I Lost My Period For 7 Years Because Of RED-S – Here’s How I Got It Back

Photographed by Ruby Woodhouse
Last month, on my first holiday abroad since the pandemic, I unexpectedly came on my period. For most people, this would have been a mild to major annoyance; for me, it was a cause for celebration.
I lost my period seven years ago to a syndrome called RED-S (relative energy deficiency in sport). The key signs of RED-S are amenorrhea (missing periods), disordered eating (or low energy availability) and deteriorating bone density. Other symptoms include irritability, recurring injuries and gastrointestinal issues.
I wasn’t a sporty person then. I wasn’t underweight or any of the other common misconceptions about why people lose their periods. I was going through a difficult time in my young adult life and subconsciously dealing with it by exercising more and eating less. I didn’t have an eating disorder (another common misconception) but I was still depriving my body of the energy it needed to run its normal physiological functions. Later, as a competitive kickboxer, I kept RED-S around by not adjusting my diet to match my training.
Have you ever missed a period or noticed it was shorter during a time of mental or physical stress? That’s how normalised missing a period has become. But it's a sign that something’s wrong and we should pay attention to it.
The body is a very clever thing. To save energy it can decide that reproduction is not a necessary function, power down your sex hormones and switch off your cycle. Miss three periods and it's called functional hypothalamic amenorrhea (FHA). A 2010 study found that half of exercising women experience menstrual disturbances, with 37% experiencing amenorrhea. Yet it’s only in the last few years that RED-S has been given a name and top athletes like CrossFit star Sara Sigmundsdóttir have opened up about their experiences of losing their period.

In seven years I'd seen five different GPs and gynaecologists, all of whom told me to go on the pill or to come back when I want to have children.

Sports dietician and RED-S specialist Renee McGregor and endocrinologist Dr Nicky Keay have been instrumental in raising awareness about RED-S and helping people recover from it. When they started working together two years ago, they received around five referrals to their clinic a month; now, they get five a week, minimum.
"Since August 2020, in just over a year, 700 people have come through our clinic," Renee tells me. "We’ve seen a fivefold increase in just the last two years. During the pandemic we were getting 25 inquiries a week." Increased awareness and lockdown fitness regimes are both culprits here but I went to Renee’s clinic in June 2021 because I’d just had enough. In seven years I’d seen five different GPs and gynaecologists, all of whom told me to go on the pill, to come back when I want to have children, that I have PCOS, that I don’t have PCOS, that I have hypothyroidism and need to take tablets for the rest of my life.
None of this turned out to be true or helpful. In fact, Endocrine Society guidelines strongly advise against prescribing the pill for treating functional hypothalamic amenorrhea.
"It reinforces the down-regulation of internal female hormones and masks the underlying problem," Nicky tells me. "It doesn’t protect your bones either, because it doesn’t contain the same hormones that are produced internally. Nevertheless, some doctors continue to prescribe it as it makes everyone feel better psychologically – but a withdrawal bleed is not a menstrual period."
After a blood test and consultation, Renee’s team confirmed I had FHA caused by low energy availability. What were they seeing that my previous doctors weren’t? "You’ve got to look at the full clinical picture," Nicky tells me. "Yes, strictly and statistically speaking, your bloods were within the normal range but quite low on the range. At the same time, you were also saying you didn’t have periods. So how can these results possibly be normal?" 
"That’s what stumps me," says Renee. "You have to treat the symptoms, you can’t just use your textbook. I’d really like to push for getting GPs and gynaecologists trained in asking the right questions and doing the proper screening."
Additional blood tests confirmed that I don’t have hypothyroidism either. Like my sex hormones, my thyroid function had down-regulated due to low energy availability. Once I’d cleared this energy deficit, things would go back to normal, so I’ve slowly been coming off my medication under Nicky’s guidance. 
I also went for a DEXA scan to assess how much my bone density had deteriorated and it confirmed osteopenia in my lumbar spine. Osteopenia is the stage before osteoporosis and, at 31 years old, that is pretty mad and maddening to hear. For seven years, my missing periods were shrugged off while my bones got weaker and weaker. It made me wonder what else could have happened if I’d just given up on getting an answer.
"You’d have been storing up massive problems for the future," Nicky tells me. "If you aren’t having periods, your risk of getting two or more stress fractures is double that of a woman who is. But it’s not just your musculoskeletal health that is affected; these hormones are also really important for cardiovascular health and affect your mood, neurological function and reaction times." 
The plan to get my period back was, on paper, very simple:

