When, where and how should we start screening for HA?

Jun 23, 2024 | Let's Hear From The Experts

Episode 61: When, where and how should we start screening for HA?

When, where and how should we start screening for HA?

Emily Everton, PT, DPT is a holistic Women’s Health Doctor of Physical Therapy and the founder of Embody Physical Therapy & Wellness, LLC in Hopkinton, MA. She specializes in Orthopedic and Pelvic Floor Physical Therapy, and is especially passionate about all things menstrual health, fertility, and perinatal care. 

Emily also supports women with Hypothalamic Amenorrhea and irregular menstrual cycles in her role as a Women’s Health coach, where she helps women restore ovulation, get their period back, regulate their menstrual cycles, and if hoping to get pregnant, do so naturally. Both during and outside of her clinical work, Emily loves to talk about taboo topics and challenge unsustainable societal standards to help girls/women find peace with their bodies and live their fullest, symptom-free life. 

Though Emily’s work was initially inspired by her own lived experience with disordered eating, orthorexia, RED-S, Hypothalamic Amenorrhea, infertility, and a poor relationship with her body…she is consistently inspired by the wonderful girls and women she is so fortunate to support on a daily basis.

In this episode:

  • Why athletes are at a higher risk for amenorrhea 
  • Defining RED-S and understanding the signs and symptoms
  • How body comments can trigger disordered eating
  • How to improve body image during period recovery 
  • Working through recovery before you’re ready to get pregnant 
  • Using HA recovery as a “permission slip” to rest and nourish

Connect with Emily Everton: 

Instagram: @emilyeverton.dpt
Website: https://www.embodyptwell.com/


Emily Everton  00:00

We don’t need to be commenting on women’s bodies. Especially at that young age, when you’re really impressionable. That kind of seeps into, like you said, your identity and that external validation. And when that starts to naturally change as you go through puberty and your body just changes as you get older, it can really lead to things like eating disorders or just a really poor relationship with your body.

Lindsey Lusson  00:18

People really don’t understand the damage that can happen even when it’s a potentially well meaning comment or a funny comment. It’s just like no, we have to stop this we have to turn this around. Eating disorder rates have doubled over the past decade. There’s not enough care. There is  more and more misinformation about food. There’s more and more fear going out about food through social media. We have to make changes about how we’re approaching this or we’re never going to make a dent in reversing what is inevitable.

Emily Everton  00:43

Exactly. It starts with us and it starts with those changes now.

Lindsey Lusson  00:47

Welcome to the Period Recovery and Fertility Podcast. Here we discuss the challenging, rewarding and life changing process of recovering your period. And finding freedom with food and exercise. Whether you’re hoping to regain your cycle to get your health back on track or you’re ready to become a mama, this podcast is for you. While the recovery process isn’t always rainbows and butterflies, it’s my hope to bring you both information and inspiration during your own recovery journey. I’m your host, registered dietitian and fellow HA woman, Lindsey Lusson. 

Lindsey Lusson  01:18

Emily Everton is a holistic women’s health doctor of physical therapy and the founder of embodied physical therapy and wellness in Hopkinton, Massachusetts. She specializes in orthopedic and pelvic floor physical therapy and is especially passionate about all things menstrual health, fertility and perinatal care. Emily also supports women with hypothalamic amenorrhea and irregular menstrual cycles in her role as a women’s health coach where she helps women restore ovulation, get their period back regulate their menstrual cycles. And if they’re hoping to get pregnant do so naturally. Both during and outside of her clinical work, Emily loves to talk about taboo topics and challenge unsustainable societal standards to help girls and women find peace with their bodies and live their fullest symptom free life. 

Lindsey Lusson  02:02

All right, and welcome to the podcast Emily!

Emily Everton  02:05

Hey Lindsey! Thanks for having me. I’m so excited to be here.

Lindsey Lusson  02:08

Well, we’re so happy to have you. I feel like we’ve been wanting to do this for a little bit now. But we wanted to make sure that you being recently pregnant are at a place where you’re able to talk and not feeling super sick. So thanks for being patient and sticking it out and getting this booked with us.

Emily Everton  02:23

Yeah, thank you for being so patient. I was like, “I could record this but I might have to take a couple hiatuses from recording just because I was feeling pretty not so great in that first trimester”. So I’m really excited. We can make this happen. And I’m definitely feeling much better at this point.

Lindsey Lusson  02:39

Yeah, well, having been through three pregnancies, and three first trimesters, I know that it is no joke. And so I wanted you to feel ready to do this. So let’s talk a little bit more about you. So I just read your bio. But tell us a little bit more about what got you into physical therapy and in particular, kind of more of like a women’s health physical therapist and focusing on pelvic floor physical therapy. How did we get here?

