Hypothalamic amenorrhea and anemia. Low ferritin. Any connection?

[Anna2005]

Hi Dr Lara Briden,

I am literally in love with your articles and how you explain complex things in simple words! Thank you for that! Your blog is an absolute period revolutionary!

I also have the "Period repair manual" book, and read it multiple times!

Please advise me about my problem. I'm 17 years old, and my cycle has been MIA for 8 months.

JFYI, I got my first period at 11, and while it wasn't always super regular, I only had missed it 1 time in my life before: at 13, when I had anorexia.

Fortunately, that time at 13, my period returned 1 month after I started eating >2300-2400 calories a day and a lot of carbs (even before the recovery weight gain).

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1. Before my period problems this time, my menstrual bleeding started getting lighter, and my 2 cycles before the full ceasing (in February-March 2023) were shorter than I used to have before (2 days instead of 5, and only some light bleeding).
2. I've been exercising for 6 months, but during the period of my life when I started developing period problems, I was sedentary. However, at the same time, I started eating less than usual due to an ED and also the fact that I was anemic and had a low appetite. But I think I ate ~1600-2400 calories a day, depending on the day and occasion.
3. I've been exercising for 6 months, but during the period of my life when I started developing period problems, I was sedentary. However, at the same time, I started eating less than usual due to an ED and also the fact that I was anemic and had a low appetite. But I think I ate ~1600-2400 calories a day, depending on the day and occasion.
4. I went low-carb ~14 months ago, and ate ~80g of carbs, some days more.
5. I've been eating much more healthy food for 6 months already, and sometimes, when I counted my calories, my daily intake used to be at ~2500-2900 calories a day (intentionally).
6. I exercise 30mins * 4 times a week (3 cardio workouts, and 1 strength).
7. My BMI is ~17.5. I lost some weight 11-13 months ago, but that was the weight I put on through the year 2022 when I was sedentary. So I'd say that before putting on weight in 2022, I had a lower BMI than now, but despite that, my period was regular and heavy.
8. I feel really active and have good mood, no cravings or things like that, except that I have very little cervical mucus and no spotting whatsoever! I've been "religiously" taking iron supplements for 6 months already, and (I guess) my ferritin is at normal levels currently.
9. Last 2 months, I've been eating 2100-2400 (max 2600) calories a day, and I re-introduced carbs 2 months ago.
10. I started eating ~500g of sweet potato a day (I have food scales in my household, so certainly ~500-600g), ~300g of rice with butter, some days buckwheat, almost every day — bread, and occasionally fruit. So I think I get ~250-300g of carbs.
11. Currently, I eat a really nice, satiating, and balanced diet with a lot of poultry, fat fish and meats, 3 eggs almost every day, cheese, 180-350g of full-fat cottage cheese several times a week, butter, ghee, yogurt. Goat cheese, and all the other yummy things.
12. I don't think I'm lactose intolerant, and I don't have problems with gluten too. I cannot be 100% certain, but I don't feel bad after eating these foods.
13. I developed a good habit of eating at least 30g of butter every day, but that can go up to 90g if I have it in my rice too.
14. I eat 3 balanced meals a day, generally until complete fullness, and sometimes even beyond.

Considering that I only reintroduced regular carbohydrates ~1.5-2 months ago, should I just wait and see whether my period will return thanks to that??

My other concerns are:

• My hirsutism got heavier ~1 year ago.

• Another thing I'm worried about is that ~2.5 years ago, when I was under stress, I had 3 months of consecutive brown bleed instead of a normal menstrual bleed. Could it be a sign of PCOS in addition to my hirsutism and amenorrhea?

• And the last question, could my amenorrhea be related to low serum iron and ferritin?

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From my self-diagnosis, looks like I was terribly anemic at the time I developed period problems (vertigo, ringing in ears, fatigue, a constant urge to drink water (constantly feeling thirsty; from what I found it's because oxygen is low in anemic people), also muscle aches, and irritability.

I then started taking 16mg of gentle iron from Now Foods 1x/day. I was taking 108mg of chelated iron/week (36mg Now Double Strength * 2 times/week) from June to August, and since then I have been taking 324mg of iron/week (36mg * 3 tablets at a time * 3 times/week).

I'm feeling awesome. and have a lot of energy, exercise moderately. I'd say I feel my best!

But, again, my period has not yet returned, no spotting since March.

Have you had patients who lost their period due to low ferritin/iron in your experience?

I'd be very grateful if you could reply to me with any advice that you think is valid. Please suggest anything, I know I asked whole 2 long questions and provided a lot of detail, so please feel free to answer either of these.

I'm planning to get the blood work done soon.

--
Anna


(edited) P.S. I just watched your interview where you talk about the "Period repair manual" book, and what you say at 2:29 is exactly my case! I started getting period problems 6 months into low-carb, and then lost my period completely!

[Anna2005]

Just another thing I forgot to mention is that ~1 year ago I also started intermittent fasting (16/8). I stopped fasting only in May, and started eating 3-5 times a day, regularly. Before than from October to May I was only eating 2 times a day.

I only now realize how damaging it could be to my fertility.

Currently I have an early breakfast and a late dinner, and a nice lunch in between. Carbs in each meal.

An example of what I eat on an average day is:

2 pieces of bread for breakfast, ~32-36g of raw cow butter, ~90g of parmesan cheese; some days it can be 3 fried eggs and a whole black skin avocado, a piece of bread, and some fruit;

~280g of cooked pasta, a can of tuna or fried fish, butter, vegetables for lunch; it can also be tortilla chicken wraps with cheese and vegetables; or 3 large roasted sweet potatoes and roasted turkey thighs;

~300g of basmati rice with ~30g of butter in my portion, beef stew or 2 chicken thighs (baked, with skin); the protein source can also be beef liver or roasted duck;

[Anna2005]

My aunt had the same period problems as me, except for that she didn't lose any weight and didn't do low carb, but she had very low ferritin. She went to a doctor who prescribed her high iron, zinc and copper doses, and she got her period back in 5 months after starting supplementing and restoring ferritin. That's why I'm wondering whether it could be a genetical predisposition that shuts down periods when ferritin is low.