Dear Alice,

I was anorexic for three years and I have been in recovery for two. At the moment, I am doing well. I have a healthy weight, I eat a balanced diet, I work out regularly though not excessively, and I feel good. However, I haven't had my period in about three years now. I had been told it would come back once I reached a healthy weight, but so far, no deal, even though I've been at this weight for over a year now.

Before I became anorexic, I did get my period regularly. I am 23 years old. I am taking a calcium supplement daily to prevent osteoporosis, but I would feel more comfortable if I did get my period again. What is going on? How worried should I be? Should I go see a doctor? What can I do about this?

— Cate

Dear Cate,

Congratulations on getting a handle on a difficult situation. Anorexia can be life-threatening, so you've essentially saved your own life — something that hopefully makes you proud. As you point out, a side effect of anorexia can be secondary amenorrhea (loss of period for six months of longer). Typically, women in recovery find their periods come back once they get their weight up to what it was before they stopped getting their period. Some women, who aren't underweight, but who stop getting their periods during times of extreme exercise and erratic eating, regain their period once they get back into a routine of healthy eating and exercise habits. So, your concern is warranted. And, yes, it would be a great idea to seek a medical work-up at this point. Before you head to your health care provider, it might help you to get more information.

There are several possible explanations for secondary amenorrhea. Given your history of living with anorexia you may be experiencing functional hypothalamic amenorrhea (FHA). While FHA seems to occur most frequently in women with low amounts of body fat, it can happen in women of various body shapes. The common denominator seems to be erratic eating patterns and/or excessive exercise. These behaviors disturb the thyroid gland and hypothalamus-pituitary-adrenal gland in ways that lead to increased production and release of steroid hormones, called glucocorticoids (including cortisol, a major stress hormone). Also, low body weight is associated with lower levels of leptin, a necessary chemical that helps to regulate ovulation. In combination, these chemical changes in the body can affect periods and stop them altogether until the chemical balance is restored through changes in behavior and/or hormone therapy. 

While your amenorrhea might be related to your history of anorexia, there are other health-related factors to secondary amenorrhea that you might want to consider:

  • Hormonal contraceptives (e.g., some birth control pills, implanted or injected methods, intrauterine devices)
  • Pregnancy or breast-feeding
  • Extreme mental stress
  • Certain medications (e.g., some antidepressants, chemotherapy drugs for cancer, oral corticosteroids)
  • Chronic illness
  • Thyroid problems
  • Hormonal imbalance
  • Benign pituitary tumor
  • Uterine scarring
  • Premature menopause

You can see there are many possible reasons for secondary amenorrhea. It's also good to know that women with secondary amenorrhea can be at increased risk for some pretty serious health conditions like: osteoporosis, bone fractures, cardiovascular disease, and metabolic problems.

You can contact your health care provider or women's health specialist. If you don't have a trusted women's health care provider, you might consider finding one soon. If money's a concern, you can check out Planned Parenthood's website to find a local health center. Some Planned Parenthood health centers offer sliding-fee services and other programs to cover the cost of care for people who qualify financially.

There's no doubt that secondary amenorrhea is a complex issue with many possible causes and consequences. And, everyone woman's situation is different. If investigating the absence of your period is the next step for you, working with a women's health specialist could help you get the answers you need.

To your continuing good health,

Alice!

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