Emily Everton  03:05

Yeah, so I got into physical therapy. I started off grad school with bio major. Wasn’t exactly sure I wanted to do physical therapy.  I just knew I wanted to be in the sciences. We’ll wrap around this but at the time, I was really into exercising and fitness and maintaining a healthy lifestyle and someone was like, Emily, you should look into kinesiology, physical therapy. So that’s what kind of changed. I changed my major into kinesiology, the study of human movement, and absolutely loved it. And that kind of led me down the path to physical therapy. 

Emily Everton  03:34

So I originally started my career in the sports medicine realm. So working more with orthopedics. I thought that was going to be my trajectory, just staying sports medicine. Pretty quickly into my career at an outpatient private practice, I started working more in dance medicine. So working with dancers and gymnasts and female athletes in general. And this was kind of the catalyst that really got me more interested into women’s health. I was kind of going through my own challenges at this time of working through hypothalamic amenorrhea myself. And then as I started to work with more dancers and more female athletes. 

Emily Everton  04:10

I made a really concerted effort to ask every client I was working with, do you have regular menstrual period, regular menstrual cycle, Many of the women that I was supporting had missing periods or regular periods. They were coming to me for repeated bone stress injuries, repetitive overuse injuries, not healing well from injuries. And I was just seeing this pattern over and over. Like I said, perhaps I was a little bit more like keen to it and aware of it because I was going through my own journey at the same time. 

Lindsey Lusson  04:38

Yeah. We’ve had several sports dieticians or people that grow up in sports division when athletes talk about this on the podcast before. I mean, you’re at risk. If you’re a female athlete and a high performing sport, you are at a higher risk for hypothalamic amenorrhea than somebody who’s not. So it doesn’t actually surprise me that you saw that a lot. And of course, you’re right, you are a little bit more tuned into it. 

Lindsey Lusson  05:07

Another physical therapist who didn’t have that history may not be asking the right questions, because I think that that is how this condition gets missed more often than not. People just don’t know to ask the right questions. But again, I do think that it’s under talked about. It’s interesting that they’re seeing you for overuse injuries and stress fractures, and all of the things that we know are actually signs of under fueling, yet the period stuff never really comes up. Why do you think it gets swept under the rug so often?

Emily Everton  05:38

I have to say to. I am located at the time I was working right outside of Boston. A lot of these dancers specifically, were coming to me upon referral from a wonderful provider, a sports medicine physician out of the Female Athlete Program at Boston Children’s. I’m not sure if you’re familiar with Dr. Ackerman, Dr. Quinn. They’re just so fantastic. So really, really grateful for a lot of the women I supported to have good multi disciplinary collaborative care. 

Emily Everton  06:07

So many of them had kind of been screened for RED-S. And for hypothalamic amenorrhea, there were some that would come to me, not through like a referral from a doctor and if we were kind of going through that path. I think, from a physical therapy standpoint, I went to physical therapy when I tore my ACL in college, and I was never once asked about my menstrual cycle, which we’re not taught this in physical therapy school. We’re not taught necessarily to ask women about their menstrual cycle, which I hope that’s changing now. I’m definitely trying to do my part in helping to change that. 

Emily Everton  06:41

But for myself, it could have been caught earlier on even just for my PT asking, even just for my doctor saying, “hey, Emily, you’ve lost a lot of weight since your last appointment”. Or picking up on some of these red flags that I think are just dismissed. People looked at me personally and thought I was just disciplined and healthy and motivated.  I think that’s the guy is where this goes, flies under the radar, people who are providers look at some of these behaviors as health promoting rather than digging a little bit deeper. And there’s such a stigma around body shape, weight size, that we don’t flag things that shouldn’t be get flagged. And I think that’s why it goes missed.

Lindsey Lusson  07:22

How beautiful could it be, if in every annual checkup for a woman; if there were multiple points of contact in the healthcare system, where we’re asking, “When was your last menstrual period? How long have you gone without a period, How often does your period come?” If we were asking a simple set of three to five screening questions and depending on the answers, if that can trigger a referral to a psychologist, to a dietitian, to somebody who can help them. Right?

Lindsey Lusson  07:50

Because I think that that’s what it’s going to take to get ahead of this rather than women really not recognizing that they’re missing period is a big deal or trying to get pregnant. Which for some people it’s like, I don’t want to say too late. But when somebody is ready to be pregnant yesterday, and they’re being told by their physician, it could take over a year to get your period back, you may never get your period back, or here’s a referral to an IVF clinic and you can get pregnant probably in the next six months, what are you going to choose? 

Emily Everton  08:18

I completely agree. People want to fast track and they want the easier option. I say easier and in quotations because that’s not necessarily the easier option. But I completely agree with you. I think sometimes in the younger population too. So when I worked with younger athletes, those first couple years after monarchy, like sometimes cycles are a little bit irregular. So I think some time that can lead to it being missed too and we’re not doing more exploration as well. That was my own personal journey as well. 

