From the Doctor’s Office to Online Chat Rooms, Women Are Talking About Their Missing Periods
When Nicola Sykes, then a scientist at the biotechnology company Biogen, went off the birth control pill to get pregnant with her first child, her predictable monthly period stopped paying a visit.
At the doctor’s, her physician asked her the standard questions about diet and exercise: Sykes recalled that she was exercising two to three hours a day, seven days a week. Egged on by some colleagues, she had gone on a strict diet and lost a significant amount of weight a few months earlier, even though her Body Mass Index (BMI) was considered “healthy” by medical standards.
After ten months that involved blood tests, ultrasounds, and MRIs, Sykes was diagnosed with a condition called Hypothalamic Amenorrhea (HA) and was told she would need injectables to get pregnant.
Sykes’ diet and exercise did not come up again in her medical care. And the injectables didn’t make her pregnant.
Eighteen years later, Sykes has three sons and runs a subscriber-based online community for women with HA. Her Instagram @noperiodnowwhat has over 18k followers. This account is but one example of a newer corner of Internet dialogue, including fitness influencers and food bloggers, encouraging women to find answers to their irregular cycles, often outside of the traditional medical system.
Approximately fifty percent of women who exercise experience irregular periods, while thirty percent don’t menstruate at all. A common culprit is HA (also known as FHA), which occurs when the hypothalamus, the brain’s control center, stops releasing hormones that start and regulate the menstrual cycle. In general, HA is most commonly associated with female athletes, women with eating disorders, or women under excess stress. “FHA is nature’s defense mechanism,” said Chrisandra Shufelt, M.D., the Associate Director of Women’s Health at the Mayo Clinic Florida and Principal Investigator for an ongoing HA study. “If you’re so stressed, your body will respond. Meaning if you are not doing a good job of supporting yourself, you won’t be able to support a growing baby. Your body shuts down your reproductive axis for a bit until you can turn things around.” HA’s relationship with eating disorders means that it is commonly associated with low body weight, but Shufelt reported that many of her patients have “normal” BMIs, although they may have experienced recent weight loss or stress.
“FHA is nature’s defense mechanism...if you are not doing a good job of supporting yourself, you won’t be able to support a growing baby. Your body shuts down your reproductive axis for a bit until you can turn things around.” Chrisandra Shufelt, M.D., Associate Director of Women’s Health, Mayo Clinic Florida
Although few people look forward to their visits from Aunt Flo, most only take her absence seriously when they want to get pregnant. But the unexpected loss of a period means more than infertility. A review article that Shufelt lead authored in 2017 stated that in the event period loss is due to HA, long-term repercussions of low estrogen levels can result in osteoporosis and potential risks to the heart. Heart disease is the leading cause of death for women in America.
“I think the menstrual cycle should be a vital sign,” Shufelt said. “For example, if your heart rate’s abnormal or irregular, we want to investigate why. Well, it should be no different with your menstrual cycle.”