Under-Eating and Reproductive Hormones (Episode 459)

Full Transcript: Episode 459

Lisa Hendrickson-Jack:

Today I’m sharing a brand new episode in my FAMM Research Series. In today’s episode we are going to be looking at a really interesting study that delves into the topic of calorie restriction, exercise, and how those two things impact the menstrual cycle. So without further ado, let’s go ahead and jump right in.

Now you may have heard me mention the study before. I’ve mentioned it a number of times. I’ve talked about it on the podcast, I’m sure, here and there in passing. I’ve talked about it in my programs with both clients and practitioners, because I feel like this study shows us in a more scientific way what we often might see in the menstrual cycle chart in a similar situation.

As always, you’ll find the link to the study over at fertilityfriday.com/459, the number for today’s episode. And so I’ll tell you a little bit about the study, how it was designed, who was in the study. But basically, the study is looking at women of reproductive age between the ages of 25 and 40. The researchers chose women who have regular ovulatory cycles. They specifically excluded women who had disordered eating patterns or full-blown eating disorders, and also women who used hormonal contraceptives recently, so they were trying to take out potential other situations that would contribute to cycle irregularities.

And basically what they did in the study is they fed these women, they separated them into two groups, and one of the groups was specifically fed a calorie-restricted diet and also assigned a certain amount of exercise. So this is something that they monitored. So one of the things about the study is that it was controlled, and so the amount of food that they were eating was measured and controlled, and the amount of exercise that they were doing was also measured and controlled.

And so basically, they specifically created a situation where this study group had a calorie restriction of about 20 to 35 percent below their baseline energy requirements. So they were specifically eating less than what they needed for the energy level. So just keep that in mind as we keep talking. Whereas the control group, they gave them what they call eucaloric. So they have a group of women who is specifically eating 20 to 35 percent less than what they need to be and also a group of women who are eating a sufficient amount. So they’re not under eating, not overeating, they’re just good.

And so they measured a number of things in the study. They measured weight loss. But one of the most interesting, I think, parts of the study for me was that they actually measured both estrogen and progesterone levels in the respective phases of the menstrual cycle. And they were looking at menstrual cycle characteristics. They were looking at whether the cycles were ovulatory. They were looking at luteal phase length. And so it’s kind of rare to find a study of this nature that’s actually looking at these particular outcomes because that’s not something that you see every single day.

And so the results are interesting. So if you’ve never heard me talk about this study before, then I would imagine that you would think like, okay, well, they’re going to show that either ovulation was disrupted or that maybe ovulation was delayed or maybe these women stopped ovulating or maybe the luteal phase was really short. So what’s interesting in this study is I feel that the results aren’t exactly what you would expect.

Some of it is. They did find that the participants who were restricting calories and exercising did lose weight. Primarily they experienced some fat loss and they kind of listed how much it was. Wasn’t necessarily significant high, high weight loss, but there was weight loss among participants. But what’s interesting is that the participants didn’t experience what the researchers termed to be significant changes in the average menstrual cycle length, the follicular phase length, or the luteal phase length. So in this group of women who were eating 20 to 35 percent fewer calories and exercising, they didn’t actually change their menstrual cycle a whole lot.

Now, that’s what they say on the surface. When you dig deeper into the study itself, you do find that there are some differences in the menstrual cycle. You do find that there’s some degree of fluctuation. And they did note that the most common change that they observed was a short luteal phase, so 10 days or less. So there were some cycle changes, but overall they didn’t actually find a significant change in terms of the menstrual cycle parameters that they were looking at.

What’s also interesting is that none of the participants stopped cycling at all, so these women continued to ovulate and continued to have regular periods during the course of the study, and any changes to the menstrual cycle itself were minimal.

What the researchers did observe was a significant reduction in estrogen production. And so they measured two specific estrogen metabolites and there was a 15 and 20 percent reduction in the estrogen that they measured and there was also a significant reduction in progesterone measured as well.

So what’s interesting about the study is even though the participants didn’t experience a change in their menstrual cycle of note, other than maybe losing a day or two of the luteal phase, not even in all participants, the majority of participants continued to ovulate regularly and continued to have their cycles look basically normal, but the kind of underlying hormonal thing that was going on as a result of the restricted eating and exercise was this drop in hormone production.

So to paraphrase how the researchers talked about this kind of surprising finding is that the results of their study challenge the notion that if you experience a significant change in ovarian hormones as a result of exercise and caloric restriction, they were expecting to find significant disruptions in the menstrual cycle. So their results actually suggest that there can be kind of profound changes in your hormone production before those changes actually significantly impact the overall length and presentation of the menstrual cycle.

