Episode 228: This week it's a solo episode looking at the many causes of irregular periods, anovulatory cycles and missing periods (hypothalamic amenorrhea).
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Chris Sandel: Welcome to Episode 228 of Real Health Radio. You can find the show notes and the links talked about as part of this episode at seven-health.com/228.
Just a note before we get started: I’m currently taking on new clients. I specialise in helping clients overcome eating disorders, disordered eating, chronic dieting, body dissatisfaction and negative body image, overexercise and exercise compulsion, and dealing with irregular cycles and cycles that have ceased altogether, which is the topic of today’s show.
If these are areas that you struggle with and would like to make a thing of the past, please get in contact. You can head over to seven-health.com/help, and there you can read about how I work with clients and apply for a free initial chat. The address, again, is seven-health.com/help, and I’ll include it in the show notes as well.
Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. I am a nutritionist that specialises in recovery from disordered eating and eating disorders and really helping anyone who has a messy relationship with food and body and exercise.
00:01:17
This week on the show, I am back with another solo episode, and this isn’t a completely new episode, but it is a second edition – one of the episodes where I redo a previous episode, like a second edition of a book. It is all about a woman’s cycle and looking at the many reasons that problems can occur. And when I say problems, I mean irregular cycles (cycles varying each month in their length or when they’re too short or they’re too long), or where cycles have ceased altogether. There can be many different reasons for ceased cycles, but the main focus in this area today will be hypothalamic amenorrhea, which is where periods stop, and this is connected to the hypothalamus, which is a part of the brain. Then there’s also anovulatory cycles, which is when you have a period but you haven’t ovulated.
The first version of this episode was Episode 22, which came out in February of 2016, so over 5 years ago – and 5 years is a long time. There’s a lot that isn’t changing with this one; I’d say most of the main points are staying the same. But in the last 5 years, I’ve updated my knowledge and furthered my understanding of research. I’ve also worked with many more clients over this time, and this clinical experience has led to more knowledge.
I’ve also released a lot of new podcasts and many articles as well, many of which are connected or relevant to this topic. I’ll be making reference to many links that will be added to the show notes, and this means this show, if you normally listen on a podcast app, is definitely one you want to reference the show notes with because there’s going to be so much information there. You can access that at seven-health.com/228.
At this stage, most the clients I work with have irregular periods, anovulatory cycles, or more often than not, no period at all. Sometimes this is the primary reason for someone working with me or for us working together. They haven’t had a period in 10 years and they’ve realised that this is not how they want things to be. It could be because they’re now wanting to conceive and have a child, or it could be they’ve started to understand the importance of a cycle outside of reproduction and that it’s a sign that their health isn’t where they want it to be, considering they aren’t getting a period. They have no desire at that point for a child, but they still want to get their period back.
A real-life example of this is one of my past clients, Lori. I interviewed her on the podcast; it’s Episode 160. I worked with her specifically for hypothalamic amenorrhea and to help her get her period back. This podcast came out back in April 2019, and I actually spoke to her recently and she now has a child. I’ll link to that episode in the show notes, but it’s a great example of someone recovering from HA (hypothalamic amenorrhea).
But in other instances, the lack of period is only one of a long list of symptoms that a client is dealing with, and the reason someone wants to work with me is more because of disordered eating or an eating disorder, and getting a period back is part of this process, but it’s just not their main goal.
A real-life example of this would be a past client of mine called Rachel. I chatted to her for Episode 126 of the podcast, and she had a long history of anorexia, and while her period was missing, this was just one of the reasons that she came to see me. Through her recovery, her period came back, amongst other improvements. I will link to that episode in the show notes too.
There are many reasons for issues with your cycle that I’m going to touch on. Most of these are interconnected. Some are kind of the same thing; I’m just going to talk about them from a different perspective. This list is by no means exhaustive. There are undoubtedly ideas that I will have missed out on, and also, I have biases based on the clients that I see and the reasons that are most affecting them. But if you are having issues with your cycle, I feel that the content in this episode is a really good starting point for both understanding how and why this is occurring and figuring out what may be driving it in your case.
I should also say that as part of this episode, I won’t be focusing on particular symptoms that are connected to your period, so things like headaches and acne and cramps, bloating, tender breasts, increased cravings, diarrhoea, constipation, trouble sleeping. But even though I’m not going to talk about these specifically, most of the reasons I’ll go through that cause irregular cycles or cycles that stop altogether or anovulatory cycles are also part of why these other symptoms are occurring.
This isn’t to say that if you are doing things right, your period and the week leading up to it are going to be completely symptom-free, but just that some symptoms or the intensity of some symptoms are being impacted upon because of the ideas I’m going to cover as part of today’s show.
00:06:30
I think it would be useful to define a couple of terms before we get started. To start with, if we’re going to talk about irregular cycles, let me define what a regular cycle is as a point of comparison. The textbook number that is often used is 28 days. A regular cycle is one that occurs every 28 days.
Cycle length can vary a lot more than this. A typical length of menstrual cycle for an adult who is not using any form of hormonal contraception is usually between 24 and 38 days. While some people have the same length of cycle every month, so it happens every 30 days every month or every 26 days every month, for others it will vary. One month it’s 27 days and the next it’s 29 days and then the next it’s 31 and the one after that is 28. Despite this variation, this would still be considered a regular cycle and a cycle that is a normal length.
Given that, what constitutes an irregular cycle? Irregularity can happen for three reasons. There’s month to month variation, there’s being too short, and there’s being too long. For variation, the official definition for irregular cycles is if they vary by more than 9 days (for example, if you have a cycle that’s 27 days one month and then 42 days the next). This more than 9 days is actually across a whole year, so it’s not 9 days compared to your last cycle, but looking at your longer cycle and your shorter cycle every year, and is the gap more than 9 days?
I also add that a person’s history is also relevant here. For example, if from age 20 to age 30 your cycle was consistently 28 to 30 days, but now it’s much less consistent (so one month it’s 25, the next month it’s 31, the next month it’s 26), then maybe this is worth investigating or thinking about simply because for a decade it was stable and now it’s not.
Irregular cycles can also be because they are too short. This would be less than 24 days, although I’ve seen some places that the cut-off would be less than 21 days. Again, someone’s history matters here. After adolescence, you may have always had a cycle that is 23 days, and this isn’t an issue; this is just your cycle length. So it’s not like these numbers are set in stone, but more of an indicator. Just like if someone’s cycle had been 32 days and it had been like that for 10 years, and then 6 months ago it changed and it’s now 25 days, this is still in the normal range, but given the previous history, it might be worth thinking about given that this change has occurred.
Irregular cycles can also be when cycles are too long, which are cycles that are over 38 days. I’ve also seen 35 days used as a cut-off, but again, this comes down to history, like I talked about with the variations with too short cycles and varying from month to month.
