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Paleo and Amenorrhea: How Extremity Can Make even the Best Diet Fail

Posted by on May 22, 2012 in Blog, HPA axis, Hypothalamic Amenorrhea | 67 comments

Paleo and Amenorrhea: How Extremity Can Make even the Best Diet Fail

The volume of emails I receive from women who start having menstrual problems on a paleo diet is staggering.    It is not an enormous volume, no.  But it is enough to give a woman pause.  What gives?  Aren’t we supposed to be healthier on a paleo diet?

Yes, we are, and really, we are.  In the vast majority of women who eat a Standard American Diet, specifically those who are overweight, a paleo diet does wonders for balancing hormone levels.  It is usually only when a paleo/whole-foods diet is coupled with restrictive norms that women start running into problems.  Too little food, too much exercise, and too much stress are really what it all boils down to.   The whole foods are not to blame– not in the slightest.  What are to blame, instead, are the obsessive ways in which people interact with these foods.

There are several mechanisms that may be at play in the physiology, depending on each woman’s genetics and how each woman undertakes her paleo diet and lifestyle.

What happens in the body when it stops menstruating

The female reproductive system runs off of a sensitive fleet of circulating hormones.   When one or several of them is disrupted, many of the others fail at their jobs, too.

During the menstrual cycle, hormone levels in the blood signal to the hypothalamus to signal to the pituitary to release FSH and LH, two hormones that in turn tell the ovaries what to do.    FSH–follicle-stimulating hormone– is released in the first part of the menstrual cycle to incite egg development.  LH–luteinizing hormone–is released in the second part of the cycle and prepares the endometrium to be shed.  Without proper FSH and LH levels, the female body can never convince the ovaries to do their job.  FSH and LH are crucial, and they rely on proper functioning of the HPA axis.

This job of the ovaries is to produce the follicles and the eggs, but in doing so it also produces estrogen and progesterone.  This fact is important for signalling menstruation, because it is partly the rise and fall of estrogen and progesterone levels throughout the month that signal to the hypothalamus to release FSH and LH at different times.   This is, in essence, a circle of signalling.  LH and FSH from the hypothalamus to the ovaries, estrogen and progesterone back to the hypothalamus, and so forth.

Hormone malfunctions that cause amenorrhea

-Decreasing estrogen levels stop the pituitary from being able to send out FSH and LH.

-Decreasing leptin levels stop the pituitary from being able to send out FSH and LH.  This is because decreased leptin levels signal to the hypothalamus that the woman is lacking energy stores and is, in essence, starving.  When the hypothalamus thinks the woman is starving, it puts a halt to normal reproductive functioning.  Leptin levels decrease proportionally with fat mass decreases.   On the other hand, leptin can also go undetected when an individual is leptin insensitive.   Insensitivity is in general a larger problem for overweight women, and low absolute leptin levels are in general a greater problem for thin women.

-Increased testosterone production interferes with estrogen levels.

-Increased stress and cortisol levels put a halt to hypothalamic and pituitary function.

Cause 1: Weight loss

Both estrogen and leptin are produced in fat cells.  These are the two blood serum hormone levels necessary to signal to the hypothalamus that a woman is fed and happy, and that it should go ahead with normal reproduction.   Without these two hormones, reproduction ceases.  It is well known in the medical literature that the low body fat of anorexic women, models and athletes is what accounts for their amenorrhea.   Without fat, a woman simply cannot menstruate.

What is discussed less often in the literature, but is still true (see Wenda Trevathan’s Ancient Bodies Modern Lives) is the fact that a woman’s reproductive system is set up to run on the nutrient basis she has as a young girl.  Throughout puberty, if a girl has a higher-than-average or higher-than-healthy body fat percentage, her ovary to hypothalamus signalling may develop as ‘handicapped’ by these fat stores.    Because fat cell estrogen is so high, the ovaries do not have to produce as much.   For example: If the body’s estrogen set point is 100 units, and fat cells produce 80 units, then the ovaries only need to produce 20 units.  Then, if the woman loses weight, the set point remains around 100 or falls a bit to a healthier level (unique to each circumstance), and the fat cells production falls to around 30 units, such that estrogen from the ovaries is then expected to make up for the rest of the estrogen deficit.   Many women have no problem with this. Their ovaries jump into higher gear.   Many others, on the other hand, do struggle.  Their ovaries never end up rising to fill that gap.  The thing is– the set point is not stuck precisely at 100.  It will decrease to a healthy level.  But it might not decrease as far as a woman bent on meeting social expectations of body image is hoping.

The alignment of a woman’s sex hormone levels with the amount of nourishment she has during puberty accounts for why women who live their whole lives on the edge of starvation can still have babies, but women whose body fat percentage decrease from 28 to 21 cannot.

This is not to say that an overweight woman will stop menstruating when she loses weight.  Each body is capable of menstruating within the healthiest range of body fat percentages, from around 20 percent to 30 percent.  But a woman who has always erred on the side of heavier might  find that she cannot dip below 23 or 24 percent body fat without losing her period.  23 or 24 percent body fat is healthy, so this is fine.  It might not fly is the woman is trying to meet ridiculous standards of Western body image, but it is optimal for her to have the appropriate serum hormone levels.