Emily Everton  08:44

And then the other thing I would say is, we’re not always looking in populations that we’re thinking it’s not present. So even in perimenopause, even on postpartum women. That’s a lot of the work that I do. RED-S and predisposition for low energy availability, and HA spectrum and irregular cycles is pretty common. But these are time periods where cycles may get a little bit wonky, things may look a little bit different. So it just kind of flies under the radar because it’s not as definitive as, say, a woman with regular cycles completely losing her period.

Lindsey Lusson  09:19

For sure. And there are a lot of things too, I think probably from just a general physician provider standpoint. There’s so many things that can lead to irregular periods and HA statistically is not as common as a PCOS or as irregularities due to prolonged use of birth control, etc, etc. I am curious about a couple of things that you said here. Maybe let’s first define what RED-S is for people who are unfamiliar.

Emily Everton  09:46

Relative Energy Deficiency in Sport, or RED-S, you might hear it spoken as. It’s basically characterized by low energy availability, which is also a huge underlying factor of hypothalamic amenorrhea as well. So essentially RED-S is characterized by not getting enough food or calories in for the amount that you are expending. And so RED-S is… This encompasses a wide array of symptoms that can pop up . Signs and symptoms of RED-S. Not all individuals with RED-S will have hypothalamic amenorrhea or missing periods.

Emily Everton  10:18

That’s something that’s really important to know. It’s a question I get sometimes like, if someone has HA or they ginna have RED-S? And it’s not one in the same. The signs and symptoms can be as low lying as fatigue, or just changes in your performance or getting sick a little bit more frequently, or anxiety. Not sleeping as well. So we see a lot of overlap in the symptoms, but it’s not the same thing as hypothalamic amenorrhea. 

Lindsey Lusson  10:22

Yeah. I usually kind of describe it as: RED-S is like the umbrella and HA is kind of a symptom of that in addition to low bone mass, in addition to digestive issues, in addition to the fatigue that you described. But what’s interesting is how does somebody know if they have RED-S. Right? Like, aside from a sports dietitian doing dietary recall, how do they know? 

Emily Everton  11:07

I think that’s so tricky. And I think that’s where more of this education needs to come up even in our schooling, even for physical physical therapists. Because just like yourself, Lindsey, being a registered dietician, you have more touch points with a client than, say, their physician or their primary care provider. In physical therapy, I’m typically seeing… I mean, in my last job, I was seeing client two times a week. Now I’m seeing people over the course of 2/3/4 months. We’re really establishing that relationship. So it’s a great opportunity to be asking the right questions and seeing these flags pop up to have appropriate referrals to a registered dietician, to sports medicine physician, to a psychotherapist. 

Emily Everton  11:49

So I think it’s catching. But unfortunately even with, I was mentioning the Female Athlete Program, most of the time, once an injury pops up, or something pops up that lands someone into their doctors, their doctors care. Not all doctors are educated in this, like I just said. So it can still go missing too. So it’s a tricky thing. But I think there’s more registered dieticians, there’s more providers that are really passionate about this. And they’re going into schools, they’re going into athletic to speak with athletic trainers and coaches and trying to get the word out there about it so that we’re identifying it earlier on.

Lindsey Lusson  12:24

I definitely think there’s more talk in education now than there was 15 years ago. So I am optimistic about that. The other thing that you said, Emily, that I wanted to dig in for a second, and we don’t have a ton of young listeners to the podcast, but on the off chance that we do have somebody who is a teen struggling with a missing period: Where’s the line? Because on the one hand, you’re right. The first couple of years of menarche, you’re probably not going to have a textbook cycle and that can be normal. On the other hand, if somebody hasn’t started their period at age 16, I don’t care how active you are, we need to be screening, because that’s primarily amenorrhea. 

Emily Everton  13:02

Yeah. It goes back to primary care providers, pediatricians need to be educated in this realm, because they need to know the right questions to ask. Because usually those are the providers that teenage or young teens, adolescents are going to see. Just to give my own example, I got my period, late 14, maybe 15. But my period never came back. And I was just put on birth control right away to “regulate my cycles”. This completely masked so much that was going on for me. And so I think that we need to be doing our due diligence. 

Emily Everton  13:36

You mentioned, where is the line. And a girl cycle might not be regular, but we can still screen for her relationship with food, her relationship to her body, her exercise patterns. These things that are flagging that might suggest that she doesn’t have a really great relationship with food. And that might be impacting her cycles as well. I don’t think that that screen and not at all. That’s definitely my personal experience and a lot of the women I support too. It stems back from a really young age. It just was never caught or identified.

Lindsey Lusson  14:06

I also think that amenorrhea is a little bit more of an obvious red flag. But you brought up the idea of the HA spectrum, which we’ve talked about before on this podcast. Where maybe you don’t totally lose your period, but your periods are irregular, you aren’t ovulating. Really any change in your menstrual cycle that’s different for you, different from your baseline, can be a sign of low energy availability, or being in an energy deficit or over stressing your body. What would be things that you would recommend somebody cling in? lf we put that under the RED-S umbrella of irregular cycles, what are some questions that you typically ask people that help you to understand whether or not that might be going on? 