I should also add that these figures I’m using here are for adults, not adolescents. With adolescents, periods tend to be more varied and can be as short as 21 days or as long as 45 days and still be considered normal. Also, if you are an adult and you are perimenopausal, this is going to be one of the drivers for change and could be part of the reason why there is now variation.
So that is the definition for irregular cycles.
00:10:20
I also want to define hypothalamic amenorrhea because it is something that I talk about a lot with clients and I help clients with, but it may be a term that is new to you, so let me break it down.
Hypothalamic is referring to the hypothalamus. This is a part of the brain and is one of the major control centres. It secretes hormones that are connected to stress and thyroid and reproduction and blood pressure and growth and social behaviours, and it also impacts on body temperature and potentially memory function. I’ve actually done a whole blog post on the hypothalamus because it’s so amazing, so I’ll link to that in the show notes.
Then the word ‘amenorrhea’ means the cessation of menstruation. So together, hypothalamic amenorrhea means that the period has ceased, and the driver for this change is the hypothalamus.
Why does the hypothalamus do this? Well, that is what this podcast is largely about, and all the changes that make it more likely that the hypothalamus is going to impact on or shut down the period.
I’ve done a couple of interviews with Nicola Rinaldi all about hypothalamic amenorrhea, and I will link to those in the show notes. She’s written a book, No Period. Now What?, which a lot of clients find incredibly helpful and a lot of clients have found before they find me. Nicola is great, and both of those interviews are great.
00:11:54
The final definition is anovulatory cycles. An anovulatory cycle is where you have a period, but at the midpoint of the cycle there is no ovulation. Ovulation is the point in the cycle where the ovary releases the egg or the ovum. The first half of the cycle is all about increasing hormones that then lead to a peak that creates this ovulation, and at the same time the hormones are creating the uterine lining, and this continues all through the cycle. If conception doesn’t occur, then this uterine lining is shed, which is the period. But you can still have the uterine lining build up even if ovulation fails to occur, in which case the period still happen and the cycle is referred to as an anovulatory cycle.
I’ve done a whole episode on the female menstrual cycle, explaining how it works and all the various hormones connected to it and the timings of the different hormones. So rather than go through all that here, I’m simply going to direct you to Episode 165 of the show. I’ll link to it in the show notes. It’s definitely not a prerequisite for understanding this episode; it can just be additional information if you want to understand the hormones and the physiology side.
Those are the definitions that I wanted to cover before we got started.
00:13:13
Let’s start with the first reason for irregular periods or anovulatory cycles or hypothalamic amenorrhea, which is stress. When people hear the word ‘stress’, it can be common to think of things like not being able to pay the mortgage, the death of a friend or family member, being in an unhappy relationship. It’s normally big or obvious stresses that people think of, where it’s something acute that feels incredibly stressful or a chronic situation that feels inescapable and is creating this obvious turmoil.
But really, this is quite a narrow definition of stress. Stress is much more pervasive than just these big events. While these big events are incredibly difficult, it’s typically more of the ongoing stresses that most people don’t even identify as stress that chip away at health.
Let me define what I mean by stress and when I use the word ‘stress’. Stress is any physical, mental, or emotional factor that causes the body to make an adaption. The body is always trying to keep to a state of homeostasis, and a stressor is something that pushes the body out of the normal range and causes the body to make changes to bring it back to where it should be.
Stress is a normal part of life, and there is just no way it can be avoided, and we shouldn’t be trying to avoid stressors. We are regularly going in and out of times of the body’s stress response, and it can turn on and off. But for the body to be able to cope, it needs to receive the things that allow it to mediate this stress response so it can then make the adaption that is being asked for and these hormones can be turned off.
What is often happening is that stress isn’t even recognised, so it doesn’t get what it needs to mediate it, or there are 5 or 10 or 20 things that are creating this stress response, and they’re just not being responded to. When stress goes on too long or there are too many stressors, this is when it starts to really create a problem.
There is a concept known as triage theory, which was developed by Dr Bruce Ames. Triage theory looks at how certain functions of micronutrients (vitamins and minerals and fatty acids and amino acids) are restricted during shortage, and that short-term survival takes precedence over functions that are less essential.
For example, if you look at all of the known functions of vitamin K, you can break these down into a list of (1) functions that immediately keep us alive and (2) functions that lead to better health. If vitamin K is then restricted, all the functions that lead to better health are essentially shut off to prioritise all the functions that help keep us alive.
While triage theory is looking at this through the lens of specific micronutrients, the same is true for how our body thinks at the macro level. It has functions that are essential for life and other functions that are about long-term health. If we think about reproduction through the lens of triage theory, its importance is fairly low down. Your survival is not predicated on reproduction. The survival order within the body is safety and security, then sustenance (which is food), and then sex or procreation. Unless your body feels safe and secure, then your body puts a lot of its other jobs on hold.
And when I say safe and secure, I mean this physically, mentally, and emotionally. Its primary focus is to get you out of harm’s way, and it will put its efforts and resources into achieving this goal above all else. When your body is under stress, it pulls the blood away from your digestive system and your reproductive system. Historically, stress was about fight and flight. You were being chased by a lion or you were chasing a lion, and the mechanisms for stress are still based on how we evolved over millions of years.
So if someone is working long hours and they’re not getting enough sleep, they’re having long gaps between their meals, they’re not eating enough and they’re spending what limited free time they have doing exercise – all of which are stresses on the body – the body is going to be spending its focus on survival and getting the body out of harm’s way rather than on libido and procreation and all the hormones that are important as part of reproduction.
When this happens, cycles are likely to become irregular. You’re more likely to have anovulatory cycles or periods will stop altogether.
Another way of looking at this is that stress is really about energy regulation. Whenever there is a stress, whatever that stress may be, the way the body wants to deal with this is to bring energy to the situation. So if you go too long between meals, your body turns on stress hormones to bring energy to your cells and fix the problem. But the same happens if you are running away from a lion, you realise you sent an email that you shouldn’t, you see some guys approaching you on a dark street – all of these create the same stress response within the body that leads to, amongst other things, stress hormones rising so they can bring energy to your cells.
One of the easiest ways of doing this is to divert energy that is being used for long-term health and instead only focus on the things that are going to get you out of harm’s way right now. As I said, reproduction is not high on the list of priorities when you are running from a real or proverbial lion, so it halts or severely minimises the energy that is going to this system and prioritises survival.
This also makes sense when you think about sex and procreation, not just the hormone cycle. The act of sex uses up calories, but really, the real energy drain comes if you actually get pregnant. The average pregnancy costs the body approximately 50,000 calories, and breastfeeding costs about 500 to 1,000 calories a day. Your body knows about these requirements, and it avoids or minimises giving you the opportunity of becoming pregnant if it knows there’s not enough energy to start with.
