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Hey guys!

So I've got a super broad question. I'm wondering if anyone else out there has Amenorrhea (lack of menstruation), has had it before and gotten their periods back, or generally has some ideas about its true causes. Last year, when I lost a lot of weight quickly on a CW carb-only low-calorie diet, I stopped menstruating. At the time, I was also under a lot of stress, attempting to finish my thesis. Years before, I weighed 30 lbs more, was also under a lot of stress and also lost my period, so I've been thinking/hoping that the Amenorrhea this time around was also due to stress. Since going paleo this past spring, I thought it would help bring my periods back, but to no avail. Its now been 10 months or so since I stopped menstruating. I eat conventional meat, canned fishes, eggs, olive oil, and vegetables. I know that my o6 ratio is high, but there's nothing much I can do about it until I return to the states, and also I remember getting regular periods on my CW diet, which also had a relatively high o6 ratio. I get plenty of sun and plenty of sleep.

I'm 5'2, 110 lbs, and perhaps at 15 percent body fat (a guess). I exercise, certainly, but not excessively--maybe a sprint, resistant, or laid-back workout once per day. My old nutritionist said I weigh too little and need to return to my 'set weight.' She asked me what I weighed when I started my period, and suggested I return to that weight, but I'm quite sure I'm above that weight now. And everything on the internet that I've found says the same thing: put on weight and exercise less. I don't really think I need to do that to be healthy. Any insight or experience you've got at all would be wonderful.

Thank you so much!

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I don't think you weigh too little. I weigh the same amount and have regular periods. See a doctor. But exercise much much less. – Bread-Eating Beelzebub Sep 9 2010 at 12:37
Well, this just happened to me for the first time (last week), so I guess it's a good question for my sake... – Marisa Sep 9 2010 at 13:23
Sure. Thank you, Melissa. But, as I mentioned below, I've been at least this active my entire life, and am now the least active I think I've ever been, maybe clocking in a few short work outs per week. – Stefani Sep 9 2010 at 14:57
Marisa and Stefani, how low carb are you? how many calories a day? – Bread-Eating Beelzebub Sep 9 2010 at 16:27
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 Definitely double that calorie intake. If you have to resort to heavy cream/coconut milk smoothies, that's what I used. Carb intake might be worth experimenting with. – Bread-Eating Beelzebub Sep 9 2010 at 21:03
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11 Answers

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See a doctor.

I lost weight rapidly last year, when I went primal, and also stopped menstruating. I put this down to the rapid weight-loss.

Wrong.

I found out that I had poly-cystic ovaries (but not the syndrome, phew!), whereby ovulation was not successfully occurring for an unknown reason. Given one of the treatments is a low-carb diet, insulin may well be implicated, but I've tried raising my carbs to see whether my body was responding in reverse to no avail. Instead, I have to take the Pill to prevent my body trying to ovulate, so that I don't burn out my ovaries. All this in the name of preserving fertility, even though I don't think I want to ever have kids of my own...

Even though it may well be that your issue is based on diet, don't risk it. I waited five months before getting checked out, and could well have ended up infertile had I waited longer.

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hey, this is awesome, and I appreciate your info and empathy. Thank you. – Stefani Sep 9 2010 at 14:55
Hey GGP. Check out this post at Melissa's blog, which explains everything I've experienced, and seems as though it might fit your experience, too: huntgatherlove.com/content/womens-set-points – Stefani Jan 18 2011 at 20:38
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Hi Sally!

Looks like the people commenting on your post aren't helping much at all. They're right-- what you're doing is pretty far from the generally accepted paleo idea/diet/etc, and I would recommend cutting fruit and including full fat in your meals-- but I also know that amenorrhea is a complex issue and possibly caused by a number of things. Most of which are not to be alarmed about, so breathe, sally, breathe!

First, rapid weight loss can mess up your menstruation, partly because estrogen is produced in your fat cells. I'm sure there are other hormonal effects of weight loss as well, especially if your diet changed in any way before beginning paleo, but I couldn't put my finger on one thing or another. Did anything get added to your diet? Deleted? Anything that is linked to hormones in research, such as dairy, soy, or conventional meat?