And what’s interesting about this whole conversation is that when you get into the weeds with cycle charting and you start to pay attention to your cervical fluid observations and you start to pay attention to when you’re ovulating in the cycle and you pay attention to your luteal phase length and a variety of other factors — basically when you get into the weeds of charting and you start to dig deeper with your observations, so you’re not just tracking your overall cycle length, but you’re tracking your mucus patterns and those kinds of things — you can see these types of things.

So what’s interesting is that these results don’t surprise me at all because I’ve seen certain patterns that would indicate this type of thing in the cycle with clients for many years. So that’s one of the reasons why I was so excited to find this study.

So I suppose one question to ask then would be, how could these types of changes show up in the cycle? For someone who isn’t testing their daily hormone levels or going through and doing a DUTCH test at different times of their cycle, how could potentially some of these hormonal changes show up in the menstrual cycle?

And so one of the most common ways to take a look at that hormone situation is by checking out the quality and quantity also of mucus. So it’s not uncommon for me to see a similar kind of pattern in women who are exercising quite a bit, who I may suspect aren’t getting enough to eat, where we’re seeing lower quantity of mucus or scant mucus.

So especially if there’s been a recent change. So it’s often easier to identify some of these things in a woman who has a history of cycle tracking because if you have a history, if you’ve been tracking for several years and you know typically how much mucus you have, but recently you’ve decided to start a new exercise program and all of a sudden now you’re seeing maybe your ovulation is a little bit disrupted, maybe the occasional cycle is a little bit delayed, but more specifically, you’re seeing a lot of dry days, far fewer days of cervical mucus, or when you have cervical mucus, it’s barely there, you only see it maybe once or something like that.

So that’s something that’s not uncommon in women who are potentially under-eating, where they’re not actually seeing a whole lot of cervical mucus. And so they might be wanting to take a fancy supplement or do something to bring it back, because they may think, “Oh, this is just a nutritional issue,” you know, in terms of like micronutrients, but it could actually be in some cases related to the overall presentation of not eating enough so that you’re not supporting the optimal hormone production. And as a result, that trickles down in your menstrual cycle to a reduction in your ovarian hormones and a reduction in your cervical mucus.

So in addition to that, in women who are presenting potentially with this kind of scenario, they may see that gradual shortening of the luteal phase or they may just see certain signs in their luteal phase that the progesterone isn’t great. So that could be an increase in PMS symptoms. It can be spotting before your period or kind of having fewer of those days of progesterone. And these things are happening in real time in response to what’s happening usually in that particular cycle.

So some of these things, if you have one cycle where there’s a dramatic increase in the exercise level but not a dramatic increase in how much food you’re eating, you may see that for that particular cycle. And then if you make some shifts and changes, you may see that improve a little bit the cycle after. So these are changes that are typically happening in real time. This is very much an example of how the menstrual cycle can serve as a vital sign and really give you that real-time feedback as to what is happening.

So to kind of sum it up then, what the study tells us. What does this add to the conversation about menstrual cycles, hormones, fertility? It tells us that under-eating impacts hormone levels even if we don’t see an obvious shift in the menstrual cycle overall length or even the luteal phase length. It tells us, it shows us that we need to eat enough, basically, in order to make optimal hormones. It shows us in black and white that there’s no way we can have optimal hormone balance if we are not eating enough food. It also shows us how sensitive we are to exercise.

One of the things that I have learned from the years that I’ve been working in this field and monitoring women’s cycles as well as my own cycle is that we are very sensitive to exercise. And it certainly doesn’t mean that we shouldn’t exercise, we need to exercise. Exercise is good for us, you know, to a point. But what it does mean is that we need to be mindful that when we are exercising, particularly when we are exercising in a quite strenuous way or intense types of exercise, even if we don’t consider ourselves to be athletic or athletes — you know what intense exercise is, right? Something that causes your heart rate to rise, something that causes you to sweat.

When we are engaged in whether it is high intensity exercise or even if it’s low intensity exercise like walking but hours and hours of it, when we are doing a lot of exercising — and yes, walking is exercise — we have to be mindful that we’re getting enough to eat. And one of the things that has come out in the previous two podcast episodes is that we should also be looking at what the ultimate goal is for the activities that we’re doing right now, because sometimes we may have different goals or different things that we’re trying to achieve, and they might be incompatible.

