus, vitamin D, all of the nutrients that make up bone, like they have to come from the diet too. And so nourishing your body and getting your period back was truly the best thing that you can do for your bones, hopefully replacing any bone loss that’s has happened, and being able to go on to have healthy bones.

So we’ll move into another body system that is impacted by low estrogen and not having a period. And that is the heart. So recent data has shown that the death rate from cardiovascular disease seems to be increasing in pre menopausal women. And Dr. Chrisandra Shufelt, who I should probably have on the podcast at some point, has done a ton of research in this area. And there’s more and more of this that we’re kind of digging into a lot of this data has come from the Nurses Health Study. And if you’re unfamiliar, the Nurses Health Study is one of the largest studies to date that’s been done on women’s health. And it includes data from over 82,000 women. And with this, there’s been some self reported data on menstrual cycle history and the kind of impact that it’s had on women’s health. And what we’ve seen is that in women with irregular menstrual cycles, there’s a 50% increased risk of developing cardiovascular disease (4). So it’s really interesting and at this point in time, we don’t necessarily have a causative relationship behind like, is it the low estrogen? Is it the under fueling? Is it the too much exercise and Dr. Shufelt is doing a lot of work and you know, furthering this and figuring out why but there’s there’s something here and one of the hypothesis has to do with the effect that estrogen has on the ability of our blood vessels to dilate instead of constricting. So one of the substances in the body that helps the blood vessels to dilate appropriately is nitric oxide. And in women, estrogen plays a key role in maintaining the integrity of healthy blood vessels through the production of nitric oxide. So there’s some connections due to estrogen, low estrogen, and those blood vessels becoming more restricted instead of dilating. And that can having a trickle down effect on our blood pressure, and just our overall heart health. And this is something that we are also kind of noticing in women who are postmenopausal. So when you go through menopause, your body is not producing estrogen. And those hormones as we are kind of heading into a stage of life where reproduction is not something that our bodies are willing to do anymore. And so we can also kind of see in women, you know, in their mid to late 50s and 60s. And beyond, we can see these heart issues. And we know that the risk for cardiovascular disease goes up with age and women. And we know that that’s due to low estrogen. But y’all Imagine if the state of your body with estrogen is mimicking that of a 60 year old women, and you’re 25. Imagine the damage that could potentially go on if 25, 35 45, you have more years where there could be potentially more damage to the heart done, than if this were occurring as part of the natural aging body processes. So again, we don’t have like full linkage there. But I think it’s really something to think about. And I think there will be more to come here.

All right, we can’t not talk about fertility, and I talked about it a lot. I want to get into a little bit of fertility consequences, right with not having a period. So for those who don’t know, you know, when you don’t have your period, you aren’t ovulating. And when you aren’t ovulating, you can’t get pregnant, you know, and this is due to, again, the low energy availability, and going back to the idea of estrogen levels being low. So if estrogen is low, the ovary cannot stimulate follicles to grow, mature and release an egg for ovulation. Low estrogen is all it’s also responsible for or estrogen levels, rather, are responsible for building up and maintaining the integrity of that uterine lining. So when estrogen levels are chronically low, you’re really not building up a lining. And this can become a huge problem. When we start thinking about fertility treatment, right, you can give somebody all the drugs in the world, but if they’re unable to grow and maintain a uterine lining that is going to be favorable for that egg and embryo to implant and and pregnancy is going to be really difficult. This is one of the reasons why low levels of fertility treatment intervention often don’t work. And it’s a little bit more complicated than just the lining, right? Because the communication pathway between the brain and the ovaries has been shut down.