Other factors that can hurt estrogen and leptin signalling may also play a role.  If a woman can correct those, then she may be able to decrease her body fat levels without hurting her reproductive system.  For example, chronic stress hurts hypothalamic signalling.  So a stressed out overweight woman is going to have a harder time with reproductive fitness while losing weight than a totally relaxed overweight woman.  This is a fact.  For menstruation to take place, estrogen and leptin levels must be high enough.   Body fat plays a significant role.  There are some other factors that can be addresssed and help as well.

Cause 2: Exercise

Weight loss can cause decreased leptin signalling, but exercise can, too.   Body fat is the major player in leptin levels, but energy deficiency in general hinders leptin.  When a woman is burning more calories than she is consuming–or when she is burning a high quantity of calories while under emotional and physical stress–her body calls it quits.  Instead of directing energy towards reproduction, it conserves it for other functions.

Cause 3: Low Calorie Diet

A low calorie diet performs the same function as both weight loss and exercise.  It stresses the body and puts the woman in a state of energy deficit.  The hypothalamus does not like being in energy deficit, so it tells the ovaries to stop working until it can get itself out of the energy deficit.

A low calorie diet is more of a problem for thin women than it is for women trying to lose weight.  Leptin levels first and foremost are reliant on fat stores.  The body can eat it’s own fat.  That is in fact how weight loss occurs.   So if a woman is eating her own fat, she is not starving.  Once her body fat levels dip too low, however, and if she is maintaining a low-calorie, starvation-type diet, then she may stop menstruating.

Cause 4: Low Carbohydrate Diet

Many, if not most, women have a real need for carbohydrates.  This cause is the most common cause of amenorrhea in the paleo world next to weight loss, in my experience.

Carbohydrates are necessary for the conversion of T4 into T3 (the active form of thyroid hormone) in the liver.  The liver is capable of producing its own glycogen when it’s not being fed sugar, but this process can become fatigued over time, especially if the woman is under any kind of stress, or restricting calories, too.

Hypothyroidism, or sub-clinical hypothyroidism, is one of the primary causes of ovarian malfunction.  Without sufficient levels of T3, organs shut down, and the reproductive organs are the first ones hit.  Without T3, estrogen cannot be produced, and follicles cannot develop.  Without T3, a woman cannot menstruate.

For this reason, many paleo women supplement their diets with iodine and find that their amenorrheic symptoms ease.  However, many others do not.  Instead, they have to add carbohydrates back in to their diets.

Another role that carbohydrates play is spiking leptin levels.  Whenever insulin spikes in response to blood glucose, leptin levels rise, too.  This means that carbohdyrates help signal to the hypothalamus that the woman is fed.  However, this is a short-term elevation.  It only spikes in bursts and with meals, so it cannot be used as a long-term solution to health.  It is important to note, however, that a high fat, low carbohydrate diet is consistently associated with the lowest leptin levels possible.

Cause 5: High-Dairy Diet (an influence, at least)

Dairy is full of hormones.  Even cows raised on pasture cannot help but produce certain hormones that influence a woman’s reproductive system.   Dairy is the most androgenic food.  It contains a protein that inhibits normal inhibition of testosterone in an individual’s body, such that when someone ingests dairy their testosterone levels can rise unchecked.  This is in fact why so many people experience acne when they eat dairy.  Even men.  It really can increase testosterone levels that much.

Moreover, much of the dairy consumed in today’s world is not organic and grass-fed but is instead choc-full of unnaturally injected hormones.  Farms and the US government are touchy about telling the public what goes into their animals, and they claim that these hormone profiles are insignificant.  However, anecdotally, myself and with some other women, it seems as though these hormones really can influence women who already have compromised reproductive function.  Conventionally raised animals can cause real problems.  This goes for dairy, and this goes for eggs and meat products as well.

Cause 6: Altered Phytoestrogen and Hormone-Ingestion Profile

This cause is related to the cause above.   We ingest hormones on a regular basis.  With a healthy reproductive system, this is not a problem.  Hormones from food are far less potent than hormones from the ovaries.  Please keep that fact in mind.   A healthy reproductive system has very little problem with phytoestrogens in foods.  But some women have struggling reproductive systems for one reason or another, and they need to be aware of what hormones they have been and what they are now consuming.

Phytoestrogens are plant estrogens.  They look a lot like estrogen, but are not identical.  This is why phytoestrogens should never be consumed as a replacement for estrogen.  Sometimes they relieve certain symptoms of estrogen-deficiency such as hot flashes, but they also fail to act exactly like estrogen does in the body.  This means that other signals and connections are not being made, potentially crucial ones.  Hot flashes may cease, but acne may continue to run on unchecked.   And other problems can ensue.  For example, breast cancer.

Phytoestrogens are primarily in legumes, nuts, and seeds.  Soy is the most potent phytoestrogen, and should be avoided at all costs.

There are other sneaky ways in which hormones can infiltrate a woman’s diet, especially if a woman undertakes a paleo diet with compromised reproductive function and inattention to the quality of her food.  For example, if a woman goes on an egg-heavy diet when starting paleo, but the chickens are fed a soy rich diet,  she is actually eating a soy-rich diet.  This is not normally a danger, but with a compromised reproductive system and a soy- or hormonal- influence from poorly treated animal products, it is worth taking into consideration.

These effects, I need to emphasize again, are not usually relevant for women with healthy reproductive systems, and should only be considered in severe cases. Only when hormone levels have dipped so low or have skyrocketed so high that the body becomes sensitive to these normally tolerable and easily managed fluctuations from food.  Certainly, conventionally-raised cows are not optimal, but I would not discourage anyone from eating them (in terms of their health) at all if they have no other options.  Sincerely.  Far, far more important is the quality of hormones being sent through leptin and estrogen signalling within the body.

