Women are lucky they have a period. (Seriously!) The menstrual cycle is a window into many avenues of a woman’s health and gives a woman feedback on how she’s doing on a monthly basis. Assessing the menstrual cycle and hormones can help us understand the impact of different foods on your on metabolism, the physical impacts of your stress, and the general state of your hormone health.
Reproduction is not an essential service. If a woman’s body feels threatened with under-nutrition, over exertion or stress, it will respond by turning off the basic requirements for reproduction and result in a loss of menstrual cycles and other physical symptoms.
When women lose their period, it’s not uncommon they go months without being assessed. Women often come into our office for other concerns such as depression, weight gain or headaches for us to find through a thorough case history that they have gone 3, 6 or 12 months without a cycle, and no one has bothered to look into it.
The menstrual cycle is actually an incredibly complex web of hormones that change daily, to produce the follicle (egg), uterine and breast changes that prepare a woman’s body for possible pregnancy each month. This dynamic process is very sensitive to external stressors such as weight loss, vigorous exercise or chronic disease, and a woman’s body will literally divert resources away from reproduction towards dealing with more acute needs (stress, chronic disease) or may be lacking the basic needs to function normally (weight loss, exercise).
When a woman is assessed for her cycle, she should have hypothalamic hormones (FSH, LH), ovarian hormones (estradiol, progesterone) as well as stress and metabolic hormones (cortisol, insulin) looked at to uncover the cause of her symptoms. If a woman has significant ‘male’ symptoms such acne, hair growth (facial) or loss (head) she should also be assessed for poly cystic ovarian syndrome (PCOS) with additional tests such as DHT (dihydroxytestosterone).
The Naturopathic Doctors in our office are often the primary diagnosis point for PCOS in young women, and are the first to suggest blood work and treatment options for the weight gain, acne and menstrual dysfunction seen in these young women.
Basic blood tests can assess whether your loss of cycling is related to your stress response, premature ovarian failure, or metabolic factors such as weight loss (1). A treatment plan should be constructed based on the cause of your symptoms, and often a ‘watch and wait’ approach does not cause women to spontaneously get better. The clinical guidelines for treating women without a period are very clear, but many clinicians report that they struggle to accurately diagnose and treat young women without a period, especially if exercise and weight loss are the possible culprits (2).
- Jameson JL, editor. Endocrinology: adult & pediatric. 7th edition. Philadelphia, PA: Elsevier Saunders; 2016. 2 p.
- Carlson JL, Curtis M, Halpern-Felsher B. Clinician practices for the management of amenorrhea in the adolescent and young adult athlete. J Adolesc Health Off Publ Soc Adolesc Med. 2007 Apr;40(4):362–5.