Period Restoration in Eating Disorder Recovery

Originally published on nyxiesnook.com; republished here with permission. Get your blog featured!

How does sudden period restoration impact on eating disorder recovery and how can it be rationalised?

According to my Clue App, prior to March, the last time I had my period was September 2018. At first I was concerned I was pregnant, then I was concerned it was a growth in the tumor, and my final conclusion was stress. I brushed it off and carried on with my life without giving it a second thought. Life itself was chaotic, I’m not denying that, but I just didn’t care enough about myself to change that.

The stress grew and grew until something clicked in me and I bought my first scale in over six years. The rest, as they say, is history.

Impromptu Period Restoration

On the first of March 2019, I experienced period restoration after six months of it being absent. To say that I felt panic and overwhelming guilt would be an understatement at best. I’d lived without giving my period much thought, too busy with recovery and crying myself to sleep at night. That is until I awoke to severe cramps and spotting early one Tuesday morning.

Regaining my period was meant to be a good sign. My body was healing and non-essentials (like my menstrual cycle) were back on the table as far as my hypothalamus was concerned.

That’s what you would think, but anorexia had other ideas…

“You have your period back now. You’ve gained back enough weight/fat now. You can stop.”

“You maybe need to cut down on the food now. You don’t want to overshoot.” 

“It’s too early. We’re not ready. Abort mission!“

I thought this was just spotting, so I picked myself up and moved on. But upon waking up the next morning I quickly realised that this was a full-blown ‘Carry’ situation. My heart sank further. I ended up doing the only thing I could do in a situation like this: I cried.

Why do we lose our periods when underweight? 

Why is period restoration needed in the first place? Surely once we hit puberty we’re stuck with our menstrual cycle for life no matter what our body goes through? Isn’t that the curse that all women are plagued with?

Let’s step back a minute and talk about what happens to the female body when menstruation is absent due to malnutrition. There are two types of amenorrhea:

• Primary amenorrhea occurs when a young girl fails to have a period by the age of sixteen.
• Secondary amenorrhea occurs when the period in a previously menstruating woman has been absent for over three months.

Amenorrhea is often seen in women with eating disorders due to extreme weight loss and starvation. Without adequate nutrition, a woman’s body doesn’t have enough energy to work correctly. Therefore, the body starts to prioritize essential over non-essential functions. The reproductive system usually doesn’t make the cut, and the period disappears.

The hormone center of our brain (the hypothalamus) can also suffer significantly. This results in the deregulation of many hormones, including estrogen, further contributing to the loss of the menstrual cycle.

In the past amenorrhea was essential in the diagnosis of Anorexia Nervosa. However, this has since been changed as many women with low body weights can still menstruate**. It was also scrapped because amenorrhea failed to take into account the diagnoses of men, young girls of prepubertal age, those on certain contraceptives and those of menopausal age.

With further reading, I was surprised to learn that even women with very low body weights can still have a period. Some people continue to have them as normal while others can get prolonged periods (this is called oligomenorrhea) which lasts thirty days or longer. Links for more information can be found here & here.

What impact does losing your period have on the body?

The period acts as an indicator for our health and it’s absence isn’t something that should be taken very lightly. It’s our bodies way of telling us that it can’t sustain itself and, as a result, can’t function normally.

Amenorrhea in a woman of child-bearing age due to starvation has a number of consequences, some of which can be reversed come recovery but not in all circumstances.

Infertility

‘You can’t look after yourself, so you can’t grow something in your womb. End off.‘While experiencing amenorrhea the body isn’t able to sustain a child, therefore increasing the chance of infertility. Whether this can be reversed changes from woman to woman, however the quicker it’s restored the higher chance that the woman will become fertile once again.

The longer a period is absent, the more likely it is that she might never conceive or that she might need help conceiving. (Please note: just because you are not experiencing a period does not necessarily mean you are unable to conceive.)

The development of pre-menopause symptoms

This is directly linked to the loss of estrogen levels and hormonal imbalances.

Osteopenia

Amenorrhea leads to the depletion of the calcium reserves in our bones. Estrogen has a direct link to this and, as previously mentioned, without the period the levels of this hormone are reduced. Without it, women are unable to maintain calcium resulting in osteopenia. This is when there is a thinning of the bone mass and is considered to be the early stages of osteoporosis (brittle bone disease).

So what now?

The reappearance of the missing link to my womanhood has left me shaken. But through reading about it and understanding a bit more about how my body works, I can begin to see the bigger picture.

• I know now that this doesn’t mean I can stop gaining weight.
• I can’t start running marathons, swimming, hiking or doing any form of strenuous exercise.
• It does not mean I have put on large reserves of fat.
• It does not mean I need to restrict again.

Period restoration means that I am moving in the right direction with recovery and that the front is finally being pushed back against the enemy.

I’m still going to cry about it though (probably).

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Chloe Faulkner

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My name is Chloe. I write about eating disorders and mental health (among other topics) over on my blog. I've suffered from anorexia for over 13 years and spent about 7 of those in quasi-recovery. It was only after a recent burnout in December of 2018 that I relapsed and decided, once and for all, to get the help I needed. I believe that each and every sufferer has it inside them to reach that point where food is no longer the enemy, and that full recovery is an obtainable goal.