– Consistently eat around 2,000 calories a day, with plenty of carbs and protein 
– Don’t exercise before eating something in the morning
– Have four servings of dairy/calcium-rich products a day to protect bones
– Decrease training to two workouts a week and honour a full rest day.
My plan was personalised and I had a head start thanks to lockdown weight gain (every cloud). Sometimes people need a lot more food and rest but sometimes the answer is shockingly simple, as Nicky tells me. "I worked with a woman who just started eating a banana before her morning run and, after years of no periods and being told she was infertile, she got [her period] back within a couple of weeks."
I was also given some behavioural tasks to overcome the mental challenges of recovery. Typically, people with RED-S are very driven perfectionists who are very hard on themselves. Team that personality type with societal pressure to look a certain way, love for your sport and an identity as a 'fitness person' and it’s easy to see why a plan of 'eat more, exercise less' could be a struggle. 
Renee’s team tasked me with looking at my limiting beliefs. These are beliefs we create and hold about ourselves from as early as childhood, which are not based on fact and can be detrimental to our health. They asked me to reflect on my childhood identity of being overweight and unhappy, how I’d grown up believing those two things were related and had carried that into my adult life.
The clinic also asked me to be more curious about negative emotions. Instead of saying "I am fearful" or anxious or uncomfortable, I should try "I am noticing I am fearful" and question why I am feeling that way.  
Both of these tasks proved to be incredibly helpful as my body slowly changed. I don’t know how much weight I’ve gained so far because why bother checking? I’ve gone up a couple of sizes in virtually everything (hooray for boobies), old clothes have been stored/donated and new ones bought. I never beat myself up about it but simply remind myself that clothes are meant to fit me, not the other way around, and that I’d rather be comfortable in bigger jeans than sad in skinny ones. 
Being curious about my emotions has also helped me to deal better with days of negative body image. By noticing what else has been going on for me that day, I’ve learned that my emotions aren’t down to how I look (an old limiting belief). There are always other factors affecting how I feel, like a bad night’s sleep, a lengthy to-do list or worrying about someone else.
It hasn’t all been plain sailing and #BodyPositivity. The day before I went on holiday, I sat on my floor feeling like shit and emailed an update to Renee’s team about how I was finding the weight gain difficult but knew I had to trust the process.
And sure enough, three days later, my first period in seven years arrived. It was incredibly empowering to know that I had done this all by myself and just trusted my body to do its natural thing.
The aim now is to stick to the plan until I have three consecutive periods. Then I can look at increasing the volume/intensity of my workouts, as long as I increase my carbohydrates to match. Once I’ve had nine periods in over 12 months, I’ll be considered fully recovered.
I can’t tell you how worthwhile RED-S recovery is. After just two months I’m sleeping better than I have in years, my skin is clearer and brighter and I feel a lot less wired in everyday life. I must have been running on pure cortisol. 
Food and exercise are also taking up much less of my brain space. Because I’ve been eating what I want for the past two months, I’ve come out the other side of going full binge and then freaking out. Giving yourself permission to have that piece of cake when you want it will do you more good in the long run.
I’m also looking forward to getting into strength training. Not only is it important to protect my bones but it gets me out of a lifelong habit of exercising to burn calories. I’m excited to get stronger, to do my first pull-up and see how my body continues to adapt. Fitting into the same jeans I wore when I was 21 is the least of my concerns now. 
Believe me: when you go through this process, embrace it and trust it, you’ll get so much more than just your period back.

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