Woman exercising and under-eating their way to infertility
'It is completely remediable, the problem can be wanting to change.'
Dr Stella Milsom
An increasing number of women are putting their fertility at risk by taking clean eating and exercise regimes to the extreme.
Women leading excessively ‘‘healthy’’ lifestyles are selfinducing hypothalamic amenorrhea (HA), a condition in which menstruation stops because of an estrogen deficiency.
Senior reproductive endocrinologist Dr Stella Milsom says HA ‘‘is a growing concern and very under-recognised as an important issue for women. We are seeing it more and more often.’’
HA is a result of one or more of the following: the body being underweight, receiving restricted nutrition (deliberate or unintentional), and excessive energy expenditure not compensated for by refuelling and stress.
‘‘I suspect that a focus on being lean, clean healthy eating, and the benefits of exercise have fuelled an increase in this condition.’’
She says the significance of periods becoming irregular or ceasing is not well understood or taken seriously enough. Women don’t typically present to a specialist until they’ve had HA anywhere from 18 months to three years.
‘‘Women should understand that missing more than one or two periods in a row (after the first year of puberty) is abnormal,’’ says Dr Milsom.
‘‘I fear that health professionals aren’t always as knowledgeable about what the lack of menstruation implies. Health professionals can be overly reassuring. For instance, coming off the contraceptive pill, or just being a teenager is not an explanation for menstrual irregularity that persists for more than two to three months.’’
Auckland blogger Megan Hutchison has recovered from HA after a three-year battle. She says part of the reason recovery was so difficult is because she thought she was doing the right thing for her health.
The 28-year-old first lost weight after the death of her mother in March 2014 and stopped getting her periods, but she perpetuated the condition by excessively exercising and under-eating to fit into her size US2 wedding dress.
‘‘I thought I was living my healthiest life, I exercised everyday and ate a really healthy diet, watching my calorie intake.
‘‘I biked to work everyday, walked my dog for an hour and also did an exercise class at the gym five days a week while I was engaged.
‘‘You’re told that exercise is good for you and carbohydrates like bread and pasta are bad, which is why it was so confusing and difficult to overcome this.’’
It wasn’t until towards the end of her wedding planning, when she hadn’t had her period for 18 months, that Hutchinson realised she needed to take her health more seriously than her appearance.
‘‘It makes me so sad and feel so stupid that I put vanity and my appearance ahead of my biggest goal in life, which is to have a family and to be a parent.
‘‘I worried that I wasn’t going to be able to have children.’’
It took two years and a concentrated effort to eat a larger and wider variety of food and resist the temptation to exercise, but Hutchison recovered. ‘‘I was thrilled to get my period back. I felt overwhelmed with emotion.’’
Sarah (not her real name) is still battling HA. The exercise fanatic who is ‘‘really passionate about being healthy’’ hasn’t ovulated for more than two years.
A specialist diagnosed the
27-year-old with HA in August
2017, after more than 18 months without her period.
Before her diagnosis she was following a ‘‘clean, restrictive diet with no processed food, and probably over exercising’’.
Her exercise regime consisted of weights and a HITT workout daily, and on occasion she’d hit the gym twice a day.
Before being referred to a specialist she visited her GP, who told her to ‘‘wait, it should come back’’. She waited for more than a year before seeking a second opinion.
‘‘It is frustrating, I thought I was doing the right thing and being really healthy, but I was doing damage to my body without being told.’’
Dr Milsom says the good news is women can recover and go on to get pregnant naturally by changing their lifestyle.
‘‘It is completely remediable, the problem can be wanting to change. The hardest part is changing the relationship with body image and food.’’
To recover and resume ovulation, she recommends girls and women to decrease, and in some cases cease, exercise.
They also need to increase their nutritional intake by about 300 calories per day and liberalise their diet with energy dense foods.