One problem that women often have with irregular periods is PCOS, Poly cystic ovarian syndrome. PCOS is diagnosed by the presence of cysts on the ovaries and perhaps a slew of other symptoms including acne, hair loss, and hair in typically male locations. PCOS has been tied--by even conventional wisdom doctors-- to insulinemia, high carbohydrate consumption, metabolic syndrome, etc. The theory is that insulinemia induces high testosterone levels and general hormone imbalance. In light of this information, doctors usually recommend that women lose weight to mitigate PCOS. However, there is still a significant portion of women with PCOS who are in good physical condition. I have no idea why. No idea. Clearly the hormone system is out of balance, but the question is: why? i haven't been able to find any research on the matter.

Secondly, whether your menstruation difficulty is due to weight loss or to PCOS, don't panic, because I promise (well, no, but I've been told its quite likely) you can still have babies. Even if you don't ovulate for years you can troubleshoot different hormone therapies with your doctor and get started menstruating again.

There are other reasons that you could have lost your period. They are much more rare, but also more serious. Good reasons all to get checked out by a good doc.

Sally I happen to know a lot about this because I think that I'm in a fairly similar situation. I stopped menstruating in November of 2009 (as I believe I stated above). That was preceded by rapid weight loss. I went Paleo in March 2010. Still at the same (healthy) weight, nothing changed. (I don't have much of a sex drive, either, note). In June, some Acne appeared, in September, even more, and to do this day I still have acne and I still don't menstruate. I got an ultrasound and it turns out I have cystic ovaries, but given that low carbohydrate diets are recommended to mitigate PCOS, there's not a whole lot more I can be doing.

I have tried all sorts of different foods. I eat very strictly paleo--saturated fats and fish and eggs and cruciferous vegetables. I have tried exercising less and exercising more, and eating different macronutrient ratios and... well, everything. Going paleo has cured me of so many problems-- insomnia, blood sugar swings, keratosis pilaris, hair loss, overweight-- but it has not cured me of this. Not yet. And there are a whole lot of variables to consider and weigh, and I don't even know half of them, both for you and for me, so I can't possibly make proper recommendations. I will 100 percent put myself behind paleo. I think its very important, and maybe it is helping. It has been shown to help many people. But hormone levels are definitely the place to start looking, and I would get tested. Its possible whatever you are dealing with is very far removed from your food choices. I'd go ahead and get behind your commenters, as unhelpful for your problem as they are, and say you might want to 'clean up' your diet and see if it helps. But I lost my period on a no-fat high-carb diet, and I didn't get it back on a high fat no carb clean paleo diet either.

And finally--you're doing great! Even though your diet isn't the most pristine paleo, you're on the right track, and you're going to figure out the problem with your periods in time. Don't sweat it. Asking questions and seeing doctors is the absolute best thing you could be doing. Way to go.

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hey Stefani thankyou so much for this comment, this really helped me see it from a clear point of view and not stress out so much haha. as far as anything being added or subtracted from my diet, i stopped eating processed foods and grains/bread/pasta/potatoes/chocolate and all that stuff, and ate purely meat/veggies/and fruit. then i added in dairy and then i added in nuts today. i've worked so hard to lose all this weight, it's been almost 20 pounds, but now i'm worried that i put my health at risk because i didnt even consider my period until lately and how it was being affected. what type – Sally Jan 12 2011 at 11:14
of hormone tests can you take? and how would you suggest that i clean up my diet? thankyou so much again for your advice and sharing your story with me, that is so great how paleo has helped you in all those areas of health. i find that paleo leaves me feeling less gluggy and sluggish as well, which is why i would be sad to part from it but i really feel that i should get my periods back on track as its abnormal for me, but it may be due to weightloss and other varables as you stated. have you still not had your period since you lost it from the no-fat high carb diet? thanks again, i'll be su – Sally Jan 12 2011 at 11:18
re to add in more fats into my diet – Sally Jan 12 2011 at 11:18
Sally, no problem. I'm glad to have a comrade of sorts as well. First, you can get just about every hormone level tested (a blood test). First go see your doctor, hopefully an obgyn, and they'll tell you what tests you need, if they think you need them. I tested high-ish for male hormones and low-ish for female hormones. I have no idea why or necessarily what this means. Supposedly, it is what has induced my cystic ovaries. Fortunately, cysts come and go with time, so nothing in the PCOS condition is really permanent. – Stefani Jan 13 2011 at 2:39
General consensus is that low fat products are overly-processed. The fat removal process often breaks up fats and makes them hard for our bodies to handle. Moreover, the decline in food quality from removing the fat is made up for with added sugar and other highly processed chemical products such as sucralose. For Paleo dieters, Natural is the way to go, so non-fat processing is a No Go. The other thing I would do is lessen the fruit intake, especially in the aim of weight loss. Fructose stresses your liver and is also associated with impaired weight loss. While natural, fruits are – Stefani Jan 13 2011 at 2:43
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Seeing most doctors or gyns about amennorhea will get you nothing more than a prescription for birth control, I'm sorry to say. If you can afford it, get a referral to a specialist, and do your own research on what tests you can request, to determine the extent of your hormonal problems.