Cause 7: Stress

The final cause should come as no surprise to anyone.  Stress halts reproduction: stress from toxic foods, stress from eating disorders, stress from social life, stress from exercise, stress from work, stress from existential despair… the list is vast.  The physiological result of all of the possible stressors is roughly the same, however.  Cortisol levels rise and these levels prevent the hypothalamus from sending the appropriate reproductive signals to the ovaries.   This may, in fact, be the most important of all the factors I’ve discussed.  There is no way to quantify it, and it burns ubiquitously throughout the Western world.  What if all of us calmed down?  What if we all lived in harmony, and peace, and did not fret?  Stress is significant, and stress is real.  Hundreds of thousands of American women do not menstruate because they are stressed.  How many more experience hindered reproductive function because of stress?  I suspect the number lies in tens of millions.

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67 Comments

  1. Do you have any suggestions about leptin reset for older women post-menopause?
    I just started reading Dr. Jack Kruse’s blog and MDA (Mark’s Daily Apple) and would like to know what you think. Does one solution fit us older women too?

    I just started reading through your blog, looking for a woman in this male dominate Paleo field…it seems no one is addressing “us” older women and our needs. They are all catering to a completely different group and I am not one of them. I like what I have seen so far here.

    Thanks.

    • Yes, definitely, thank you Erin! You are right. I don’t write about menopause often because I have’t done it– where I HAVE done all hypothalamic amenorrhea, PCOS, disordered eating and weight loss– but it is very important to me, too, and the more and more I dig into research the better I under menopause.

      So more on that, soon. I care about you, I really do.

      Yes, please drag womenly folk into this conversation! I don’t know how much I can help, but I can certainly be as loud for them as they would like me to. :)

      Re: leptin. Good question, I’ll go with “yes.” Lots of people are skeptical of Dr Kruse. I am, too. Skeptical of most things I read. But because of that skepticism, I started going through his science bit by bit, and very much of it is spot on. I haven’t looked at all of it. I know he makes a few big leaps, especially with his interpretation of evolution, but a lot of the hypothalamic research I find to be really forwrad thinking and in line with recent studies.

      I’d say go ahead, on that account, in terms of eating protein in the morning (a good idea, as a personal experiment and anecdote from myself. For people with low estrogen, I think this is helpful for getting to sleep at night). Eat three meals each day. Cold therapy I also really enjoy.

      My caution is about carbohydrates, as always. I think women need them. Maybe not menopausal women as much as women of child-bearing age, but still a) women have a weaker propensity for tryptophan conversion to serotonin than men, so eating carbohydrates later in the day can boost a woman’s serotonin levels b) carbohydrates help keep the thyroid pumping at a good rate, which in turn boosts estrogen levels, and c) eating carbohydrates, in addition to having a bit of body fat, convinces the body its not starving, which is great for estrogen.

      Perhaps I shall write a post on that to be real clear and help people along.

      • Thank you so much Stefani. I look forward to the post/blog in the future. Continue this journey there are many of us women that need a voice out here for our issues, so we too can live a quality healthy and happy life.

      • For what it is worth, making the switch to paleo/primal 18 mos ago has really smoothed out the eratic hormonal swings I thought were the norm of peri-menopause. I haven’t settled back into a “normal” cycle, but I’ve gotten so much closer and feel less of a hostage to my hormones.

  2. Your blog is awesome and I am EXTREMELY thankful that I stumbled upon this. I have had PCOS for about 5 years now and stopped eating really low carb…I’m kind of amazed that I was able to eat so few calories for so long. I’ve read elsewhere that dairy and conventional meat can be problematic for women with PCOS but does that also apply to yogurt, omega 3 eggs, and fish as well? Those all tend to be my main protein sources since I can’t afford grass fed meat right now.

    • Hi Sonya!
      Excellent question. All dairy products, yes. Yogurt and butter, and even ghee. Eggs not quite as much, but still, unfortunately, yes. I find that pastured eggs, however, are just perfect and to die for. You could probably also deal with eating them so long as the package does no say “soy fed” on them, like many do. And fish– eat away! All seafood is fair game.

  3. Sweet, I never buy soy fed. Thank you so much Stefani, I’m implementing your suggestions ASAP as I am a frustrated, thin pcos-er :)

    • Yeah, I’ve got a strong suspicion that while some thin PCOSers have insulin resistance, the other thing PCOSers are actually women with PCOS-type metabolic dysregulation AND hypothalamic amenorrhea. I’ve had a post brewing on that subject for several months now, just sitting in my brain.

      • Hi Stefani, I just found your blog and have already read MANY of your posts. I was wondering if you could point me to where I can find out if I have an issue with hormons, PCOS, insulin resistance or thyroid issues. Is there specific tests or specific doctors that really know about this kind of stuff. I find my reg. doc is so main stream that I don’t get access to this kind of information unless I do the research. How do you know if you have an endocrine issue and is there test to go with that? I guess I am wondering what kind of check up I should ask for and where I can find a doctor to do all these things. (I have many of the concerns you talk about here, no period for a long time, lost weight then to gain, tired/sluggish, not feeling “right”, cravings, breast size hasn’t come back since gaining weight back…)

        I am trying to build a plan of action. What and if I should follow any diet. What kind of exercise I should be doing, and if I need some kind of help to balance out if there is an issue with above stated concerns. I always hear check with your doc, but what do I ask him to check for? If I want to try kelp powder – or a diet – or have a problem what do you ask them to check?

