Warning: This is a potential trigger blog post particularly if you are #ttc or struggling with fertility issues. At the same time, I hope that my story can inspire others that no matter what the fertility issues you are or have been experiencing, there can be a positive and happy ending.
Throughout my life I would say that I describe myself as a typical Type A personality — micro-controlling every aspect of my life and I’ve always been extremely career-focussed. When I met Ryan at 22 and we subsequently got married when I was 28, children were in the future plan, but not immediately. I’ve never been very maternal or had maternal instincts — to be quite honest both Ryan and I weren’t sure if we wanted kids. We seemed to change our mind on a monthly basis. I know that might perhaps sound that we were ungrateful but trust me when I say that is far from the truth when you read my story.
We didn’t follow the traditional route at all (marriage, kids, house, etc.), since the right time hadn’t come up for us yet. Even though we understood from our friends and family that there is ‘never a right time to have kids’, what followed our wedding was the biggest job in my career putting on the London 2012 Games, another big job and move to California for a year, and this all culminating in a career change for both myself and Ryan, which led to me re-qualifying as a PT and working in the fitness industry.
Four years ago, however, at the age of 34 we were finally settled in our lives and careers and ready to take that next big step. So, I came off the contraceptive pill.
When you believe that you have looked after your body your entire life — just to give you an idea I barely drink alcohol, have never taken hard drugs, never smoked, always exercised, have always eaten well — the last thing I thought I would struggle with was my fertility. Unfortunately, all my hidden problems were unveiled when I came off the pill. It was almost as if I was hiding behind a mask my entire adult life. As a side point, I discovered many of my past mental health issues were linked to the pill (despite any true scientific evidence out there to prove so), but without steering off track here I will leave that story for another day.
At first, I wasn’t too concerned that I hadn’t regained my periods because I had heard from friends and clients that it can take up to a year for the pill to leave your system, for the body to balance its hormones and to get your periods back. After all, I had been on the pill since I was 17 so that was a considerable length of time for my body to play catch-up after having fake periods each month for 16 years. But I was hopeful my periods would return and after speaking to my GP who advised me to ‘come off the pill, take folic acid and have lots of sex’ I was thinking to myself, ‘well, it must be quite straightforward then’.
After six months of no periods I started to worry and so I went back to the GP, which is when they started to book me in for various fertility tests. These involved multiple blood tests to determine my reproductive hormone levels, an HSG (a hysterosalpingogram is an X-ray to look for abnormalities in the womb or blockages in the fallopian tubes) and ultrasounds to look at my ovaries.
I was also referred to a fertility centre, unbeknownst to both Ryan and I, that this somehow put us in the system and waiting list for IVF treatment. I will never forget that first appointment. I thought we were seeing a Gynaecologist to help me understand why I wasn’t getting my periods and possibly to perform tests on Ryan’s sperm count and quality. But by the end of this very confusing consultation, I left with a prescription in my hand for some kind of pill that was to instigate my periods (what — like the contraceptive pill that I had been on all my adult life?) and then we would start follicle tracking — basically the preliminary stages of IVF. All I remember was turning to Ryan on the bus ride home and saying, ‘I think she’s putting us forward for IVF. I don’t re-call at any point mentioning we wanted to go down the IVF route. I want to know why I haven’t got a functioning menstrual cycle!’. I was feeling let down by the medical system (not the first time in this story!), and started to wonder if other women in a similar position to me would also be similarly blindsided by their doctors and simply put forward for IVF as the only ‘fertility option’. It was at that point I called up the Gynaecologist and had her discharge me from the IVF fertility clinic.
Back to my fertility tests — my HSG was all clear, but my blood tests and ultrasounds indicated that I was very low in oestrogen since I had a very thin uterus lining and hence why I wasn’t having a period each month. At no point during this stage did anyone, doctors or nurses, even mention HA. What they did ask me, however, was how much I was eating and what I did for a living. I should add here that I have no history of eating disorders per se, however through my HA diagnosis I was to learn later than any type of disordered eating in my past could lead to an absence of your menstrual cycle. When I mentioned I was a PT and subsequently outlined how much exercise I was doing per week, I was met with one of two types of response. One was the typical ‘jaw drops to the floor’ look of astonishment, and the other was that slightly condescending ‘I know what the problem is here’ look that a teacher would give you when they know you’ve done something wrong and you’re going to have to make amends quickly. Essentially, they were telling me that my situation was very common, particularly with women who have a history of eating disorders and those who exercise a lot or who are athletes.
‘Right, ok’, I thought. So, I am supposed to believe that one of the greatest things in life that brings me joy and makes me feel good — my exercise — and what helped me overcome my depression, is now causing me to lose my periods and now I am being faced with fertility issues? Sorry, but I just don’t buy it.
Yes, you might believe me to be stubborn, but rather looking back now I know I was in denial. Remember that by this point no medical professional had diagnosed me with a health condition (which I know now to be HA) and could show me scientific proof that I was in some way responsible for doing damage to my body. I needed a second opinion and so I went back to my GP.