Emily Everton  14:47

I think there’s good tools like the RED-S CAT screening. You can look that up. That’s in the research. That’s a good screening tool. When I was working in the outpatient clinic at my first job, I was definitely seeing more younger girls who were say dancers or in athletics. So questions I would ask them were one, have they gotten their period, are their cycles regular? Very commonly cycles aren’t regular. So then I’ll ask, when are your cycles regular? Do you notice a change in your cycle when you are in the intense season of dance or in your sport? Because a lot of times you’ll hear, “My cycles are irregular, but then from this month to this month, when I’m training, I don’t have a period, but then it comes back.” 

Emily Everton  15:29

And so that’s a really big red flag too.  Some doctors, I never want to speak poorly upon doctors at all. It’s just not in the education sometimes. But myself, I was told, “Oh, that’s normal, because you’re active, you have a low body fat percentage. It’s okay that you lose your period around certain times”. So I think that that’s a big red flag. And we have to think the biopsychosocial model. Asking about things like anxiety, mental health: how are you sleeping? How’s your attention in school? Can you really focus on what your teacher is teaching? Are there any changes in grades or your ability to get homework done, and stuff like that. Because those are going to be subtle signs of under feeling, low energy availability as well, that we can kind of pick up on. 

Lindsey Lusson  16:15

I love that. And I think you’ve kind of opened up a whole different segue. But for certain individuals too, it may not be that the root problem is an eating disorder, but rather, they have so much anxiety about performance in school or performance in their sport that now their appetite is taint. Right? So I think that it can almost be like a chicken or egg scenario. 

Lindsey Lusson  16:38

\But when somebody’s having prolonged irregular cycles or amenorrhea, no period at all, I think that that’s when we really have to start looking more at the food side of thing. Potentially screening for disordered eating and eating disorder. And I think that this is a good segue to talk, if you’re okay with it a little bit more about your story. Because you mentioned that while you were missing your period, you were flying under the radar. But in hindsight, you recognize that you were struggling with orthorexia. Is that right?

Emily Everton  17:03

Yes. Definitely orthorexia. Definitely challenge relationship with food, my body all of the things.

Lindsey Lusson  17:09

Tell us what orthorexia is and why this is… I mean, in my opinion, I think that this is the fastest growing eating disorder that unfortunately isn’t in the DSM-5. So I don’t know what we’re doing about this. But I’d love to hear more about your experience and how you actually recognize that this is what was going on for you.

Emily Everton  17:27

So, orthorexia is clinically defined as an obsessive focus on healthy eating. Typically with associated restrictive behaviors. Because when you are focusing on eating only pure, clean, healthy foods, you are thus restricting all other foods. Typically also characterized by a mental preoccupation with dietary choices. That was definitely my history. Just so much of your brain capacity and your mental energy is dedicated to researching the healthiest options, looking at ingredients, and food labels, and all of that stuff that making sure you’re really just putting the purest ingredients into your body.

Emily Everton  18:03

My story didn’t necessarily start with orthorexia. So just to give a quick recap, focusing attention was brought to my body from such a young age. But I can remember I was born into a smaller body, whether that’s due to genetics or whatever it may be. I had to go for weight check ins every six months instead of every year because I wasn’t gaining weight appropriately from a young age. My peers would poke fun of me and make jokes about how thin I was. And beans, that would pop out of my head just because I was really thin. So from the time I can remember, there was just a focus and attention brought upon my body.

Emily Everton  18:41

And then when I got into high school, I was in competitive dance and cheerleading, and I was a flyer. So they threw me up in the air. So as you can imagine a lot of focus on body weight, shape size with that as well. And that is where my focus on my body and my focus on food, on exercise really took a turn. I had mentioned previously, earlier on in our discussion, I got my period around like 14/15, really light. Was unsure if it was even a bleed, I was just so excited because I had been past all of my friends. Like “when’s my time gonna come”. Then it never came back. So my pediatrician put me on birth control and like birth control, I gained quite a bit of weight in a really short amount of time.

Emily Everton  19:26

And so obviously this was really hard for me being a flyer too. I think I gained nearly 20 pounds in a really short amount of time and that is what catapulted me into really having a poor relationship with my body. I started to try to control what I was eating. At the time it wasn’t like this orthorexia type pattern. It was just like eating diet foods trying to eat less. Going to cheerleading practice but then also going for a run and exercising above and beyond my sporting activities. And then fast forward to college, I cheered at the collegiate level. 

Emily Everton  20:01

That is where I really branched into the orthorexia type tendencies. So after my freshman year, I gained a little bit of weight, came back for summer break. And that is where I just started really taking out all “unhealthy” foods. Really tapped into that clean eating type restriction. Only ate the purest foods, and I have lost a lot of weight and my body composition changed a lot. I remember going back to college and sophomore year, and it was noted by a lot of people. And of course, at the time, I enjoyed that attention.

