REPRODUCTIVE HEALTH

What It’s Really Like to
Have Amenorrhea

by MICHELLE KONSTANTINOVSKY

Based on my personal experience, the most common initial reaction to the statement, “I don’t get a period” is the statement, “lucky!” And I get it—periods can be inconvenient at best, debilitating at worst. For most people who get them, the irreparably stained underwear, profound pain, potentially embarrassing bleed-through scenarios, and often ridiculous cost of pads, tampons, and other protection can make periods a huge pain in the ass. But if you have amenorrhea (aka a lack of periods), at least a few of those things can start to sound tolerable—desirable even. 

I first wrote about amenorrhea almost seven years ago, in my first freelance writing gig. I’d pitched it to my editor as a desperate attempt to be paid for researching a health condition I’d been coping with for nearly a decade at that point (and, to be honest, I was also desperate for my first byline). This, reader, is where we drop any social weirdness about TMI, because things are about to get specific. 

I started getting periods a little before my 12th birthday, and as far as periods go, they were pretty okay. I didn’t have heavy bleeding or the type of knock-you-out cramps some of my friends dealt with every month. They were kind of just your textbook, average, run-of-the-mill periods. Until they stopped. 

I’d always struggled with my weight, but for the first 15 years of my life, the struggle was in dealing with what others thought of my weight—I didn’t think much about it at all. I was taller and heavier than most girls in my grade and my mom dealt with disordered eating during my young years. Maybe it was rebellion against the schoolyard teasing and the diet talk at home, but for whatever reason, I didn’t spend too much of my time worrying about my body. And then, somewhat suddenly, it was all I could think about. 

When I was around 16, I felt fed up. I felt unattractive, I felt different, and I felt like something needed to change. So I started eating less. While in my opinion, no teenager (or adult for that matter) should engage in any form of restrictive eating, those prone to obsession (I was) and perfectionism (yup) definitely shouldn’t dabble. But all that’s easy to say in retrospect — the reality is, I didn’t know what I was doing would spiral into full-blown anorexia, and my family and friends didn’t realize something was wrong until I was way too far gone in the disease. 

My periods stopped some time within the first few months of losing a significant amount of weight (I hesitate to say how much—although I regrettably have in other forums — because I know firsthand how triggering numbers can be). I had no idea at the time, but this is called secondary amenorrhea. While primary amenorrhea refers to a total lack of menstruation by age 16, secondary amenorrhea means you’ve missed three or more periods after previously having regular cycles. Amenorrhea isn’t a disease; it’s a symptom. That means it can indicate a variety of conditions, including genetic abnormalities like Turner Syndrome or benign pituitary tumors. 

After major hesitation on my part, my doctors were able to drag it out of me that my recent major weight change hadn’t been due to healthier eating habits or more physical activity; it had come as a result of near starvation and daily punitive workouts that were wrecking my relationships, eroding my personality, fogging my brain, and just generally making me miserable. The amenorrhea made sense—eating disorders are one cause of the issue.  

It’s important to understand that you don’t have to have amenorrhea to be diagnosed with anorexia, although this was the case back in the day. Anyone — any age, any gender, any size, any ethnicity, etc. — can have an eating disorder, and furthermore, plenty of people at low body weights continue to get periods. But amenorrhea can be a result of anorexia. 

The simple explanation for why this is: when your body is running on such a low amount of fuel, it has to prioritize the functions it performs. Reproduction isn’t a bodily function that’s essential for survival, and menstruation is part of reproduction. When your body senses that it has to shift its priorities in the event of malnutrition or extreme physical stress, it can suppress the hormonal production in the brain that’s necessary for menstruation. When that production shuts down, periods go away. 

That’s what happened in my case. And while I was immediately prescribed birth control pills to “regulate” my cycle, I learned much later that the “periods” I got on the pill weren’t really periods, but withdrawal bleeds from the hormones. So while I was working hard with nutritionists and therapists to restore my weight and deal with the underlying issue, my menstrual situation wasn’t “fixed.” 

Over the years, I tried to take breaks from the pill to see if my period could resume on its own, though it never did. During those trials and errors, I found out I have osteopenia, a bone-thinning condition that’s due to low estrogen. It wasn’t until I found a great gynecologist specializing in reproductive endocrinology that I found a patch and pill regimen that works for me and that she says can help deliver the proper amounts of estrogen and progesterone my body needs to be healthy. 

While many women who lose their periods due to eating disorders eventually regain normal menses when they regain the weight, that wasn’t the case for me. My doctor says she’s seen it before—sometimes the “insult” (in the case, the eating disorder) occurs at just the right time (or, well, wrong time), so that it throws the whole system off permanently. That means if I stray from my medication, I don’t bleed. But that also means I risk doing long-term damage to my bones, my heart, my uterus, and other internal organs. 

And while using a patch and taking progesterone pills isn’t exactly how I’d envisioned reclaiming my period, it’s the best solution I’ve found for me and most importantly, allows me to commiserate with my girlfriends about how much periods really suck. Worth it.