A little over a year of no periods and with no signs of them returning, the GP referred me to an endocrinologist. Now, I am no medical expert but what I do believe should have happened is that I should have seen an endocrinologist as soon as it was determined that low oestrogen (i.e. a hormonal issue) was one of the reasons I wasn’t getting my periods. But we all know the NHS system is not as interconnected as we would hope so of course you have to factor in waiting lists for appointments with specialist departments.
The first endocrinologist I saw (early Summer of 2018) asked me for a very quick overview of my medical history and why I was there and said that I would get booked in for various tests — several blood tests again as well as an MRI scan — to determine whether my pituitary gland (often classed as the ‘master gland’ because it controls several other hormone glands in your body, including the thyroid and adrenals, the ovaries and testicles), displayed any abnormalities and therefore wasn’t ‘firing’ properly to my reproductive hormones.
The blood tests indicated low oestrogen again and the MRI displayed normal characteristics for my pituitary gland. You would think at this stage I’d have felt a bit defeated knowing that apart from low oestrogen my body seemed to be functioning on a neurological level and to some extent hormonally, quite well. At this point no-one had really explained to me why I still had no periods. However, I did leave with an answer and a diagnosis and that diagnosis was Secondary Hypothalamic Amenorrhea — the first time I had ever come across that medical term.
I’ll try not to go into too much scientific detail about what HA is, but in essence it is this:
HA is defined as a missing period of 3 months or more and it’s of hypothalamic origin. The hypothalamus (master regulator) is the major control centre in the brain and it takes in inputs from all over your body, including information from your stomach in terms of the mechanical receptors that tell you how much you’ve eaten — i.e. various hormones are generated when you eat fats, carbs and protein. It also takes in information about your stress levels, in terms of your cortisol levels. The hypothalamus basically collects all of this information from your body and sends out signals to the rest of your body’s systems to tell them what to do. It sends out thyrotropin-releasing hormone to adjust your thyroid, corticotropin-releasing hormone to adjust the production of stress hormones from your adrenals. It sends out gonadotropin-releasing hormone that causes the pituitary gland in the brain to make and secrete the hormones luteinising hormone (LH) and follicle-stimulating hormone (FSH), which are the two main hormones which control your reproductive cycle. It also controls your water balance and adjusts where your body is expending energy.
In terms of the ‘amenorrhea’, the strongest factor is under-fuelling — not eating enough to support everything that your body is doing. And when that happens, your hypothalamus is sensing that your body is not getting enough energy and it tries to shut things down to conserve energy. So it will prioritise only the vital bodily functions like pumping your blood, making you breathe and making your brain work. At the same time, it shuts down functions that are not deemed essential — one of the top things being your reproductive system.
Primary amenorrhea is the absence of a first period in a young woman by the age of 16. Secondary amenorrhea is when a woman who has had normal menstrual cycles stops getting her monthly period.
In short, HA tends to come from under fuelling with some level of either psychological stress or stress from exercise layered on top of that in a synergistic way.
GREAT! I have a diagnosis, which I was happy about even though I had never even heard of HA, let alone how to pronounce it. What was the treatment? Is there treatment even available? The endocrinologist I saw didn’t exactly send me away with a toolkit of remedies to help kick-start my recovery. So, I did what I do best — my own research.
There was extensive information on HA on Dr Google, but you had to be very weary of the source of that information. A couple of things kept coming up again and again, though, and that was that HA was most common in women who either had a) a history of or were currently suffering from an eating disorder or disordered eating — not me — and b) athletes or women who train excessively, particularly in HIIT. Hmm, sometimes me, but not regularly the case. ‘Mental stress’ was mentioned but not a major factor in the causes of HA.
I had basically written myself off both of these major causes of HA and decided that despite this I should investigate it further. What I did know is that it was strongly affecting my chances of conceiving and because of my age at the time (entering the latter part of my thirties), I was starting to run out of time.
Little did I realise at this stage — and I feel quite heartbroken having written that paragraph because now I see how all the dots connected over the years — I was living a life of complete denial. I didn’t look ‘unwell’, but as we all know you cannot tell someone’s health from what they look like. I also often had thoughts about whether it was truly an issue that I had no menstrual cycle — after all, it was convenient to miss a bleed each month and continue your life as normal! However, by the end of my journey I had educated myself so much about my menstrual cycle that I do wonder what on Earth I was taught about menstrual health at school, if anything.
When something goes wrong with your health and your body is sending you warning signs, you have to stop and accept that something is fundamentally wrong and needs to be addressed. I now realise more than ever that awareness is the first step to change. But the next step is asking for help. Always remember you deserve help and to be supported and you always deserve to get better.
Alongside seeing the endocrinologist, I had started seeing an acupuncturist. My mother-in-law was an acupuncturist and before she passed away in 2016, she recommended that when we start trying for a baby to see an acupuncturist as she had helped many women fall pregnant who were struggling to conceive via different means. My acupuncturist specialised in infertility and had researched HA extensively to help my case and I was receiving bi-monthly treatments with her. She also prescribed me some Chinese herbs as well as nutritional interventions to help create more of a ‘warm’ environment for my womb (a comfortable place to house a baby). She had made comments about my weight, which I took in jest, saying it was hard to insert needles into my abdomen because of my defined abdominals. She asked if it was possible to put on more fat around that area because it would increase my chances of fertility, but I laughed it off and kept saying (and this is true) that having always been more of a ‘pear-shaped’ body I tend only to put weight on my hips, bum and thighs. She was also acutely aware of my intense work schedule — I was always rushing off to the next client or next class to teach straight after my acupuncture appointment. But I assured her I had everything under control, and I wasn’t overdoing it…or so I thought.
