UPDATE: Since writing this article, I have taken EVERYTHING I learned in my journey to get my period back, and wrote a book on the topic, so you have everything I know about amenorrhea in one place. This book is written for runners who have lost their period, but regardless of what sport you do, if you don’t get your period, Overcoming Amenorrhea: Get Your Period Back. Get Your Life Back will help.
Okay, so you know my story by now. As a pro runner, I stopped running completely, overcame hypothalamic amenorrhea in just a few months, and went from zero menstrual cycles in NINE YEARS to pregnant within a few months!
Things happened kiiiiinda quickly for me, and I realize that for many, it might take a little longer to overcome that secondary amenorrhea, but it definitely can be done.
Having become the face of irregular periods (or should we more accurately say, non-existent periods!), I suppose I should start at the beginning, as I have realized that this is a VERY common problem, especially for runners and those who are interested in their health and wellness.
What is hypothalamic amenorrhea?
Now, before I go on to tell you what I did to get my period back, I would like to start with the amenorrhea definition for anyone who is confused. I know now just how few people even knew what this word meant before my story blew up in the media. I am going to explain this in my words and give you an official version:
According to Shady Grove Fertility:
“Hypothalamic amenorrhea is a condition in which menstruation stops for several months due to a problem involving the hypothalamus. The hypothalamus is in the center of the brain and controls reproduction. It produces gonadotropin-releasing hormone (GnRH). GnRH signals the production of other hormones needed for the egg to mature and for ovulation, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) after ovulation. In turn, FSH and LH signal the ovaries to produce estrogen. Estrogen thins the cervical mucus and—along with progesterone (from LH)—prepares the uterus for a fertilized egg.”
Now you get to see the scientific words, but to me this is what it means to me:
Hypothalamic amenorrhea is where you stop getting your period on a monthly basis and you either have very long menstrual cycles, or lose your periods completely as your body does not have the energy to keep the reproductive system functioning correctly. This can be because of a few factors, but the primary ones come down to too much exercise and not enough calories. You might be underweight, you might be on the lower end of normal weight, but for your body It does not have enough calories to maintain the fertility cycle.
That is what I learned, and as much as I wanted to fit in with other professional runners by having that elite runner body, that was just not right for my body, and if I do return to professional running in the future, we will be making changes.
How to get your period back when you stop having regular menstrual cycles because of exercise
Now, before I go on, I first want to say a disclaimer; today I will be sharing exactly what I did, the steps I took, and how long it took. Unfortunately as with us all having our own individual set point for our weight, we also all have our own journey to embark on to get our cycles to start again.
My approach was drastic, but that was because I had already spent the past year working on exploring all the tips and tricks to get your period back that I had read about while I continued chasing my running goals…and actually, without doing that, I would never have accomplished my goal of running for Great Britain and Northern Ireland, nor would I have knocked my marathon PR down to 2:36.
Before I made my conscious decision that overcoming my hypothalamic amenorrhea was priority number one for me, here are some things I did to try to figure out what was going on:
Once your period has been missing a few months, you really need to start paying attention and trying to figure out what you can do, and what could be wrong. This took about a year for me before I started to find experts to talk to and find out what could be going wrong.
Start with your GP or your gynecologist first, to have some tests done to rule out other issues with your reproductive system and also to check your bone density. This is VERY important, especially if you have had even one stress fracture (fortunately I never had a fracture, just a reaction once). If your bone density is low, ESPECIALLY if you are young, you are seriously putting your entire long-term health in danger and could be at a high risk for fractures (not just running related) for the rest of your life.
This is probably the most critical step, and although as I have mentioned many times, no one could really find much wrong with me, at least we could rule things out one by one to make sure they were not issues. You might think, “oh, I will just deal with this next month, I have too much going on”, but trust me, the time just gets away from you and it will never be a good time.
Some experts I would recommend:
- GP (many over the years)
- Gynecologist (Dr Jennifer Fuson, who is now going to deliver my baby!, I also saw another doctor in Michigan who did the initial tests)
- Reproductive specialist (I could not find one near me, but from others, this has been a HUGE help)
- Endocrinologist (Dr Miers)
- Wellness coach/consultant (I recommend Tawnee Gibson)
- Naturopath (Natasha)
Now, these can get expensive, but often, if you work your way up the chain, and continue to show that you are concerned, the doctors will continue to pursue it and you can use insurance.