        Do you think everyone should be on a paleo-type diet? And cut out the non-paleo food groups (beans, soy (even fermented soy?? or Sprouted tofu, edamame?))? Or is this just for some people with the issues you talk about?

        Also, are there any posts you have in particular you think I should read?

  4. Hmmm, I definitely need to find out if I’m actually insulin resistance. I have always assumed that I was carb intolerant to some extent since I am an apple shaped south-asian (as you may know, Indians have the highest risk of developing diabetes and my family history definitely supports that).

    I’ve spent most of my life chubby, finally outgrew it and lost weight without actually trying to, and was obsessed with losing my belly and was an underweight vegan for some time. I quit the vegan thing and but then managed to screw myself over again with a low carb/low cal diet+too much running which then led to some serious insomnia and amenorrhea again. I exercise much less and focus on strength training but still have acne and hormonal issues.

    I’m starting over with a clean slate now by trying out strict paleo eating but since there are a million factors to take into account in my journey with hormonal chaos it’s still a mystery for me.

    For thin PCOSers who ARE insulin resistance, would the same carb guidelines apply? I’ve spent some time trying to tame the carb lover in me and was easing into a low carb diet (not low cal tho) but now I’m not sure if that’s the right way to go. :/

    • Omg I just saw this post and your reply – we are on the same boat! From being a chubby kid to an underweight vegan, and now on paleo and hiit but still underweight. My period stopped and I thought it was because I was on the pill but I think it’s been too long! Waiting for test results so keeping my fingers crossed!

      • sorry, i’m just seeing this!

        I’ve actually regained my menses and what helped is eating MORE than i previously ate. I know that that might be scary when you’ve been chubby in the past but if you’re eating whole foods (most of the time) it’s pretty damn hard to gain a ton of weight.

        Also what helped me really limiting cardio exercise. my pcos was doing better but then i started runnning allot and had amenorrhea for a year and horrible insomnia. Now i just lift heavy 3x a week and do some conditioning maybe 2 days a week for 10-15 minutes max. I’ve gained muscle, which i needed since i was underweight, and I don’t have insomnia anymore, thank god.

        I just wanted to share my experiences, in case it contains any info that might be helpful or relevant to you. Though i still have my set of issues (slightly elevated testosterone), my test results are much better and i have gotten periods without using any prescription drugs for these past 5 months for the first time in years.

        • Can I have your email?! Just want to know more details as I haven’t gotten my period for 3 years now. I’m 21

  5. Wow, Stephanie. I have been dealing with post-pill amenorrhea for 7 months now and I cannot thank you ENOUGH for this post. I have been struggling to determine what the heck is wrong with me and you really helped me to feel like I may be able to get back on track. Thank you, thank you, thank you!

    I will definitely be eating a sweet potato per day now to add to my carb intake!!! Love those things when roasted in the oven for an hour :)

  6. Stephanie,

    I just started reading your blog, but I am really impressed! I realized that my knowledge of all things Paleo, while acquired over many years, has been almost exclusively from the male perspective. I have been on and off of the pill since I was 16 (I am now 24 and have been off of it for about a year and a half). Whenever I am not on the pill, my period is wildly irregular (often disappearing for up to 6 months).
    My question is, basically, how much exercise is too much? I like to be active (I do yoga 3 or 4 times a week and crossfit 3 or 4 times a week) but I am concerned about my fertility. I have always been thin, but I tend to put on muscle and cut fat really easily, even when I don’t exercise all that much.
    Also, I understand the importance of carbs, and I have never limited them too much, but I usually don’t eat any carbs at breakfast and limit them at lunch, because otherwise I am hungry all day long. I usually eat a sweet potato with dinner and maybe some fruit or dark chocolate. How do I incorporate more carbs without creating constant cravings?
    Sorry for rambling, but all of this is really shaking up my idea about what is good for me and what is not (I thought I had it all figured out!)

    Thanks!

    • Hi Emma,
      Sounds like what you’re doing with carbs should be good. I also recommend eating them later in the day. Really, I wouldn’t sweat trying to add more. More potato at dinner or some at lunch would be just fine, but if you find your cravings are going nuts don’t bother. People should eat, I believe, macronutrient ratios that make them feel the best and operate the best.
      Your problems with menstruation may be because of low body weight or stress, or probably a combination of the two. Or it could be something else entirely and you should trust your doctor on that account more than I. Re: your exercise. Doesn’t sound excessive to me, but don’t forget that not eating enough calories to make up for the exercise as well as any psychological stress will make the physical stress of exercise all the harder to bear.

  7. Hi Shefani! Awesome post, totally explains why I didn’t have a period for almost 4 months. Until last month, that is. I seen a gyno & she prescribed me a pill to start my period (started with “my” i’m pretty sure). Do you think that was a good idea or should we have just left it alone?

    • Hi Courtney,
      I have no idea, given that I do not know what you are dealing with. Your doctor may know best, but I do personally believe that birth control is just a band-aid on a wound, and that the underlying causes need to be addressed in order for healing to occur. If restriction is your problem, I recommend heaping on lots of love and lots of food over the next several months.. and then maybe you can come off whenever you feel you are ready. There is no “need” to regulate your cycles — so long as you menstruate once or twice per year (medically induced is fine) your endometrium should remain healthy enough and cancer free.