Even just having a period increases the energy demands of the body. Across a cycle, your basal metabolic rate will actually increase, and fairly significantly. You can be needing an extra 500 calories a day just before your period compared to the early part of the cycle – which means cravings before a period make sense, because most people aren’t aware of this fact and aren’t adjusting their eating accordingly.
So reproduction, whether we’re talking about having a period all the way through to childbirth and breastfeeding, are costly from an energy standpoint for the body.
But I should add that the body is incredibly resilient. We managed to reproduce thousands and thousands of years ago and over millennia when life was a lot less secure than it is now. So despite the fact that stress can affect reproduction, it is amazing how hardy the body really can be.
I want to share an excerpt from the book Why Zebras Don’t Get Ulcers by Robert Sapolsky. It is one of my favourite books of all time, and is one of my go-to sources for all things stress.
‘There were studies of women in Nazi concentration camps conducted by Nazi doctors. In a study of women in the Theresienstadt concentration camp [I really cannot pronounce the name of the camp], 54% of the reproductive age women were found to have stopped menstruating.
‘This is hardly surprising; starvation, slave labour, and unspeakable psychological terror are going to disrupt reproduction. But of the women who stopped menstruating, the majority stopped within the first month in the camps, before starvation and labour had pushed fat levels down to the decisive point. Many researchers cite this as a demonstration of how disruptive even psychological stress can be on reproduction.
‘But the surprising fact is really the opposite. Despite starvation, exhausting labour, and the daily terror that each day could be the last, only 54% of these women ceased menstruation. Reproductive mechanisms were still working in nearly half the women. Undoubtedly, certain numbers of these would probably be having anovulatory cycles, where they were menstruating without ovulating, but still, that reproductive physiology still operated in an individual to any extent under these circumstances is absolutely extraordinary’.
Stress in all of its forms is really the first reason for issues with your cycle. Stress in one form or another is going to be linked to all the other reasons for cycle problems that I’m going to go through, and that is because stress, when it’s not correctly mediated, is really the inability to meet the demands of the body. When this happens, certain functions are turned off and other functions are turned down, with survival being the focus of the body.
But rather than me just oversimplifying things and saying it’s all stress, I’m going to cover all the different reasons that can be creating problems with a woman’s cycle.
00:22:57
The next potential cause for irregular periods or anovulatory cycles or missing periods is RED-S, which is the acronym for relative energy deficiency in sport. When I recorded the first version of this podcast, I didn’t refer to this as RED-S; I called it the female athlete triad.
The female athlete triad is a group of three symptoms that are commonly seen in female athletes, and they are: (1) eating disorders such as anorexia and/or bulimia or severe to moderate calorie restriction, and this can be both intentional or unintentional; (2) amenorrhea, which is lack of mensuration, or oligomenorrhea, which is irregular periods; and (3) osteoporosis or osteopenia, and this is the thinning of the bones or low bone mineral density.
The female athlete triad was a term that came into use back in 1992, and there was much debate about the components of it and how they were interconnected. It was then in 2005 that the International Olympic Committee (IOC) put out a consensus statement giving the condition more exposure. But after 2005, as research continued and as the IOC did more research, they noticed that there were a couple of issues with the name.
Firstly, at its core, the condition is about energy deficiency. There isn’t enough energy to match up to someone’s sporting activities, but their living, plus growth and repair, just being a human being. This would affect all people rather than just females. But secondly, this was more than just about bones and menstruation. The deficiency was also having an impact on metabolic rate, immunity, cardiovascular health, hormones, blood health, growth and development, psychological health, digestion – basically every system in the body is impacted on when there isn’t enough energy coming in.
Based on this increased understanding, the IOC released a consensus statement in 2014 updating the term ‘female athlete triad’ to ‘relative energy deficiency in sport’ (or RED-S). I’ve actually done a whole episode on RED-S when I interviewed Charlotte Gibbs. It’s Episode 160. I’ll put a link to it in the show notes.
I want to look at energy deficiency, as this is a huge driver for irregular cycles, anovulatory cycles, and hypothalamic amenorrhea. This can be part of RED-S or it can be low energy where it’s not connected to exercise or movement.
Insufficient eating or undereating is incredibly common for the clients that I see, and when not enough is coming in, the body has to turn on more stress hormones and focus on safety and security instead of procreation. Not enough food equals the body diverting resources from reproduction, and this can lead to periods ceasing or anovulatory cycles or irregularity or just lots of symptoms during and leading up to your period.
This insufficient eating can be intentional, with someone going on a diet or with an eating disorder, the goal being to lose weight or to maintain a certain weight, or because they are trapped in an eating disorder. While the intent isn’t to impact on the cycle per se, the intention is to restrict their eating in some way.
But it can also be unintentional, with someone simply trying to be healthy. They are following things that they’ve read, they’re eating lots of salads or raw vegetables or steamed vegetables, they’re doing lots of juicing, they go to the farmer’s market or shop at the local health food shop, maybe they’re vegetarian or pescatarian or eat plant-based. Maybe they signed up to My Fitness Pal and it told them a specific calorie amount to be eating and they’re doing this. They don’t think that they are undereating, and they’re not really trying to; it’s just that the food they consume is mostly low calorie food, or the calories they’re aiming for are lower than what they really need.
Given the world that we live in, this unintentional restriction is actually really common. I’ve worked with many clients who genuinely thought that what they were doing was healthy and this was the goal of them eating this way. And I’m not even talking about orthorexia here, where it turned into an eating disorder, but simply they were misinformed and thought that what they were doing was supporting their body.
Often, this has been nutrition students who were clients and fall into this category, or people who over the last couple of years became interested in food and health and had started making changes based on what they had read in some book or some blog. To start with, it felt like it worked out really well, but after a while they started noticing that problems were occurring, and they were confused as to why.
Confusion really is at the heart of insufficient eating, whether someone is intentionally restricting or unintentionally restricting. Most people I work with have this warped sense of what the body needs, and the reality is it’s really much higher than what they believe. I’ve done a whole separate podcast on restriction that I’ll link to in the show notes because if you haven’t listened to it, I would highly recommend that you do. I’ve also done a video before walking through a calorie calculator that I sometimes use with clients that estimates what they need. As part of the video, there are caveats with it, but typically people are pretty surprised by how much it’s estimating they really need.
I’d also recommend checking out my recent episode on the Minnesota Starvation Experiment, as this looks at how undereating affects the body. While all the participants in the study were men, there were changes in their reproductive health that is the equivalent of irregular cycles and anovulatory cycles or cycles stopping altogether.