Regular blood work from Inside Tracker to see if anything stood out as a red flag
I have been an Inside Tracker fan for years as it allowed me to see how I was doing nutritionally and with my training. If my numbers were way out of optimal, I would know that I was either not doing a good enough job to get the right nutrients in, or I was overdoing the training, which would give a warning sign before you might even notice something was off.
I had these about every 3 months, and I never managed to get all optimal, mostly because I always had elevated ALT and AST levels from the hard training (my doctor actually ended up sending me to a liver specialist and I had a liver ultrasound, all good!). However, other than DHEAS, my other indicators that are related to amenorrhea were always in the right zone and overall, I was showing very good results. This was a major source of relief that I was getting in the nutrients my body needed to function.
These numbers are important to pay attention to, and if they are outside optimal, that can be a HUGE warning sign that this is not only affecting your running, but your long-term health:
Other numbers might be a good indicator to check into something else, and at least see where you can improve, they give you recommendations and food suggestions (with your diet type) to improve those numbers.
If you use my coupon code TINAMUIR for Inside Tracker you can get 10% off.
Eating more fats
Now, I will admit that I went a little too far in this direction when I made my diet high fat, high protein. Although I knocked 4 minutes off my marathon PR to run a 2:37 in London while doing this, I would guess I ended up 40% fat, 40% protein, 20% carb. Although I was actually able to sustain this during the marathon training, as soon as I dropped down to shorter stuff, the amount of races I crashed and burned at increased substantially.
However, it is INCREDIBLY important as females that we get enough fats in our diets. I know there was that stupid low-fat phenomenon 10 years ago, but that is SO WRONG! We need fats to not just be healthy, reproductive women, but healthy PEOPLE!
No more low-fat milk, yogurt, crackers, peanut butter, drinks, ANYTHING!
If you are going to get the treat/junk food, get the full version! Chances are it still isn’t great for you, but it is better than the version with all the nasty stuff they use to replace the fat (which is actually often sugar).
Ways I like to add healthier fats:
- Butter (organic, grass-fed and finished, try find Kerry Gold)
- Nut butters (make your own, I LOVE my homemade almond butter, literally just almonds put into a food processor!)
- Olive oil, avocado oil, coconut oil
- Coconut (remember my CRACK, coconut butter, HEAVEEENNN)
If you love your veggies, that is okay, just try to add some of those. I often talk about sweet potato and almond butter, or try roasting your veggies in oil and seasoning rather than microwaving or boiling, add avocado to your sandwiches, eat coconut butter anytime anywhere (I love a tablespoon before a run). Try to get as many of these in as you can.
Take a few weeks off running after your season
After a big race or any more than 6 months of running.
I know it seems counter intuitive and you might lose a little fitness, but I have preached maaaanny times (like HERE and HERE for marathons) before about how critically important it is, especially if your body is already in a fragile state.
I recommend you take 1-2 weeks off every 4-6 months of running. if you have a big marathon or race that you have been training for, after that is the perfect time to do this, but if you are racing shorter distances, pick a point to be the end of your season, then rest.
No cross training, no restricting (or even backing down) on calories. This is just a time for your body to gain a little weight and rest, it might be just enough to kick-start your system, and with that, you wouldn’t even need to take as drastic of a move as I made…potentially ever! The sooner you can get this fixed, the less likely you will be to have to do what I did, or take a more aggressive approach.
I know it is tempting to cut down on calories, but firstly, your metabolism is still running just as well as it was when you are running, ti doesn’t slow down that fast, AND I recommend every runner gain a little weight after a season, really.
It’s worth a try, and I know quite a few runners who have found that gives them just enough to get their cycles to return.
If you are running too fast on your easy days, you are just asking for trouble. Not only are you making it pretty much impossible for your body to perform on race day as everything kind of ends up on this spectrum of medium hard, but you are also telling your body that it is in a high stress state EVERY DAY.
If you make those easy runs easy enough, it will not only save your running, but also give your body a ginormous sign that you are not in danger every day!
I know it is harder than it sounds to go easy, and often we may think we are going easy enough, when we are not, but the effort scale is the only real way I recommend to make sure you actually are running slow enough.
See a Registered Dietitian
You might wonder why I didn’t put this one under experts, because surely they are the experts in their field, but this one is CRITICAL. After making sure you do not have anything wrong with your reproductive system in general, your nutrition is going to be the NUMBER ONE THING that will make the difference between having a period and not.