  8. i LOVE you, stephanie! once again, you have allayed my fears. i’ve been more or less paleo for a while now, but definitely have had periods of being more on and more off. lately i’ve been fairly strict, and have also returned to crossfitting so my exercise levels are way up, too. and i’m happy with both these things–but haven’t gotten my period in about two months, and am feeling a bit weird about that.

    so regarding “women needing carbs”… that doesnt mean processed carbs, though, right? vegetables and such count? because i eat a ton of those. do you think it makes sense for me to work in other types of carbs (grains, basically) on a more regular basis?

    and other than that, i’m thinking i should just stay the course, despite not having gotten my period, because i’m eating healthy and feeling great and like being active.

    thanks for your thoughts on this!

    • not grains, no. but starches, fruits, vegetables, all good game. :)

  9. hi i just came Across ur blog how informative well i was looking to find the ‘real’ healthy levels of hormones for women, i am trying to have all health markers in place eg digestion, and as i am not mentsulating at 24 i trying to find how far off my blood levels are to healthy and how to improve them. is a blood test a good sign? thank u so so much

    • blood tests are the best!

  10. Hi Stefani,
    Do you have recommendations for iodine supplementation? Would kelp powder be a good place to start?

    • Kelp is a good place to start, yes, I think the right place. And err on the side of less than more at the beginning… also it is CRUCIAL to know you do not have Hashimoto’s before you do that… definitely a recommendation to talk over with your doctor or an endocrine specialist

  11. Hi, Stefani! Thank you for your wonderful posts, as always. My question is this- about how many carbs should women be shooting for? 75-100? More? Thanks!

    • What feels good. I would start with 100 and experiment from there. :)

  12. Hi! I absolutely love your blog. I am wondering what are some suggestions for foods that will help you get your period back? I haven’t had a period in a year , so I’ve reduced my exercise a little and I’m trying to eat more fruits and carbs. I have noticed some improvements with my hormones, but still no monthy cycle. I eat a paleo diet, but I use to aviod alot of carbs. I heard healthy fats help alot too? I really want to get healthy, so any suggestions would be great!

    • Sounds like what you’re doing is all the right steps, Ashley. LOTS of food, lots of carbs, lots of fat, lots of time. :)

  13. So what about women like me who have the exact opposite problem? Mine didn’t stop it went into over drive. I went from a 3-4 day period and being in perimenopause to a so far 14 day period and much heavier flow. That seems to be somewhat common too from reading on other Paleo sites.

  14. Thank you so much for this informative post! I’ve been eating paleo now for 6 months but have had amenorrhea for 2 years now. I’m 27 and was diagnosed with adrenal fatigue 1 year ago. I was into distance running before and also struggled with disordered eating. When I was diagnosed with adrenal fatigue I gave up running and switched to yoga, but it didn’t give me that high I get form working out. I eventually found crossfit and got hooked on that. I kept telling myself the workouts were much shorter than before so it was okay to push myself that hard. I have realized it’s still too much for my body right now. I’m just starting back up with yoga now and feel like I’m on the right path. Thank yo again for all the information you provide, I love your blog!

  15. Is it dangerous to “use” this type of amenorrhea as a birth control method? I want to outwith Mother Nature’s determination that I get pregnant after having sex!

    • Usually low libido accompanies it, so I find it to be un-ideal. And yes. :)

      • I didn’t think I would get a positive response, but I figured, all she can do is say no! It doesn’t sound like a good idea if I put some actual thought into it.

  16. I’m 40 and have been trying to get pregnant for 2 years. For the first time in my life, since starting paleo, my cycle is all over the place. I know I’m probably entering peri-menopause, but strange that this came soon after starting paleo. How many carbs per day would you recommend is ideal to optimize fertility? Types of carbs?

  17. Hmm this is really interesting! I’ve actually noticed the opposite effect on my periods when I eat paleo! If I’m really good and eat at least 90% paleo, my periods are much cleaner (no spotting at the end), lasts only about 4 days, and I don’t have cramps! And I haven’t skipped any periods yet…

  18. This post has been very helpful. I started doing crossfit and eating paleo about a year ago. About six months ago I decided to stop taking the pill and haven’t had a period since (not pregnant). I’ve been a bit worried, especially since it still hasn’t started after progesterone. It’s great to hear that this can be normal for some women and is helping to relieve some stress I’m feeling about this. I also have a lot of life stressors going on right now, which I believe are contributing as well. Either way, I’m working with my doc to figure things out but thank you for this informative post.

  19. Thank you so much for post. I was wondering if you could provide some references. That would be a great start for some further reading.
    Thanks again for a great blog!

  20. I’m trying to get pregnant, which is really hard when my cycles are 40-80 days long. Since upping my carb intake to 100-150 grams a day this past month by way of sweet potatoes, white rice, fruit and some lentils to “feed” my thyroid, my basal body temperature is slowly rising. This month I had a 36 day cycle, no hot flashes, etc… The Perfect Health Diet website has a lot of info about carbs, thyroid, fertility… I am definitely more hungry, and I eat more often, but my goal is not longevity at this point. I need my brain to feel “fed” on a regular basis by the glucose.

