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Hypothalamic amenorrhea and anemia. Low ferritin. Any connection?

Posted: Mon Dec 11, 2023 8:13 am
by 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!

Re: Hypothalamic amenorrhea and anemia. Low ferritin. Any connection?

Posted: Sun Dec 17, 2023 4:13 am
by 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;

Re: Hypothalamic amenorrhea and anemia. Low ferritin. Any connection?

Posted: Sun Dec 17, 2023 4:15 am
by 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.