It’s not as simple as oh, let’s just get this. You know, let’s just get a follicle growing. And let’s just you know, make sure that that’s happening. And there’s so much more going on. That needs to be fixed first. And so a lot of like REIs and Obs won’t treat HA patients with ovulation induction meds like Clomid and Femara, a lot of them will recommend going straight to IVF. And we all think that’s annoying, right? Like why can’t I just try and maybe you can and I’m not here to say that like people with ha can’t ever respond. I’ve actually seen really good results in my program with clients who choose to use fertility treatment in conjunction with a proper period recovery plan, they are able to respond to normal doses of letrozole and Clomid and go on to get pregnant and have healthy pregnancies. But if somebody is very active in their HA, they’re still over exercising, still under fueling. We haven’t seen the best outcomes. And so our guys aren’t, you know, in the wrong for pointing their patients to IVF because there are better outcomes. But let’s also remember that like you, when you start an IVF cycle, and you are still not feeling your body properly and you are in your body is still stressed. It’s hard to force a pregnancy in a body that is undernourished and overstressed. And so I’ve seen people go through failed rounds of IVF. I’ve seen people go through IVF and only get one embryo. And you know, I talk more with one of my clients, Whitney in this in $15,000 to $30,000. And this is in the US, but it’s going to depend upon you know, the center, the doctor your work came with and then the patient’s individual medical needs. One thing that we he shares in our episode on Episode A team from IVF, to national pregnancy is that because her hormone levels were so low, and this is very common with AJ, that she needed the highest doses of medications to respond. And so when we think about this range of kind of like, low end, high end, I went and did the math on some of the medications. And I think that for someone in the depth of HA, you’re gonna have a really hard time working with a reputable IVF clinic, doing the genetic testing, which you are going to want to do to make sure that your cycle is successful, you’re gonna have a hard time getting out of an IVF cycle for under about $25,000. And so you know, some people can get it covered by insurance, and some people have that money. And that’s fantastic. And this is not to shame anyone who chooses to use IVF to get the family of their dreams, I don’t think there’s anything wrong with that. But I do want people to be educated and to recognize that you don’t just do IVF like it is a big thing. You know, you’re injecting high doses of hormones into your body.

If you talk to anyone who’s been through an IVF cycle, they’ll tell you about these gigantic progesterone oil needles, the best way to it to give the body the progesterone it needs in an IVF cycle to support pregnancy is intramuscularly with a very large needle of progesterone, all that to just say that IVF is not the easiest thing in the world. And a lot of times we think that this can be the easy way out. And you also gotta consider you know, the the flip side, right of like, what if IVF doesn’t work, and that money could have been used for college or a vacation for a down payment on a house, you know, like thinking about what else you could do with that money if IVF wasn’t something that we needed to get pregnant.

Alright, I want to move a little bit more away from some of the impact that period loss can have on our physical body systems and talk a little bit more about how it impacts like our emotional health. So women with HA, we’ve had research studies that show that they have significantly higher depression scores, greater anxiety, and increased risk of being able to cope in healthy ways with daily stress (5). This is kind of like a complicated beast. But we do know that hormones play a role. And we also know that fueling plays a role. So when somebody is constantly under eating, they are not providing their body with adequate amounts of glucose, which is carbohydrates broken down to maintain healthy blood sugar levels, low blood sugar, compounds anxiety. So if we have just generalized anxiety, like a lot of people with aging do, we are not doing ourselves any favors when we are going seven hours without eating when we are limiting carbohydrates. And so that anxiety can really just be this really vicious cycle with I’m under fueling. And I already have anxiety and then on my blood sugar’s low, now my blood sugar is high, and we’ve got these swings. And that can really impact our mood to research has also shown that women with HA have kind of greater feelings of insecurity. I think a lot of people can relate back to this, I can relate to this. And I can relate to this. Thinking back to you know, my past struggle is just this feeling of inadequacy and lack of control, which kind of makes sense why so many people start to turn to disordered eating and counting their macros or eating super clean, or, you know, paying attention to the amount of calories they’re burning. We’re all looking for this control as a coping mechanism.

