Could your fitness routine make your body believe it’s postmenopausal?
Lizzie Catt meets the women losing their periods because of exercise habits
Bouncing out of bed in the morning, working as a fitness trainer and getting compliments on her six-pack abs in the supermarket, it was hard for Holly Hammill to believe her healthy lifestyle could be anything but good.
Founder of the TIO CrossFit gym in South-West London, Holly, 41, is a positive person with bundles of energy.
She swapped boozy nights out for running in her late 20s, finished her first marathon at 29, then found CrossFit, a highintensity combination of weightlifting, gymnastics and bodyweight exercises in her early 30s.
“I went from running a bit to training six days a week, sometimes twice a day,” she says. “I absolutely loved it and felt amazing – even better after I’d done my nutrition qualification. The leaner and stronger I got, the better my training felt. I was eating 2,000 calories a day, I was never hungry and my BMI was right where it should be.”
Yet something wasn’t right. Around 2014, Holly’s periods gradually became further apart, then stopped altogether. After a year, she went to the GP.
“I saw four or five doctors in the end but I was a bit pooh-poohed.” As Holly wasn’t underweight or trying to get pregnant, doctors weren’t concerned. “I had to fight to take it further,” she says. “I was tested for PCOS (polycystic ovary syndrome), which has similar symptoms, and after various tests I was prescribed hormones, though the specialist unhelpfully said, ‘ Well, this is a bit of a Sherlock Holmes case’.
“Eventually, in 2019, I came across a book, No Period, Now What? by Nicola J Rinaldi PhD, about hypothalamic amenorrhea (HA). I read it in one sitting – all these case studies of women just like me – and I thought, it’s so obvious. This is what I have.”
Despite working in the fitness industry, Holly had never heard other athletic women talk about their periods stopping and didn’t feel comfortable raising it herself.
“I heard somebody describe it as a secret that fit women keep from each other,” she says.
Rinaldi, however, was keen to start a conversation about missing periods.
After being diagnosed with HA in 2004 she started researching and blogging on the subject before publishing her book in 2016.
HA, Rinaldi explains, is “one of the multiple
The leaner I got, the better my training felt, I was never hungry
ways a woman can lose her menstrual cycle”, occurring when signals from the hypothalamus, the brain’s hormonal control centre, are shut off or turned way down so no egg grows and no ovulation occurs.
Eating habits, exercise, weight loss, stress and genetics usually combine to cause the problem, which is, in most cases, reversible.
Yet HA is still frequently misunderstood and misdiagnosed, despite the fact that, as Rinaldi tells us from her home in Massachusetts, years of untreated HA can have serious consequences.
“There’s a myth that you only get HA with an eating disorder but you have women with
all kinds of body types who aren’t exercising excessively and are losing their periods,” she says.
“High intensity exercise can suppress appetite so you don’t realise that your body needs more food.”
With hormones in “essentially a postmenopausal state”, Rinaldi says women will not only struggle to become pregnant but can suffer low bone density and osteoporosis, increased risk of cardiovascular disease and dementia, feel cold, have brittle nails, thinning hair and even need to use the loo more due to a thinning of the bladder lining caused by a drop in the estradiol hormone.
IVF is unlikely to succeed and, if women do become pregnant, they’re at higher risk of stress fractures and pre-term delivery. The No Period, Now What? approach to rectifying HA is ‘all in’ – eat around 2,500 calories a day, cut out high intensity exercise during recovery, and reduce stress (Rinaldi is keen to emphasise she’s not an eating disorder specialist and urges people with disorders to work with a treatment team).
The median recovery time is five months, with many women reporting their periods returning sooner.
Exercise itself, says Rinaldi, is not the problem, it’s a lack of understanding about how many calories are really needed.
“Fear mongering” around food groups such as carbs and dairy has also resulted in people filling up on fruit and vegetables, leaving their bodies short of what they need. “If you eat a cookie a day, it’s not the end of the world – you’re not going to get diabetes,” says Rinaldi. “I absolutely 100 per cent think that exercise and high intensity exercise is healthy, it just has to be fuelled properly.”
Holly gained 20lb and made a recovery by swapping workouts for dog walks and yoga for three months.
She ate cake and bread alongside her usual meals, kept exercise low intensity for a further three months, then gradually reintroduced high intensity activities.
With hindsight, Holly can see how some of what looked and felt healthy was causing HA.
Tracking macro-nutrients (‘macros’ break food down into carbs, fat and protein), had become “like a game of Tetris. You think, ‘these are the numbers I need to hit in the day, what food combinations shall I do?’ It sounds insane, but you get into the mindset,” she says.
Holly’s nails are no longer brittle, her hair doesn’t fall out, she sleeps better and she’s even enjoying the return to the ebb and flow of hormonal emotions after years of feeling “happy but emotionally flat”.
As her calorie intake went up, her hunger returned, indicating that her body had been in survival mode.
Her fitness levels barely changed and yes, the washboard stomach has softened but she doesn’t mind.
“Maybe it’s to do with being in my forties, but I finally feel like myself.”