I have preached time and time again that I ate a lot, I ate enough, I didn’t give up my sweets, and if I went out to dinner, well, I had a burger and fries. I was a seemingly healthy weight, slim, but not too thin, so this may come as a surprise, but I was not eating enough for the training my body was doing.
Yep, I can admit it.
I was underfueling, and that was part of the reason I could not get my cycle back no matter how hard I tried.
I tried to do it alone, I saw nutritionists and spoke to experts, I did all the calculators and everything indicated I was getting enough, but it was only once I started working with Nancy Clark, after I stopped running that I realized I really wasn’t.
We think we can just make changes, I mean why would you pay someone to look at your diet? Come on, there is so much out there and we think we know what the best foods are. We know the healthy, nutritious foods, we know we need fat, we know we need balance.
We know it all.
Except we don’t.
If you are going to spend your money on one thing, it should be a registered dietitian (assuming the ultrasounds and tests for your overall reproductive system are covered in your insurance/NHS care), seriously.
This was the game changer.
I may have gained 15lbs, and stopped running, and I think both of those played a part, but at the end of the day, I think not eating enough for the amount I was burning was the biggest reason.
If you see an RD, one who understands runners, and they help you see where you are making mistakes, my friends, you may not even have to change your running.
That in itself is worth a try, right?
How to make your period come back if none of the above work
If you really have tried all of the above, and my disclaimer is that as I mentioned, I did NOT see the RD until after I stopped running…so who knows what could have happened if I did see Nancy Clark before…
However, if you are desperate, either because you want to start a family or you have started to notice some health issues that are really starting to scare you, it might be time for a big change, and this is gonna be scary, but I promise you my friends, it WILL BE WORTH IT.
I hope I am proof of that, and I hope you can see that the sacrifices we make ARE worth it.
If you are not quite able to give up the running or allow your body to gain the weight it needs, you can go about it the slowly ripping off the band-aid method. Tawnee and I discussed this on our pregnancy podcast. She decided to pull away slowly, never actually stopping running, but removing all intensity and stress. She also slowly gained weight to see what happened.
I would strongly recommend that podcast if this is you. This is as far as I am going to go with this aspect, as I am talking to those of you who are ready to really make a change. You REALLY want a baby or you REALLY want to get your health back.
Well, if you want it enough, you WILL do what you need to do, at the end of the day, thats it.
If you don’t think you can give up running (exercise), control of your eating, and your Type A personality, well, the harsh truth is, you really don’t want it enough.
I am not saying it’s gonna be easy, far from it. There are times when you will wonder if its worth it, you will consider abandoning ship, but if you REALLY do want a baby or want your health back, then you will stick the path and do it.
Because so many women have reached out to me saying that they do really want this, but it’s just really fricken scary (and it is!!), I made this video, and I hope it helps. I was terrified too, going through this huge emotional turmoil, and remember, for me, my running was my career!!!! So yes, terrifying, but actually, once I did it, said it out loud, I felt relief as I had finally taken charge of my own future, and was doing something about it rather than letting that little stick in the back of my head keep poking me, reminding me that I was “broken”.
I am not saying it is going to always be all fun and games, I felt relief at first, but I had many moments of feeling like a lazy blob, but what you will gain during this time will blow your mind, and you will learn a respect and love for yourself you never had before, even at your physical best.
Sounds too good to be true, but coming out the other side, you will realize who you ARE, not what you are.
You will realize that you are beautiful and wonderful. You are strong and smart. You are feminine and funny. YOU, my friend, yes you, have SO much to offer this world, and you will finally be able to discover it.
So are you ready to take the leap?
Here is exactly what I did for the 12 weeks it took me to go from 0 reproductive activity to pregnant.
I think this one is pretty well-known by now. I went from running 90 miles a week to 0. Not a single step for 3 months.
Did I miss it?
Honestly, not as much as I thought I would, but I will say that it gets easier, you will be shocked how quickly you get used to life without it. You will find all this new time to be able to meet friends for breakfast, straighten your hair, put on a dress, do all the things that you don’t normally bother with as you have to exercise again in a few hours.
I loved that part, and I felt like a real woman for the first time in my life. It was fun to learn, and people will SHOWER you will confidence and compliments as they can see you have made an effort.