Unfortunately, this keeps us in a loop, I feel out of control, I’m going to gain control, I also think is a little bit ironic that we are seeking control over food over our bodies. And as we get further and further into disordered eating food actually ends up controlling us. And it’s a hard loop to get out of. And it’s hard because in some ways we feel like controlling food and exercise is a way that we’re coping and it’s helping us to manage our anxiety. But the combination of that as an unhealthy coping mechanism, plus the low hormones really just make this really unfortunate low mood state. And sometimes people don’t even recognize how this feels, and the idea that it can be better until they’re on the other side of it. I hear that so many times for my clients that I just thought I was a really anxious person, you know, but recognizing the difference of anxiety being wrapped up in disordered eating and not having adequate hormone levels to boost our mood and what that can feel like on the other side. I think that that also goes hand in hand with how our relationships are. You know, just thinking back to when my ha We’re in my always kind of most disordered in my relationship with food. I think back to like, in my 20s, I had such a hard time, like going out meeting people and dating. And the truth of the matter was, was that my routine with exercise my routine with food was really ruling my life. And it really held me back from being present in relationships, being open to being in relationships, and being like a good partner, being a good friend. And, you know, that’s not everybody’s experience, because I also work with a lot of people who are married, but they talk about how the low libido, the lack of lubrication, just feeling very dry really impacts their, their intimacy with their partners. And then we think about back to just that idea of like, your routines with food and exercise, ruling, your life just has a really negative impact on our relationship, it can impact your marriage, you know, both from like a physical standpoint and an emotional standpoint, let’s think about the fact that if there isn’t a lot of energy available in the body, you only have so much energy, mentally, to commit to work to commit to being there emotionally for your partner to commit to time with your kids. And so, when we talk about what happens when we don’t get our period back, I think that one of the things that we don’t always recognize, but is a real thing is that we live kind of these low functioning lives, where we can do all the things, but in we’re functioning, but we’re not functioning optimally, we’re missing out on some of that fullness. And so if you’re at this place in your recovery, where you’re like, Well, my family’s complete, and my life’s pretty good. Like, it’s okay, you know, so great. It’s good. I, you know, I would just encourage you to ask yourself some questions like, how is your marriage? Like, could that be better? How’s your anxiety, right? Like, on a scale from one to 10? Are you 9.5? Is that where you operate? And what if you could operate at like a five or six and thinking about, you know, what could be better another one that we’ll go into, because this is such an important part of my story.

I know, it’s such an important part of a lot of the clients that I work with, and their story and why they choose recovery, is thinking about your relationship with food, how you feel about food, and the messages that you are sending your kids, or your future kids about your habits and beliefs around food. being somebody who has struggled with an eating disorder for over a decade, that was one of my fears in getting pregnant. And in particular, being pregnant with a daughter and raising girls now is, am I going to pass my struggle on to them, and this is a complex beast, right? I grew up in a home where food was mostly very neutral. And I think that I’ve had, for the most part, a pretty positive relationship with food modeled for me and I still developed an eating disorder. So this is not to say that you are 100% responsible for the outcome of your kids, the choices that they make, and the things that they are subjected to. That being said, your relationship with food will lay the foundation for your child’s relationship with food. And so if you’re constantly worried about calories, ingredients, with good and bad foods, even if you think you are going to model that differently for your kids, there are going to be subliminal subliminal messages that are going to show through in the way that you approach food, talk about food, talk about your body. And so that’s something to really think about, right? If you are thinking, hey, I’m good, I’m in a good place. Maybe it’s not about you, right? Maybe it’s about your relationship with your partner, maybe it’s about the life that you want for your children. And thinking about it from that perspective, I think can be really helpful when you’re making this decision about next steps and is recovery right for me.

