Q) I am 20 years old and haven't had a period for over a year now. My GP suspected that my weight loss was the trigger (I lost 7 kg when I went to live abroad last year) and put me on a balanced diet. However, after six months, I still have no periods and seem to be unable to put on weight. Can you offer any advice?-H.S., via e-mail
A) Although the absence of periods (known medically as 'amenorrhoea') usually indicates pregnancy or menopause, there are a number of other reasons why a woman may stop menstruating. As your doctor has explained, weight loss is one of them, although thyroid dysfunction, poly-cystic ovarian syndrome, excessive exercise, stress and certain drugs (such as oral contraceptives and antidepressants) are also known to cause the condition (Am Fam Physician, 2006; 73: 1374-82).
If your doctor has ruled out drugs and any underlying condition, the following self-care steps may be helpful.
- Consume enough calories. The reproductive system is closely linked to nutritional status, so any energy deficit-either because of dietary restriction, intense physical exercise, or both-can, over time, lead to a loss of menstrual periods (Hum Reprod Update, 2006; 12: 193-207; Endocrinol Metab Clin North Am, 2001; 30: 611-29). Simply eating more-or exercising less-may be all that's needed for you to resume normal menstruation, but the process can take up to a year (BMJ, 1978; 1: 321).
- For quicker results, try adding a daily high-calorie nutritional drink to your diet. This proved to be beneficial for some athletes with amenorrhoea (Int J Sport Nutr, 1999; 9: 70-88; Int J Sport Nutr, 1996; 6: 24-40).
It may also be worth keeping a food diary to record the amount of calories you are consuming each day. Use an online calorie counter, such as found at http://nutrition. about.com/library/bl_nutrition_guide.htm.
- Increase your fat intake. Amenorrhoeic women-even those with normal body weight-tend to have lower intakes of dietary fat than women who menstruate regularly (J Soc Gynecol Investig, 1994; 1: 84-8; Clin Endocrinol [Oxf], 1999; 50: 229-35). So, consuming more fat-from healthy sources such as nuts and seeds, oily fish (or fish-oil supplements, to avoid mercury), olive oil and avocados-may help your period return to normal. The above-mentioned calorie counter can also tell you how much fat you need, as well as your protein and carbohydrate requirements.
- Find out your metabolic type. Make sure you are eating right for your biochemistry (see page 6). Also, consider the glycaemic index (GI) of foods. Eating healthy, non-processed high-GI foods, provided that they match your metabolic type, may help you to gain weight.
- Consider supplements. The amino-acid acetyl-l-carnitine (ALC) has been shown to be promising in the treatment of amenorrhoea. In a study of 20 amenorrhoeic women taking 2 g/day of ALC, hormone levels improved and around half the women resumed their menstrual periods within three to six months of starting the therapy (Acta Obstet Gynecol Scand, 1991; 70: 487-92). Vitamins C and B6 (pyridoxine) as supplements may also help in some cases (Int J Fertil, 1977; 22: 168-73; J Clin Endocrinol Metab, 1976; 42: 1192-5).
- Look after your bones. Amenor-rhoeic women are at an increased risk of bone mineral loss (BMJ, 1990; 301: 790-3), so make sure you're eating the right foods for strong healthy bones (see WDDTY vol 19 no 12 for 'The best diet for better bones', page 10). Calcium and vitamin D supplements may also prove useful.
- Reduce stress. Several studies have found a link between high cortisol levels-the hormonal response to too much stress-and amenorrhoea (Eur J Endocrinol, 2000; 142: 280-5; Am J Obstet Gynecol, 2000; 182: 776-81). So, stress-reducing techniques such as yoga or meditation could be worth your while.
- If you smoke, quit. According to a study of 2544 teenage girls, you're nearly twice as likely to suffer from amenorrhoea if you smoke one or more packs of cigarettes a day (Am J Public Health, 1992; 82: 47-54).
- Try acupuncture. Some studies suggest that acupuncture can have a positive effect on amenorrhoea (Wien Med Wochenschr, 1981; 131: 123-6). It appears to work by regulating hormone levels, thereby stimulating ovulation (J Tradit Chin Med, 1993; 13: 115-9).
- Consider herbs. Vitex agnus castus (chasteberry) has been traditionally used to treat a number of female conditions, including amenorrhoea, and is approved by Gemany's Com-mission E (Drug Saf, 2005; 28: 319-32). In clinical trials, the herb was able to normalize certain hormones related to menstrual loss, including prolactin and luteinizing hormone (Arzneimittelforschung, 1993; 43: 752-6; Phytomedicine, 2003; 10: 348-57).
Blue cohosh, motherwort and yarrow are other traditional herbal remedies for absent menstruation, but it may be better to consult a qualified herbal practitioner to get an individualized prescription.
High-calorie, but healthy
Consuming more of the following foods may help you put on weight:
v pure fruit juices and smoothies
v dark chocolate.