  21. This site is such a great resource. I was just thinking about how many men could be potentially suffering from the same infertility issue but that might never know it and continue to low carb it. I myself am in a bit of a predicament similar to a lot of women. It has been a 5 year battle to figure this out. Adrenal Fatigue/HPA axis dysfunction. I had started Paleo 5 years ago due to increasing acne problems. It was getting worse and making me fall in to a deep depression. In retrospect it was a symptom of what was a nasty case of adrenal fatigue. I continued down that long insomnia/amenorrhea journey for a number of years. But you know what? My 10 year acne battle completely cleared up, as well as my life long psoriasis. Ok, so insulin resistance in check. Then I got all up on Matt Stone’s crazy but somewhat logical(requires some very progressive thinking) eat bullcrap diet. Results??? almost a normal body temp, return of Aunt Flow!(5 yr absence, since even before paleo), hair growing in thicker(low carb is notorious for thinning hair). But dun dun dun……Ack, welcome back insulin resistance! Welcome back acne,and psoriasis, oh yeah and turning into a fat ass(and no not a self complex sort of thing) I’m fine with 5 or even 10 extra pounds, not 20+. Alas, here I am somewhere in limbo, like WTF??? Do I want fertility or clear skin??? Obviously both, so my research continues, with the help of this site and so many others. It’s a tricky thing those adrenals, along with leptin, insulin, serotonin, a predisposition to elevated testosterone, and trying to get frickin’ situated in this hetic environment, all while trying to be a “bad broad”.

  22. Hi Stefani. I read this and it’s the best article I’ve seen so far – it’s all new to me. I have an eating disorder and have lost my period for three years. I have around 130g of carbohydrates a day with a very high intake of fat from nuts and eggs. I also eat legumes and soy. What kind of protein can I eat instead? I am so afraid of carbohydrates, though :(

    • Eat animals! And do not be afraid of carbs! The BEST and really, in my observation, only truly effective way to overcome hypothalamic amenorrhea (losing your period from something like an eating disorder) is to eat a lot and to eat often — of all macronutrients! Carbs are your friends, I promise.

  23. Hi Stefani! Thank goodness I stumbled upon your post, because I was on the brink of stopping this Paleo way of eating altogether. I started the Paleo diet (using Robb Wolf’s book), as a way to eat healthier, not to lose weight. However, a month into the diet and I lost 5 pounds and a good amount of body fat. That was 4 months ago, and I have not had my period since. I have re-gained 3 of the 5 pounds, but have still not had my period. I am wondering if I have really messed up my Leptin, among other things. After reading your post, I think I see where my problem lies…I am counting my vegetables as part of my 150 carbs a day. If I am understanding your carb logic, carbs that count towards your daily macro nutrient, are starchy carbs…sweet pot, cassava, squashes, berries etc. So when you give the range of 100-150 carbs a day, are you referring to starchy carbs?

    THanks in advance!! Trying to get my cycle back on track….

    • Yes! Starches and fruit. Put ‘em back in, go wild. If you’re not trying to lose weight, I don’t think going lower than 150 g has any benefit at all, and may in fact be harmful

      • Perfect! Exactly what I thought. Thank you so very much!

  24. Hi Stephanie. I have been reading all of your work with interest lately because my cycles have vanished. I had HA prior to my pregnancies and since having 2 children my cycles have been longer (45 ish days). For the past year, I struggled with bloating and someone referred me to “it Starts With Food” and I attempted adopting the principles: 3 meals per day, with the exception of pre/post workout meals, eliminated grains, beans, etc. I have always kept most of my carbs to the post workout window or ate them in the morning as part of my first meal. However, I was used to eating every 3 hours or so.

    Now it has been almost 60 days and I have not ovulated. I am adding more carbs in per your recommendation. I was pleased that my bloating is gone. But i want to be healthy too. Why no carbs in the morning? I thought that was the best time to eat them? Also, is it spacing my meals out more contributing to my irregularity?

    I had gestational diabetes during my pregnancies. It was a real blow to me, as I have only eaten whole foods and I have been very lean most of my adult life. So I get nervous about adding carbs all day. I worry that I am more sensitive to insulin. Do you have thoughts on this? I have no problem eating a sweet potato after workouts, as my body can handle the sugar. But when I am just eating it at dinner, I worry that the sugar is bad for me. I am having a constant struggle to find what is optimal for health and fitness. I would love some feedback. Oh, I am 34, a weight trainer, plus yoga exerciser. I am lean, but the only change in my body comp is the bloating.

    • Ugh, god, did I really say don’t eat carbs in the morning? I am sorry, I think that was latent paleosphere carb fear coming out in me. I should go back and fix this post.

      Eat as much carbohydrate as you want with whatever meal you want. This morning I had a bit of liver, kale, two mangoes and an apple for breakfast. I’ll do avocado and an apple for lunch, and then more fruit, fat, and protein for dinner. Works awesome for me — listen to your body and give it what it needs to feel good above all.

      • Hi Stephanie , just a short question- don’t you eat proteins for lunch? Or it just depends – I try to listen to my body and sometimes I don’t crave protein and omit it.