Something I also want to mention when thinking about insufficient energy is that timing also matters. The idea here comes from a great paper that I’ll link to in the show notes called ‘Within-day energy deficiency and reproductive function in female endurance athletes’. Throughout a day, we will eat at certain times. You eat a meal, and this meal will provide you with energy. It puts you into a positive energy balance. Then over the next hour or hours, the energy from that meal is used, and at some point the energy runs out.
At this point, we go into negative energy balance and we have to use energy from the body. During short periods, this will be energy coming from glycogen, which is how carbohydrates are stored in the body. Once glycogen is depleted, it comes from breaking down fat and muscle, and this is known as catabolism.
What the paper found was that the more time that someone experiences negative energy balance during the day, the higher the likelihood their periods would cease. According to this paper, the decisive point seemed to be where there is negative energy balance of 300 calories or greater and that continuing on for many hours.
Even if there are two people who eat the exact same amount of calories across a day, how it’s structured over that 24-hour period makes a huge difference with how many hours they’re going to spend in that negative energy balance, and especially that negative energy balance that’s more than 300 calories. So if you are exercising in a fasted state in the morning and/or not eating much in the first half of the day, this extended amount of time and negative energy balance, especially considering that you will enter into that state during the night-time, is much more likely to cause a problem.
I know it’s also popular to have reduced eating windows these days because of intermittent fasting, but again, this could lead to increased negative balance and make irregular cycles or anovulatory cycles or cycles ceasing altogether much more likely. This is especially the case if total calorie intake is also lower than what is needed.
Nicola Rinaldi did a great job explaining this paper in detail in a post on her ‘No Period. Now What?’ blog, so I will link to that article in the show notes.
00:31:54
There is undereating in a general sense, as I’ve been talking about, but then there’s also undereating because of specific macros. Macros is short for macronutrients and refers to carbohydrates and proteins and fats. With undereating them, it would be when you’re keeping one of them low.
In the world of dieting, one of these macros is normally demonised, and this typically follows a cyclical pattern. Things come in and out of fashion. You go back to the 1910s and 1920s, protein was the enemy. We were told that we need to keep this low if we want to remain healthy. This was when the Kellogg’s cereal company started up, and it was partly in response to this fear around protein. More recently, in the 1980s and 1990s, fat became the enemy, and fat-free products became the rage. Everyone was trying to keep fat low.
Then from the 2000s onwards, carbs have now become the enemy. The popularity of Atkins really kicked this off, and then other low-carb diets started up. Paleo became a big thing, and then in more recent years, keto took over where paleo left off. Then if you really want to take it up a notch, you could go down the carnivore route, where all you eat is meat.
Vegetarianism and being plant-based has now become much more of a thing, and while this isn’t so much about a particular macro per se, it is a shift away from animal products, which are naturally higher in protein or could be naturally higher in fat. So while being plant-based isn’t necessarily about low protein or low fat, this can be what happens.
Give it another 5 years and things will change again, and something else will be made out as the villain. Honestly, none of the macronutrients are inherently bad. None of them singlehandedly cause poor health. All of them can cause problems when they are in too high or too low amounts, but that’s just like basically everything else in life.
What I want to do is look at how having low amount of each of these macros can create a problem with your cycle and getting your period. And let me just say that none of this stuff is set in stone. There are people who could eat a low-fat diet or a low-carb diet and have no problems with their cycle. If this is true in either case, then great. But what I typically find is that when any of the macronutrients goes too low, problems do arise.
Most of the time, this is because total calories are also too low, so it’s total calories are too low plus there is then a specific macro that is being reduced. But even when calories are where they should be, if a specific macro is too low, problems can occur.
Let me start with carbohydrates or carbs. They are your body’s preferred energy source. This is energy so that you can think and run, but also energy to run all of your various systems. Keeping carbohydrates too low means that your body has to use fat and protein as an energy source, and to convert fat and protein into energy in decent amounts is actually part of the stress response within the body and is an adaptive mechanism.
When you are doing this continually, it means the body is in a constant state of low-grade stress, and as we talked about earlier, you want to be doing things that are shutting off the stress response, not perpetuating it. Otherwise, it can hamper your ability to have cycles and to ovulate.
Carbohydrates are also important for liver function, and the liver and detoxification are a huge impact and hugely important for hormones. Your liver breaks down most of the reproductive hormones, so it’s important for regulating your hormones at different points in your cycle. If you aren’t taking in adequate carbohydrates, then the liver doesn’t have the sufficient energy to be able to do this.
For clients I see, carbs are definitely the macro that is most often being reduced to way too low an amount, and that’s just because since the early 2000s, it has been the main villain and what we’ve been most warned about. While low-carb diets are the craze and have been the craze for a while, for most they aren’t very good from a reproductive perspective.
I’ve actually done a whole podcast episode on understanding carbohydrates. It’s Episode 156. I did an addendum episode based on feedback I received from that show, and the addendum episode is Episode 159. I’ll link to both of these in the show notes, but if you really want to understand the functions and the importance of carbohydrates, then check out these episodes.
The next macronutrient is protein. Of all the women I see with problems with their periods, a large percentage of them have been past or are current vegans or vegetarians. Even when this isn’t the case, regularly people who are suffering with period issues are eating a low-protein diet, and often unintentionally.
I would say this has changed somewhat over the years because of how protein is praised and held up as the macro you really want to be consuming, but even still, unintentional undereating of protein does happen fairly regularly.
When protein is eaten, it is broken down into amino acids, and these amino acids are used for every system, organ, and transaction within the body. Basically, everything in the body is protein or amino acid dependent. When protein is in too low an amount, it can have a far-reaching impact.
There are two things I want to focus on here in relation to protein and reproduction. The first is that protein is one of the raw materials that are used to create hormones. If you’re not taking in enough protein, there’s often not enough of this to create the hormones in the first place. Then the second relates to detoxification and liver function. When your liver is detoxifying, it needs a number of substances for this to happen, and one of the most important of these is protein, or specific amino acids. When it doesn’t have these, the hormone levels can be impacted upon, and the liver isn’t able to perform its regulatory functions.
So if you’re eating a low-protein diet – and often, as I said, this is unintentional – it can have an impact on your cycles.
The final macro is fat. Fat is probably the macro that has been most maligned of all. As I say, carbs have taken quite a bashing for the last two decades, but it doesn’t really compare to what happened with fat for so many decades. Fat really is crucial for your cycle because it’s important for hormone production. I mentioned that protein is part of the raw materials that hormones are made from, and fat are the same. With too low fat, there’s just not enough of the basic building blocks to make hormones.