So for example, if your main goal is weight loss and you are actually not currently trying to conceive, you have a temporary goal or a specific goal, a target that you’re trying to hit, then for a period of time in order to achieve that goal, you may choose to exercise more and you may choose to, whether it’s reduce calories or restrict calories or watch what you eat, that’s certainly an option for weight loss. When you’re charting your cycles, if you’re paying attention to what’s happening, you know, cycle after cycle while you’re doing this, you will see in real time what that is, how that’s going to affect your cycle.

So one of the things that I like about charting is it doesn’t allow us to live in a fantasy world where we can pretend like these things don’t affect us. You are faced with exactly how your actions are affecting your hormones. You will see it play out in the chart in one way or another. And so it’s very interesting to see consistently for the vast majority of women who exercise, work out, when you up those energy levels, when you lower the food, you can see right there in that particular cycle how it’s going to affect you.

So I think that charting helps to keep you balanced. It helps to prevent you from going too far over the edge. And especially for in those cases where you are working on a specific goal for a specific period of time, I think it can be very kind of humbling to actually see how much your actions can affect your hormone levels.

And to see those correlations is a very transformative experience. I’ve had many clients who are trying to conceive and they’re working out a lot and they’re trying everything but lowering the exercise, you know, to get the hormones to balance. And eventually we get to a crossroads, it’s like, okay, you’ve tried everything else, you’ve taken all the supplements, you’re doing everything but lowering the exercise or eating a little bit more. And if you really want to see those results, if you really want to get that luteal phase length up or if you really want to balance those hormones to create an optimal cycle for conception, then we’re going to have to, you know, something has to give here.

So why don’t you try one cycle with lowering that exercise level or something like that? And I can’t tell you how many clients that I’ve worked with when we do something like that and they gain a day or two on their luteal phase just by lowering the exercise — or it’s usually lowering the exercise. It’s harder, I think, for a lot of women to eat a whole bunch more food. So what I found is that often that will be the thing that correlates, but I’m sure it could be done in other ways as well.

And I feel like time and time again, I’ve just been there for these experiences and realizations with clients who kind of just are floored by how much of a difference something like that can make. So, you know, taking it back to the study, it does show us that in order for us to have optimal, normal hormone levels, we do need to remain eucaloric — in the, you know, research term — but we need to make sure that we’re consuming enough to offset our overall calories.

And I say this all the time, you know, women, when we’re trying to — we start an exercise routine, when we’re changing our diet up, usually the goal is to lean up, to get our body into a smaller state, you know, that’s typically what the goal is for women. And for men, typically they’re trying to bulk up, they’re trying to build muscle. And so it’s pretty common, stereotypically speaking, for men to then go and make sure that they’re consuming more. If they’re lifting, they’re consuming more. They’re making sure to get in more calories so they can build that muscle. But for us as women, we don’t really tend to think about it that way.

And so we end up eating either the same amount or maybe naturally we eat a little bit more. But ultimately we’re not typically adding in additional protein, for example, to ensure that we are feeding our bodies and feeding our body’s ability to make optimal hormones.

So another couple points that I just wanted to go over. What the study also shows us is that it’s possible to have poor hormone production even in a relatively normal-looking cycle. So I think that’s something to remember also. It’s easy for, I think, women who are kind of in the know about this stuff with their cycle to say, “Well, you know, I still ovulate, I’m still menstruating obviously, I’m not exercising that much, you know, I’m definitely eating enough,” right? I’ve heard that a thousand times.

So I think that this is a nice reminder that you can still have a cycle and you could still be ovulating and you could still have not optimal hormones if you happen to be under eating for a period of time. So that’s something to keep in mind, and that’s when we get into more of those subtle signs of low hormones on the cycle when you’re really tracking and in the weeds with checking your cervical fluid and nuances of the luteal phase and all those kinds of things.

So just to put it out there, it’s even possible to have a normal length luteal phase and still have not optimal progesterone. So that’s something to keep in mind as well. And then also these hormones fluctuate from cycle to cycle. So if you have typically normal cycles, typically don’t have issues, it’s still possible to have a cycle where you are working out a lot or under eating and have that shorter luteal phase that one time or whatever.

So it’s always a conversation. It’s always something that is not just stable, it’s not just stationary. It’s really reflecting what’s going on with us on a cycle-to-cycle basis.

And I think there’s something else that is helpful to think about as well. So this type of activity, which is the kind of over-exercising, under-eating type of behavior, that can lead to hypothalamic amenorrhea, HA. So the kind of worst outcome of this behavior when it’s gone unchecked, if you’re not eating enough and exercising too much, is to lose your period altogether.