Just to give you an idea, my week of training/work/sleep looked something like the following at this point:
20 client sessions a week on average
10 classes taught a week (Pilates and Barre)
I trained myself 6 times a week, sometimes twice a day
Training consisted of weight training, spinning, Pilates and Yoga
Average steps per day: 15K
Sleep: average 6 hours
I will be honest and didn’t stop this intense cycle of work and training for a long time, despite doctors’ requests and what I knew about HA at this stage. I was still in denial about exercise in particular, since there are so many scientific studies to prove that it helps increase serotonin and other feel-good hormones. Exercise had always made me happy and made me feel confident in my body. I hadn’t been given any evidence that exercise had any adverse effect on the body.
A pivotal moment happened in July 2018 when I booked myself and my husband on a Yoga and Surf Retreat in Portugal. It was there where I suffered my first breakdown. As I mentioned at the start, I am a tough girl with a typical Type A personality, who as sensitive emotionally as I am, always puts up a front and hates to show any sign of weakness. At the end of a mid-week evening Yoga class we finished the class with a 20-minute meditation session. This was the first time I experienced a guided meditation session with an experienced teacher and during that meditation something came over me. I couldn’t tell you what it was or even what the teacher was talking about exactly, but he knew that it had flicked a switch inside of me. He came up to me after the session finished and as the other guests were leaving the room and simply asked if I was ok. At that point I broke down crying. Completely and utterly emotionally exhausted. I remember saying something like ‘I can’t do it anymore. I’m so stressed and it’s damaging my health.’ He threw his arms around me and gave me a hug. From an emotional standpoint, he knew exactly what I was going through. In the nicest possible way, he gave me a bit of a pep talk on how to stop putting so much pressure on myself, not only for the sake of my own health, but for the sake of my relationship with my husband who cared for me so deeply. I know he will probably never get to read this story, but his words that evening have had a profound impact on me ever since.
It was enough for me to take more notice of my health, but not enough for me to change my physical habits. The acupuncture wasn’t working (mainly because I wasn’t changing my lifestyle) and I knew I had another follow-up appointment with my endocrinologist at the end of September, hoping that they would somehow offer me a miracle solution for my HA once and for all.
This time I saw a lovely and very empathetic endocrinologist who truly spent the time to understand where I was at with my fertility journey. After looking at my notes she said, ‘Well, Yasmine, the good news is that there’s actually nothing physically wrong with you per se. Yes, you are lacking in a functioning menstrual cycle, but we’ve done all the relevant tests and we now need to understand what else might be causing this for you.’ She asked if I had reduced my exercise and I said I had tried to (very unsuccessfully) and what else might be causing me stress. I then confided in her that I suffered from depression from the ages of 18 through to 23 and that I have a long-standing history of body dysmorphia.
Body dysmorphic disorder (BDD), is a mental disorder characterized by the obsessive idea that some aspect of one’s own body part or appearance is severely flawed and therefore warrants exceptional measures to hide or fix it. The exceptional measure for me was exercise and the exercise was what kept my body weight to a fixed amount or lower (for the sake of anyone reading this who might be triggered by this story, I will not be disclosing any weight measurements). I had never, ever classed myself with an eating disorder, because I love food! But what I had unknowingly been doing most of my adult life is controlling any weight gain through excessively exercising. And because of that, I realised at that point that I not only had developed an unhealthy relationship with exercise, but I actually had an addiction to it.
Hindsight is an amazing thing when you realise what you could have stopped happening in your past that could have significantly changed a future (for me) health outcome. I firmly believe in learning from your mistakes and to not dwell on the past, but I feel stupid when I can recall multiple incidents where my overtraining was out of control…and I was warned about it.
One of those incidents, which sticks firmly in my mind, is in Spring 2012 when I was training for my second marathon. I was still working at London 2012 and quite stressed since we were only a few months away from the start of the Games and I crazily signed up to do the London Marathon that year.
I was carrying a light box of merchandise down the emergency stairwell, as I couldn’t be bothered (and thought it too lazy) to take the lift two flights of stairs. Unfortunately, I was wearing heels and misjudged a step and fell flying headfirst down the set of stairs in front of me. These were hard, stone stairs. If it wasn’t for the cardboard box breaking my fall, I would have certainly fallen on my face and broken something. Instead it was my legs that took the brunt of the fall and when I managed to slowly stand up, I was so shocked at what happened that I just brushed myself off and walked calmly back into the office.
I didn’t scream. I didn’t cry. No-one would have been able to hear me anyway, but I also could never cope with the embarrassment of that in front of my colleagues. I had told my manager and she immediately asked me if I was ok and needed medical attention, but in my typical way I dismissed it as nothing. The truth is, I was in absolute agony and my legs were completely knocked and bruised.