Fats are also used to regulate sex hormones. They’re needed for the production of hormone-like substances that help with hormone amounts and hormone signalling. Fats are also needed for the absorption and utilisation of the fat soluble vitamins – vitamins A, D, K, and E – and these vitamins are incredibly important for reproduction.
Just like carbs and protein, a low-fat diet can have a negative effect on your cycle. The way to repair this is to increase the intake of whatever macronutrient is needed.
00:39:42
The next potential driver for irregular cycles or anovulatory cycles or hypothalamic amenorrhea is eating a low nutrient diet. With nutrients here, I’m referring to vitamins and minerals.
This can be occurring in two ways. One is that because of all the restriction and the cutting out of whole food groups and the low numbers of calories, there simply isn’t enough coming in. So even if someone is really trying to eat lots of ‘healthy’ food, because of the quantities, it’s just not providing enough of the nutrients and the vitamins and minerals for what the body needs.
The second option is that someone isn’t restricting and they are eating enough calories, but because of food choices, there are certain vitamins and minerals that are in too low amounts.
With the clients I see, it’s most always the first option, which can feel strange because for so many clients, they are trying to focus on health and they are trying to eat nutrient-dense foods. But it’s just often not in high quantity enough, or they’re eating foods in a form that is difficult to digest. Even if on paper the food is nutrient-rich, they’re just not able to digest it well, and they’re not getting the nutrients out of it.
Typically when working with clients, I’m not actually thinking about vitamins and minerals so much, because I know that if we focus on the foods and getting in enough, this will naturally take care of itself. For most clients, the bigger concern is the under-fuelling of calories, not so much the missing vitamins and minerals.
And really, all vitamins and minerals are important for reproductive health. This could be either directly, by impacting on hormone production and supporting ovulation, or could be more indirectly, by supporting energy production or increasing stress tolerance, which then allows for healthy reproduction to occur. So rather than go through each nutrient and talk about all their supporting functions with reproduction, just know that having a diet that is low in nutrients could be impacting on your cycle.
00:41:54
The next area I want to mention is exercise. This can be in the context of RED-S, even if the term ‘relative energy deficiency in sport’ doesn’t feel appropriate. I think one of the stumbling blocks with RED-S is the narrow belief about who it can affect. It has the word ‘sport’ in the title; the previous term that it replaced, which was the female athlete triad, had the word ‘athlete’ in its title. The name RED-S was coined by the International Olympic Committee (IOC). All of this can make it feel like it’s something that only affects real athletes, like people who are doing this chosen sport for their living.
But this just isn’t true. RED-S can affect anyone who is training where this training is not being met with sufficient calories to match up with the demands being placed on the body and sufficient rest time. While I do think RED-S is rampant in professional sport, it’s equally a problem for those who wouldn’t even use the word ‘athlete’ to describe themselves.
If you think, ‘Well, I’m only running three times a week’ or ‘I do rock climbing, but it’s more of a hobby, so this couldn’t possibly be an issue’, I would say think again. I don’t specifically work with professional athletes; over the years, I have worked with some, but most of my clients are not. But they’re still having their periods impacted upon by the exercise they’re doing.
Everything in physiology follows the rule that too much can be just as bad as too little. In practice, I see lots of women who are exercising in excessive amounts or at least in excessive amounts in comparison to how much they are eating. Exercise is a stress on the body, and as I said earlier, this doesn’t make it bad or inherently bad, but if you’re not eating enough to meet the demands of those extra calories and you keep this up consistently, this is going to have an impact.
I would say it’s worth expanding on the word ‘exercise’ here to not just mean time spent in the gym, but really movement in general. It could be someone who has a physical job. Where I live in the country, there are lots of horse yards. If someone is spending their days working at this yard, mucking out stables, pushing wheelbarrows, getting hay bales, working the field, this is a lot of work, especially in the wintertime. Same thing if someone’s a landscape gardener.
It could also be someone who is doing no other movement than walking, but they are walking for long periods of the day, or even if on paper it doesn’t feel like they’re walking for that long, it’s enough of a drain because of the level of intake that is coming in compared to what the body truly needs.
We live in this world where we have this misguided understanding of what it means to be fit and what it means to be healthy. Society praises physical endurance. It really lusts after strength and muscle, and every aspect of what makes RED-S the most likely outcome is really just coveted instead of discouraged. And this is in the regular world. This isn’t even in the professional sports world.
As I said, I think this is much more rampant in professional sport, and I talk about this in the RED-S episode that I did with Charlotte Gibbs that I referenced earlier. But for everyday folk, this is still a problem.
As part of my year-end roundup podcast that I did for last year, the one that looks at my favourite books for 2020 and my favourite documentaries, etc., I referenced a book called Little Girls in Pretty Boxes: The Making and Breaking of Elite Gymnasts and Figure Skaters. It was all about the injuries and eating disorders and abuse and mental health breakdowns that these athletes face. While it was published back in the mid-’90s, it felt like so little has changed.
While I think exercise and fitness is put up on this pedestal, I do think we misunderstand the impact this can have on the body when insufficient calories are coming in to match up to the exercise. I’ve done a whole podcast on exercise and fitness, and it’s Episode 90 of the podcast. If you want to know more about this, then check it out. I’ll put it in the show notes. But overexercise is definitely another reason for irregular periods and anovulatory cycles and hypothalamic amenorrhea.
00:46:32
The next potential reason is to do with body weight. In the original version of this episode, I talked about being at a low body weight or a low fat percentage, but I actually want to correct this. What is low is a relative thing. You could have two people at the exact same BMI or body fat percentage, and for one person this is achieved normally and naturally, while for the other person they are only at this weight because of dieting and restriction and overtraining.
Periods can be impacted upon because of weight whether someone is at a BMI of 18 or 28 or 38 if that weight is below where the body naturally wants to be. Someone can have natural, normal, and regular cycles at all of those weights if that’s also where the body naturally wants to be.
The reason for the period issues isn’t the weight; it’s just the insufficient energy. If someone is at a very low body fat percentage or they are at a very low BMI, it’s more likely that they’re going to have issues, but it’s more likely they’re going to have issues because it’s more likely that their body doesn’t naturally want to be there, but it’s there because it’s been restricted to get there – which means that intentional weight loss is likely to result in issues with your cycles, irrespective of whether you believe that weight loss is healthy.
For many clients, losing weight was the thing that triggered issues with their cycles, and that’s irrespective of how low their weight actually got down to. When the restriction then ends and the weight returns, their cycles improve. It’s not always quick and smooth, but it does happen dependably so.
I really wish more people knew this, and by people, I also mean GPs and gynaecologists. I’ve lost count of the number of times that clients have struggled for years and years or decades, but when they go and speak to the people who are experts in this, they are told that they don’t know why this is happening, and they’re encouraged to keep up the exercise they’re doing because it’s obviously healthy. They’re told that they obviously must be a healthy eater, and they’re told that it can’t be because of their weight because they aren’t too low a weight. They aren’t visibly emaciated and matching up to the stereotypical view of what an eating disorder looks like.
