Thursday, September 19, 2013

Menstrual cycle abnormalities in exercising women, including me.

So  much great information on HA is available in the medical literature.  it really is a shame that your average OB is not better educated.

My friend was recently told that she had less than a 50% chance of regaining cycles if she gained weight / cut exercise.  Way to pull a stat out of where the sun doesn't shine doctor!

Here's an article where they followed women with FHA for an average of eight! years.  The doctor counselled them on the advisability of gaining some weight and cutting exercise to help restore cycles and improve bone mass density.  70% of the women started cycling again.

Those 70% gained between 6.5 - 28 pounds.  Cycles were regained for the most part between years 1 and 2 of changes.  (Keep in mind that these were gradual changes and many of the women were on either HRT or birth control pills, with a break every 6 months or year to see if they were cycling).

Take a guess as to the weight change of the women who did not start cycling again.  Surprise surprise, either no change or a decrease of a pound or two.  Unfortunately they don't mention changes in exercise.

I also think that the cycles could have resumed more quickly had the weight gain / exercise changes been made in a shorter timeframe.  Most of these women were not trying to conceive at the time the study started, so had less incentive to restore cycles in a short timeframe.

This is another interesting article where three menstrual cycles were examined in either sedentary women, or "moderate exercisers".  (On average, running 20 miles per week plus 5 hours of other, nonspecified, exercise).

In the sedentary women, 91% of menstrual cycles were ovulatory, 9% (all in one woman) had a luteal phase defect.  In the exercising women, 45% were ovulatory, 43% had a luteal phase defect, and 12% were anovulatory.

There was no significant difference in energy availability between the ovulatory and LPD cycles in the exercising women (although both were lower than the sedentary women).  Again, though, I bet you can predict what the energy availability looked like in the anovulatory cycles... yup - MUCH lower.  These women had an average energy balance of about -1000 calories per day, and also ate only about 50% as much fat as the others.

So even in recreational exercisers who are cycling, the energy deficit can cause cycle issues.

Speaking of luteal phase (LP) defects, I now have four postpartum periods to compare in my own life.  In all three live birth cases, my first cycle was while still breastfeeding, but I weaned right around the time the second started.

After #1 was born my LPs were as follows (P = I used Prometrium 200mg 1x/day) (bmi 21.9):
4, 8, 7, 16P, BFP

After #2 (bmi 20.7):
6, 6, 7, 9, 9, 9, 10, 10, BFP [

After my mc (bmi 21):
7, 14P, 14P, 14P, 14P, 10, 12, 13P, 14P, 18P, 17P, 12

After #3 (bmi 20.3):
10, 10, 11, 12, 12, 12

Guess what the difference is after #3 when my LPs have been much better and gotten longer much more quickly - VERY LITTLE EXERCISE!

Now, I ride my bike maybe once a week and play ice hockey once a week.  A fair bit of walking bc of chasing after the kids, and I lift weights once in a blue moon.

After #1 and 2 were born I was playing hockey 2-3x/week, biking to/from work, and lifting weights 2x/week.

More food for thought.  Pun intended ;)

3 comments:

Ceejay said...

Hey Nico,

This isn't totally related to the post except the part about the LPD and something that worked for me. Once I started cycling on my own before pregnancy #1, I always had about 9-day luteal phases. I took progesterone supps for a few cycles but then stopped and got pregnant without them. I was exercising pretty lightly at that point. After my first pregnancy, my cycles returned about 14 months postpartum, about a month and a half after weaning. I was ovulating earlier than before (around day 20-25 rather than after day 30) but still had the 9-10-day LPs. Then my naturopath gave me something called Progon-B, a biodentical Progesterone that you take orally rather than as a cream, since the creams can cause more problems. She told me to start taking it as soon as I saw signs of ovulating, which was often by day 14 or so--it was taking my body a while to actually get over the hump and ovulate. I did that for two cycles, but starting the progon so early actually prevented me from ovulating at all (which surprised my naturopath a lot). So I would take it for about 12 days and then my period would come and I would stop, but never ovulate. Since it didn't seem to be working. But then, next cycle, my LP was magically around 12 days! It stayed that way, getting about a half a day longer each time, for the next three cycles, while my ovulation day got earlier each time. The third cycle, I ovulated on day 18 and was pregnant. So it seems like the biodentical progesterone accomplished what the synthetic never did and jump-started my luteal phase to be long enough on its own. I hadn't made any other diet or lifestyle changes during this time, and my exercise levels were very moderate. In fact, my life was the most crazy during that third cycle when I got pregnant--we had just moved overseas. I feel like other women might want to try the Progon-B option. I think it's available to purchase online, no prescription required.

Anonymous said...

I am 16 weeks pregnant with my first and just reading your blog now. It's very informative. I am 28 years old now and probably had hypothalamic amenorrhea from age 17-24 because of exercising and low body fat percentage. My period returned in early 2010 and has been regular ever since. All it took was gaining a bit more weight. Despite all that, I got pregnant the first month trying with my husband. I didn't even know how to read a pregnancy test correctly I was such a beginner. I never tracked ovulation, never had any miscarriages, never tried any fertility treatments. When I wasn't getting my period I was about 120lbs at 5'8", once I hit like 128lbs, it came back. I wasn't even trying to lose weight, I was just very active. I know it's not the solution for everyone but I really believe that your body knows your healthy weight. When I was 120lbs I was internally cold a lot and miserable. I should have listened more to my own body. I think this was very preventable on my end and I regret not trying harder to get healthy at the time.

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