After hobbling home at the end of the day I showed Ryan the injuries and we both wondered whether I needed to go to A&E in case I had sprained something. The bruises were incredibly deep, and I was still in a lot of pain, but we didn’t think A&E was necessary. My next words to Ryan were ‘I know you’re going to think I’m stupid for even thinking this, but I need to get to the gym to train’. He did think I was stupid and refused to even give his opinion on the matter as he knew I knew what he was thinking. I didn’t call my parents — I don’t think I even told them this story. So, I called my mother-in-law to simply ask whether she thought I’d be ok running with my injuries. She also gave me a stern talking to and asked whether I could have at least one rest day and see how I felt the next day. I said I would think about it. That lasted all of 5 minutes and then I packed my bag and went to the gym to train and run 8 miles.
The moral of the story there, apart from always take the lift when you’re carrying any kind of load, is please listen to your body. Always. I wasn’t listening to it then and that was before I realised my fertility issues. Three years later I gave up running — not only because I had at that time fallen out of love with it but for me it is one of the more painful reminders of how my addiction to exercise began.
Returning to my endocrinologist appointment, she had asked me what had helped me in the past to overcome my depression and high propensity for stress. Although I had never been on anti-depressants (I always refused them trying to seek an alternative route), the one thing that helped me enormously was seeing a psychologist. With that, I was referred to see a psychologist in January 2019.
I was put forward for Dynamic Interpersonal Therapy (DIP), which aims to help you understand the connection between presenting symptoms and what is happening in your relationships by identifying a core repetitive pattern of relating that can be traced back to childhood. Throughout a period of four months, this can help identify what could be contributing to psychological stress. It was the right therapy for me as I actually discovered a lot of pent-up emotional childhood trauma and by the end of the treatment felt I had healed a lot of emotional blockages.
After all these health interventions you’d think that it was time to cut my losses and proceed with IVF. But I wasn’t ready to give up on trying to get my periods back naturally. I tried the last possible route — Nutritional Therapy.
I had actually seen a Nutritional Therapist (NT) the previous year as I was curious to see how it might help alongside the acupuncture I was having. The lady I saw actually knew a lot about HA as she had struggled with it herself (due to emotional stress and overtraining). She overhauled my entire supplement cabinet as well as focused on my gut health (key to improving my emotional wellbeing and reducing any extra stressors on my body).
Digestion issues are actually very commonly linked with energy deficiency and stress. Back in 2015 when I changed careers and entered the fitness industry, I suffered for 2 years with IBS (Irritable Bowel Syndrome). What I thought at the time was an infection or virus I had picked up from working in the gym, I later discovered was because of my HA. When you’re in an energy deficit (overtraining and under fuelling in my case), your body has trouble making the enzymes that you need to digest different foods. A lot of those symptoms go away when you increase energy intake, pay attention to rest, plus focus on repairing and healing your gut through food and probiotics. Fluctuation in hormones (my low oestrogen) has a direct effect on your digestive system.
My NT had also introduced to me the practices of mindfulness and gratitude, which I didn’t take to straight away if I’m honest. But I committed to everything else in her plan. She also asked if I could integrate more time to myself in my week (I’ve never been able to do this at the risk of feeling guilty that I’m not working) and reduce my exercise (at that point still a problem for me). As we finished the course of 3 months working together, I thanked her for her help as I certainly had implemented certain changes to my lifestyle and still use a lot of her practices to this day. If anything, she made me realise that in a job where I give so much to others, I was never truly giving back to myself.
Fast forward a year and a half to May 2019 and on a recommendation from a friend I had decided to give NT one last shot and see a specific women’s hormone specialist — Angelique Panagos. I had been to a couple of her talks before and I remember agreeing with a lot of the things she said and thought, well, let’s give this one more go!
I should add here that financially I had spent a lot of money on my health by this point — more than I think I ever had in my life. But I truly believe sometimes it is necessary to do so and that you really can’t put a price on health. If it were to help myself finally get my menstrual cycle back, to help me fall pregnant and crucially, get my life back, then I was willing to do what it took to do that. To a point, of course, which is why seeing Angelique was sort of my last resort.
Similarly to my previous NT, I had to give Angelique a full health and medical history including how long I was on the contraceptive pill for and what interventions I had tried leading up to seeing her. Angelique was probably the strictest with me on my exercise regime. She told me I would have to reduce to two yoga sessions a week (refer back to my weekly schedule above) and for those sessions to be restorative yoga. She could see my body visibly froze at those words. I think my response was, ‘Er, ok, I will try’. She gave me some harsh truths — ‘Yasmine, you do want a baby, don’t you? It is paramount we get your periods back and your health back on track.’
The other complete gamechanger at this stage was when Angelique recommended I do the Dutch Test. The Dutch Test is the most advanced hormone test (done by urine testing), offering an extensive profile of sex and adrenal hormones and melatonin, along with their metabolites, to identify symptoms of hormonal imbalances. I was to do this test over the course of a month and then see Angelique once the results had come back.
The results of that test were the trigger I needed to force me to make some drastic changes to my lifestyle. At my next appointment Angelique asked me to sit down next to her and view the results on her computer screen. To be honest I had no idea what I was looking at apart from a series of figures and graphs. I knew about cortisol (our stress hormone) and its effect on the body, but I was about to be delivered some cold hard truths about how my body was being affected by chronically high stress levels.