Lindsey Lusson  20:36

[indecipherable] of praise and validation, or was it more concern?

Emily Everton  20:40

Concern for sure, but I think perhaps some of the women listening to this podcast perhaps for you, Lindsey, any attention brought to an eating disorder or disordered eating is going to further feed into that restriction most of the time. So although loved ones were concerned for me, I kind of thought of it as like, Okay, what I’m doing is working, this is changing my body and all the right ways. Now I have the interception to say that was really unhealthy. But at the time, I didn’t quite have that awareness.

Lindsey Lusson  21:11

For sure, and I think there’s so many parts of your story, if I can dissect it and get back for a little bit that are red flags. Right? With the body comments and the emphasis on your body being so small for so long, really kind of set the stage for that being your identity. And then when you were placed on birth control, and your body changed, there was fear of that identity being taken away. So the coping mechanism was how do I control and that just morphed over time. Sorry for the psychoanalysis on my end here. That just worked over time and into different forms of disordered eating and eating disorders. And you’re right. Even when somebody is expressing concern, the eating disorder here is “you look great, keep going”. Unfortunately, the body comments are never helpful in any situation.

Emily Everton  22:00

And that’s something that I shared with my own journey was hypothalamic amenorrhea and getting on to the other side. I shared that with all of my loved ones, all of my friends. Even though you’re doing this because you love me, I don’t want comments on you look great, you look healthier. I shared with them it’s really not that helpful to really make those comments to anyone, because you never know what’s going on behind the scenes. Commenting on anyone’s body, whether it’s something good or bad, we don’t need to be commenting on women’s bodies. And I think that is just really important, too, because that was a big part of my journey. I think it is for a lot of women.

Emily Everton  22:39

Even just hearing over and over, “you’re so thin; Everyone wants to body like Emily”. Especially at that young age, when you’re really impressionable that kind of seeps into your identity and that external validation. And when that starts to naturally change as you go through puberty, and your body just changes as you get older, it can really lead to things like eating disorders, or just a really poor relationship with your body. So I think from the coaches level, from teachers level, from our parents, from our friends, I just think it’s something that needs to be talked more about, because it really can impact things.

Lindsey Lusson  23:10

We have very firm boundaries in our house. I’ll probably not even always deliver it the nicest way. But we don’t make comments on people’s bodies. And even if grandparents, aunts and uncles are commenting on my kids bodies, I shut it down real fast, because people really don’t understand the damage that can happen even when it’s a potentially well meaning comment or a funny comment. It’s just like, no, like, we have to stop this, we have to turn this around. Eating Disorder rates have doubled over the past decade. There’s not enough care. There’s more and more misinformation about food, there’s more and more fear going out about food through social media. And we have to make changes about how we’re approaching this. Or we’re never going to make a dent in reversing what is inevitable.

Emily Everton  23:52

Exactly. It starts with us. And it starts with those changes now. That is something that’s been high on my mind since our pregnancy as well. And thinking about this coming into our next journey into parenthood as well, and just creating those firm boundaries. I’ve been really firm with my… I have the most amazing support system. So it hasn’t been challenging. But that is something we’ll be bringing forward into our family as well.

Lindsey Lusson  24:16

And I think with your personal experience, and probably what you do now too, you’ve talked a lot on your social media about improving body image and how we both know the body kind of has to change during HA recovery in order to be healthy again. I think that this is by and large, the biggest pain point and stumbling block for people in recovery is: I am scared of how my body is going to change. I am not going to like the way that I look. I’m going to feel unhealthy, I’m not going to feel beautiful. How do you support women through that process?

Emily Everton  24:52

Yeah, I love this question. I love talking about body image because you are so right. Even beyond hypothalamic amenorrhea and eating disorder recovery, I think it’s fair to say, every single woman and individual man who struggle with body image issues too are going to struggle with some form of body image, poor body image at some point in their life. So it’s really applicable to all of the women that I serve. Even going through pregnancy and postpartum, a lot of this pops up. It’s conversation that is important to have. 

Emily Everton  25:24

So top three tips. I think my first tip that we’re kind of talking about psychoanalysis earlier, so this isn’t necessarily psychoanalysis. But I think oftentimes, and especially in HA recovery, we’re just like, I want these negative thoughts out of my head, I don’t want to deal with it. Like, am I always going to be like this? How do I get to the other side? Yeah, fix me. I just want to get rid of these thoughts. And so where I start is, how can we stop? How can we try to not put so much pressure on ourselves to get rid of these thoughts and to just remove them and to judge them? Because that’s not always so helpful. 

