Today I’m writing about something that’s a little bit awkward…but I think that’s exactly why we need to talk more about it. Many of us ladies (and perhaps men) have a bunch of negative beliefs about menstrual periods — that they’re gross, dirty, annoying, shameful, unnecessary, inconvenient, etc. — and that 6th grade puberty class probably didn’t help 🙂 I want to share a little bit of my journey here, and hopefully inspire some curiosity about your (or your partner’s) menstrual and hormonal health, because it matters.
Getting my first period
The first thing I remember about my menstrual journey is that I was incredibly anxious to get my first period. I was an active fourteen-year-old gymnast and was dreadfully conscious of the fact that every girl around me had started their period, except for me (or so it seemed). I read every Judy Blume book I could get my hands on and worried constantly that there was something wrong with me. I thought that maybe I had a rare, undiscovered disease where I bled out of my nose instead of my vagina, since I had a lot of nosebleeds back then (I wish I were making this up, but I’m not). Finally, while struggling over an assignment on war poetry, I started bleeding for the very first time. The relief!!! I was fourteen, which is a little later than average, but not anything to be worried about.
Unpredictable, painful, inconvenient
Of course, once I started my period, I wished I had never gotten it. I worried about whether I was going to bleed during gymnastics competitions. They weren’t regular at all, which made them hard to plan for. And they were so painful. I remember being in agonizing pain before a French final exam one time. My sweet friends bought me some french fries from McDonalds and prayed for me. I think it’s important to note that at this point, irregularities in the menstrual cycle are totally normal, and everybody’s process is going to be a little different — your body is cranking out a lot of hormones, and it takes a while (several years, actually) to get into a predictable rhythm.
Hypothalamic amenorrhea – losing my period over and over again
In my late teens, I started to under-fuel and over-exercise my body in response to some stressors in my life. I had no idea that I was developing an eating disorder and remained in denial about this for several years, but my body immediately sensed what was going on. I stopped getting my period almost instantly. I think ‘hypothalamic amenorrhea‘ (HA) is kind of an obnoxious term, but essentially it means your brain tells your body, “Stop! We don’t have the resources to sustain a pregnancy, so shut off the periods for now.”
My period came back in fits and starts throughout college and into my early twenties, but whenever I resumed the disordered eating and exercise behaviors, my period would stop like clockwork. I did get worried about this — not necessarily because I wanted to get pregnant right away, but because I am a worry-wart, and possibly because I knew instinctively that something else was going on with my health. However, whenever I raised my concerns with doctors and OBGYNs, they told me that it was no big deal. I wish someone had asked me a follow-up question about my eating habits or my lifestyle. I wish someone had told me that not getting your period was dangerous for your bone health, because making progesterone during your cycle is how your body retains its bone density. Instead, they told me that once I was ready to get pregnant, we could talk about some pharmaceutical interventions.
Charting, the pill
I remained dissatisfied with their answers, but also felt a little crazy and overdramatic for making such a big deal out of what didn’t seem too worrisome in the eyes of medical professionals. At this point in time, I was also starting to get interested in a form of birth control known as the Symptothermal Method (STM). At this point, I actually had been prescribed hormonal birth control (the pill) by my OB/GYN — the box of pills had been sitting in a corner of my bedroom for a long time — but for some reason or another couldn’t bring myself to take them. I read the classic resource, Taking Charge of Your Fertility by Toni Weschler, and had started to give charting a go on my own.
Wait…what’s charting? Charting simply means tracking your temperature and other fertility signs such as cervical mucus and position on a chart; here’s a recent incomplete example of one of mine. By tracking these patterns, you get a sense of when you ovulated: after you ovulate, your body’s temperatures shift higher. In this cycle, my temperature shift occurred between day 17 and 18, so I likely ovulated on day 17. Side note: it’s a myth that every woman ovulates on day 14! It’s simply not true. It’s like saying, every woman is 5’5″ 🤦.
Anyway, I remember feeling kind of lonely and crazy at the time, because no one I knew was doing this stuff. It seemed a little neurotic. And besides, my charting efforts at the time felt fruitless because my periods were coming once every three months or so, and my temperatures had no clearly-defined pattern. My chart was literally all over the place. However, charting is what first tipped me off to the fact that my body clearly wasn’t functioning at its optimal level — in fact, it wasn’t even close. Other than the fact that my cycle lengths were irregular as an adult, there were two other characteristics of my menstrual health that helped me to grasp that something about my lifestyle – particularly my nutrition – needed to change.
Luteal phase length & anovulatory cycles
I don’t want to get overly technical here, because there is such a wealth of science information and research behind all this stuff, but I do want to share some specifics of what I learned in my charting journey. So first off, a couple of definitions:
Luteal phase: This is the phase within your cycle that starts from ovulation and ends when your next period comes. Counting the start of your period as day 1, this means on average that the luteal phase is between day 15 and day 28, lasting a total of 14 days. Having a luteal phase <10 days is known as luteal phase defect, and can indicate low progesterone and predict infertility and miscarriages.
Anovulatory cycle: This is when you have a cycle in which an egg is not released. It is perfectly normal to have this once in a while, if you’ve just started getting periods (menarche), or if you’re approaching menopause, but can be a cause for concern if you’re not ovulating at least most of the time otherwise.
In summary, charting – even through my wacky cycles – helped me to realize that (1) I had a very short luteal phase, lasting 6-9 days and (2) I often had cycles where I didn’t ovulate at all.
Recovery, progress, and the amazing human body!
Whew. This is a long post. But we’re finally getting to the turning point in the story.
Having the tools and the resources to observe and learn about my menstrual health was critical in helping me realize that my poor eating and self-care habits were sabotaging my overall health and making me miserable. I was cold all the time, grumpy, always in pain… and no wonder, since my hormones were out of whack. Learning about how my choices were affecting my fertility also made me realize that I was impairing my dream of carrying a pregnancy to term some day. I got some much-needed help from a team of professionals – a registered dietitian, a specialized doctor, and a specialized therapist. Learning to fuel myself properly and stop compulsive exercise was excruciatingly difficult after so many years, but that’s a whole other story for another time 🙂
Two months or so into treatment for my ED, my period returned. Just as charting my wacky periods helped me to know that something was going wrong, observing my menstrual health restore itself over the next several months and become regular again has been one of the most amazing signs of recovery and progress. I am in awe of the human body (and in particular, of the female reproductive system!) and sad that this is still such a taboo subject in our culture and in many other parts of the world. My luteal phase lasts for 14 days like clockwork, and I can clearly identify ovulation. A little geeky, but honestly, it’s so cool when you learn how to figure this out for your own body.
All the things I didn’t get to talk about
I’m going to stop here… but I want to acknowledge that there are ton of important topics that I didn’t even begin to address, since this is just my own personal story. Some of these topics are:
- Charting with PCOS;
- Charting when coming off hormonal birth control;
- Using charting as a tool to either avoid or achieve pregnancy;
- Involving your partner in this process;
- The importance of progesterone and your period even when you’re not trying to get pregnant;
- Specifics on how to track fertility signs (body basal temp, cervical mucus & position, etc)
I’m hoping that if you’re interested, you’ll check out the following resources that have been incredibly helpful for me:
Taking Charge of Your Fertility by Toni Weschler (book)
Kindara (free app I use for charting; their website has a lot of great info too!)
The Real Life RD (blog that talks extensively about hypothalamic amenorrhea)
Fertility Friday (podcast)
And as always, if you want to talk, please reach out!