When we then work together and their cycles improve if they’ve been irregular cycles, or they return if they’ve been missing, and this comes about because of the increased food intake and reduced exercise and their weight increasing, they become angry, and rightfully so. They were told for years or decades that what they were doing was healthy and they were being encouraged by their GP or their gynaecologist to do the exact thing that was causing the problem.
So just because you think your weight is not that low or it isn’t too low or that you aren’t exercising that much and that it can’t be having an impact, I would say that it can be, and it often is. I’ve done a whole episode on weight set point that looks at how the body regulates weight, so I’ll link to that in the show notes as well because it explains why there is diversity in terms of size, and that just because you believe you can and you should be a specific weight, your body can think very differently to this.
00:50:10
Somewhat connected to this idea of suppressed body weight is the concept of cognitive dietary restraint, which is another potential reason for issues with your cycle.
Cognitive dietary restraint is defined as the perceived ongoing effort to limit dietary intake to manage body weight. This is the mental energy to cut calories or to cut carbs or to avoid certain foods with the intention of modulating weight. This typically would be to lose weight, but also could be to maintain a specific weight.
This could simply be seen as dieting, that cognitive dietary restraint is what happens when someone goes on a diet, but the key thing to understand with cognitive dietary restraint is it’s about the mental process, not what is actually happening in reality. Someone could be following a strict diet and be experiencing cognitive dietary restraint, or they could be not following a diet but simply thinking about body weight and that they should be restricting, and that they feel like they’re failing, and this is also cognitive dietary restraint.
This means that it’s separate in its actions to the changes that happen in the body because of actual reduced calories. Often they go hand in hand, but they can be separated.
This is why it’s important, because the consequences of dieting or restriction don’t only occur because of the malnutrition, or when a certain level of weight is lost. Irrespective of weight, the mental and emotional impact of cognitive dietary restraint has an impact on health. I’ve actually done two podcast episodes on cognitive dietary restraint, looking at the various experiments and research papers and how it affects a multitude of functions in the body. I’ll link to those in the show notes.
In the first of these episodes that I did on cognitive dietary restraint, I actually go through a paper that looks at ovulation and bone health and cortisol levels and how these are affected by cognitive dietary restraint. What the study found was that in otherwise healthy premenopausal women, the higher the cognitive dietary restraint, the more likely they were to have subclinical issues with their cycle. These issues would include having anovulatory cycles (so getting a period but not ovulating), or it could be having a short second half of the cycle, which the research has classified as less than 10 days. The participants in this situation then did ovulate, but they had a shorter second half of the cycle, and this is often referred to as luteal phase defect, as the second half of the cycle is known as the luteal phase.
Combined with this, when someone had a higher incidence of the subclinical ovulatory disturbances, over the space of two years their bone mineral density became less positive. The reason for this is that reproductive hormones like oestrogen and progesterone aren’t just about reproduction. They have many functions within the body, and one of those is to do with bone health. When hormone levels are lower than they should be, bone mineral density is affected.
I go through the paper and other papers in much more detail in those two episodes on cognitive dietary restraint, but I wanted to simply mention it here and demonstrate here how it can have an impact on your cycle.
00:53:45
In the original version of this episode, I mentioned that being heavier or overweight could also be a potential reason for irregular cycles. I did say that I often thought it was more likely correlated than causative, but I do want to clarify things here.
Weight and health are not the same thing. While there can be some overlap between them, health is incredibly complex. You can have people who are healthy and people who are unhealthy all along the weight spectrum. While being at a higher weight is often correlated with worse health outcomes, this doesn’t mean that the weight is causing the problem.
When we actually look at studies and control for certain factors like socioeconomics, level of physical activity, smoking, alcohol consumption, fruit and vegetable intake, then weight stops being much of a factor.
The added wrinkle here is that we aren’t very good at getting people to lose weight and keep it off. We can in the short term, but once we pan out to five years, it is only the tiniest fraction of people who have actually kept the weight off. A much bigger percentage of these people are now heavier than if they’d never dieted in the first place.
I’ve also done a podcast all about weight stigma, which actually explains a lot of the reasons for why higher weight causes problems. It’s not the weight itself; it is the stigma. I’ve also interviewed Jeffrey Hunger, who is a researcher who’s done a huge amount of work in this area of weight stigma. I’ll link to both of those in the show notes.
Given this, my focus is weight neutral and not weight focused. If someone makes healthy changes and this naturally leads to weight loss, then this is totally fine. I’m not saying that this is bad or they have to put the weight back on. If it’s natural and spontaneous, then this is what the body wanted to do. But if weight doesn’t change, this is also fine. There’ll be improvements because of the healthful behaviours that they are doing, even if weight doesn’t change – or even if weight goes up. If they’re truly supporting their body, then this is where the body wants to be.
While last time I said higher weight could be an issue, I would now say that it’s much more likely to be a symptom and not the cause.
00:56:05
Hormone production is the next thing that I want to talk about. This is really connected to everything I’ve already been going through with stress and undereating and overexercising and the body sitting at a lower weight than it wants to be, but I think it can be helpful just to understand hormone production in the body, specifically reproductive hormone or steroid hormone production and how this could impact on your cycles.
Typically when talking about this stuff, a visual aid is helpful, where you can look at the actual hormone flowchart that I’m talking about. But being a podcast, I don’t have one of those, so I’ll just do my best to explain things and hopefully you can visualise what I’m describing.
For hormone production, there are different steps. We start at the top with our raw material, and from this raw material we create a hormone. From this hormone, further hormones are then produced, and certain hormones are useful in their own right, but they’re also useful as a raw material or precursor that a further hormone is then produced from.
As I said, I want you to think about this as a flowchart where at the top there’s a raw material, and then the different hormones are created in a sequence of steps. At the top of the flowchart, you have cholesterol. I know most people consider cholesterol to be this big, bad thing that causes heart attacks and cardiovascular disease, but it’s actually really important, and your body uses cholesterol to make all of your steroid hormones, including your sex hormones. The majority of cholesterol is made in the body, in the liver, as opposed to coming in from the diet. But dietary amounts do matter.
When I said that your body uses protein and fat to make different hormones, it’s to create this first step, to create the cholesterol. So with irregular cycles or anovulatory cycles or hypothalamic amenorrhea, low cholesterol could be the problem, meaning that there isn’t enough of the raw material for the step. This can happen alongside low triglycerides, which is low fats.
