If you're new to my blog, please check out my previous blog post to know more about my background and how I was diagnosed with Hypothalamic Amenorrhea (HA) here
A Brief Overview of HA:
Hypothalamic Amenorrhea - when you lose your period completely, have prolonged periods, or irregular periods due to lack of energy for the reproductive system to work properly. There are a lot of factors that play into this but it typically comes down to exercising too much and not eating enough.
Main Factors Involved:
As you know from my previous post, I had a difficult experience with a nurse practitioner diagnosing me with Polycystic Ovarian Syndrome (PCOS) without discussing my symptoms or my history.. let alone doing bloodwork or an ultrasound!
Once I found out I had HA, I was very hurt and discouraged. I was embarrassed that as a healthcare professional - Physical Therapist and Strength & Conditioning Specialist- that I didn't know there was something wrong with me. But now the truth was right in front of me the entire time.
All of those years I went to countless physician appointments (primary care and gynecology) and was told that "you are the picture of health" and "you have nothing to worry about" continued to haunt me.
How could I have not known this??
For those of you who know me personally know that I am a researcher.. AKA nerd #nerdalert.
I took several days to research PCOS and Amenorrhea and learned more about HA. I can give you SO many statistics about the average BMI and body fat of women who conceive and the FSH, LH and progresterone levels to ovulate but I'll spare you just this once :)
Through my research, I found a book called No Period, Now What? It has been so very helpful throughout this process. It shows evidence-based research (right up my alley!!) to support HA diagnoses and a step-by-step Recovery Plan. It even has a section for significant others and spouses!
I learned that it was very commonly misdiagnosed and not many people knew much about it (even specialists in obstetrics and gynecology).
To be honest, I'm not sure why that surprised me so much. I see it in my profession all the time.. where many people are mislead to take pain medication and undergo unnecessary injections and surgeries to end up right where they left off..
STILL IN PAIN.
If it's that way in the Orthopedic world then why would it be any different in Women's Health?
Our first thought is, "What medication can help me with that?" rather than figuring out the underlying issue.
Okay.. I'll get off my soap box!
So I decided to follow the Recovery Plan in the book No period, now what?
The plan looks a little something like this:
For someone like me - I have NEVER had a regular cycle and usually only have 1-2 per year - then the recovery process needs to be drastic... literally, life altering.
My body fat was also very low so I had to gain some weight and provide my body with a little bit of extra cushion ;)
Now if you're reading this and thinking, "this is bonkers.. how does this help anything?" then you're not alone. I had a VERY difficult time hearing this.
My entire life I've been active and moving. I rarely sit down. I eat when I'm hungry (which is pretty much all the time) and like to keep moving throughout the day. I can also be a bit of a stress ball and that's partly due to me wanting to please and be accepted by everyone.. I also overthink everything I say (not always but sometimes) which causes unnecessary stress.
So to counteract all of that I have to go for long walks, do light yoga, eat as much as want and listen to my hunger cues. I have to incorporate more fat and carbs into my diet- I was unintentionally eating a low carb and low fat diet without realizing it.
I wasn't properly nourishing myself even though it seemed like I was eating ALL. THE. TIME. It wasn't enough and I've learned tricks to incorporate more fats and needed calories without even noticing it.
Moving on.. let's get to the meat and potatoes..
I recently had my bloodwork done and all of my hormone levels were within normal limits!! And I'm talking mid-range levels.. not on the lower range of normal. I wish I had done bloodwork before I started the Recovery Plan to show how much of a difference it made!
When I was in my early 20s I had bloodwork done and at the time I didn't even care to look at the numbers.. I blindly trusted my physician. But I do remember them being very low. I remember the physician telling me they were well below normal limits but that birth control would get them "back on track."
Since that encounter, my exercise, eating and stress habits haven't changed much so I can assume that my bloodwork would have been quite low before starting the Recovery Plan.
I also ended up having to get off birth control. With birth control, my periods were "regular." However, after undergoing an arthroscopic shoulder surgery I developed a blood clot in my arm that eventually went to my lungs (AKA pulmonary embolism (PE)- the silent killer).
After the blood clot and PE, I was not allowed to take estrogen supplements (AKA birth control) and guess what? ... 4 years later and still irregular periods. I thought the birth control was supposed to "fix" it?
This recovery process has been one of the most difficult (if not THE most difficult) thing I have faced in my life. I didn't realize how important exercise was to me. I also didn't realize the impact that my body image had on my life.
Since starting my company, I had a healthy view of my body and grew to love my muscles and strength. I was empowered to be a fit female confident in my ability to move and explore the world!