I have been participating in the online 'paleo' community for several years now and have seen many women - most especially slim ones - experience amenorrhea on low-carb paleo. There are different sorts of stress that can cause/contribute to infertility. Mental/emotional stress is a big one, so is the stress from too much exercise, especially cardio (this is the main factor in athletes losing their fertility, not body fat percentage). Weight loss, especially due to a semi-starvation low-fat diet which has huge effects on hormonal balance, is a huge factor in amenorrhea. For some of us, low dietary glucose even with adequate fat and calories, is such a strain on the body that there is no energy left over to maintain a cycle.

My recommendations:

Eat at least 200g of starch per day until you get your period again. Potatoes, sweet potatoes, white rice, plantains and bananas are good and mostly 'paleo' sources.

Eat plenty of fat too. Consider adding some to meals.

Stop doing cardio until your fertility is restored.

Don't be afraid to gain a few pounds, and some percentage points of body fat. If you are really at 15% that is awfully low, and keeping it at closer to 20% (which does mean gaining weight, get used to this idea, 115 or 120 might be where you need to be) should help correct the problem.

Amenorrhea is not healthy. It affects many aspects of your health and your body, in particular your bones. I would make it a big priority to solve this problem, if I were you.

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2 
 So true regarding the starch issue - I lost my period after 6 months of very low carb paleo (with a lot of life stress on top of that) Then after a bit of reading I decided to eat some starch everyday. Within a week of reintroducing the starch my period returned! Now that my period is over I am going to cycle my starches weekly to get these last few bits of body fat off. Once my bodyfat levels are down I will make starch a regular part of my maintenance paleo way of eating. – Grottenolm Jul 2 2011 at 0:47
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Low circulating T3 or leptin levels can cause amenorrhoea, so losing a fair amount of weight can drop leptin levels and stop the release of luteinizing hormone that triggers ovulation. The solution is to gain more body fat, or increase thyroid hormone levels (e.g. the various over-the-counter thyroid supplements such as iodine or tyrosine), so that the body thinks it has enough energy reserves to support a pregnancy.

I discussed the role of leptin in anorexia nervosa awhile ago: http://entropyproduction.blogspot.com/2010/01/leptin-and-anorexia.html

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Women have a significantly higher body fat than men. The typically feminine curves consist to a large extent of body fat. For this reason, it is also for aesthetic reasons a minimum body fat for women.

Women with a very low body fat (under 20 to 22%), there are often health problems. Widespread problems are:

irregular or absent period reduced fertility or infertility bone loss (osteoporosis) brittle bones

29% body fat is considered optimal for a woman to become pregnant.

Exercising 2 or 3 times a week should be enough (read "The primal blueprint")

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Um...29% body fat is obesity. Definitely NOT healthy AT ALL. Plus, she said that when she weighted 30 lbs. more she also stopped menstruating. – Pili Sep 9 2010 at 13:47
thanks, Pili. Exercising 2 or 3 times a week should be enough and is, but I've been active my entire life, which I enjoy, and my level of activity is still far below that of most athletes I know. Additionally, I said my 15 percent was a GUESS, was just trying to say that I look athletic without being emaciated. – Stefani Sep 9 2010 at 14:54
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 In women obesity starts with more than 32 % body fat (wikipedia)... – Kikilula Sep 9 2010 at 16:37
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I had amenorrhea for 12 years and at 43 finally got my period back. In my experience I had to learn to be uncomfortable. I am 5'5 and was a super lean 105. My body did not like this and though I liked the way I performed athletically and looked, I was destroying my body (as you are). I "looked" healthy but I had to stop working out for 6 months and gain weight in order to see changes. (and I tried everything, RX, Paleo, Leptin Reset, etc.) I do believe in all those diets but they DID NOT help MY amenorrhea. I am 120 now. I don't like the way I look but I sure do like my body functioning in a healthy way. If all tests are coming back inconclusive you might have to make a decision that your training and "healthy" eating aren't helping.

Best wishes.