The next step down the flowchart is that cholesterol is then converted into a hormone called pregnanolone. Pregnenolone is the mother hormone that all of the rest of the steroid hormones are made from and all the rest of them flow from. This means it’s really important that the body is able to make that conversion from cholesterol to pregnanolone. For some people, this is where the problem lies. If the body is not producing enough pregnanolone, then there’s not going to be enough to produce the sex hormones, and subsequently you get problems with your cycle.
To make the conversion from cholesterol to pregnanolone, proper thyroid function is required, and specifically thyroid hormone T3. The thyroid is your master gland that controls metabolism. It sits in the neck around the Adam’s apple, and if it’s not working properly, then the conversion can be reduced. Interestingly, if you look back at historical medical textbooks, testing cholesterol was originally used to test for thyroid issues well before it was used to test for cardiovascular disease. If someone had high cholesterol, a low functioning thyroid was suspected.
Apart from T3, you need adequate amounts of vitamin A and copper to make the conversion from cholesterol to pregnanolone. If this isn’t happening, then there’s not going to be enough of the raw materials to make the sex hormones. If this is the case, you can have high amounts of cholesterol or normal amounts of cholesterol, but you’ll just have lower amounts of pregnanolone.
From pregnanolone, hormones can then go in a couple of different directions. It can go one way to progesterone or the other way to DHEA. If it goes in the direction of progesterone, this then can be further converted into stress hormones like cortisol and cortisone, and if it goes the other way to create DHEA, from DHEA the body then converts this into reproductive hormones like oestrogen and testosterone and other hormones.
In an ideal world, people would be producing the right amounts of these various hormones from the pregnanolone. But if you’re in a situation where there is chronic stress, that stress, in all of its various guises, impacts on hormone production. As I said earlier, survival is paramount in comparison to our need to procreate, and this means that when you create the pregnanolone, it then gets shuttled off to be converted into progesterone and then immediately converted into cortisol and cortisone, which are part of the body’s stress response, leaving then limited amounts available for reproductive health and the reproductive system.
Lower amounts of progesterone and oestrogen are then produced, and these are hormones that are crucial to regular and healthy cycles. So basically, managing stress takes precedence over everything else, and this is what happens at the hormone level.
Hopefully this description of hormones was easy enough to follow, and you can see how at the different stages along the process, when problems arise, it can have a knock-on effect on the cycle.
01:01:38
Medications is the next cause for problems with a cycle. Medications like antidepressants and antipsychotics and anti-inflammatory drugs can disrupt your cycle and cause you to have much longer or much shorter cycles. Many of these drugs elevate prolactin, which is a hormone that can block a number of other important reproductive hormones.
These drugs can also be an added burden to the liver, which can also be part of the problem. As I mentioned earlier in the section on macros, the liver is incredibly important for hormone regulation. If it’s not able to keep up with this, then certain functions can start to go awry.
Let me just clarify here: (A) I’m not a doctor, and (B) I’m not for one minute saying you need to come off these medications. Please be really clear about that. All I’m saying is that if you are on these medications and you’re having problems with your cycle, they could be partly responsible for this.
01:02:31
The next variable that can affect cycles is alcohol. Alcohol, even in quantities that doesn’t cause damage to your liver or to other organs, can cause irregular cycles. There is no magic amount with this, like if you cross it you’re going to start seeing the problems. The amount will differ from person to person. But if you are having problems with your cycle and you do consume alcohol regularly or maybe less regularly but when you do, it’s in high quantities, it could be something that is impacting on your cycle.
Smoking would be the next factor. Smoking depletes certain vitamins and minerals as well as increases the body’s need for certain vitamins and minerals. These include B vitamins, particularly B5, B6, B9, B12, and also vitamin C and vitamin E and selenium and magnesium. Lots of these are also needed for healthy reproduction. If these are used up or being depleted, there’s going to be less around for these important functions.
Because of this, smokers have a greater chance of anovulatory cycles and shorter cycles with a shorter follicular or first half of the cycle. There’s also an increased risk of anovulation with shorter luteal phase (shorter second half of the cycle). While this could make it sound like smoking is always going to lead to shorter cycles, if someone isn’t ovulating, there can be longer cycles or more irregular cycles. For example, you could have a shorter half of the cycle, but the second half could be much longer or vice versa.
There is a paper called ‘Smoking and infertility’ put out by the Practice Committee of the American Society of Reproductive Medicine, which I will link to in the show notes. This goes through all the impacts that smoking can have on reproduction.
Obviously, the amount of smoking makes a difference. Someone smoking one or two cigarettes a day is going to have a very different impact than someone smoking 20 or 30 a day. But if you are a smoker and you’re having problems with your cycle, it could be a contributing factor.
Vaping has obviously become much more commonplace in the last decade, but much of the research on this is in its infancy, and it isn’t anywhere near the same level of research as with cigarettes. So at this stage, I can’t point to any research with how vaping affects cycles. I did a search and the only things I could come up with were things in rodents, and I didn’t think that was good enough at this stage. So at this stage, I don’t have any papers to share around vaping, but my hunch would be it’s probably going to have some level of impact.
01:05:20
The next potential factor in causing irregular cycles or anovulatory cycles or hypothalamic amenorrhea is insufficient sleep. I think sleep is probably the most undervalued health behaviour people can do, or even when someone starts to appreciate the importance of sleep, they still struggle to get the required amount. This could be that they just underestimate how much they really need, thinking ‘Oh, I’ll be fine with 6 hours’ when they really need something more like 8 hours.
Sleep is all about repair. It’s when you are most active in turning over the cells of bone and muscle and organs and tissues and replacing them with new cells. Our bodies are constantly in a state of catabolism and anabolism, and sleep is when this is most important for this to happen.
Sleep is also the body’s clean-up time; throughout the day, during many normal, healthy functions, substances are created that are damaging for the body. But by sleeping, the body sends in the metaphorical clean-up crew and the bin lorries to remove all of these substances.
Sleep is also incredibly important for the mind. It’s how you process the mental and emotional events of the day and refresh your mind for the day ahead. It helps with your brain piecing together unrelated ideas and memories and creating connections that increase creativity and enhance performance and learning and memory, and also in terms of your ability to handle psychological stress and your stress tolerance.
In terms of this podcast being all about cycles, how does sleep affect it? Sleep can negatively impact on a wide range of hormones connected to reproduction – progesterone, oestrogen, luteinising hormone, follicle-stimulating hormone, and testosterone. It can impact on leptin, which is often thought of as a hunger hormone, but it also has a role to play in ovulation. If inadequate sleep is occurring, this can then be impacting on your cycle.
Often, issues with sleep are directly connected to many of the issues that I’ve already been mentioning – undereating and overtraining and being at a lower body weight than your body wants to be. These interfere with sleep, and mostly because sleep is a time when you’re using calories and you’re doing the repair work. If not enough is coming in, then sleep can be impacted.