Emily Everton  26:00

And how can we instead, bring awareness and try to hear what these thoughts, what this part of us is trying to tell us. So we have lived our entire lives being fed this information, that being thin, and your not gaining weight is always the goal, it’s very, very valid, that when your body does start to change, you’re gonna have all of these intrusive thoughts come barreling in. So what I like to start with is just bringing awareness and letting that part of you, letting those thoughts have their place, instead of judging them.  Instead of trying to push them away, let’s acknowledge them and hear what they have to say. 

Emily Everton  26:35

And then we kind of talk about what these thoughts are. Any thought we have is trying to serve a purpose. Usually it comes back to some form of trying to protect us. So how are these thoughts trying to protect us? Again, we live in a society where it makes it really unsafe to allow your body to change,  to gain weight, to be anything but thin and this ideal body body image. So can we acknowledge that the thoughts are just trying to serve a purpose and trying to protect us? And then can we acknowledge the action that we want to take on that? 

Emily Everton  27:05

So in the past, sometimes these body image and intrusive thoughts are gonna lead to us to restricting our food to over exercising and to serving that greater purpose of getting external validation we want and not allowing that judgment from gaining weight. And so I kind of work through this cycle. And that was kind of just a quick work through through it. But instead of judging the thoughts, can we let them show up? Can we bring awareness? Can we see that they’re serving a purpose, and try to kind of dissect where that purpose is coming from. And then how can we change the action step? How can we rewrite the story? 

Emily Everton  27:37

Instead of restricting food, instead of over exercising, instead of doing the things that we used to do in response to these thoughts, we choose a different action. We don’t restrict, We still nourish ourselves the same we would if we did exercise or didn’t exercise. And so when we do this time, over time, over time, our brain has an amazing capacity to adapt this wonderful, beautiful thing called neuroplasticity. And this takes consistently rewiring the thoughts and the actions that we’re playing out. So I know that was probably a really long thing. But I think that’s not often the thing we hear when we think about body image, but it’s really effective when you keep practicing it. 

Lindsey Lusson  28:16

Repetition and time are probably the two secret ingredients for healing your body image. Because it is about understanding… I always encourage people too to think about the origin of where the thought came from. Is it because you were teased as a kid? Is it because, Mom was always on a diet or bashing her body? 

Lindsey Lusson  28:37

Is it because that’s what the popular girls were doing in school, right? Like, what is kind of like the origin of those thoughts? And what if we push back against that Like, what would that mean?

Lindsey Lusson  28:50

And also understanding you brought in the idea that outside of the context of HA and eating disorders. Outside the context of people who are identify as female, everybody struggles with body image. Why is that? Is that maybe because there’s a $73 billion diet industry that profits off of your insecurities? Not to let go, because that could be a whole separate podcast episode. But just kind of understanding that you are made to feel insecure, because there is an industry that profits off of that. 

Lindsey Lusson  29:21

And if we can push back against that, what could that mean for your life moving forward? I think it’s something might be like kind of a constant grappling for most people because even through like a HA recovery journey, getting to the point of becoming pregnant. I don’t I mean, correct me if I’m wrong, but I’m sure that 100% of every single day we probably don’t always jump out of bed and love the way that our body looks, but we can still care for our body and be in alignment with what we believe to be true.

Emily Everton  29:59

Absolutely. I think that it comes down to just getting to a place of body respect, body neutrality. I never praise that there’s the school to have body positivity, a positive body image 100% of the time. Because personally, I just don’t think that’s realistic. I consider myself too 100% being on the other side of HA and my disordered relationship with my body. That doesn’t mean that some days, I’m not feeling as comfortable. What it does mean is that I still choose to respect my body to nourish my body, to listen to what she is asking of me, and listen to what she needs to not judge her and then take action that’s going to hurt her and myself along the way. 

Emily Everton  30:41

So I think we get to this place where it just doesn’t impact us negatively like it used to. A couple other tips that come on that is, perhaps not that root cause approach. But doing a clothing audit, getting rid of those clothes that no longer serve you. I mean, we always talked about this in the HA space. But I have gone through bags and bags and bags of just clothes that I got rid of, because they were no longer serving my body.

And it doesn’t mean you have to spend thousands of dollars on a whole new wardrobe. But just getting some clothing items that you feel comfortable and help you to feel a little bit more confident, can really, really help. Because if you’re trying so hard to improve your body image, and not let the weight gain get to you.  You’re trying to squeeze yourself into clothes that no longer serve you that can make it really, really challenging. 

Emily Everton  31:26

And the third and final tip I’ll give is exposure therapy. So I don’t know if you do this with some of your clients, Lindsey. I’m typically, I very often make referrals to other providers, including therapists too. And so, exposure therapy, you can’t always jump right to it. But I think it can be extremely, extremely helpful. So this could look like exposing parts of your body that you feel really uncomfortable with. Typically for some women, it’s like their belly region. And simply looking in the mirror, placing your hands on your belly, feeling the way that it’s changing, that was so helpful for me. 

