A friend of mine—lets call her V—went ten months without a menstrual cycle in 2020. She is in her twenties, eats a healthy diet rich in fruits and vegetables, and exercises almost daily, but not to excess. She maintains a healthy BMI and does not take any medications. As the only other vegan body I physically know, I believe her story is worth sharing.
Women aged 15 or older who have not had their first menstrual cycle have amenorrhea. Secondary amenorrhea describes women who have had a regular cycle in the past, but then experience a cessation lasting three months of longer. So my friend, V, met the criteria for secondary amenorrhea.
I took a class in college about weight and disordered eating. I was taught that most women who suffer from amenorrhea either suffer from eating disorders or are elite athletes.
But, what of those who do not fit into these two narrow categories?
After two months without a cycle, V was distraught. She wasn’t sexually active so she knew she could not be pregnant. V did not tell anyone until the third month, when she finally broke down in tears and called me. My friend felt such intense shame about her lack of a cycle—and I still find that sadly paradoxical. Because many women have historically been shamed for their cycles or forced into “red tents” during their period. And yet, when a young woman’s cycle does not come, she does not feel relief. She feels ashamed, afraid and alone because menstruation is both taboo to discuss and a sign of health and youth.
And then, of course the pandemic made seeing a doctor difficult. She hadn’t had a cycle for nearly five months by the time she was able to see a gynecologist. Once there, they tested her blood for deficiencies and thyroid issues. The doctor performed a pelvic exam, checking for abnormal cells, ovarian cysts or other structural abnormalities. There was no mention of diet, physical activity or mental health during the exam.
Everything came back normal. The medical team advised V that they could refer her to a specialist “if she wanted.”
So she felt mildly relieved, but overall unsatisfied. What was going on with her? She discussed this with her therapist, who knew that V was a vegan who lived an active lifestyle. Her therapist casually suggested, why not add more fat to your diet?
V’s diet was high in carbs and low in fats, as many vegan diets are. Nuts and nut butters are not something she frequently kept around, for example. I think she thought that low-fat diets are healthier. Which is not surprising, considering that carbs are the human body’s preferred source of energy
But she took her therapist’s advice and started adding extra oil to her stir fries, doubling up on servings of avocado and munching on roasted nuts throughout the day. And finally, after ten months, her cycles resumed. Just like that.
Why menstrual cycles matter for female health
Many women experience unpleasant symptoms during their monthly cycles, such as mood swings, bloating, cramps, and fatigue. And these symptoms are obviously a nuisance. But menstrual cycles and the hormone production involved are vital for female health. Bone health is inextricably connected to menstrual cycles, for example. When women enter menopause, their bodies stop producing as much estrogen. Estrogen deficiencies pose the risk of decreased bone mass and osteoporosis. So many older women will begin taking estrogen, calcium and/or Vitamin D supplements to offset this increased risk. But for women who have not entered menopausal age, menstrual cycle abnormalities resulting from estrogen deficiency may lead to bone fractures later in life. Yikes.
What to do if you experience secondary amenorrhea
So, if you’re experiencing menstrual abnormalities of any kind, make an appointment with a medical professional as soon as possible. If your BMI is lower than 18.5, you will need to gain weight. And even if your BMI is considered healthy, adding more healthy fat to your diet can help your cycles resume.
Let us put the common misconceptions about amenorrhea to rest. You don’t have to be an elite athlete or suffer from anorexia nervosa to experience amenorrhea. In fact, research demonstrates that nearly half of women who exercise recreationally will experience some level of disruption to their cycles at some point. I am hopeful that further inquiry into this topic will offer valuable insight and help to females in the future.
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Photo: Bruce Mars via Unsplash