The last I’ll touch upon is just the way that under fueling low estrogen, lack of regular healthy hormones can have on our brain function. So we have research that shows that declining estrogen levels before during and after menopause can impact our memory and our risk for Alzheimer’s disease (6). Some studies have shown that having low estrogen can have a 1.5 to two fold increase on the risk of dementia in women that have chronically low estrogen levels. And again, some of this research is extrapolated from people who have kind of self induced menopause whenever we have like a hysterectomy. But there’s something here and the reason why I’m reaching to some of these studies y’all is because we don’t know like the actual term Hypothalamic Amenorrhea is a relatively new term. As I mentioned, Dr. ShufeltI think is doing some really fabulous work in this area, especially when it comes to hypothalamic amenorrhea and implications for heart health. But there’s still a lot to come and we’re kind of learning here we know that estrogen and has a protective effect on the neural synapses (8). And so, you know, we see that cognitive decline to go back to this 65, seven year old woman. Yeah, like that makes sense. Because she’s, you know, 1520 years removed from menopause. And there are a lot of things that can happen to the body as we’re aging. But we do know that we have that D, kind of estrogen. And so again, you think about, all right, somebody goes through menopause, 55, they live to be 75. They’ve got X number of years, where the brain has that cognitive decline, we don’t have all the optimal amounts of hormones to protect that. Well, what if that’s been going on in somebody since they were 20? And like, what could their brain function look like as a 45 year old, you know, just thinking about it that way. I also think it’s interesting, I’ll kind of bring in the idea of like pregnancy, brain and Mom Brain, especially like in the postpartum period, I think a lot of people will recognize that, like, Hey, I’m not my sharpest. And to be fair, a lot of people aren’t sleeping. So you know that that makes sense. But also to when you’re breastfeeding, you don’t have a cycle, estrogen levels are low. And so I think that there’s a lot of linkage here that maybe people can relate to and understand, I’ll also bring back in the idea of, you know, brain fog, right. And I think this is like such a fun bus, bird and wellness culture that everyone’s talking about, you know, I just don’t feel sharp, I feel like I can’t concentrate. You know, it’s hard to concentrate. Again, when your body is almost kind of in robot mode, and only focusing on, you know, one or two tasks that you can do well, and you’re just spread so thin and your body doesn’t have the energy that it needs to be sharp, and be equipped to do things really well juggle multiple things.

And that’s something that I hear a lot from people and choosing recoveries, that they’re able to find other parts of their life, there might be these new hobbies that they’re able to engage in, because they now have time and they’re not exercising 15 hours a week, they have more time for relationships, they’re happier, they laugh more, they smile more. And so I think that there are a lot of things in recovery that aren’t totally apparent when you’re stuck in Ha but there are a lot of things that start to come up as you are getting further into recovery. So let’s talk about some next steps. I know that this can feel really overwhelming. And as I said from the beginning, my intention with this episode is not to scare you or to shame you if you’re at a place where you’re not yet ready to really dive in and commit to the process of getting your period back. However, if this does scare, you know that there is a very real solution. And a lot of these things that we talked about with heart health, bone health, cognitive decline, fertility, like a lot of these things can either be prevented if you’re not there yet, or reversed if you are there.