She proceeded to explain how your cortisol levels rise naturally in the morning, helping you to wake up. This is why you actually don’t need caffeine first thing in the morning to make you feel alert, and if you are relying on caffeine to stay awake then it’s your sleep that should be made more of a priority. Then as the day goes on your cortisol levels peak and stay at a constant for most of the day before melatonin (the body’s marker for darkness, sometimes known as your sleep hormone) kicks in in the evening, just when your cortisol levels should decrease naturally helping you fall asleep.
My results showed a very different picture.
My day started with a big burst of cortisol, as once my alarm goes off I am pretty much up and out of bed ready to get on with my day. Yes, I drank caffeine but never more than 1 cup of coffee or 2 cups of tea per day, and never after 2pm. But my cortisol levels would continue to rise, and rise, and rise. Sometimes they would fluctuate, but they would never decrease towards the evening. In fact, they would stay at an alarmingly heightened level up until bedtime. It was as if I was going from 0 to 100 and staying at 100 day in and day out. My body was burning out.
When Angelique explained how this translated numerically in the data, in comparison to the average of a female my age, I was displaying chronically high levels. Angelique hadn’t seen data like that in any of her patients before.
I was stunned and quite ashamed. How could I have allowed this abuse to my body? I was trying not to blame myself but at the same time, for someone who always thought she was in tune with her body, the truth was far from it. I had the evidence laid bare in front of my eyes and things absolutely had to change from now on.
By this point HA had affected me physiologically, mentally and emotionally. I was trying to remain positive that if I made the changes to my lifestyle, put on weight (hard for me to do) and quit the exercise (the hardest thing anyone has ever asked me to do, particularly for the sake of my health), then surely my periods would return soon.
I had come away with so many take-aways from my work with Angelique, particularly regarding my body’s propensity for and management of stress. Most of you may know that I worked 10 years working in corporate jobs before changing careers. Stress was a natural part of working in these environments and I feel I dealt with it quite well during that time. As soon as I changed careers and started the vicious cycle of overworking myself when I started my own business, I was exhausted all the time. I guess until you are presented with a health issue due to, essentially, ‘burnout’ it’s your body’s sign to tell you to stop and change the way you’re approaching things.
I delved into research to understand how chronic stress affects the body. Chronic stress leads to HPA (hypothalamic–pituitary–adrenal axis) dysregulation (aka adrenal fatigue), low progesterone relative oestrogen dominance, and increased inflammation. Symptoms like PMS, anxiety, insomnia, irregular periods, fibroids, infertility, diabetes, and cardiovascular disease can be the outcome of long-term stress exposure. My antidote to this? Remove all forms of stress from my life. This included certain foods that caused inflammation in my body, which I gave up to improve my gut health. I started meditating religiously every morning as a non-negotiable. I prioritise my sleep with the Oura Ring (a sleep tracker). High-intensity exercise such as running and HIIT training increase stress hormones like cortisol and suppress your hypothalamus, so any form of intense exercise was out of the question. My exercise at the point consisted of a couple of Vinyasa Yoga classes a week and the Pilates classes I was teaching. Oh, and I started to take the bus more instead of walking everywhere.
We were designed evolutionarily to have babies when we are in a safe environment. My body was in no shape or form to house a baby at that stage and in the years prior. I think back now, and I possibly saved Ryan and I some heartache at the very start when we were almost about to start IVF the first time around, because I genuinely feel my body wouldn’t have been able to hold onto a child.
Our bodies are a fine-tuned machine and they don’t want to be inefficient, so if we support it to function optimally it will naturally move towards this as a preference. When your hypothalamus is sensing that your body is not getting enough energy it basically tries to shut things down to conserve energy, and as I mentioned at the start of this story, this is why my reproductive system had shut down for so long — it wasn’t an ‘essential bodily function’. Coupled with that, I had been on the contraceptive pill all of my adult life (a story for another day), which means your brain-ovarian connection has never really solidified. I needed to nurture my hypothalamus and work on myself to create a safe environment for a ‘baby hotel’.
I began to make those big changes in my life — I owed it to myself for my health and my future chances of being a mother. If you didn’t think there were enough ‘epiphany’ moments so far in my fertility journey, well, there was one more to come. And it came in the form of a lunch date with a close male friend and old colleague of mine. I don’t know what encouraged me to tell my fertility issues to him, but it just came up in conversation during our chat. He stopped me immediately when I mentioned HA, and said, ‘Now Yasmine, I don’t know much about what you’ve told me just now, but what I do know is that my girlfriend is going through the same thing. I’m going to connect the two of you so you can chat.”
I really do believe that fate presents itself a lot in my story so far. When I first was diagnosed with HA I felt so alone. I had never heard of HA, nor knew anyone around me going through it, and that’s where you fall down this rabbit hole of ‘what ifs’ and ‘whys’. Prior to speaking to *Sarah (my friend’s girlfriend), I had met another fellow ‘HA-er’ from having overheard her story to her friends at the start of a Pilates class we were both attending. What are the chances? We are friends to this day, and both recovered our periods within a month of one another.
