Q.I’ve had anorexia in the past. I’ve been in the care of a great therapist and have been in recovery for three months. My question has to do with my period. When I was anorexic it stopped, and it hasn’t yet started. I guess I should ask my doctor, but frankly I’m more comfortable asking you. Why did my periods stop? I’d like to know the biology of what happened to me, as weird as that sounds. I’m not having sex, so there’s no chance of me being pregnant, but it feels awkward to not know when I’ll start having periods again. 18-year-old
Mary Jo’s response: I’m so very pleased you’re doing well. Connecting with a great health-care provider is important. Congratulations on your recovery. I am pleased you wrote to me, not only because I treasure your trust, but also because you’re willing to allow your question in the paper to help other young people.
Though I honor your trust in me and am grateful for it, talking with your therapist will help you maintain the relationship that is supporting your recovery. Why not talk with us both? Here are some ideas for communicating with your therapist:
1. Write down your questions before your visit so you remember them.
2. Hand the questions to your therapist if you’re anxious about speaking.
3. If talking works for you, be honest. Stating “I have a few questions but I’m uncomfortable asking them” will open the door to communication.
Missing periods is called amenorrhea. It’s common for a woman living with anorexia to experience amenorrhea; it is one of the symptoms of the eating disorder. Let’s talk about anorexia first.
As you know, a person living with anorexia nervosa (typically just called anorexia) is deeply afraid of gaining weight. The individual may think about food constantly but limit how much food is eaten. Anorexia is more than just a problem with food. It’s a way of using food or starving oneself to feel more in control of life and to ease tension, anger, and anxiety. Although most people with anorexia are female (85 to 95 percent), boys and men can also experience the symptoms.
Signs of anorexia vary, but typically the person:
• Has a low body weight for her or his height;
• Resists keeping a normal body weight;
• Has an intense fear of gaining weight;
• Thinks she or he is fat even when very thin;
• Misses three menstrual periods in a row (for girls/women who have started having their periods);
People living with anorexia may:
• Avoid food;
• Count calories of all food;
• Eat food in small amounts;
• Eat only food that is “low-fat” or “low-calorie;”
• Exercise frequently, and to the point of exhaustion, even when sick;
• Look in the mirror frequently;
• Spit out food after eating;
• Wear clothing that is too large, or baggy;
• Weigh all food
• Check body weight frequently (at least daily)
• If a person causes vomiting after eating, he/she may be bulimic
Amenorrhea occurs with anorexia due to hormonal changes in the woman’s body. Amenorrhea can be primary (happening before a girl begins menstruating) or secondary (happening after puberty and the onset of periods). Most women living with anorexia will experience secondary amenorrhea as a result of those hormonal changes.
I don’t think it’s weird to want to understand your own biology – curiosity is wonderful and our bodies are amazing. Low body fat and low body weight interrupt the normal release of a hormone called Gonadotropin Releasing Hormone (GnRH) from the hypothalamus. GnRH affects both Follicular Stimulating Hormone (FSH) and Luteinizing Hormone (LH), both of which are necessary for normal menstrual cycles and ovulation (the release of an egg). Until body fat returns to normal a woman will not ovulate; without ovulation the uterine lining doesn’t build up and menstruation doesn’t occur.
Most women in recovery resume periods when treatment decreases the symptoms of anorexia. A therapist and medical doctor may be part of your health-care team. Treatment includes helping the person reach a normal weight, treating any psychological issues related to anorexia, and helping the person discover and deal with any actions or thoughts that caused the eating disorder.
Some sources for help are: National Association of Anorexia Nervosa and Associated Disorders (847-831-3438), http://www.anad.org; National Eating Disorders Association (800-931-2237) http://www.nationaleatingdisorders.org/; National Institute of Mental Health (866-615-NIMH or 6464), http://www.nimh.nih.gov/index.shtml; National Mental Health Information Center (SAMHSA) (800-789-2647), www.samhsa.gov.