So let’s talk about some practical steps you can take today, right now in this moment as you’re listening to this episode and thinking about what you’re going to do afterwards. So if you’re not ready to jump into recovery, right now, my encouragement to you would be to come up with a timeline for when you will, maybe that’s three months in the future, six months in the future, nine months in the future, you know, think about that time and set an actual date, when you will get serious about it spoiler alert, there probably isn’t a perfect time, there is no perfect time to seek recovery. And so if it’s not today, I want you to think about when that date will be and if you’re recognizing that that this there is no perfect time and it just need to get started. Like maybe this is your sign but to the user day you’re gonna commit my second tip would be to set a small goal this week to dial back on your movement and or nourish better what does that mean? What could that look like maybe you commit to eating breakfast like a real breakfast not like a protein in your coffee college and in your coffee like a real like sit down meal breakfast maybe that is your small step and you commit to doing that and you do that you do that you do that you think wow, I did this I feel great. I think there can be a very real snowball effect of recovery in a very good way with our habits when we really commit to doing one thing so that’s a place to start you know find recipes, find new recipes that you and someone else can make together that include a carbohydrate and dinner I think that’s like such a common place where we tend to skimp and think we don’t need them. But make it fun like find pasta recipe make homemade pasta, do you have the time or just think about you know, if you’re in a family setting and everyone has a carb and you skip it like start including that in your dinner. On the exercise side, like maybe thinking about how can you trade out one of your high intensity workouts for a yoga class? Or better yet, you know, thinking about taking taking some a break setting some boundaries? No a fun way to go about it. I’m all about how do we make recovery fun Take a vacation where there is no gym, there’s no gym access, right? So you’re kind of like forcing yourself out of your comfort zone. And while that can feel really scary, and some people listening might be like, Oh my God, I could never do that. One of the best ways to improve your relationship with exercise is to set those boundaries and to do it. And that can be easier said than done. But if you just commit and you do it, a lot of times, what I see with my clients is that when you allow your body to rest, you realize it’s not so bad, the world didn’t stop turning, and you can move on with your life. And that again, can build some confidence in your ability to set boundaries and take a step back. So there’s just some small places to start. And I hope that that’s helpful for you guys. You know, be sure to save this episode, share this episode, if you’re wanting other people in your life to understand why are choosing recovery, because I know sometimes that can be met with some pushback. But ultimately, I hope that this served as some information and maybe helping propel you into the next steps in your recovery journey.

Answering Your Questions

Let’s answer some questions. So I am taking these questions from people that submitted through a Google Form who are on my email list. And so every other week, I send out emails to my list to share tips and tricks about recovery. Sometimes I share a recap of what we’re talking about here on the podcast to make sure everyone stays up to date. But I also give you the opportunity to submit your questions for me to answer it live on the podcast. So if you are wanting to be able to do that, make sure you are on my email list, you can go to my website get my free period recovery meal plan. And that will get you on the list to be able to ask these questions. So with that, let’s jump in and answer a few. So the first question I have is from Michelle, Michelle says, I heard that you are not supposed to get a withdrawal bleed on the progesterone test. If you have FHA. I did get one What does that mean? Am I borderline things? So Michelle, this is such a good question. And let me start by kind of explaining what what we’re kind of talking about here with giving synthetic progesterone, a lot of times it’s called the Provera challenge. And your OB might prescribe this as a form of testing your hormones or seeing whether or not you are building up a lining, if your hormone levels are in kind of that low to normal range. Now Provera has medical necessity. In some cases, in individuals without ha we do want to make sure that we are shedding that uterine lining, even if we aren’t having regular cycles to protect against endometrial cancer. So your OB might be prescribing this for a couple of reasons. That could be one. The other thing that they could be using it for is more of the screening tool, as I already admit, already mentioned, some OBS will say, Hey, if you don’t respond to Provera, you have Ha, some will say, if you do you don’t have ha It’s PCOS, or it’s some other cause of irregular cycles. I do not agree with that. Because having had H A for 13 years, there are times when I was given the Provera challenge. And I did respond and got a withdrawal bleed. And there were times when I did not. I have also worked with a ton of clients that do respond to Provera, but still very much have ha and so oftentimes what happens with Provera, if you get a bleed is nothing. Nothing after and nothing about this synthetic form of progesterone is going to jumpstart your cycle like you might be told. Now there are rare instances, typically with people who don’t have a day where Provera has done this. There are also instances where it might feel like Provera jumpstart your cycle if you’re putting in the work with recovery, right. So if you are working really hard on getting your period back, you are eating more exercising less putting on some necessary body fat and your hormone levels go from a very low range to a range high enough to start building up a lining and then you are given Provera and you get a withdrawal bleed and you continue your recovery journey, it is possible that you would go on to ovulate and have cycles but that is not due to the synthetic form of progesterone, the Provera medication that would be due to you your body and you doing the work. So to circle back to the original question, you can still very much have H A and get a withdrawal bleed from Provera why If that means is that your hormone levels are normal, you are able to build up some sort of a lining, but you’re still not able to cycle on your own. And that still can very much be due to over exercise under fueling, not giving your body what it needs to do those things. And I see that all the time in my practice.

