Introducing my new baby... 3.5 years in the making!

I am incredibly excited to tell you guys that my book is live!!!!  It was officially published on April 15th. I still can't get over when I go to the Amazon page and click "Look Inside", it's MY words (along with my coauthors, of course :)), my design, everything.

It's 535 pages that contain everything I know about hypothalamic amenorrhea and recovery, getting pregnant, trying to conceive again, and life afterwards. I hope so much that women who are searching for answers about their missing period find it and *their* life worth living.

The book's website is at noperiodnowwhat.com, and there are links to purchase paperbacks through the printer, Createspace, which seems to be best (read least expensive) for purchasers outside the US, or through Amazon and ebooks (epub, pdf, and Kindle). If you do purchase a paperback, email the receipt to paperback@noperiodnowwhat.com and I will send a code to download the ebook for $3.

Note that the Createspace shipping times have been much faster than they estimate - in the US it's been about a week faster, Canada has generally been taking 3-4 days, and Australia was 12 days (vs. the 2.5 months quoted!!)

I'm also thrilled that the feedback I've gotten so far is exactly what I had hoped.

"The authors have really done their research and the information provided is well documented but also very approachable to the “non-science” types. There’s a perfect balance between the hard science facts and the personal stories. It's written in a way that makes it easy for you to imagine that you’re having a good conversation with a well-educated and concerned friend rather than reading through a stuffy reference book."

"No Period. Now What? is awesome. I’ve never seen a book with such a balance of science and humanity. I love that every single page is speckled with our stories. It’s like reading my own diary. And then it’s all backed up with more research that I ever knew existed."

"I have to say, in the few chapters I've read so far it has been the best reading material for HA. I lost my period about 18 months now and I am at the stage where eating and gaining weight is absolutely terrifying for me. I went from 184 to 118 to currently 134 and I want to train for the NYC marathon this summer. Reading about your journey and the other women's has really hit home. I hope I have the strength one day to make myself healthy again. Just know that this book is very special,  especially for people like me whose doctors, nutritionists, etc have said I was ok without my period so essentially gave me no guidance."

No Period. Now What?

Guess what arrived on my doorstep today???

These are proof copies, there are a few more adjustments to make, but we'll be going live with a new website and BOOK ORDERS by the end of next month.  I am SO excited!!  When I started this project, I thought, "Oh, it'll take me a year..." Well, here we are, three years six months 17 days later (not that anyone's counting).

Coming soon at: https://www.createspace.com/5797901

Update!!!

Eeeek, okay it's been more than a year since I've posted.  Whew!  In that year, we have all but completed the book - our working title is "No Period. Now What?" and we will be unveiling the cover SOON!  Our plan is that editing and copyediting will be completed by the end of August, then we'll send some copies out for review and proofreading... and publish not too long after that.

In the meantime, there are over 130 pages that we've cut out of the book... so I'm going to start sharing some of that on here, and on our book's site once we have that up and running.

Here's a bit I just cut out of a chapter tonight...

Nico has always asked on the Board, “Do you want to be thin, or pregnant?” It is a choice. Not one that everyone has to make, but it is the bottom line for those of us whose systems are sensitive enough to trigger HA when we are at an energy deficit or overexercising (and stressed). What’s more important to you? Do you want to improve your bone density, heart function, and brain function by getting your period? Or do you want to continue rigid eating and exercise habits and use treatment to possibly get pregnant—then end up right back where you started?

Commentary from Fitty: Whoaaa, hold up a minute. “ . . . sensitive enough to trigger HA”? OK, so while I do agree that there are some who may be sensitive to HA due to genetics, I also believe there may be more women similar to me. I was NOT sensitive to HA. I worked pretty darn hard to create the hole I dug . . . and it was deep. In addition, the unstable and chaotic relationship with my LOWMI (loved one with mental illness) who has schizophrenia and bipolar disorder, added a major stressor cherry right on top! So before some of you decide to run with the “I have a sensitive system and that’s why I have HA” baton, please know that many of us worked relentlessly to get there. If you happen to be a little hardheaded like I am, take the time for a good self-evaluation. It can be helpful to consider that you too may have pushed pretty intensely to get to where you are. By recognizing this, you can now apply that same effort and intensity to get back out!