        • Sure! I try to eat it spread throughout the day, but skip it in meals often too

  25. Dear Stephanie,

    I am an 18 years old girl suffering from secondary amenorrhea for 1 year and 3 months since Feb 2012 when I moved to a new city to begin college I have euthyoroid levels but my LH, FSH, oestrodiol, progesteron and prolactin are extremely low. When I began college, I was super stressed out with my course(extremely intellectually stimulating.)and also with moving to a new city and as a result I lost my appeptite(college food DID NOT help) and dropped from about 110 pounds to 97 pounds ( I am 5’1). I wasn’t doing strenuous exercise, only running 15 minutes 3-4 times a week(it helps with my stress). Looking back, I realised I was probably suffering more anxiety and depression than stress(I didn’t realise it then). I have been gaining weight(the exercise has stopped) since for more than 7 months(maintaining for the past 2 months) now but still no period … I don’t know what to do I am back to my orginal weight. I don’t follow a specfic diet but I definitely don’t eat processed foods or fast food-I am not a fussy eater (I cook all my meals now) Doctors just keep telling me to gain weight and suggest that I can take the pill. I REFUSE to take the pill. If you give me some advice, I would be so ever grateful. I just know there is some way for my body to recover!!

    Thank you so much for your article. It really made me understand more about my condition.

    Sincerely,
    Sammy

    • You can always just ask for more time, Sammy. It takes time to heal. Eat as often as you can, and keep the exercise to a minimum, and the stress as well. I highly recommend checking out the Fertile Thoughts forum to see what they’re doing for their HA. http://fertilethoughts.com

      I hope that helps at least a bit. I know it’s not much, but you either need more time to put on weight and convince your body it isn’t starving or to go on the pill or to live with estrogen levels low enough that most doctors think it might put you at risk for osteoporosis.

      • Thank you for your reply Stefani ! :) I know my body needs time to heal but sometimes its just so frustrating!!

  26. Do you have any tips on how the Paleo diet can be used for weight gain for women with eating disorders? Maybe in the area of how to get their periods back?

  27. Stefani,
    Great articles as always. Years ago i suddered with anorexia athletica. I lost my periods of course as i was 86lbs eating under 1000 calories, 0 fat and excersising everyday for hours

    The ED became a binge eating ED while still over excersising. At 138lbs i got my period back after 5 years of restricing binging and over excersising.

    Last year, i got a handle on the binge eating. I lost wieght restricitng again 0 fats and still over excersised. I am 5’3 30 years old. I lost my period last year at 118-120 lbs.

    Over the last two months i have been eating 1800-2200 cals a day, 60-100 gm fats 150-200 gm carbs 100-120 gm protien.
    I cut back on the excerisie. I do an elliptical 45 mins 5 days a week and very light light weight circuit 3 times a week.

    (As oppssed to running junping rope hiit and heavy lifting for 4 hours everyday of the week)

    Am i doing ok? Am i on the right track? Do you think i can stay at 120 lbs while eating more and excersising less and get my period back?

    I know your not a doctor i was just wondering what your opinion was. I love myself like this.
    And i need to get pregnant.
    Bmi last checked was 21 and 20% fat

    Thank u

    • Definitely on the right track. Have a bit of patience and give your body time. Focus on mental stress reduction as well and increasing your sleep as much as possible. Anything you can do to convince your body to relax will be helpful. If after a few months you don’t feel it, then try ratcheting up the calories a little bit. 188 is still fairly thin for your size. Many women think you need even more than what you are doing in order to overcome HA. It varies by the woman and by the extent of the “damage” – so all you can do is your best.

      Congratualtions on the huge strides you have made — you’re an inspiration.

  28. I’ve been on paleo for 6 weeks and my period is a month late. Its never happened before as im sure you’ve heard so many people say before. But I feel okay. Emotionally, I feel much better since ive started paleo. And im eating right and including a fair amount of carbs in the form of fruit and potatoes. Could it be late because I’ve changed my diet completely? Pre-paleo, I’d eat disgustingly, tons of sugar each day. I strength train every other day, and sleep for 8 hours and I try my best to relax once I feel an ounce of stress. So should I just wait it out or change something? Thank you.

    • Yes! I’d wait to panic for a few months at least to see how things level out. Just be wary for any negative effects you might experience, document them, and them take ‘em to your doc if you gotta.

  29. Hello Stefani,
    Thank you very much for this blog entry.
    For years, other women (usually older ones) have been threatening me with the prospect of amenorrhea because of my low BMI. It was quite obvious that they were jealous, but still, I was often worried that they may be right. It is funny that a younger woman has dissolved those problems for good!
    I was a skinny child, but despite of my low weight, my breasts started growing when I was 10 and my periods started when I was 12. Even when I exercise a lot and my BMI puts me in the ‘underweight’ category (though my GP says it’s fine), my periods are still there, and I don’t even do ‘spotting’.
    Now I can stop worrying about them disappearing if I’m not stuffing myself with biscuits and cakes!

  30. Hi Stefani,

    I have been looking everywhere for information relating Paleo and Hot flashes… I’m sort of scared/sad that I might have started early menopause! I have been doing Paleo only for 2 weeks and after a week I started getting hot flashes! never had them before, also my period is 2 weeks late…
    I’m 38 years old, don’t take the pill, have 2 kids, which means I haven’t had hormone problems, so I’m really hoping these hot flashes are part of a faster metabolism? :/

    I really hope is diet related and not early menopause.
    Thanks in advance for your response! <3

    • That totally depends on what your were eating and such before and how that has changed now… be sure to eat all the macronutrients and get sufficient calories, too.

  31. Hi Stefani,

    I started a paleo lifestyle in October and stopped menstruating until late January when I went to the doctors and was prescribed a prescription for progesterone. I hated the way the medicine made me feel despite the fact that it helped me get my period back. However I have stopped menstruating again. I have reduced my crossfit exercise regimen to one day a week and continue to eat paleo. Do you have any suggestions about how I can restore my hormones naturally? I am so stressed out about it and feel helpless. Thank you so much, I really appreciate your posts and advice. I look forward to hearing from you.