Alright, let’s switch gears and answer a question from summer. So Summer shares that she is 32 weeks pregnant, and she says My stomach is getting majorly squished by my uterus, which is so common during pregnancy as you’re entering into that third trimester, she asked any tips on getting those calories in with reduced stomach capacity? I love this question. Because I think that a lot of people who enter into pregnancy after a day recovery, might be still battling some fears around gaining weight and body changing, and they might feel more comfortable restricting calories. And so I love this question, because it’s basically asking how do I get those calories and because I want to gain enough weight during pregnancy, I want to nourish my body and I want to be able to help this baby grow and be healthy. And so here are my tips, I would recommend making sure that you are being smart with the things that you’re eating. If you are a volume eater and you eat a lot of vegetables, or maybe you eat things that are very high in fiber, I’m not saying don’t do those things. But it’s going to make more sense when we have reduced stomach capacity to focus on things like nuts, like seeds, like not butters, oils, butter, avocado, if we can really think about how to pack in enough energy and calories in foods that don’t take up a lot of stomach volume. That is what’s going to be able to give your body the calories and the nutrients that it needs to support continued growth of baby and continued weight gain of mama. So focusing on fats. Another strategy I really like is using liquid calories. A lot of times when we’re feeling full, or feeling like we don’t have a lot of room, liquid calories can be really helpful because sometimes it’s easier to drink down calories than to eat them. So doing like a smoothie with full fat milk and adding in some seeds and nut butters. Fruit, honey, you know, we really are struggling with putting on adequate amounts of weight during pregnancy. And this can actually go for recovery too. But thinking about really dense sources of fat so like heavy cream, ice cream, you know, really thinking about how can I pack calories in without making my stomach feel like there is so much food in there. So liquid calories and fats also too, I would recommend kind of small frequent meals again, this one could go for recovery as well. Sometimes it’s going to be easier to get everything that your body needs in if you are eating every let’s say two to three hours versus trying to eat a large meal not being able to finish it feeling uncomfortably full, and then waiting another five or six to eat it. So little bits of things like granola, nuts, dried fruit, you know, one of the things that I recommend to a lot of my clients is like going to the bulk bins at the grocery store and making kind of your own tracks and that can be kind of fun in some good variety. So frequent eating liquid calories and focusing on healthy fats would be the best way that I would go about making sure that you are getting the nutrition that you need at this point in your pregnancy when your stomach is just feeling squished so we don’t have a lot of room.