I believe that I will be able to return to working out and moving freely! But my first priority is my health.. BMI and body fat doesn't define me. I have (and probably will) continue to gain more weight during the recovery process but that's okay.
It can be frustrating seeing other women work out as often as they please without having to worry about it affecting their hormones. But I have come to appreciate how every body has a unique genetic makeup.
One person may function great at a BMI of 19 and someone else may function better at a BMI of 23. One person may function well at a body fat of 18% while someone else may function better at a body fat of 23%.
I believe that I'm going through this for a reason.. whether it's to raise awareness for HA to individual women or if it's to discuss this diagnoses (respectfully) with physicians to prevent other women from being misdiagnosed.
I haven't figured out what my role is just yet but I look forward to finding that out.
I want to give a shout out to all of my friends, family and followers who have been so supportive through all of this! There have been many times I wanted to say "forget this, give me the medications!" so I could return to my old way of life but so many people encouraged me to keep on the Recovery Plan.
I also want to throw an extra big shoutout to the hubs!! There have been many nights where I have questioned (and I"m sure there will continue to be more) if I'm doing the right thing. And time and time again, he would continue to tell me how much he loves me and is thankful that I'm doing this for our family. I could not be doing this without him!
For those of you who have been to countless physician's to be told that "you're perfectly normal" but are fearful that something isn't right.. I urge you to read the book No period, now what? It's an informative read backed up by evidence-based research!
The book also teaches you how to read your lab results after having bloodwork done. It also explains how you may have follicular cysts on your ovaries that are from lack of ovulation. They will go away once you have recovered and are regulated but if you're not careful, can easily be misdiagnosed as PCOS.
It's important that we advocate for our health! And in order to properly do so we have to be educated! That may require us to respectfully disagree with our physicians on occasion.. but that's okay! As long as we do so in a kind manner then there should be no issues.
Just know that with the change in healthcare, physicians are seeing more and more patients daily. It's tough for them to remember everything you told them when they're juggling 20-30 other patients that day. So knowing your specific measurements and understanding that BMI is not the only indicator. You can be in a "normal" and "healthy" BMI range but still have HA. You can also be below the "healthy" BMI range without having HA. It all depends on a thorough understanding of your history.
Please feel free to shoot me any questions that you might have! I would love to hear what you think about HA and to see if you might have possibly been misdiagnosed or even overlooked entirely and labeled as "healthy."
If you found this helpful please let me know by commenting below or emailing me at firstname.lastname@example.org
Dr. Katie Spruell, PT, DPT, CSCS
Whether you've been suffering with your pain for weeks, months, years or even DECADES! There's no need to fear.. You are not alone!
Let me throw out a few stats:
I'm sure you knew that you weren't the only one in the world suffering with back pain but now you know how it's becoming a bit of an epidemic.
Whether you suffered your injury from saving a child from a burning building or perhaps just sitting at your desk working on your computer.. back pain can literally be a pain in the butt.. *ahem* I'm talking about Sciatica that stems from your back of course ;)
If you read my last blog post regarding The Real Reason You Can't Get Rid Of Your Pain then you know that there can be a number of reasons behind the cause of your pain. And without doing a thorough assessment (and no that doesn't have to involve x-rays and MRIs.. they really aren't needed as often as you think) it can be difficult to diagnose.
In my practice, I have noticed that the majority of patients are lumped into a particular category and that I have found several exercises beneficial. However, I recommend you see a Doctor of Physical Therapy in your area if your back pain persists.
Be mindful of how you're sitting.
That doesn't mean you have to have perfect posture! That just means stop sitting like a slouch!! Sit up tall.. this is can also increase your alertness.. hellloo Monday morning!
Keep your feet flat on the floor and your bottom all the way to the back of the seat. You can roll up a towel from home and put it in the small of your back to promote good posture (you can also purchase a lumbar support roll here).
Make sure your computer is at eye level. So that means, sit tall and then adjust the height.. it might be at "eye level" when you're slumped over but that doesn't help much does it?
And remember.. don't worry about sitting perfectly. Just be more mindful of your positioning throughout the day and you'll be surprised at how much it will help! Although if you suffer with very poor posture then you may be sore from sitting upright.. don't worry, that goes away!
Get up every hour.
One quick an easy way of doing this is drink PLENTY of water. This will force you to get up every hour to go to the restroom so you won't forget.
Another way is setting a timer for every hour. If you're like me, I tend to get consumed in my work and don't realize how much time has passed and realize it's been 4 hours!
By that time it's going to take A LOT of work to undo the pressure that's been placed on your back. Just think.. you were sitting with poor posture for 4+ hours.. what makes you think that you'll fix it with just one exercise?
However, with daily modifications and changes to your life you will gradually start noticing a difference. It might not be right away but it WILL happen!