The phone call to *Sarah was the massive lifeline and catalyst I needed to go full on into my recovery. Her story was in ways similar to mine — she developed an unhealthy relationship with exercise (CrossFit) and food in a bid to lose weight, at the same time held down a stressful job as an A&E doctor, and consequently lost her periods. It was only when, from a medical standpoint, she was so surprised at the lack of knowledge of and information on HA in the general medical community. It was only when she started heavily researching HA that she found the book, ‘No Period. Now What?’ by Doctor Nicola Rinaldi. The book that changed everything for me.
After a 2-hour conversation, I had not only ordered that book but another book that was recommended to me on Amazon on the same topic. That book, ‘Overcoming Amenorrhea’ by Tina Muir, was the first book I read on HA and I finished it in 2 days. I was completely absorbed by Tina’s story as it related so much to mine, bar the fact I wasn’t an elite runner. Tina had set the elite running world alight by coming out to the media with her story that she was to give up elite running to get her periods back and have a baby. She received some criticism from fellow running athletes, but far more praise from the rest of the sporting world and beyond that she had brought to light a topic that was very much kept taboo for so long. It is apparently well known in the female running world (I cannot say for other sports) that coaches will train their female athletes to be so underweight they will lose their menstrual cycle. They cite it as an ‘inconvenience’. An old running coach of mine, *Richard, a few years ago told me this exact same story of coaches he knew.
As a side point, *Richard was actually the first person from a non-medical background to ask me about my menstrual cycle with regards to my training. I had had two big half-marathon races coming up, within two weeks of one another, and I was feeling exhausted and frustrated at not having hit a PB in the first race. I asked *Richard what he thought I was doing wrong and he sat me down and asked me to detail out my training schedule to him. He also asked me whether I had a regular menstrual cycle (this was at the height of my HA back in 2016 when I hadn’t been diagnosed), to which of course I replied I hadn’t. *Richard said that I was overtraining and basically forbid me to run at all for the next 10 days (cue my ‘shocked gerbil’ impression) in order to recover my body and my nervous system. He didn’t want me to run the second race at all, for fear that I would injure myself. But stubborn ol’ me ran it anyway and luckily I was ok. No PB though, and I knew deep down that the reasons for that were because *Richard was warning me about my health. Referring back to my earlier story, it was soon after this I gave up running completely.
I had never heard of the phrase ‘all in’ in relation to health until I read Dr Rinaldi’s book. Going ‘all in’ was Dr Rinaldi’s recovery plan for HA that she had coined from her extensive research on hypothalamic amenorrhea as well as her own experience with recovery. When I read the following part in the book, I knew I was in for some home truths: -
“You might be tempted to think that your weight and eating habits are just fine because you aren’t ‘underweight’, and this section doesn’t apply to you. That’s not true, because no matter what your current size, you can be under-fuelling for your body.”
Boom. There it was. A massive question for me all this time was ‘why me?’. How come other slim women/athletes/models etc. are getting their periods and having babies and not me? I have always lived a life of comparing my body, looks, etc. to other people (quite upsetting I know, but we all have been there). Now I see the importance of reminding myself not to compare my journey with others. You don’t know what their own truth is behind closed doors and that their version of what healthy is, is going to be different to what healthy is for YOUR body.
What does going ‘all in’ mean exactly? Well in short it is the recovery of your health and your fertility and for me, the fundamental goal of getting pregnant. To get to that point you need to supply yourself with energy not just for your day-to-day needs, but also to replenish your body after years of under-fuelling (in my case 10+ years). When you’re exercising in an under fuelled manner then there are all these negative health consequences as I’ve detailed above, with one of the main issues being losing your periods.
I was sold. Particularly as the book detailed several case studies from women sharing their HA recovery stories and who had fallen pregnant (if that was their goal) and the fact that Dr Rinaldi has conducted the biggest research study on HA in the world.
Going ‘all in’ was my last resort and this is what it entailed: -
1. Following the book’s eating plan every day (essentially consuming a minimum of 2500 calories per day). NO foods were out of bounds!
2. Cutting out all high intensity exercise
3. Reducing stress and making time to relax
To the average person this might seem achievable but for me it was the toughest part of my journey yet. I was still very anxious about gaining weight considering I had never been over a certain number on the scales and this meant I couldn’t control my weight any longer. I was very conscious about what people might think, particularly considering my job, but as it turned out no one even noticed — apart from my mum, she notices everything, but she actually said that the extra weight suited me.
I knew that at my lowest body fat I was 14% and low body fat, particularly for a female, is unhealthy in the long term. It means your body will have lower levels of leptin (the hormone that helps us to maintain our normal weight), which is produced by body fat. Leptin tells your body that it has plenty of energy and can expend energy freely and it can run its metabolism at maximum speed.
So, the weight had to go on, the intense exercise had to stop, and I had to make as many areas of my life as ‘zen’ as possible. This was still hard, too. And when everyone around you is telling you to relax and take it easy, it’s not so simple when your body and mind have been wired a certain way throughout your life. But I had to keep reminding myself that after all, no one can put your health first apart from yourself.
The recovery time for HA-ers depends on many factors — how quickly you go ‘cold turkey’ on your ‘all-in’ journey, as well as weight-wise where you’re starting from. The book recommends a rough estimate on what BMI you should hit, but as I’ve eluded to before, how many kilograms I needed to put on versus the next female could be very different.