I also loved that it no longer dictated my day, enjoy that you can just let the day unfold rather than stressing about when you are going to get your run in and how you are going to dance around family and friend obligations to get your training in.
Sure you will miss it, but follow the list (below), and you will soon find joy in other places. Read this article for more about how running can stop your period.
Just cause you stop running, does not mean you replace it with thee hours of cardio a day or even one hour! I took three weeks completely off EVERYTHING. I did no exercise whatsoever other than daily life…and as I work from home, lets just say that didn’t involve much either.
If you MUST go for a walk, make it a nice stroll, very slow, and take note of what you see around you. Use the time to call a friend and catch up or listen to a podcast (hopefully the running for real podcast!). I enjoyed doing this, but be careful that you do not fall into the trap (like I did) of thinking that you have to make it worthwhile. DO NOT feel like you have to walk “at least” 45 mins-1hour to “make it worthwhile”. This walk is literally for health, so 20-30 minutes is fine.
After the initial few weeks off, I started to strength train with Drew twice a week. This really was all the exercise I did during the 10 weeks I took off, and I knew that was enough to be healthy when combined with a few walks, and that was all I needed. Your body is in recovery mode, so it is working hard to repair your reproductive system.
This is where I absolutely LOVVEEDDD having my Garmin Vivosmart+, it meant I could make sure I was getting the recommended amount of movement, without overdoing or stressing out my body. I could see my heart rate all day long, and see my stress level (will discuss later).
Some days I would struggle to even get halfway to the recommended amount of steps, but as my body began to turn around, and the positive signs of a functioning body returned, I found I had more energy to want to do things outside and just got it in naturally, without trying, without forcing, and without stress on my body or mind.
I LOVE this activity monitor, and especially now, it has become my all day every day accessory.
Make a list of joy
So you love to run, and you miss it, right?
Running won’t be the only thing in the world that makes you smile.
Write yourself a list of all the things you enjoy. It can be as simple as eating a bowl of cereal to sitting on a beach watching the sunset. Whatever you like. I mentioned this in a previous post about injuries, but this is SO important during this process. Really think about it, take about 20 mins, and just think of all the things that make you smile or bring joy.
Then start working through them. I am willing to bet that some of them were no go’s while you were running, too risky.
For example, being on a trampoline makes me smile, so I signed up for a trampoline class. No pressure, no stress, just having fun, and it really was!
Eat the foods you have been avoiding for so long
This is the one time in my adult life (ironically I kind of did it as a teenager…before I lost my periods!), where I just ate what I wanted when I wanted. Extra servings of ice cream, fried chicken, grilled cheese sandwiches.
Let yourself have fun with it! Go crazy, and allow yourself to eat “fertility foods”, the more you are able to let go, the quicker it will happen. No Period? Now What. will help tremendously with this part.
I know it can be terrifying, and at times you will eat that food and suddenly imagine yourself obese, barely able to walk down the street, BUT that won’t happen, and your body will thrive on the fact it has the extra calories to dedicate towards repairing your reproductive system.
At first, you will probably notice that you are RAVENOUS all the time, as if you have opened the floodgates, but embrace it. It is scary and you wonder how you can possibly be hungry again when you just ate a MASSIVE amount, and in my case, even more than I would be eating when I was running 90 miles a week, BUT it will calm down. Our bodies are incredibly smart, and once it has repaired your body, your hunger will go way.
BUT, here is the caveat, you MUST let go of a certain weight goal/level.
If you monitor that weight all the time, first you are kind of okay with it, but you just don’t want to gain any more than x pounds or be any heavier than x weight, you are asking for trouble and your cycle will probably NOT come back.
The biggest part of the weight and eating more aspect is that you HAVE TO let go of that restriction, all of it.
On the foods you eat, there should be no “bad” foods.
On the amount of weight you will gain, your body WILL find where it wants to be, and that might not be where you want, it may be a few more pounds than your friend also going through this, but it is right for YOU.
On the amount of food you eat. If you are hungry, eat, simple as that.
I don’t think its a coincidence that I have ended up at the weight I was when my period was regular as an 18-19 year old, when I ate intuitively. Suddenly the weight gain just stopped, and my hunger suddenly retreated. Why?
Because this is the weight my body likes to be at.