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Hi Flip. that's really helpful. I've been troubleshooting this for a long time, and it looks like starches are helping, but more than anything the weight is helping. The thing is-- I'm 5'2 and 118 lbs, putting me at a BMI of 21.5, well above "underweight." My hope is that it just takes time. How long did it take you at your current weight to begin menstruating? Did you go up from 105 slowly or suddenly? PS 120 at 5'5 is still a low BMI, and I am SURE that being fit with a bit of curve is totally beautiful on you!!!! – Stefani Mar 8 2012 at 1:33
Hi Stefani, How long have you been at 118? Are you training? Honestly, from what I have studied it seems that the women that cut exercise and gain weight are the first to get their periods. I personally didn't trust this theory. (which is why I have had HA for over 10 years) I did increase slow BUT again keep in mind I combined only walking with this weight gain. Also, I NEVER let my body exist in a deficit. I ate small meals regularly and ate like a "normal" person. Not super crappy but bread, rice and pizza were now okay in my diet. – Flip Mar 8 2012 at 14:29
To answer your question about I don't think is so much about the current weight which was only a month as much as it was the total package of reduced training and gaining weight. The reason I say that is because a year ago I got up to 120 but was training super intense and still had HA. Then in Feb. I broke my foot and didn't train for 2 months but was 105 and still had HA. My body needed both, which was what many girls were telling me but I didn't trust them nor my body. Now I conclude there is evidence this works. I am a great expample because I am old so if I can do it, you young – Flip Mar 8 2012 at 14:33
will recover. It is just a fact that when you are younger you recover quickly. Keep me posted. I wish there was a way to exchange e-mails without the whole world seeing it. ha! – Flip Mar 8 2012 at 14:37
That's exciting to hear that cutting exercise will help. I've cut way back, but maybe what my body needs is to eliminate it entirely for a little while. I've also picked up a nasty habit of fasting often. I keep fasting because I am thinking that it might improve my insulin sensitivity after all of the carbs I am eating and grazing I am doing-- I often put on some weight and eat regularly and then panic, so I fast and exercise a lot for a few days to get "back to normal" (at my 118). What I need to do is stop overeating and undereating, and find the right balance where I'm not worried – Stefani Mar 12 2012 at 4:28
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For what it's worth, I have not yet menstruated whilst on paleo.

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Hi there i'm 19 years old and i'm really worried because i started paleo when in June 2010 and have been doing it up until today and have had REALLY irregular periods, as in, i've had one period during this whole time and that was in november. I'm really worried, i've been to the doctor and was told it's probly due to weightloss (i've gone down from 159 to 140 at the moment, but it's been over the course of 7 months) but i'm only 19 and don't want to become infertile, this is my biggest fear that something is wrong now. I've had two ultrasounds and they havent found anything, only a little bit of fluid around one of my ovaries but that's it. I had a period in Late october 2010 but that was after having two pills of Yaz which i then stopped due to finding out really negative side effects. My diet consists of Breakfast: 2 bananas, skim milk, ice in a smoothie and egg whites or a fruit salad with egg whites, fruit in between breakfast and lunch, then for lunch i'll have protein and veggies/fruit, and a snack of veggies or fruit and then for dinner i'll have protein and veggies. Please help in any way that you can if you have any ideas as to why i am not getting my periods. i have ALWAYS been regular, and up until May 2010 this stopped just before i started paleo. Is this just due to weightloss?

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 It sounds like you're not doing paleo. Too many fruits and veggies and not enough fat. – pfw Jan 11 2011 at 12:22
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 As pfw said, doesn't seem like paleo at all. May be helpful to review paleo basics E.g. paleonu.com/get-started. For starters, much less fruit, much more fat. If u want to stick with dairy, then at least keep it full fat. Also, might want to add some meat to your breakfast. And why are u avoiding egg yolks? And I'm curious about what u define as "protein". – The Primalist Jan 11 2011 at 17:40
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 Looks like you're on a Faileo diet: huntgatherlove.com/content/are-you-faileo-diet – Paleo Seb Jan 12 2011 at 9:10
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 Fats won't make you gain weight, Sally. 1300/1500 calories is probably enough, you just need to eat better food. Don't avoid the egg yolk, it's the best part! It's really too much to answer in a comment, if you look at some of the "new to Paleo" threads, you should find some great answers! – sherpamelissa Jan 12 2011 at 13:30
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 Eating fruit with every meal is much more likely to make you fat than eating dietary fat. You need to do some reading girl! – rar Jan 12 2011 at 18:20
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Hi guys! I am Cherise... I wonder why I missed my period for about five month... I am so worried until I dont dare to tell my mom what had happen. Besides, I also afraid to visit a dostor... Can anyone tell me what to do to overcome this period problem?