Through reading several chapters of the book I started to research more into the link between low oestrogen and bone density. Dr Rinaldi talks about how not having a period is strongly correlated with below normal bone density. The birth control pill mitigates this to a degree, but does not replace lost bone. Essentially, low oestrogen levels lead to bone breakdown and bone density and amenhorrhea are linked tightly because bone cells contain oestrogen receptors.
Knowing how bone density is related to bone health and strength and that the risk of bone fracture increases as bone density decreases, I started to become concerned with my situation and that no doctor had by this point recommended I take a bone density test (known as a DXA or DEXA scan), despite every blood test indicating my low oestrogen levels together with my HA diagnosis.
So I requested a DEXA scan through my endocrinologist. A bone density test is the only test that can diagnose osteoporosis before a broken bone occurs and it can also detect whether you have osteoporosis or if you should be concerned about your bone health. This test uses a machine to measure your bone density. It estimates the amount of bone in your hip, spine and sometimes other bones and test results are reported using T-scores. A T-score shows how much your bone density is higher or lower than the bone density of a healthy 30-year old adult. A T-score of -1.0 or above is normal bone density and I was happy to find out that my T-score was 0.5. I was in a very healthy range and there was no cause for concern.
How this links to the next part of my story, is that a research study in the book concludes excellent evidence to prove that ongoing energy deficiency contributes to bone loss. It also adds that weight gain and continued adequate caloric intake are important for bone rehabilitation. Having been on the Pill for so long, another research study indicated that the Pill has been shown to decrease the rate of bone breakdown, but they also reduce bone formation. This explains why women who go on the Pill, particularly for an extended period of time (like I did), don’t lose additional bone mass, but nor do they gain. What seemed to be more evident is that weight gain, and vitally, the return of the menstrual cycle, are associated with bone density increases. With my positive DEXA scan result I felt my body was on the right track.
September 2019 came and by the end of that month I had put on 3 kgs. I just want you to read that again. Just 3 kgs. Probably what many of us would just put on when we go on a 2-week holiday, right? My exercise was still just Yoga and Pilates, with a bit of weight training to maintain strong bone density (another post for another time!). I meditated every morning, my gut health was back on track, and I had started to reduce my workload.
On the morning of October the 11th, 2019, I popped to the bathroom before I left for my first client of the day and noticed a slightly darker stain on the toilet paper. I think my heart stopped for a moment. ‘Surely not’, I thought. At this point in a hurry I searched high and low at the back of my bathroom cabinet for a tampon, praying that I still had a couple (quite the comedy moment!). I did (and yes, the expiry date was up 2 years ago but I wasn’t going to worry about that at the time!) and then off I went to my client. By the time I went to the bathroom at my client’s house, my first natural period in 3 years had arrived. I felt like screaming for joy (remember I was still in my client’s bathroom!). I don’t know how I contained myself for an hour (my client will be laughing at this if she reads this), but as soon as I left I called Ryan and my two close girlfriends screaming ‘I GOT MY PERIOD’ from the local high street. I was so happy I couldn’t have cared less who heard me.
Dr Rinaldi’s recovery plan had worked. The most surprising of all for me was that my body was screaming for just 3kgs of weight (amongst the other methods) to trigger my periods to start again. That will haunt me for a long time, because it shows that I was controlling my weight for so many years without even realising it.
The key to a successful recovery from this point is to aim for 3 recovery periods. Luckily my periods continued to come, albeit irregular, but that was very normal for someone like me who had been on the contraceptive pill all of her adult life prior to the HA diagnosis.
At this stage we had decided to proceed towards IVF. For me, the fact that I hadn’t fallen pregnant yet naturally was not deemed as a failure in my eyes. I just knew that my body would be more prepared to take on something quite as invasive as IVF. I had also heavily researched the IVF process as well as sought comfort and reassurance from a close friend who went through IVF successfully and I felt it was the right decision for Ryan and me.
I knew that one of the reasons I wasn’t falling pregnant naturally was because there was still a missing link in my menstrual cycle, which was that I wasn’t ovulating. I never had any of the ovulation signs nor when I used any OTKs (ovulation test kits) did they indicate I was ovulating at all. When you are on the contraceptive pill, you do not ovulate (and possibly with HA as well), so you don’t get all the benefits like the marked increase in oestrogen and progesterone (remember I was very low oestrogen during the years I experienced HA). Add to that my previously high stress levels (when stress hormones go up then progesterone levels go down), and hence why my monthly ‘Day 21 Progesterone’ blood tests over the past 6 months had indicated I still wasn’t ovulating.
We had the first fertility appointment in early March 2020 and then…COVID, and subsequently, lockdown hit.
This threw a massive spanner in the works, especially as we were so close to getting started. But the situation was out of our hands, and instead I threw myself into work, transferring my entire business online in the first weekend of lockdown.