Interesting fact of the day!

I'm in the midst of analyzing data from my surveys to add to our book on HA recovery (more on that soon!!!)

I was looking at what percentage responded to Provera by getting a bleed, and how long after the last pill that bleed typically was.  I also decided to look at whether bleeding in response to Provera predicted recovery of natural cycles.

Answers:

*  18% (48 / 256) responded to Provera the first time they tried it (most likely while working towards getting a diagnosis).
*  26% (31/119) responded to a subsequent Provera challenge.

*  The median time to response was three days after the last pill
*  95% bled by five days after the last pill,
*  All but one (out of 86 reporting time to bleed) responded by eight days after the last pill

The interesting fact of the day is that responding to Provera in no way predicted recovery of natural periods!

* 46% of those who bled in response to Provera restored natural cycles (prior to moving to treatment to get pregnant)
* 47% of those who did not bleed resumed natural cycles.

For all intents and purposes, the same.  I would have expected that bleeding in response to Provera would strongly predict regaining natural cycles.  Apparently not!

What's a few extra pounds?

I'm knee-deep (maybe more like neck-deep) in working on my book on hypothalamic amenorrhea recovery; currently working on chapter 23 out of 30, so getting closer and closer...*huge grin*.

A couple of months ago I noticed that I was feeling HA-like symptoms again, despite cycling regularly ever since I weaned baby #3 about a year ago.  I do a lot of work late at night, and I was constantly feeling cold, having to get a sweater to put on, despite keeping the house at a fairly balmy 70 degrees.

My scale broke a while ago and I never bothered to replace it, so I had no idea how much I weighed.  I did a quick check at the gym one day (I am currently spending 45 minutes a week there, while #2 has his gymnastics class) and was surprised (and yet not) to find that I was at a mere 124lbs.  That is pretty much what my weight was when I was at the height of HA - I dropped to 120 for about five seconds, but 124 was my stable weight.

Things are VERY different now than my HA days - I eat whatever I feel like and get a total of about two hours of high intensity exercise a week (writing a book is not conducive to exercise!) as opposed to limiting myself to 1500 calories with 2-3 hours of daily exercise.

But, between my weight being lower than I expected and feeling cold all the time (and hungry at night too), I was clearly not eating enough.  So I added ice cream, bigger portions, whole milk to my cocoa (which has become my new addiction) and weighed myself about a month later, back up to my standard of 128.  Whew.

Today I hopped on the scale again, another six or so weeks later, and now up to 132. My initial reaction was, "gulp", but then as I thought about it more, A) I'm nice and toasty warm, I've been in short sleeves the last few nights - and the temperature in the house has been exactly the same, B) I'm not nearly as hungry in the evenings, and C) I'm not even noticing my clothes fitting differently, and D) my cycle is MUCH more normal (back to a nice 12-day LP).  So who the heck cares? On top of all the other positives, I actually think my face looks a bit fuller = fewer lines = younger so there's that too.

I'll take it!

Menstrual cycle abnormalities in exercising women, including me.

So  much great information on HA is available in the medical literature.  it really is a shame that your average OB is not better educated.

My friend was recently told that she had less than a 50% chance of regaining cycles if she gained weight / cut exercise.  Way to pull a stat out of where the sun doesn't shine doctor!

Here's an article where they followed women with FHA for an average of eight! years.  The doctor counselled them on the advisability of gaining some weight and cutting exercise to help restore cycles and improve bone mass density.  70% of the women started cycling again.

Those 70% gained between 6.5 - 28 pounds.  Cycles were regained for the most part between years 1 and 2 of changes.  (Keep in mind that these were gradual changes and many of the women were on either HRT or birth control pills, with a break every 6 months or year to see if they were cycling).