I would recommend completely getting rid of any scales in your house, and even stepping on backwards when you go to the doctors. Let go of the need to be a certain weight, you are repairing your body, and only your body can tell you what that needs to be.
This can come from many areas. This might mean learning to say no to more opportunities, which might make you sad initially, but stress is a HUUUUUGGGEEEE part of this, and one of the biggest things I did was remove my need to be productive all the time. I started carving out me time, hours each day where I would just sit and relax, either watching TV or sitting in the garden.
You might feel lazy, and that you could be doing something more useful (I certainly did), but you will be amazed by how much of a difference you feel when you start to let go of that need to be successful and impressing everyone all the time.
And even better?
Your friends and family will notice that you are not so distracted and highly strung all the time, so they will enjoy your company more, love you more, which will bring you more satisfaction and happiness, it really is a win win.
I also recommend acupuncture. I would go to Blue Lotus acupuncture every other week, and I found it was wonderful to rest and fall asleep on the table. It took me a little while to allow myself to be able to take naps during the day, but acupuncture, it was like the gateway drug into rest and relaxation, and they will work on any other issues you might have with the treatment itself.
I am still going every other week, and can’t imagine not having it in my life…and yes, I do pay for it! It is worth it!
Another way I enjoyed seeing how I was doing with removing stress was watching the stress monitor on my Garmin VivoSmart+. It tells you how stressed out you are at any given moment, and even has you do a 2 minute relaxation session, which is really cool. Also great for seeing your heart rate and it reminds you to move if you have been sitting too long, that way you don’t feel too lazy!
Think we could be friends?
I am always this honest, real, raw. If this article speaks to you, I really believe we could be friends and I could help you as you get your health back. Drop your email below, and I will reach out to you
Okay my friends, I think this is it.
Actually, I am sure this is not all of it, but my brain is fried, and this post is JUMBO as it is. I am going on vacation as of today for 2 weeks as we head to England, so if you email me, it may take a few weeks before I respond, but I am sure I will have more to add to this post by then anyway.
At the end of the day, it comes down to this:
Ask yourself, what is more important? Eating more and gaining a few pounds (that no one will notice) but being able to continue to run or ending up having to stop completely? There is no right answer, and as you see, it will work out in the end, but you have to be prepared for some big, scary changes. The other side is worth it, really.
Now, if you want to know more, my story has kind of covered the internet lately, so I am not going to share every article, but here are a few things I do recommend you do/read
- Purchase my book Overcoming Amenorrhea: Get Your Period Back. Get Your Life Back and
- No Period. Now What?
- Listen to my podcast with Tawnee on the Running for Real podcast
- Read this about athletic amenorrhea for more detail about the steps I took
- Why exercise can cause amenorrhea (what the research says)
- My letter to anyone with amenorrhea in SELF magazine
- This Another Mother Runner Podcast I was featured on
I think that might be it.
Okay, Tina is out. Have a wonderful few weeks! The podcast will still have a new episode every Friday, but the rest…not so sure!
Hope this helps, you CAN do this. Please pass this on to anyone you know (or suspect might be) is going through this.
Fascinating article! Just curious if you know your blood type? I just started doing some research about blood type and diet and how certain blood types (type O) do better on a high protein/fat diet vs other blood types.
There is no scientific basis for the blood type diet and could lead someone to restrict foods that do them no harm. The diet is based on the fact that your blood antigens will cross react with proteins from foods as they enter your bloodstream. Protein from food doesn’t get into your bloodstream- it is coagulated in your stomach by acid and then broken down into amino acids by enzymes in your stomach and small intestine. The resulting mix of amino acids entering your bloodstream from the small intestine looks the same to your immune system no matter what the original proteins were. Only a very sick gut such as in coeliac disease, will admit intact proteins into the bloodstream, and in that case it’s not your red blood cell antigens that interact with those proteins, but your white cells.
Is there any way to subscribe to your post via email? I love to keep updated on your progress with your pregnancy and your life, however I can’t seem to via email. 🙁
Thank you for this podcast. It keeps me motivated to reach my dreams of running and writing my story. May I have your permission to add your link to my blog?
Of course 🙂
Great article Tina lots of great info here – thanks for sharing as always. Will order that book.
Did you find you had to get to a certain BMI? I’ve heard 22 is the cure all but not necessarily for everyone if you’re fueling properly. I’m working on regaining mine and actually got one! But I’m only a BMI of 20 and it’s been irregular…