I’ve ghostwritten several books about hormone balance! Here’s an excerpt from one on the topic of anovulation, and how it’s related to a woman’s period and fertility. The client was a natural practitioner who has helped hundreds of women through such issues.
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Zarina and I had been friends for 20 years. She knew about my work at the vitamin store, and sometimes asked me about natural health and supplements. I was always happy to help! Her family sometimes felt like my own.
One day, Zarina brought her beautiful, accomplished, 19-year-old daughter Julie into my store. Julie had sun-kissed skin and brown hair streaked with natural highlights. She was incredibly fit and had been a high school athlete. Her shoulders were squared and her chin lifted with confidence.
After we finished hugging hello, Zarina said, “Liz, we actually came to see you for some advice.”
“Of course! You know I love helping you!”
“Well, this question isn’t actually for me. It’s for Julie. She has some questions about fertility.”
“Sure! What’s up, kiddo?”
With her characteristic sunny smile, Julie said, “You know my boyfriend and I have been dating for a long time, right? Well, we want to get married next year.”
“Wow, congratulations!” I said. “He’s a wonderful guy!”
“Thank you!” she beamed. “And we want to have a big family. Lots of kids!”
“Excellent! You’re going to make a great mom!” She would, too! She was incredibly loving and fun, and she also knew how to set boundaries.
But Julie’s smile dimmed a bit. She looked concerned. “The thing is, I’m not sure I’m fertile.”
“Why’s that?”
“Because I don’t have periods. Or when I do, they’re really few and far between, and the flow is super light. Is there anything I can do to boost my fertility?”
I said, “Well, let’s back up. Your fertility might not even be the issue. I think it might be your period.”
“But if I’m not bleeding, doesn’t that mean I’m not ovulating?”
“Not necessarily,” I explained. “It’s true that ovulation and periods do go hand-in-hand for women with healthy hormones. But if your hormones are off, the whole thing can go topsy-turvy! For example, some women don’t ovulate, yet they still bleed. (That’s obviously not a healthy period, it’s called ‘abnormal uterine bleeding.’) And other women do ovulate, but then don’t have a period. I have a hunch that you might be one of them.”
“So if I’m ovulating, but not bleeding, does that mean I can get pregnant?”
“No, you’d still want a healthy period for pregnancy to occur.”
The poor girl looked so confused.
“There’s still hope!” I said. “Let me ask you this: how often do you exercise, and what do you usually eat?”
I thought I knew the answers to this, but wanted to confirm it with her. She explained that she exercised every day for a few hours, and yes, she ate tons of veggies. She loved lean proteins, low to no carbs, low to no cholesterol, and no sugar. At first glance, this sounds like a prescription-perfect diet for a lot of people. It’s so healthy! But a lifestyle this extreme isn’t healthy for most women—especially women who exercise as much as Julie did.
“Okay, I think I know what the problem is,” I said. “You don’t have enough body fat and cholesterol.”
“Body fat and cholesterol?” Julie frowned. “But I thought I didn’t want those things?”
“You don’t want too much of them, that’s true. But too little means your body can’t produce the hormones required to ovulate. That’s called anovulation: when you’re not ovulating. And your body also can’t form a healthy uterine lining for your fertilized egg to latch onto.”
“But I’m not underweight,” she said.
“That’s because muscles are heavier than fat. So it’s possible for the scale to say you’re at the right weight, when really you still don’t have enough fat.”
Understanding dawned in her eyes. “I’ve never thought about it like that.”
Julie wasn’t alone. Many female athletes fall into this situation. Athletic coaches who train young women should treat a girl’s period as a marker for her health. If she’s not bleeding, then she’s training too hard and eating too lightly. It’s a form of malnutrition. Coaches have to find a balance between training hard and ensuring their girls are healthy. Anovulation also happens to women with anorexia.
As one study put it:
“A high proportion of well-trained dancers and athletes have amenorrhea [“amenorrhea” means you’re not having periods], though weight may be in the normal range, since muscles are heavy (80% water, compared to 5–10% water in adipose tissue). The amenorrhea is usually reversible with weight gain, decreased exercise or both. The amenorrhea is due to hypothalamic dysfunction; the pituitary-ovary axis is intact, suggesting that this type of amenorrhea is adaptive, preventing an unsuccessful pregnancy outcome. Evidence is presented that the high percentage of body fat (26–28%) in mature women is necessary for regular ovulatory cycles.”
That study showed that for many women who don’t have periods, the hypothalamus isn’t able to do its job. The body understands that it’s not in a good position to carry a healthy baby to term (not without seriously endangering the mother), so the body responds by shutting down ovulation altogether. It’s the body trying to conserve its resources.
I further explained to Julie that progesterone and estrogen are produced from cholesterol. “So while you don’t want your cholesterol getting too high, you definitely don’t want it too low, either.” After talking more, I helped her see that she could include healthy, fat-rich foods (like salmon, nuts, and avocados) in her diet without actually getting fat. “I’m confident we can get your periods going again if you change your diet add some nutrients and herbs and just exercise a little less.”
Julie was all smiles again. “I can definitely do that! How long will it take?”
“If you stick with the program, you should start seeing changes in three months. But don’t try getting pregnant just yet. Let’s make sure your periods are regular and healthy first.”
“Okay,” she said. “I don’t need to get pregnant this year. I’m definitely thinking long term. We want a big family.”
“Wonderful!” I said. “I’d be honored to help you get there!”
And get there she did. One year later, Julie’s wonderful boyfriend became her wonderful husband. A short time after that, she had her first child. Today, Julie is a happily married woman with five beautiful children.