Emily Everton  32:02

Other things that sound a little bit like strange sometimes, but notice later, you’re acting on your partner too. So one thing that I used to do is get out of the shower. And if I was going to walk through our bedroom, I would cover every single inch of myself with like a towel. So can you kind of welcome yourself to just expose yourself to your partner and to yourself as well. The more that you expose your brain and yourself to those things that are making you anxious or uncomfortable, the less overwhelming and the less they start to impact you. So a bit of exposure therapy can be really helpful, too.

Lindsey Lusson  32:35

I don’t think I use that exact technique. But I will say on a personal note that that has also been helpful for me, I think. Inside our program, we also talk about affirmations a lot. Allowing yourself to try to zoom out like if you were to look at your full body in the mirror, instead of going zooming in on “problem area”, zoom out and look at your body as a whole. And think about your affirmation, which could quite simply be there’s nothing wrong with my body. My body is an instrument, my body is healing. Whatever speaks to you. And if you don’t have one, you can probably Google this right now, body affirmations or body image affirmations. 

Lindsey Lusson  33:16

And having that word I mean, I think that affirmations, to circle back to the idea of repetition, is super, super powerful. I do encourage clients to do what I’ll call like dress rehearsal. So let’s say somebody’s been in recovery, and their body has changed. They’re going to their friend’s wedding or it’s date night, or it’s their birthday. They had to size up and they’ve got this new dress or this new outfit. I encourage people to put that on and it doesn’t have to be like to the nines, like you’re about to go out, but at least put the outfit on and move around in it.

Lindsey Lusson  33:49

 Sit down stand up, experience life in it. That way, when you go out, you’re not constantly thinking about oh, I didn’t realize that this dress was tighter in this region. Oh, I didn’t realize that it was the short when I sat down. So you’re not caught off guard. You’ve already experienced that. And so then you’re wearing it what it feels like and you can totally forget about it. You can concentrate more on the conversation or the wedding or that whatever you’re out doing. So kind of a different form of exposure therapy. But I like what you said to too. I think that’s amazing.

Emily Everton  34:19

I love that. I love the dress rehearsal. That’s a really great idea too. I think that allows us to be more present in the moment like you were saying, obviously, expose ourselves to that at a time.

Lindsey Lusson  34:31

Well, to wrap us up here we kind of hinted at this at the beginning of the episode that you were you kind of newly pregnant but moving out of that first trimester. What’s pregnancy been like for you so far? What’s been kind of the biggest surprise in a good way? And maybe also biggest surprise, and then oh, gosh, I didn’t anticipate that this was actually going to be a challenge.

Emily Everton  34:51

Yeah, thanks for asking. We’re just so so thrilled. I think I’ve always thought that the female body and women’s bodies are absolutely amazing. But I don’t think I’ve ever had as much gratitude and just sheer awe of what my body is capable. So I am so thrilled. We talked a little bit more about this. And I’ve been pretty open on it. I’m talking about in social media too. But the first trimester definitely hit me pretty hard. The nausea, the vomiting, a lot of vomiting. And just low energy, a lot of low energy. So that was, I don’t know, if it was surprising. I think it was a little bit more intense than I was expecting.

Emily Everton  35:32

But we’re heading into week 14, that second trimester, I’m feeling the energy come back then has gotten so much better. I’m able to do follow a little bit more of a routine, than I was in the first trimester. And I’m feeling a lot better. I think preconception wise, and just getting to this point, I’ve just been doing a lot of reflecting and I think that it’s just another reminder that recovery is the absolute best thing that I have ever, ever chosen. 

Emily Everton  36:03

And I always come back to that even with a woman I support. HA recovery is a choice. And it’s a choice that we have to make and kind of commit to so it was the best choice. Just the fact that I’m now pregnant on our own when doctors told us we would never get pregnant over dinner and wine or that come back when you want to get pregnant and just get on birth control. And then we’ll figure it out after. Just like what a way to be like, No, that was not my truth and I knew it wasn’t. And here we are. So I’m just feeling so good.

Lindsey Lusson  36:32

I love it. It’s so full circle with the fertility piece. But something that I think is really admirable about you, Emily is that you didn’t like myself and other people, you didn’t put off recovery, if you will, until you wanted to get pregnant. Tell us more about the conscious choice to choose recovery before you wanted to start your family. 

Emily Everton  36:51

Yeah, so I wouldn’t say this is maybe different from everyone. It’s not different from everyone. But something a little bit different from my journey is that I did for a long time, before I even decided to do a take on HA recovery, I knew that I was struggling. I knew deep down that my lifestyle was not sustainable and my habits were not serving me. And I almost got to this phase of just really being burned out from the way I was living. I knew I couldn’t sustain it anymore. I knew there was more, I knew I wasn’t getting my period whenever I was off birth control. And I just like knew deep down that something more was going on. 