But I feel like this study highlights the spectrum. So people don’t just wake up without a period. You know what I mean? It’s not like it’s just something that happens overnight where everything was totally fine and then all of a sudden, you don’t have a period. So women who lose their periods, who develop HA, they likely were doing these types of behaviors for quite some time before the period went away. So the under-eating, over-exercise type behaviors were likely happening for a long time before it actually resulted in the complete loss of their period.

So this study, I think, also gives us that hormone measurement to show that there is a spectrum of this. So I often will say that if a person is engaging in some of these behaviors, but they still have a period, but we’re seeing signs of low hormones, that they’re somewhere on that HA spectrum. And so that’s something really interesting to think about as well.

So this study, I feel like, gives us more evidence to the fact that it’s not just all or nothing. It’s not just perfect cycles or you lose your cycle altogether. So again, it’s something for all of us to kind of keep in mind, especially if you’re listening and you’re quite active yourself. It’s something to keep in mind because when we’re very active, we have to take care of ourselves. So taking care of yourself means that we have to make sure we’re getting enough to eat so that our muscles can rebuild, so that we can sleep well and all those great things.

And in addition, when we are exercising a whole lot, we need to make sure that we give ourselves rest and a break every now and then so that our bodies can rejuvenate. So there’s a lot of things to consider if you work out a lot — and by a lot I mean let’s say four or more times a week — and walking is exercise. So if you’re going for like two-hour walks or hour walks every single day, that’s exercise, you know.

And so if you have never thought of yourself as an athlete, maybe it’s time to consider, if I did consider myself to be a world-class athlete, what would I do to take care of myself? What do world-class athletes do to take care of themselves? Do they skip meals all the time or are they making sure to get enough meals so that they can really build back their muscle and they can kind of maintain that optimal functionality of their body?

I think the best way I can describe it is they’re looking to maintain the optimal fitness level. They’re also getting enough sleep. If you’re a world-class athlete, you can’t just scrimp on sleep because when would your body recover, especially if you’re doing so much activity?

So hopefully just the reminder that when you are working out a lot or exercising a lot, whether you think it’s exercise or not, you want to make sure to up the self-care to really take care of yourself.

And I think the last piece I feel that we can learn from the study is that it’s possible to have problematic habits related to exercise and diet but still have a menstrual cycle. So I think that’s really important to remember.

And this is a really interesting and it’s a broad topic because I feel like most women in this day and age, in this culture that we are living in, most of us do face this issue to some extent because what our culture tells us is beautiful are often very, very skinny, lean individuals — and this quote “perfect body.” Really, when we think about what is the body image that is presented to be optimal, it’s a body of a very young person. I feel like often a person who hasn’t necessarily had children, because we really don’t have that allowance for just the shape and a figure and tummy and all those different parts of the female body that do shift as we get older and do shift once we’ve had children and things like that. So it does create a very unrealistic expectation that affects all of us to some degree.

And the women who’ve lost their periods, women with HA, I feel are often the canary in the coal mine. They’re kind of telling us how bad it can get, you know, how bad our societal expectations are of women’s bodies, to put us to such an unrealistic ideal.

So, you know, I’ll kind of leave it there. I’m not going to go too far into the weeds about the body image piece of it. But I just wanted to share the study with you today because I thought it was a really interesting also kind of follow-up to the previous couple of episodes where we’ve been talking about this concept. And I always love to bring the menstrual cycle into this topic because I feel like the menstrual cycle is a great equalizer. The menstrual cycle doesn’t lie and it tells us what’s really going on.

And so even if you’re telling yourself a story about how, “I’m eating more than enough,” and, “definitely not over-exercising,” if you have an eight-day luteal phase and you don’t have any cervical mucus to show when you can remember a time when you used to see mucus pretty much every cycle, then that is information for you that you shouldn’t ignore. And the actual real-time data should be challenging whatever story you’re telling yourself in your head, because ultimately, if your hormones were optimal and if everything was great in your body, your cycle would fall into those normal parameters.

So if you can think of somebody who you think would benefit from today’s episode or you think would be interested, make sure to share it. You’ll find the show notes page for today’s episode over at fertilityfriday.com/459. If you are really loving the FAMM Research Series or if you’re new to the series, you can head over to fertilityfriday.com/research and you’ll find a list of all of the episodes in this series. And so I hope you have a wonderful week, weekend, whenever you’re tuning into the show. And of course, as always, until next time, be well and happy charting.