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Questions About Amenorrhea and How it Affects Bone Health

Amenorrhea

No Period. Now What? By Dr. Nicola J Rinaldi

Dana Magee, RD, LD, CLT utilizes the book “No Period. Now What: A Guide to Regaining Your Cycles and Improving Your Fertility” to discuss amenorrhea and also its affects on bone health.

What is amenorrhea and how does it occur?

Amenorrhea is the absence of the menstrual cycle in a woman of a child bearing age and can occur due to:

  • Stress: either physical or emotional stressors.
  • Too low of body fat/weight: It is possible to lose your period at a “normal” weight but it is more common in women with low body weight. Losing 10 pounds, even in years past can affect the loss of menstrual cycle.
  • Over-exercising: Eating when you are hungry and stopping when you are full may not accommodate the caloric deficit from exercise especially if your diet is too low in fat. Over exercise can also increase cortisol levels which will affect reproductive hormones. You can even be moderately exercising 3-4 times a week or less and when coupled with other variables (energy intake, stress, genetics) may lead to amenorrhea.
  • Under eating: food is our energy source and fuels our top priorities first: heart, liver, lungs, brain and then the rest goes the next level of necessity hair, nails, immune cells, bones, maintaining our body temperature, our digestive system (constipation) and our reproductive system.
  • Genetics: explains why someone with a similar physique may lose their period while another one won’t.
  • Polycystic Ovarian Syndrome: other symptoms include weight gain, fatigue, unwanted hair growth, hair thinning on the head, infertility, acne, headache, sleep disturbances.
  • Tumors of the pituitary gland

Amenorrhea is a sign that there may be decreased bone mineral density. This can be evaluated with a DEXA scan prescribed by your physician. How is amenorrhea related to bone density?

Amenorrhea can cause bone loss(osteopenia) due to the decreased production of estrogen which plays a large role in regard to bone health.

  • Estrogen stimulates bone formation
  • Estrogen suppresses bone resorption
  • Estrogen inhibits the break down of bone
  • Estrogen affects the role of vitamin D which plays a role in building the bone
  • Estrogen is what helps maintain levels of calcium in the bones

What is a DEXA scan?

  • Enhanced form of x-ray technology that looks at your bone mineral density, and bone loss.
  • Measures this by using x rays to see the thickness of your bone.
  • The results of the scan will alert you to possible osteopenia or osteoporosis.

What other tests are helpful?

  • Luteinizing hormone (LH)- a spike in LH causes the mature egg to release (ovulation). Levels are considered low when less than 2.0 IU/L.
  • Thyroid stimulating hormone (TSH)- drives secretion of thyroid hormones which help control metabolism.
  • Estradiol (E2)- secreted by maturing eggs and drives changes in LH and TSH. Levels are considered low when less than 20 pg/mL.

What about birth control pills?

Birth control pills can mask amenorrhea. We may think that if we are getting our period everything is fine. You may visually be bleeding but it is not an indicator of your health. Birth control may help to stop bone loss, but may not replace bone already lost.

What can I do about amenorrhea?

The bone loss that occurs with women experiencing amenorrhea may be reversible following lifestyle changes. The longer that you are experiencing amenorrhea, the weaker your bones get.

Suggestions for reversing complications:

  • Eat more

    • What might be getting in the way of fueling enough? Take some time to answer the following questions:
      • Do you have forbidden foods or food groups that you don’t allow yourself to have?
      • If you eat one of those do you feel guilty and anxious afterwards?
      • Is your eating dependent on exercise- you allow yourself to go out to dinner only if you go to the gym to burn off the extra calories or skip other meals?
      • Do you cook separate meals for yourself?
      • Avoid social gatherings because you don’t want to deal with the food or people asking why you are not eating?
      • Have you trained yourself to ignore your hunger- getting pleasure out of not “caving in”
  • What are other signs of under fueling?

    • Stress fractures or broken bones
    • Feeling cold all the time
    • No libido or lubrication
    • Tired
    • Awoken in the middle of the night or early morning hours
    • Brittle hair, nails, skin problems
    • Bowel issues

“Just as you put fuel into your car when the gas tank is empty you need to put fuel into your body. My car always seems to run out of gas when I have no time to deal with it. But do I find time to get to the gas station and fill of up my tank? Of course. Non negotiable.” Nancy Clark- Famous Dietitian

  • Exercise less

    • Do less running, and more weight bearing exercises
  • Calcium foods

    • Green leafy vegetables, sesame, seeds, black eyed peas
  • Evaluate vitamin D and K levels

What about birth control pills?

Birth control pills can mask amenorrhea. We may think that if we are getting our period everything is fine. You may visually be bleeding but it is not an indicator of your health. Birth control may help to stop bone loss, but may not replace bone already lost.

Resource: No Period. Now What?: A Guide to Regaining Your Cycles and Improving Your Fertility by Dr. Nicola J Rinaldi

If you or a loved one is experiencing amenorrhea and would like to meet with a Registered Dietitian, please call (301) 806-0556 or click here to schedule an appointment today.

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