There are obvious reasons that your period may be MIA — like, of course, pregnancy. But there are other factors that can affect menstrual cycles…and some may cause your periods to stop entirely.
Slight cycle irregularities are expected, but amenorrhea (which is defined as the absence of menstruation, causing someone to miss one or more periods) can be a red flag.
As we’ve begun discussing recently, lifestyle factors like nutrition can affect menstrual health.
We’ve all heard that not eating enough or dealing with an eating disorder can cause amenorrhea, but the relationship between what we eat and our menstrual health may be more intimately linked.
We sought out Anna Bohnengel, registered dietitian and fertility nutritionist, to break down this relationship, weigh in on the role nutrition can play in amenorrhea, and share tips on how people can get their periods back in a healthy way.
What are some factors that can lead to amenorrhea?
Knowing that someone is experiencing amenorrhea is not enough to make a diagnosis — this requires more individualized medical attention.
“If your period has gone AWOL, your first stop is to your doctor to rule out medical or anatomical causes,” says Bohnengel. “The most common causes of a missed period is pregnancy or lactation/breastfeeding.”
However, other causes can include a pituitary tumor (which can be benign, but may throw off hormones), a hormonal condition like PCOS or hypothyroidism, side effects for medications, or uterine scarring (especially after a procedure like a D&C or fibroid removal), according to Bohnengel.
If there’s no medical cause, it could be lifestyle-related.
“Once you've ruled out these medical conditions, it's time to look at your lifestyle,” says Bohnengel. “Chronic stress to your system can cause the hypothalamus in your brain to tune down hormone signaling to your ovaries, preventing or blocking ovulation (bye, bye period).”
Issues like under-eating, over-exercising, insomnia, and mental or emotional stress can all be factors here too.
What role can nutrition and eating habits play in menstrual cycles?
“For many women, the menstrual cycle can be a monthly barometer of overall health, significantly influenced by diet and lifestyle,” says Bohnengel.
It’s common to associate menstrual disruptions with under-eating, but Bohnengel says over-eating can affect a person’s cycle too.
“In cases of under-eating, the hypothalamus in the brain detects danger and shuts down hormone signaling to the ovaries, preventing ovulation. This is known as hypothalamic amenorrhea,” says Bohnengel. “In cases of overeating (particularly overeating of simple carbs and processed, fast foods), if it results in excess body fat, that in turn can contribute to excess estrogen, which can cause uncomfortable symptoms with each cycle, like cramping, very heavy bleeding and clotting, tender/sore breasts, difficulty sleeping, anxiety [and other issues].”
It’s not as simple as how much you’re eating.
“Beyond total food intake, the balance of your macronutrients can also have a significant impact on your menstrual cycle,” says Bohnengel.
First up, let’s talk carbs. They’ve earned a bad rap, but they’re actually so important for your hormonal health.
“Eating complex carbohydrates (fruits and starchy vegetables like potatoes, corn, winter squash, etc.) paired with proteins and fats can help maintain stable blood sugar levels,” Bohnengel adds. “This is crucial because fluctuations in blood sugar can influence hormone levels, particularly insulin, which can indirectly affect estrogen and progesterone balance.”
Bohnengel adds that protein is essential for hormone production, metabolic health, and ovulation, while healthy fats play a vital role in hormone production and balance as well.
These macronutrients support menstrual health even in people with regular cycles.
Healthy eating is great, but it can bleed into obsession.
There’s so much information about what is and is not ‘healthy’ out there, and it can be hard to find that line between fueling your body and obsessing about what you put into it. How do we define that line?
According to Bohnengel, here are a few lifestyle-related signs that someone may be obsessing over what they eat:
- Constantly thinking about food to the point that it distracts you from conversations, work, etc.
- Fear of food — which may manifest as the need to eat “healthy” keeping you from participating in social events. (“If you stay home to avoid temptation, that's a red flag”, says Bohnengel).
- Having a list of foods you fear and will not let yourself eat
- Cooking foods you would not eat for other people in your life
There are physical signs of under-eating as well. Aside from irregular or missed periods, these can include:
- Constipation and bloat
- Always feeling cold
- Poor sleep
- Dry, brittle hair, nails or skin
- Hair on your head thinning
- Poor exercise stamina or recovery
- Anxiety
Can over-exercising make your periods stop, even if you're eating a sufficient amount?
We’ve heard about high-level athletes who have experienced amenorrhea due to the strain of training.
“Over-exercise in and of itself could put your body in enough stress to prevent ovulation,” she says. “That said, typically, overexercise blocks menstruation when you're not eating enough to fuel your workouts.”
Let’s talk about the role BMI plays.
As we’ve been recently discussing, BMI (or body mass index) is a flawed metric which doesn’t always give a clear picture of a person’s health. Could this play a role here — could people whose BMIs fall within the “healthy” range think they’re eating enough even if they’re experiencing amenorrhea due to under-eating?
“100%, yes this plays a role,” says Bohnengel. “Losing your period, or other menstrual cycle issues, can happen at any body shape or size. The myth is that if you're undereating, you'll lose weight or be super skinny. In reality, if you're chronically underfed, your body has built in mechanisms to protect you by holding on to fat stores. So many who under-eat have ‘normal’ or higher BMIs.”
What can people experiencing amenorrhea do to get their periods back?
First of all, it’s a good idea to rule out any medical issues before moving into lifestyle modifications. After all, you’ll want to make sure you’re eating enough (and enough of each essential macronutrient). Pulling back on exercise, increasing sleep, and managing stress can also be helpful.
“For many, the thought of eating more can feel very scary. This is normal and it's okay to go slow, adding back in one scary food at a time, or increasing portions one meal at a time,” says Bohnengel. “If your period is missing, that's a sign that your overall health is jeopardized: it's not just your reproductive health that suffers. It's your bone health, your heart health, your sleep, your mood, [and more].”
Blair Sharp is a freelance writer who lives in Minnesota with her husband and son. Her words have been published in various publications, including Parents, SheKnows, The Bump, and Insider. Find her writing daily on LinkedIn and check out her weekly newsletter, Hey Freelancer! Head to her website www.blairsharp.com for more.