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 see a doctor! -- – Bread-Eating Beelzebub Feb 7 2011 at 12:58
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 See a doctor, I promise whatever you learn will be a good thing to know. That said, if you want to talk through how to deal with your mom, how to make a doctor's appointment, any personal issues you might be having about it, drop me a line @ pepper@paleopepper.com – Stefani Feb 8 2011 at 6:14
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I was diagnosed with PCOS a few years ago. I typically had about 2 periods per year. The doctor put me on birth control and told me that it might "jump start" my body. So after 2 years of being on bc I decided to see if my body was "jump started". I stopped taking my bc and had 1 period in 2009. Obviously the bc didn't do the trick. In June of 2010 I went vegan(no dairy, no eggs, no meat. lots of fruit, veggies, nuts, seeds, beans, and whole grains. a little tofu. hardly any junkfood) and got my first period(in June). I also ran 3-4 miles 7 days/week. I have had a period every month except August 2010(I got married and think it might have been due to stress that I missed my period). In April 2011 I started Crossfit(high intensity workouts 3 days/week) and in May I decided to try a paleo(no dairy. no beans. hardly any grains. lots of organic, grassfed meat and veggies. moderate amounts of nuts, seeds,and fruit) diet. I had a very light period in May and didn't get a period at all in June. I want to have a baby some time in the near future so I didn't want to end up back where I started. Two weeks ago I decided to go back to my vegan diet with a small allowance for seafood only(2-3 times per week). I got my period today. I honestly think the reason I didn't get my period last month was because of the addition of meat into my diet and the reason my period arrived today was because I omitted meat from my diet. That's a super fast adjustment for my body to make. I know it seems crazy that my body would be that sensitive to animal protein, but there really doesn't seem to be any other way to explain it. I think everyone's body is different and certain things work for certain people. I highly recommend omitting dairy from your diet and cutting back on grains/gluten as much as possible. From there you can experiment with different animal proteins and seafood to see what works best for you. FYI I am 28 years old, 5'4", and 125 lbs. I have been at this same weight for the majority of my life, regardless of my diet. However, I have developed more lean muscle on the paleo diet. This is why I intend to keep seafood in my diet if my body allows.

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 I'm 99% sure that you didn't lose your period because you ate meat. You lost it because you went from a balanced, carb-rich vegan diet to a VLC paleo diet with no sources of starch AND on top of it you had recently started doing very high-intensity exercise. I would probably lose my periods living that way too, and I don't even have PCOS. Your gluten-free vegan diet sounds pretty healthy to me, but please don't be afraid to eat animal products - they did not cause this problem. – animalcule Jul 1 2011 at 18:35
Some people need starch to be healthy. I know I do. I was lucky enough not to get infertility from my VLC experimentation, but if I hadn't listened to my body I could have. – animalcule Jul 1 2011 at 18:36
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I started paleo in August 2010, and after the first month, went VLC, strict orthodox paleo - I was probably eating 1500 cals and 20g carbs a day (I'm 5'1'', lightly active)

About a month after going VLC, my period stopped dead. Soon after that, my sex drive died a rapid death and I found it incredibly hard to lose weight despite regular IF and a 1200cal/day diet. I was cold a lot, too. I was probably eating about 60/30/10 t0 65/30/5 most days.

After about 6 months of 1200cals/day, occasional IF, and misery, I got down to 110lbs, and, not being able to face any more of the lethargy, hunger and cold, I gave up trying to lose more weight and went back to 1500-1600 cals a day, and about 20-30g carbs. I gained a few pounds, but was no longer weak/cold/hungry. However, the amenorrhoea remained until I did some reading about insulin, leptin, aT3, rT3 and T4. A test from the doctor confirmed low levels of aT3 and raised levels of rT3 and T4.

I overhauled my diet from VLC strict paleo to LC paleo-primal, going from 10-20g carbs a day to 40-70g by adding in root veggies, tomatoes, bell peppers, some fruits, a little full fat goat yoghurt, occasional sugary treats etc. About a month later, my period came back after an 18-month absence. Regular ever since.

Not enough cals + not enough carbs (+ too much training) = (too low body fat), low leptin, low aT3 = no periods.

(sidenote - of course you can eat a lot of carbs and still get amenorrhoea if the training vs calories balance isn't right. I spend many years on a competitive rowing team and almost all the lightweight females had <20% BF and amenorrhoea, something overwhelmingly common in female athletes)

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