Emily Everton  37:26

In the back of my mind, pregnancy and growing a family was always so important to me. And I knew that if I didn’t have a period, then I wouldn’t be able to do that naturally. But I think I just really set my mind to it. And it was like, I know, I need to do this. Nothing sounds more amazing to me than having a period on my own. Like, how cool is that for my body to do that and to give me the sign of safety and actually trust me and feel safe enough to get a period. 

Emily Everton  37:26

So I think once I graduated from PT school, from grad school was when I was like, enough is enough, I’m getting off birth control. My husband and I are highschool sweethearts, we’ve been together for so long. And so we weren’t even engaged yet. But I was like, I’m gonna get off birth control and he was super supportive. So I think it was just this accumulation of recognizing my lifestyle was no longer sustainable. My anxiety was increasing, I was so burnt out from the way I was living. That almost getting a diagnosis hypothalamic amenorrhea was like a permission slip. It was like, okay, here we are, I have this permission slip to lean into surrender, and to rewrite the story, because I know I can’t keep doing this.

Emily Everton  38:34

It took me 18 months. I always share that because I think that it’s a like we hear of stories where it’s really quick and I know that mine could have been quicker. But I don’t regret the path that I took. And yeah, and now it served me so well, because I started that journey a while ago and now here we are pregnant. And I think there’s just a whole another stress component when your only motivator is you want to get pregnant ASAP. 

Lindsey Lusson  38:58

Yeah. And it’s also an added pressure. Because when you put it off like that, it’s like I have to get my period back to get pregnant and the pressure that’s put on the female, even though it’s not intentional, and it shouldn’t just be on the female. But the pressure that I hear a lot of people taking on is I’m the reason we can’t have kids, I did this. And so it is a gift to work on your relationship with food, work on getting your period back, even if it does take you longer to do it beforehand. But for some of us sometimes Hindsight is 2020. 

Lindsey Lusson  39:34

For me personally, I just, quite frankly didn’t have the information. And if I could rewind the clock to when I was in recovery from my eating disorder, if somebody would have said, You’re doing amazing, and there’s this whole other piece that you have to do. I don’t know at 25 years old that I would have been like yeah, let’s do it. Who knows. So I do think that there was obviously the Lord’s hand in pacing me the way that it happened. But it literally was not until the year that we wanted to get pregnant that I even knew what hypothalamic amenorrhea was. So for me huge knowledge.

Emily Everton  40:10

I think there’s two things I would add to that one. My health literacy in being a healthcare provider, and having done all this research and working in women’s health… I wasn’t really into the woman’s health realm all the way back then. But my health literacy definitely helped in my journey, because I knew this is not healthy. This is not certainly me. I’m worried about my bone health, I’m worried about XYZ. Whereas not all women have that health literacy. So that 100%. Even when relatives would kind of question, Are you sure you need to gain weight? Are you sure you need to do that? I knew it was what I needed to do, because of my own medical and health background. 

Emily Everton  40:50

So that was one thing. And two, we talked about this before starting hopping onto the podcast too, I thin, a very big beneficial part of starting before you want to get pregnant and everyone has their own story, and everyone has their own timeline, but for me was that it gave me so much time to work on my mindset, my deep rooted conditioning and beliefs. That has served me 10 million fold going into pregnancy where a lot of things are out of your control. 

Emily Everton  41:22

When you’re having massive food aversions, you’re just kind of eating whatever you can, you’re not doing all of these things. But that old Emily like the past version of me would have never let go of or would have had a really hard time dealing with. So just from like that standpoint, Recovery has served me so well through pregnancy too. And my body hasn’t changed significantly quite yet. But my body’s changed a lot and I think those body changes coming back to that body image is another consideration.

Lindsey Lusson  41:50

100%. Well Emily, where can listeners connect with you? How can they learn more about what you do and your practice? And how did they learn more?

Emily Everton  41:59

Yeah. For social platforms, I’m most active on Instagram so I’m @emilyeverton.dpt.

Emily Everton  42:06

I had such a fun time with our conversation today, Lindsey. We didn’t talk too much about like the PT aspect…

Lindsey Lusson  42:12

Oh my gosh, we didn’t. You know what we’ll have to do a part two hopefully befgore you deliver because after might get a little bit dicey. But yes, There’s more to talk. We definitely need to have you on again.

Emily Everton  42:23

And my website https://www.embodyptwell.com/ so that’s where you can learn a little bit more about the way that I support women too just in my practice as well. So I would say those are the two main platforms to find me.

Lindsey Lusson  42:35

Amazing. Well, thank you, Emily, and we’ll try to have you back on again before baby comes because there’s so much more that you have to teach us and we thank you so much for your time.

Emily Everton  42:46

Thank you so much for having me, Lindsey.

Connect with Lindsey Lusson: 

Instagram: @‌food.freedom.fertility
Website: www.foodfreedomandfertility.com/
Twitter: @LindseyLusson
Tiktok: @food.freedom.fertility


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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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