Read on to discover a major red flag that your dieting has gone too far.
"I was 17 when I stopped getting my period," says Sarah. Now 26, she dropped to close to 50 pounds in high school on a restricted diet and punitive workout regimen. "Even now that I'm at what's considered to be a healthy weight for my height, I don't have normal cycles."
This absence of menstruation is called amenorrhea and is subcategorized into two types: primary amenorrhea and secondary amenorrhea. Primary amenorrhea refers to no menstrual periods by age 16. Secondary amenorrhea occurs when women like Sarah previously experienced normal menstruation, but then stopped having periods for three to six months or longer.
Everything from stress to medications and even pituitary gland tumors can lead to secondary amenorrhea, but if you've stopped getting your period after embarking on a strict weight loss plan, an overly restrictive diet and/or too much exercise could be to blame.
"A lot of times, people take 'healthy lifestyles' to an extreme," says reproductive endocrinology and infertility specialist Dr. Lee Kao of Laurel Fertility Care in San Francisco. "People begin to say, 'We don't eat this or we don't eat that,' etc. Instead of advocating that kind of extreme 'health,' which in my mind is not healthy at all, people should take a less aggressive approach and look at a balanced lifestyle and diet."
While the absence of regular menses may seem like an appealing scenario (and birth control pills such as Seasonique even market themselves with the promise of reducing a woman's periods to four a year), amenorrhea carries serious health consequences.
"In the short run, if we are talking about a couple of months, nothing significant will happen to the reproductive system," Dr. Kao says.
However, if a woman is taking her dieting too far, even a short-term loss of periods can signify other issues, like an electrolyte imbalance and an impaired reproductive system. "In the long run, the most important thing when this lasts beyond three to six months is that the ovaries are not functioning regularly," explains the infertility specialist. "Secondarily, these women have low estrogen levels because their ovaries are not making estrogen. Without appropriate levels of estrogen, the most significant things women notice are menopausal symptoms: difficulty sleeping, night sweats, etc."
Perhaps even more critical than these unpleasant symptoms is the loss of calcium that women with amenorrhea eventually experience. "Women collect calcium in their bones until they are 25 to 30, which is when they maximize all the calcium they will ever have," says Dr. Kao. "From then until menopause, estrogen helps in balancing calcium loss and intake. Without estrogen from regularly ovulating ovaries, there can be significant loss in calcium when amenorrhea lasts beyond six months. If they also have other hormone imbalances, electrolyte imbalances, not enough sunshine, an irregular diet without milk products and if they smoke, these [factors] put them at high risk for osteoporosis, which is a long-term thing most people are not aware of."
Though only in her 20s, Sarah has already experienced the calcium-depleting effects of amenorrhea due to her extreme weight loss. "My doctor recommended I get a bone density screening a few months ago, and the results indicated that I already had osteopenia," she says, referring to a bone-thinning condition many doctors believe is a precursor to osteoporosis. "It's scary to be faced with that at such a young age."
While the dangers of amenorrhea are considerable, many women continue to put their health at risk in favor of maintaining a weight that is lower than appropriate for their bodies through dieting and excessive exercise. "I used to work in Hollywood, and that is part of the culture there," Dr. Kao says. But with skinnier-than-ever starlets gracing magazine covers and emaciated models routinely strutting down the runways, women throughout the world are being affected by the ever-mounting pressure to be thin.
Though not every woman who embarks on a weight-loss regimen takes it far enough to induce the hazardous effects of amenorrhea, those who may be struggling with eating disorders should immediately seek help. "These women really need to see a nutritionist, and if they are intentionally [restricting food or over-exercising], they should [seek] counseling with a therapist and also consult with a family doctor and their primary OB/GYN," says Dr. Kao. "Nowadays, people should understand that physical appearance does not determine anything, though that's easier said than done, especially in the younger age group."
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