Do the opposite motion than you're used to.
If your job requires you to sit all day or lift objects (or kiddos) off the floor then that shows you're primarily in flexion and need to work on extension.
If you're a gymnast, pole vaulter, crossfitter or any other type of athlete then you will probably benefit from more flexion.
But not always!
I've seen many crossfitters who work out 5+ days a week present with low back pain. After going through their history I find a lot of similarities to my other patients who don't do crossfit on the regular..
They sit majority of the day for work.. They're at home with their kiddos picking up toys, changing diapers and wrangling kiddos all day.. They're a massage therapist or personal trainer working with clients and helping them stretch.
All of these show more of a flexion-based lifestyle.
Flexion = bending forward at the low back (see pictures above)
Extension = bending backward at the low back (see pictures above)
You can see how day-to-day activities typically involve more flexion than extension.
If your daily activities involve a lot of flexion then try doing the opposite.. whatever that may be! Listen to your body and see if what you're feeling is painful or more of a stretch.
And for those with bulging and herniated discs.. be very careful! Usually extension based exercises are helpful such as the cobra (see pic below) but sometimes it requires more than that. That's when you need to find a local Physical Therapist to help you find out what the best positioning is for you.. otherwise, you'll be next up on the chopping block.. literally.
Go for a walk!
After work, take some time for yourself and go for a peaceful walk. Take in your surroundings and decompress from the day.
And if you're sitting all day, walking will promote more extension of the low back and should help take pressure off those segments that have been compressed all day while sitting.
It will also help decrease stress levels which will help you relax and sleep better. Sleep is paramount in the recovery process!
And don't forget about those endorphins! They'll make you feel good and give you energy to tackle the rest of the day.
However, be careful not to walk up too many hills.
Walking on an incline can place excess stress on your back and puts your low back into a flexed position. If that's the position you typically stay in all day then no need to add more time in that position!
This is a difficult topic to tackle - *cough* elephant in the room *cough*..
Losing weight can be the difference between living an active and enjoyable lifestyle versus undergoing multiple surgeries and taking pain medication for the rest of your life.
Now if you have 5-10 lbs or even 20 lbs to lose.. you would probably benefit more from Tips #1-4.
But if you have 30+ lbs to lose then that's another story.
Now I love people of all shapes and sizes, but if you want to get pain-free and achieve an optimal outcome then you might want to assess what you're eating.
That doesn't mean to calorie count or go on a crazy and restrictive diet.. To me, that's just as bad because once you go off the diet things typically will go right back to the way they were but now you are filled with guilt and shame.
Instead of a restrictive diet, think about building a sustainable eating plan that consists of ALL food groups.. even the "unhealthy" ones. The only difference is eating in moderation, moving more, and listening to your hunger cues.
I recommend going to the grocery store and looking for whole foods.. Foods that come from the earth and are not processed. Stay on the outside of the grocery and don't go to the middle aisles.. usually that's where they store the processed food such as cookies, crackers and other pre-packaged food.
One easy way of navigating the grocery store is by looking at the ingredients and choosing items with 5 ingredients or less!
I can go on and on about this.. but I'll save that for another post.
The main thing I want you to get from this is that...
There is still hope.. LOTS OF IT!!
So don't give up just yet! And it's okay to disagree with your physician.. you don't always have to have pain medications, injections or surgery. There are alternatives!
And I cannot stress this enough to you.. seek out the best Physical Therapist in your town. A true musculoskeletal specialist that can perform a comprehensive assessment to determine the true underlying cause of your pain!
And if you haven't read my previous post.. check it out here. It will tell you more about why you may be having difficulty getting rid of your pain!
If you're local to the Nashville area, I provide FREE Discovery Visits and Phone Consultations. I would love to talk with you and explain how I can specifically help YOU and YOUR pain.
I also offer Money-Back Guaranteed after 2-4 sessions if you're not completely satisfied with the results. I 100% believe in what I do. I have seen people's lives transformed by making minor modifications to their daily routine. You will be surprised what the body can overcome if you are able to address the real reason behind the pain.
And please subscribe to my newsletter to get email reminders for my upcoming posts! I'll also send you my FREE Back Pain Guide!
I would also love to hear any questions that you may have! Please email me directly at email@example.com or comment below!
Dr. Katie Spruell, PT, DPT, CSCS
KS Fitness + Co, LLC
Dr. Katie Spruell, PT, DPT, CSCS
I am a licensed Physical Therapist and Certified Strength & Conditioning Specialist practicing in Nashville, TN. I started a small private practice - KS Fitness + Co, LLC - in April 2018. Recently I moved my practice to Knoxville, TN.