Now, I should add here that through reading my story so far you probably have been wondering how I coped going through this journey when being surrounded by mums with babies and bumps every day (where I live is ‘Nappy Valley’ after all), as well as having trained multiple clients throughout pregnancy and beyond in my 5+ years of being a PT. Many of my closest friends who knew my situation raised this point and whether I should pause training in this field considering what I was going through. I have to be honest that in no way did training these clients discourage me from my determination and efforts to become a mum myself. On the odd occasion I would be asked by a client or class member if I had kids and you sometimes don’t know what to say other than — ‘no, not yet’, or ‘no, but we’re working on it’, but I remained positive that it would happen for me…it was just a matter of how long did we have to wait? The times I found it more of an emotional struggle were when friends fell pregnant, and I recall a time when a Yoga teacher friend of mine had announced to me she was pregnant just before I was due to do her class. I cried silently to myself for the whole class, because those times were when my struggles really dawned on me and made me realise how much I was keeping my health issues behind closed doors. I was desperate for my own ‘pregnancy happiness’.
Turns out we had to wait until June 2020 when the fertility clinics opened and what proceeded was week after week of going back and forth into the hospital to have my blood tests and ultrasounds. These are all the preliminary tests you need before you start IVF. The frustrating part was that every time I had these tests, I had to go into the hospital two days before to have a COVID test.
It didn’t help discovering that my AMH (Anti Mullerian Hormone) test result was very low. An AMH test is used to check a woman’s ability to produce eggs that can be fertilised for pregnancy. AMH levels help show how many potential egg cells a woman has left. In four years, my levels had declined to a very low level that I only just qualified for IVF on the NHS. I still tried to remain positive.
During this time one of my closest friends fell pregnant. My heart sank when I heard the news. Of course I was over the moon for her but because it was a surprise, a huge part of me wanted to scream at the world and shout ‘BUT WHY NOT ME? WHAT HAVE I DONE TO NOT DESERVE THIS SAME HAPPINESS?’. I was furious at the universe that after almost four years of working on myself and finally recovering from HA that the one goal I had was still not achieved. I was ready to give up — fully and wholeheartedly.
It didn’t help matters that a couple of months prior I had heard from a couple of other old friends who had fallen pregnant, too. This was now affecting my mental wellbeing more than I initially thought, and together with lockdown (where we all sat alone with our thoughts a lot more often) this was pushing me into a dark place of complete despair.
I promised myself I would remain positive, however, and I never, ever stopped believing that I could fall pregnant naturally. With that promise I made to myself I started practising manifestation. I am the least spiritual person you will meet; however, I do believe in fate and so I thought visualising falling pregnant and being pregnant would help steer me away from comparing my situation to others and any other negative thoughts.
The first thing I did was build a baby shrine in our bedroom — nothing big, just some baby shoes, soft toys and a children’s book. The aim was when I meditated in the morning the shrine would be the first thing I looked at. The second thing I did was walk around visualising and acting as if I was pregnant. Weird, I know, but I guess it stopped me from falling into bad habits with exercise again and also slowed my days down (instead of constantly rushing everywhere).
The final thing I tried was writing letters to my future child. This had not only been recommended to me by one of my close friends, but also I read about it in Tina Muir’s book. I was slightly weirded out about the thought of doing this, but I was amazed how quickly the words flowed when I started writing. I had so much to say to this ‘future child’ of mine. When I was at my lowest point and was ready to give up (June 2020), I wrote the longest letter of all, on my own at home with my cat by my side (my only source of immediate comfort at that point). No-one, apart from Ryan and my sister-in-law, knew what I was going through at that stage and that day I cried the most I had in almost 4 years.
It is said that ‘you never know the gift your lowest moments will grant you with’. I was about to receive the biggest gift of all when everything changed in July. I discovered for the first time I had ovulated naturally (using OPKs), and on the 9th of August I took a pregnancy test. After so many failed pregnancy tests over the years, I couldn’t quite believe it when I read, clear as day, ‘positive’.
We were only two weeks away from starting IVF. I am the sixth person I know who this exact same situation has happened to. Whether you think it’s the fact my body just ‘let go’, gave up and relaxed, whether the manifestation together with my positive outlook had worked its magic, or whether it was simply fate. I was and am pregnant. Mine and Ryan’s dream had finally become a reality.
‘Per aspera ad astra’ are the words I live by and I have them tattooed on my wrist. Translated it means, ‘from darkness and hardship to the stars’, and is quite ironically the moral and mantra of my fertility story. And as I sit here 16 weeks pregnant with a healthy baby girl growing inside of me, I have never in my life been so in tune with my amazing body.
Thank you for taking the time to read my story.
There are three women who have been instrumental in my recovery from HA — they are Angelique Panagos, Tina Muir and the incredible Dr Nicola Rinaldi, who without her book “No Period. Now What?” and support group, I would have felt so lost and alone in my journey.
Thank you to a small group of girlfriends (you know exactly who you are) who knew about my journey and supported me through the ups and downs. I know from reading this you will realise I kept a lot of personal parts of the story hidden, but please know you have all played integral parts in helping me believe in myself. It is also thanks to your encouragement that I decided to write this story.
Thank you to my mum, who not only has been a soundboard throughout this journey (via many Skype calls as she lives in Germany), but also from an emotional and maternal perspective. She never once stopped believing I could fall pregnant naturally.
Finally, to my husband Ryan — you witnessed it all from the start and yet were so patient and understanding at every step of the journey. I cannot wait for this next chapter of our lives.
*Some names in this story have been changed for privacy reasons.