    Simone

    • If you lost weight you should definitely consider putting it back on. Limiting the cross fit is good. Reduce stress as much as possible. Make sure you eat carbohydrates – fruits and starches – liberally throughout the day, paired with healthy fats and between 50 and 100 grams of protein. I hope that helps. For so many women it is often the weight change or the carbohydrate change – but it is different for every woman

      • Okay great, thank you so much. I am 5’4 and before going Paleo I weighed 130 lbs. Once I began Paleo and Crossfit I went up to 133 lbs but lost a significant amount of stubborn fat. This was when I stopped menstruating. I now weigh 135 lbs and am having trouble getting back down to 133 lbs. I have been so afraid to eat carbohydrates because I associate carbohydrates with insulin and fat storage. However, I have realized that I need to eat carbohydrates from fruits and starches in order to menstruate. Maybe the weight will come off once I integrate these carbohydrates back into my diet and manage my stress better. I pre-ordered Sexy by Nature and cannot wait to read it! Thank you so much for everything Stefani, you have made me feel hopeful again.

  32. You really had me ‘ah-ha!’- and ‘huh!’-ing this entire article. Perfect balance of science and applicable information.

    One thing that can’t be stressed enough, though (which I lacked here) is that not all ‘carbs’ are equal! 100g of spinach or rutabaga or brussels sprouts is NOT the same as 100g of enriched wheat bread or even ‘whole grain’ brown rice.

    If women really want to have positive results, they must be willing to opt for foods that nourish, not just meet a ‘quota’ for ‘carbs’ ‘fats’ and ‘proteins’.

    That’s why I love. love. love. love. love. paleo. I have celiac, a zero-tolerance of dairy, all legumes, and eggs. So paleo was a good option for me. And despite the fact that I now eat tons more fats (healthy fats, mind you) and large portions of meat and vegetables, I’ve become more lean than when I was playing soccer and track year-round in high school. It’s amazing.

    Ok, end paleo plug. I really appreciate this post and will certainly try figuring out my carb balance thanks to this info!

  33. Hi Stefani,

    I asked a fertility question on your FB page for the podcast you recorded with LivinLaVida Lowcarb last week. I’ve also ordered your book so if your advice is to read the book first, please forgive me for being impatient!

    However, I’m wondering if you can point me in the right direction re: my menstrual cycle and fertility issues.

    I have been Paleo for only 3.5 short months and in that time my IBS and chronic constipation has gotten about 80% better. I was previously a very strict low-cal dieter w high cardio exercise thrown in most days. As a result of the Paleo changes I’ve made, I’ve actually gained 10lbs since Jan this year.

    I struggled with unexplained infertility with my son (now 20mths) for nearly 3 years. We finally fell pregnant naturally after a failed attempt at IVF. We have been trying to have another baby for the past 12mths with what seems like similar issues.
    Prior to Paleo my cycle was around 33 days, since Jan it’s been 33, 37 and this month I’m on day 42 and counting. Unfortunately I’m not pregnant.

    I was wondering what you think I should do? I’ve seen a fertility specailist and his first line of attack is fertility meds for ovulation and AI which I don’t want to do. I feel as though I’m finally getting my body healthy. The meds didn’t work last time so I don’t want to take a backwards step..

    Can you advise who I could possibly see (what type of health provider) or some reading I could do to find a course of action?
    I realize this is a lengthy and involved question! I’m just at a loss as to what to do next…

    Thank you Stefani for all that you’re doing for us ladies!
    Chantal

    • Well, the more details the better, so no worries there. In fact, more still would help. What was your diet like before paleo, and what it is like within paleo? Plenty of carbs and fat? You need to make sure to eat enough carbohydrate — at least 100 g / day of fruit or starch — to support reproductive and thyroid function. Have you eliminated grains and dairy?

      Re: “unexplained infertility.” Does this mean you do not have any physiological problems like blockage in your fallopian tubes? If so, I have a feeling your infertility was due to physiological and psychological stress. That being the case, I am not surprised that you put on weight when you started paleo, if that slowed you down or healed your body at all. It’s also possible that you went crazy on saturated fat and this is just a big hormonal shift for your body. Unfortunately there are way too many questions for me to be of any real help, but my general ideas are that relaxation is key and letting your body eat as much as it needs, including fat and carbohydrates in whatever portion you crave (it might be best to try to approximate the macronutrient ratio you were eating before when you menstruated regularly).

      I hope that helps at least a bit!

  34. Great article! However I have a more detailed question I would love your opinion on!
    I have been doing 70/30 pale for a few months and my periods never changed, length wise, however last week I started the virgin diet where you eliminate gluten, dairy, eggs, soy, corn, peanuts, and artificial and added sweeteners for three weeks. I was suppose to get my period 7 days ago but it didn’t come. I’m definitlaly not preggers, I took two tests just in case. Could the diet be why it hasn’t come yet? I usually have a 30 day cycle but its going on 38 days. I don’t necesarily restrict calories and I’m very active all the time. Let me know if you have any thoughts on my situation! Thank you!

    Megan

    • Has your weight changed? That could change your cycle. Complete elimination of soy can also change your cycle since it acts as an estrogen in the body and your body may be readjusting to its absence

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