If you have a restrictive eating disorder and you are a young woman, then there is a chance you don’t have a normal menstrual cycle and quite possibly experience what is known as hypothalamic amenorrhoea.
Perhaps you have a hit and miss irregular cycle or maybe you have not had a period for some time (years or even decades). Either way, you might not think it matters that much.
BUT I am here to tell you today that your period does matter.
It matters a lot.
If you are experiencing amenorrhoea then this means your oestrogen levels are going to be very low and low oestrogen affects your physical, mental and cognitive health and function.
Not taking this seriously is to not be living your best life (which ok, if you have an eating disorder you are not living your best life either!!).
Not all women with hypothalamic amenorrhoea (HA) have eating disorders but it is understandable why many with eating disorders do experience HA when the three main causes are psychological stress, excessive exercise and disordered eating (or restrictive diets).
**It is also worth noting here that hypothalamic amenorrhoea does not just happen in people who are in lower weight bodies… with the right contributing factors women in any size body can develop HA and while we are talking about body size – still having a period also does not indicate that you are at a ‘healthy weight’ or recovered from an eating disorder!**
Anyway, I am getting sidetracked.
Back to the impact that having low oestrogen levels due to hypothalamic amenorrhoea is having on your body and brain.
Two of The Physical Health Consequences of Low Oestrogen
HA has many consequences on physical health but in this post I shall just mention two of significance.
Low oestrogen increases the risk of cardiovascular disease due to mechanisms leading to increases in cholesterol and blood pressure… If any of you have ever had a cholesterol test when you have a restrictive eating disorder and been surprised to find it was actually quite high – this is almost certainly the cause.
Low oestrogen due to HA also results in significant bone loss and so the risk of developing osteopenia or osteoporosis is very high, even in young women.
But this post is not to focus on the physical risks of HA as I reckon most of you know about these, as do any medical teams you might be under. This post was to address the lesser known or spoken about impact that HA has on a woman’s brain.
Oestrogen & The Brain!!
The consequences of amenorrhoea that are rarely spoken about but definitely need to be are the consequences of low oestrogen on the brain – on our mental health and cognitive function.
Oestrogen has influences on a huge number of brain regions which all serve different but crucial functions, as well as affecting receptors for chemicals such as serotonin and dopamine, which are key in mood regulation. All of this means that changes to oestrogen levels can really impact our behaviour and mood.
Stress & Mood
Now, I said earlier that stress was a leading factor in the development of amenorrhoea, but this is a two way relationship and the low oestrogen actually has a great impact on our stress levels too.
Women with low oestrogen experience more depression, greater anxiety and increased difficulty in coping with daily stress compared to women with healthy menstrual cycles.
Many women with HA also experience higher levels of insecurity, inadequacy and a sense of lack of control (any of this sound familiar?!?).
And, it is not just general stress, depression and anxiety that can arise from low oestrogen. Research also tells us that it can give rise to a greater risk for affective disorders and PTSD.
Fear extinction and being able to process traumatic events is more effective in women with high oestrogen levels than low, from which it can be concluded that if you have chronically low oestrogen levels from amenorrhoea, then you are at overall greater risk of adverse effects from trauma.
But what about our sleep?
Oestrogen has a big impact on our sleep. It improves our quality of sleep, reduces our time to fall asleep and increases our amount of time in both REM and deep sleep. Oestrogen also stops us from waking frequently in the night.
Now sleep is a crucial part of our lives and the importance of sleep is often overlooked. Good sleep is vital for our mood, productivity, alertness and cognitive function so being sleep deprived due to low oestrogen from amenorrhoea is going to have a much wider negative impact on your life.
Memory and Cognition
It is also known that oestrogen really impacts on our memory and cognition (thinking skills) and not just as a result of sleep quality. Oestrogen also has a big role to play in enhancing our brain’s neuroplasticity and so ability to rewire and adapt (key in recovery!).
Women with greater oestrogen levels have better attention and focus, as well as planning ability and mental flexibility (and we know rigid thinking is a common feature in eating disorders!).
Last but definitely not least, it it also worth noting that oestrogen can protect against inflammation in the brain and in this way is NEUROPROTECTIVE… it protects our brain against strokes and other neurodegenerative disorders and higher oestrogen levels significantly reduce our risk of alzheimers in later life…
This might not matter much to you now if you are still young but it will matter in future years and you should care about it now too!
With all of these incredible effects of oestrogen on our health, it is hard to deny that establishing good and healthy oestrogen levels is crucial for current and long term health and function.
I did not write this post and highlight these consequences of low oestrogen and amenorrhoea that you might be experiencing to scare or upset anyone but to really help people understand why recovery and resumption of a healthy hormone balance is so important.
I also think that it is fascinating to understand how many of the effects of low oestrogen are symptoms common to those with eating disorders that are so often attributed to the eating disorder (such as high anxiety and depression, rigidity, reduced ability to cope with stressful events, higher responses to trauma and even insomnia). Until we get our periods back and oestrogen levels to a healthy level, we cannot know which of these symptoms are related to the eating disorder and which might just resolve for us with a bit more natural oestrogen in the blood.
Amenorrhoea can be overcome with all the things we have to do in eating disorder recovery: exercise cessation, unrestricted eating, weight gain (yes really!) and of course stress reduction.
I know that eating disorder recovery is hard and resuming periods might be something that in itself is a difficult concept for some but if it is, it is also worth noting that your brain, when you resume your periods and have more oestrogen flowing, will also be working better and the future tripping fears you have now might just prove unjustified.
Eating disorder and HA recovery gives you a chance to have healthier hormone function and a much happier brain, leading to a fuller life, not just in your future but today too.
**A little note to any male readers – sorry chaps, this one was really for the ladies but if you are a guy with an eating disorder, make sure you also geek up on the consequences to male hormones!!**
Albert K, Pruessner J, Newhouse P. Estradiol levels modulate brain activity and negative responses to psychosocial stress across the menstrual cycle. Psychoneuroendocrinology. 2015;59:14-24. doi:10.1016/j.psyneuen.2015.04.022
Brann DW, Dhandapani K, Wakade C, Mahesh VB, Khan MM. Neurotrophic and neuroprotective actions of estrogen: basic mechanisms and clinical implications. Steroids. 2007;72(5):381-405. doi:10.1016/j.steroids.2007.02.003
Glover EM, Jovanovic T, Norrholm SD. Estrogen and extinction of fear memories: implications for posttraumatic stress disorder treatment. Biol Psychiatry. 2015;78(3):178-185. doi:10.1016/j.biopsych.2015.02.007
Shufelt CL, Torbati T, Dutra E. Hypothalamic Amenorrhea and the Long-Term Health Consequences. Semin Reprod Med. 2017;35(3):256-262. doi:10.1055/s-0037-1603581
Tranoulis A, Georgiou D, Soldatou A, Triantafyllidi V, Loutradis D, Michala L. Poor sleep and high anxiety levels in women with functional hypothalamic amenorrhoea: A wake-up call for physicians?. Eur J Obstet Gynecol Reprod Biol X. 2019;3:100035. Published 2019 May 1. doi:10.1016/j.eurox.2019.100035