Infrequent or Missing Periods
Missed or infrequent periods Women’s Health Matters
5 reasons why you keep missing your period, other than pregnancy. Global News
Not all periods are 28 days apart Global News
Amenorrhea from youngwomenshealth.org
Athlete’s Triad (Hypothalamic Amenorrhea) or RED-S
This is a common condition I see in older teens and young adults when the amount of energy used for activities is not replaced by the amount of energy taken in (food). This leads to low energy availability (LEA). Relative Energy Deficiency in Sport (RED-S) may be due to excessive exercise or training, stress, or restricted and disordered eating. This leads to anovulation which means a monthly egg is not released from the ovary. Your body loses the trigger to have a period 2 weeks later. Your body chooses to use energy for breathing, working, thinking, living and sacrifices reproduction (periods) temporarily. Bloodwork and ultrasound usually rule out other reasons. To correct hypothalamic amenorrhea, find ways to make sure you are feeding your body enough so that it has enough energy to have a period, and / or adjust your exercise or training. A nutritionist / dietician may help. Increase energy intake by 300kcal /day (eg. 1.5 cups of cooked sweet potato, 1 slice of bread with peanut butter , 1 pancake with 2 Tsbp of syrup, or 2 scoops of protein/carb formula) in intervals over a year. Adding in healthy fats, more carbs especially in athletes, and protein (especially if vegetarian or vegan), are extremely important. Add nut butters, oils, full fat 9%+ yogurt, ice cream, chocolate milk, cheese, crackers, pretzels, and dips. Decreasing fibre by using applesauce or juice instead of whole fruit can also help. For how to add in more protein, check out this amazing list from Dieticians of Canada. If you lose your period for over a year, see you doctor about supporting your bones too, because estrogen is important for bone building. Foods with calcium, vitamin D drops, and weight bearing exercise are important for bones.
RED-S from Athletics Canada
Athlete’s Triad from Kidshealth.org
PolyCystic Ovarian Syndrome (PCOS)
What is polycystic ovarian syndrome? Global News
Everything you need to know about PCOS. FLARE Magazine
An app I use to track my period says I might have PCOS. Should I trust it? Healthy Debate
The goals of PCOS treatment are to feel good about yourself (address acne, hair removal), improve nutrition (regular small meals and healthy snacks) and increase cardiovascular exercise, and to have a regular period bleed (progestin withdrawal or birth/period control pills) to shed the uterus lining. Regular shedding/bleeding protects the uterus from abnormally built-up lining that can lead to abnormal cells (hyperplasia or uterus cancer if eg. less than a handful of periods per year for many years). All of the above also help with improving metabolism to prevent associated or causative insulin resistance and diabetes. Inositol or medications to manage blood sugar may also be recommended. Period regulation will help fertility later if/when you decide to have children.
Primary Ovarian Insufficiency (POI)
Unfortunately, the decrease and loss of ovary function can happen at any age, including girls who have never had a period, those who start getting infrequent periods, and those before age 40. The diagnosis is usually unexpected and upsetting. The condition used to be called premature ovarian failure or early menopause. Causes can be genetic or hereditary, autoimmune, due to injury, previous radiation or chemotherapy. It is important to replace hormones that would naturally occur until menopause (about age 51). Ovulation may occur in 5-10% of people with POI so steps should be taken to prevent pregnancy or to preserve fertility depending on your plans.
POI from youngwomenshealth.org
Info and Support from Daisy Network
What’s nutrition got to do with it?
For all of the above conditions, having a nutritionist or dietician can be helpful to ensure you are managing lifestyle factors that can improve the missing periods.
In PCOS, healthy nutrition and weight loss can decrease adipose (fatty) tissue where estrogen is converted to testosterone leading to symptoms like unwanted hair or acne. The excess estrogen also stimulates the uterus lining (which can be be associated with hyperplasia or uterus cancer if untreated). Skipped periods due to anovulation can be restored with 10% weight loss in those without lean PCOS. There is also growing research about myo-inositol in helping insulin resistance and PCOS symptoms. Ask your doctor about Health Canada approved options. In athlete’s triad, calorie intake (energy in) should match exercise or activity output (energy out) so there is enough energy to have periods. In POI and athlete’s triad, women need to replace estrogen levels that are low. Estrogen is important for bone building, so foods with calcium and vitamin D are important. Find a dietitian to help you with your nutrition at the award-winning website, UnlockFood.ca from Dieticians of Canada.
Finally, it is very common to have irregular periods in the first 2-3 years after having your first period. It takes time for the brain (hypothalamus and pituitary) to learn to communicate with the adrenals and ovaries (HPO axis) through hormone messengers to regulate ovulation (egg release) that leads to periods.