Take a guess as to the weight change of the women who did not start cycling again.  Surprise surprise, either no change or a decrease of a pound or two.  Unfortunately they don't mention changes in exercise.

I also think that the cycles could have resumed more quickly had the weight gain / exercise changes been made in a shorter timeframe.  Most of these women were not trying to conceive at the time the study started, so had less incentive to restore cycles in a short timeframe.

This is another interesting article where three menstrual cycles were examined in either sedentary women, or "moderate exercisers".  (On average, running 20 miles per week plus 5 hours of other, nonspecified, exercise).

In the sedentary women, 91% of menstrual cycles were ovulatory, 9% (all in one woman) had a luteal phase defect.  In the exercising women, 45% were ovulatory, 43% had a luteal phase defect, and 12% were anovulatory.

There was no significant difference in energy availability between the ovulatory and LPD cycles in the exercising women (although both were lower than the sedentary women).  Again, though, I bet you can predict what the energy availability looked like in the anovulatory cycles... yup - MUCH lower.  These women had an average energy balance of about -1000 calories per day, and also ate only about 50% as much fat as the others.

So even in recreational exercisers who are cycling, the energy deficit can cause cycle issues.

Speaking of luteal phase (LP) defects, I now have four postpartum periods to compare in my own life.  In all three live birth cases, my first cycle was while still breastfeeding, but I weaned right around the time the second started.

After #1 was born my LPs were as follows (P = I used Prometrium 200mg 1x/day) (bmi 21.9):
4, 8, 7, 16P, BFP

After #2 (bmi 20.7):
6, 6, 7, 9, 9, 9, 10, 10, BFP [

After my mc (bmi 21):
7, 14P, 14P, 14P, 14P, 10, 12, 13P, 14P, 18P, 17P, 12

After #3 (bmi 20.3):
10, 10, 11, 12, 12, 12

Guess what the difference is after #3 when my LPs have been much better and gotten longer much more quickly - VERY LITTLE EXERCISE!

Now, I ride my bike maybe once a week and play ice hockey once a week.  A fair bit of walking bc of chasing after the kids, and I lift weights once in a blue moon.

After #1 and 2 were born I was playing hockey 2-3x/week, biking to/from work, and lifting weights 2x/week.

More food for thought.  Pun intended ;)

Energy availability and exercise

I've been doing a lot of research for my upcoming book and have come across a lot of really fascinating information that is just not very well publicized.  So I'm going to take a little time out of writing every few days and share some of the info here.

The first article is this one:  Energy availability in athletes, by Anne Loucks et al.

So here are some of the tidbits from this article (it's a review, so they're other studies that are referenced. I have not read each individual study yet.)

In studies where men or women were in "room calorimeters" (basically a device where they truly can measure every scrap of energy that you're using), they found that exercise was NOT compensated for by an increase in hunger signals, which meant that it was extremely easy to operate with an "energy availability" that was too low to sustain normal physiological processes = reproductive system shut down and all the other negative effects of hypothalamic amenorrhea. This is because exercise actually produces a hunger suppressive signal.

They did note that there ARE some people for whom hunger signals increase with ongoing exercise, they called these "compensators" vs. those for whom hunger signals did not increase, "non-compensators".  This difference could partially explain the difference between women with similar BMI and exercise, one who menstruates and the other who does not - nothing overt, but one IS adequately fueling her body and exercise, and the other is not.

Also, the slowdown of physiological processes happens immediately when not enough energy is being consumed; in the same experiment, they showed that the resting energy expenditure was decreased by 90 cal a day when in an energy deficit. So one day of negative energy balance isn't going to throw everything off, but throw in three or four in a row, and you're not doing your body any favors.

It explains so much about why you have to over-feed to actually recover from what you've done to your body. All those systems that have been shut down have to ramp up again, and use more and more energy as they do - and reproduction comes last!. So keep on eating, and sitting on the couch!!! (or if you do exercise, don't rely on your hunger signals to compensate for that exercise, you probably need to eat more than you think to make up for it.)