Okay, and let’s do one more before we wrap for this week’s solo episode and answering your questions on the podcast. So this question is from Laura. And Laura shares that she just got off estrogen patches, she has gained weight and she says I got the okay from my gyno to come off the patches last week, Laura asked, I want to know if I’m going in the right direction. I’ve been putting in a lot of effort and I’m nervous to see what my body is capable of now doing. I don’t have any cervical mucus and I was on the patches since January. Thank you. All right. Well, Laura, this is great. I mean, it sounds like in addition to going on hormone replacement therapy, which can be a fantastic bridge, if we are really concerned for bone loss or if somebody has been missing their period for a significant amount of time, perhaps in relation to an eating disorder. That hormone replacement therapy can be a really good bridge to support making sure that we’re not losing more and more and more bone mass. We already talked a little bit more about this in this episode, but the gold standard for recovering bone mass that might have been lost is getting your period back. But again, sometimes it can take people a long time. And hormone replacement therapy is a good bridge. I’ve seen clients use this in my program, and I do think that you have a really good chance terms of being able to cycle on your own. Now that you are off it, you’re putting an effort, it sounds like and you’ve gained weight, those are two really good important steps in the right direction, I will say that it might take some time, you know, kind of like we were talking about Provera a second ago, the hormone replacement therapy is probably not going to jumpstart your cycle. So what typically happens is you’re on these estrogen patches, you’re getting some you’re getting extra, you know, hormones kind of coming in and your body might respond to, you might start to see cervical mucus, because of the supplemental hormones that you’re taking, when you come off of them. They are eventually working their way out of your system, and then what you see the symptoms that you have, that’s going to be your body. So you know, next steps would be to make sure that you really are well supported, you are nourishing your body enough to support growing a follicle allowing your body to ovulate and eventually get that period and cycle month after month. And so if you haven’t been, you know, guided by a registered dietician, particularly someone who knows what ATA is, and has knows how to properly guide people on that, that could be a really good next step. You know, in a perfect world, when we cycle off something like the estrogen patches, we would like to think that the body has gotten to a place where it would be ready to do it. I’ve even seen people go on estrogen and progesterone and be able to have kind of an induced period, and then cycle off of that and then be able to actually have their period. But again, you do have to be putting in the work, which it sounds like you have, I think that you know, you give yourself kind of a timeframe, right. So maybe that’s six weeks, maybe that’s three months.

But I would say that, you know, give yourself a timeframe. And if you aren’t actually cycling on your own within whatever timeframe feels good for you, that would be a really appropriate time to reach out for more help or think about if there’s some other things that you should be doing to support your recovery. So, y’all thanks for those questions. We’re getting more and more and I’m super excited about that. I’d love to answer more of these on a future episode, so be sure that you are again on my email list so I can be able to select and answer your question and thanks so much for listening. Thank you so much for tuning in and listening if you found this episode to be inspiring or helpful, please share on social media and tag me at Food dot freedom dot fertility. Also don’t forget to leave a rating and a review!


  1. Shufelt CL, Torbati T, Dutra E. Hypothalamic Amenorrhea and the Long-Term Health Consequences. Semin Reprod Med. 2017 May;35(3):256-262. doi: 10.1055/s-0037-1603581. Epub 2017 Jun 28. PMID: 28658709; PMCID: PMC6374026.
  2. Prior JC. Progesterone for the prevention and treatment of osteoporosis in women. Climacteric. 2018 Aug;21(4):366-374. doi: 10.1080/13697137.2018.1467400. Epub 2018 Jul 2. PMID: 29962257.
  3. Behary P, Comninos AN. Bone Perspectives in Functional Hypothalamic Amenorrhoea: An Update and Future Avenues. Front Endocrinol (Lausanne). 2022 Jun 20;13:923791. doi: 10.3389/fendo.2022.923791. PMID: 35795153; PMCID: PMC9251506.
  4. Solomon CG, Hu FB, Dunaif A, Rich-Edwards JE, Stampfer MJ, Willett WC, Speizer FE, Manson JE. Menstrual cycle irregularity and risk for future cardiovascular disease. J Clin Endocrinol Metab. 2002 May;87(5):2013-7. doi: 10.1210/jcem.87.5.8471. PMID: 11994334.
  5. Marcus MD, Loucks TL and Berga SL. Psychological correlates of functional hypothalamic amenorrhea. Fertility and sterility. 2001;76:310–316. [PubMed: 11476778]
  6. Giles DE, Berga SL. Cognitive and psychiatric correlates of functional hypothalamic amenorrhea: a controlled comparison. Fertil Steril. 1993 Sep;60(3):486-92. PMID: 8375531.


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I’m a fertility nutritionist and registered dietitian who specializes in hypothalamic amenorrhea. My passion is helping women trying to conceive find freedom with food and exercise, so they can recover their period, and get pregnant naturally.

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Jan 19, 2022

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