But sometimes it is for separate reasons to this and it’s more a matter of habit. Someone is used to going to bed at a late time or they’re staring at a screen right up to the point of going to bed and this is interfering with sleep. I’ve actually done two podcasts on sleep with a real deep dive into why sleep is important, the various processes that happen as part of sleep, and all the ways you can improve your sleep quality and quantity. I’ll link to both of those in the show notes.
Connected to this same idea with inadequate sleep is night shift work, which is another driver for issues with your cycle. While we have the ability to have 24-hour life and stay up all night, this is not how we evolved. Our body follows a circadian rhythm, which is the 24-hour cycle from when hormones are naturally high and naturally low and certain functions are turned off and on depending on the time of day. This circadian rhythm is based on, or at least largely impacted upon by the light and dark cycles. Unfortunately, shift work starts to disrupt the circadian rhythm.
A study of 119,000 women found that those working evenings and nights had a 33% higher risk of menstrual problems such as irregular periods and fluctuations in how long they lasted. The more your work schedule fluctuates, the more likely you are to experience problematic periods. One study found that women who worked rotating shifts were 23% more likely to have very short cycles, less than 21 days, or very long cycles, 40 days or more.
Something like shift work may not be the easiest for someone to change. If you are a nurse, if you’re a flight attendant, it’s not easy to just stop working shifts without having to leave your job. What I would say is that it is rare that any one of these causes creates problems with your cycle singlehandedly. If you’re working shifts, it will mean that you’re starting from a more difficult place, and you may have to do more on top of these things than someone else, but there’s no reason that this isn’t achievable. If you are a shift worker, I don’t want you to immediately think, ‘Oh gosh, I need to leave my job’. But I do want to say it is likely going to be having some level of impact.
I would also add that some of it is the shift work and some of it is just other things that occur because of the shift work. Someone who’s doing shift work may be getting less sleep. Someone who’s doing shift work may have longer periods between their meals, or they may eat in a more erratic way because of the demands of their job. I’m just speculating here; I’m not saying that this is the case, but it could be affecting other areas of a person’s life, and it’s not just because of the circadian rhythm piece.
01:10:50
Specific illnesses are the next thing that could be having an impact on your cycle. This could be things like polycystic ovary syndrome, endometriosis, fibroids, a thyroid condition, uncontrolled diabetes, advanced liver disease, and many different sexually transmitted diseases.
Or there may be something wrong with a particular gland in the body – the pituitary gland, which is located in the brain and produces a number of hormones like luteinising hormone and follicle-stimulating hormone and prolactin. All of these are reproductive hormones. If there’s something wrong with this organ, you may be producing either deficient or excessive amounts of these specific hormones, and this can then impact on your cycle.
All of these different illnesses or issues have different symptom profiles, so there’s nothing I can specifically say to look out for, but especially if your cycles have changed, then it’s worth getting investigated.
I did a whole podcast on polycystic ovary syndrome with Julie Duffy Dillon. It’s Episode 162. PCOS, or polycystic ovary syndrome, is probably one of the most common reasons for irregular cycles. There are a lot of misconceptions around PCOS, especially in terms of the advice with treating it, so if PCOS is something you’ve been diagnosed with or you think it could be something you’re dealing with, then I would say check out that podcast episode.
01:12:23
The next cause of problems with your cycle can be things in the environment, so environmental or occupational toxins. Xenohormones (also called xenobiotics) are synthetic chemicals that have a hormonal influence on all living creatures.
This is most applicable for people working in jobs where they’re exposed to these things – things like automotive manufacturing and repair, paint and varnish, the electronics industry, industrial cleaning, metal part degreasing, dry cleaning, glues and fibreglass, nail polish remover, carpet laying, farming with petrochemical-derived pesticides, herbicides, and fungicides. The majority of xenohormones are estrogenic in their effect, meaning they have a similar effect to oestrogen in the body, but their impact is much stronger.
I know that sometimes the tendency when hearing about these kind of things is to vow to only ever eat organic food or to never use cosmetics or to do a liver cleanse to rid yourself of this stuff. I don’t think that that panic is warranted in a lot of situations. It’s also impossible to avoid this stuff. But what I think is if you are someone who works in any of the jobs that I’ve listed or any that I’ve missed but are more involved with these kinds of substances, you are more likely to be exposed to these substances in higher amounts, so you’ll be absorbing them in larger quantities. If you are having issues with your cycle, this could be the reason or at least part of the reason for this occurring.
01:14:10
The final reason for problems with your cycle can be due to constitution. Your constitution is that mixture of things that you have inherited and those that you have acquired through your life, particularly factors from the first couple of years of life. Everyone has constitutional weaknesses – things that even from a young age were a problem or have been a problem for a really long time.
For example, even in good health, you have a sensitive digestion and are more likely to have problems with this. Or for someone else, even in good health, they have a weaker immune system and are much more susceptible to getting colds and the flu.
The opposite can also be true, with people having constitutional strengths – systems that, no matter how bad things get, are unaffected. I work with people with eating disorders where every system was failing them, but their digestion was always just fine no matter what. Or even at a really low weight and with lots of exercise, they were typically able to keep their period.
I think it’s useful to recognise these constitutional strengths and weaknesses because it can help you be more realistic with things. If you’ve always had problems with your cycles in good times and bad, maybe this is always going to be a weaker area for you. This isn’t to say you can’t greatly improve it or even get to a point where it’s not causing any symptoms at all, and maybe there are behaviours that have been going on for a really long time, since you were a teenager, that are actually impacting upon the cycle, and when these change, things improve. But sometimes this isn’t the case, and it is more just a constitutional weak spot.
When life gets tough or things go wrong, it’s more likely that this weakness is going to be the area where problems are noticed first. So it’s important to realise where you have your constitutional strengths and where you have your constitutional weaknesses so when things do go awry, you can have context with this.
That is the last of the reasons and the last of it for this week’s podcast. I hope you have found this helpful. There were a ton of episodes and resources that I made reference to throughout the show, so I really suggest checking out the show notes, which is seven-health.com/228. If you struggle with your cycle for one reason for another, have a think about your current life and your situation and all the things that I went through today that could be having an impact. This is something I work on a lot with clients, and that clients seek me out for.
As I mentioned at the top of the show, I am currently taking on clients, so if what I went through in this show resonated with you and sounds like something that you want to get help with, then please get in contact. You can go to seven-health.com/help and have a read about how I work with clients and register for a free initial chat.
That is it for this week’s show. I will be back next week with another guest interview. Until then, take care of yourself, and have a good week.
Thanks so much for joining this week. Have some feedback you’d like to share? Leave a note in the comment section below!
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