Hypothalamic Amenorrhea Recovery (Episode 462)

Full Transcript: Episode 462

Lisa: This is the Fertility Friday Podcast, episode number 462.

Lisa: Welcome to the Fertility Friday Podcast, your source for information about the fertility awareness method and all things fertility. I’m your host, Lisa Hendrickson-Jack. I’m the author of The Fifth Vital Sign and the Fertility Awareness Mastery Training Workbook. I’m a certified fertility awareness educator and holistic reproductive health practitioner with over 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting, balancing hormone health, and optimizing the menstrual cycle without hormones.

I have been consistently outspoken about hormonal birth control over the past two decades and its impact on fertility and overall health, because you have the right to know how your body works and how artificial hormones disrupt that natural process. I teach women’s health professionals how to utilize the menstrual cycle as a vital sign in their practices, and I host live coaching programs to help you achieve optimal fertility and health, because it’s important to have healthy menstrual cycles regardless of whether or not you want to have babies. I’m also a wife and mother of two beautiful boys and a brand new baby girl. This podcast is designed to empower you to take full control of your cycles, your fertility, and your overall health. And I’m so excited that you’re here with me today.

Lisa: In today’s episode, I’m sharing an interview that I did with two of my previous FAM practitioners. And this episode is all about HA, and it’s a really interesting mix of professional and personal experience, as both of these FAM practitioners have gone through and experienced HA themselves and have also experienced the journey to bringing their periods back, and the struggles to maintain healthy cycles, and the ebbs and flows of the HA journey.

One of the things that I’ve learned throughout several years of working with a variety of clients, including a number of HA clients, is that not all women on the HA spectrum, as I term it, fully lose their periods. There’s plenty of women who are on that spectrum somewhere who potentially are exercising a little too much or eating a little too little and have not yet fully lost their periods, but are certainly showing the signs of under-eating or over-exercise or a combination of both.

And I feel that this episode is just so interesting because it really delves into that territory. The territory of the HA spectrum, what this really looks like in real life for women who are wanting to overcome this, and for women who’ve lost their periods, why getting your period back is actually not the end point — it’s the beginning of a new journey of maintaining healthy cycles. And of course, as both of my guests are FAM practitioners, we are also gaining a specific insight into the role of the menstrual cycle in helping us to navigate this stage.

I’ve interviewed both of today’s guests before — Holly Leever and Dani Sheriff — and so I’ll go ahead and introduce both of them, and I’ll also make sure to link their previous episodes that they’ve joined me on in the show notes page.

Holly Leever of Rosebud Wellness is a licensed acupuncturist, herbalist, yoni steam therapist, Arvigo abdominal massage therapist, and fertility awareness method educator. She works with women to optimize their menstrual cycles and fertility. She is especially passionate about working with women in the perinatal time. She works with menstrual cycle issues, fertility challenges, gynecological concerns, pregnancy symptoms, and postpartum recovery. She also hosts a weekly podcast called Womb Wisdom, which is a combination of information on women’s holistic health practices and stories from women on their experiences with menstruation, fertility, pregnancy, birth, postpartum, and motherhood.

Dani is a board-certified functional nutrition counselor and certified FAM practitioner. Dani’s niche is coaching women with hypothalamic amenorrhea — HA — to recover their missing periods and their zest for life with a mixture of holistic nutrition, lifestyle, and body image counseling. Dani fell into this line of work after being an athlete and chronic dieter for many years, when she discovered that her overtraining and under-eating was the cause of her declining hormonal health. She made a pivot to learn all she could about hormones, the menstrual cycle, and the connection between chronic dieting, exercise, and women’s declining fertility. She is the host of the Hypothalamic Amenorrhea Podcast and founder of The HA Society, a support community and coaching practice for women who want to get their periods back. Dani and her business partner have developed the Holistic HA Practitioner Certification and accredited coaching certification specifically to train more people to help women with HA.

So without further ado, let’s go ahead and jump into today’s episode with Dani and Holly.

Lisa: So I’m really excited to be here today with two of my favorite people. So I’m here today with Dani Sheriff and Holly Leever, both practitioners, FAM practitioners who’ve graduated from the program. And today we’re talking about HA, which I’m really excited about because I feel like Dani and Holly, you both have such an interesting perspective — both a personal perspective and a professional perspective — but also through the lens of the FAM program, which is highly focused on the menstrual cycle. So I feel like this is going to be a very interesting conversation about HA that maybe a lot of the listeners haven’t necessarily heard before, like from this perspective.

So before we jump in, let me give both of you an opportunity to just introduce yourselves. Maybe share a little bit about — like Dani, just maybe to share — you’ve been on the podcast a few times so we can certainly direct the listeners to previous episodes with you, but just give us a rundown of what you do, maybe your own history with HA, and then I’ll flip to Holly and we can do the same.

Dani: Yeah, yeah, cool. Yeah, this is like my third time on the show, so I’m officially a friend of the show. So yeah, we call ourselves HA and fertility coaches with a really specific niche on helping women with hypothalamic amenorrhea get their periods back. So we work one-on-one with women and I run a community that does life coaching. So really just like in the weeds with all of these women having these conversations all the time, that’s what I do. And yeah, I completed Lisa’s program, I’m a functional nutrition counselor, and all good things.

Lisa: Well, and you had your own personal experience with HA, which obviously led you to kind of do this work. And since then, your daughter’s over a year now, maybe almost two?

Dani: 18 months, yeah.

Lisa: Yeah. So I’m sure we’ll get into some of that, but it’s interesting — you have the experience all around and also bringing your period back postpartum as well. So I’ll let Holly jump in and share a little bit about your background too.

Holly: Sure. So my business is called Rosebud Wellness and I’m an acupuncturist and herbalist, and I also completed the FAM program. I do some other holistic healing modalities and focus on women’s health. I don’t specifically focus on HA, but I have an extensive personal background. I had anorexia pretty much starting when I was a teenager and then first sought residential treatment when I was 29. And my daughter is almost three, which is crazy, and I just got my period back during the FAM program this last year in September. So it took me some time. So I kind of got back in the HA space a little bit postpartum too. So, yeah.

Lisa: Well, so I thought this conversation — this kind of union of great minds in this topic — would just be really beneficial to kind of flesh out some of the nuances. I think part of the reason I thought to do this conversation is, Dani, you and I just had lots of conversations over the last two years around HA, and I find it really fascinating to hear your insights into HA. So that’s why I keep asking you to go back on the show. And similarly with Holly, I feel like we’ve had just so many conversations kind of in private about HA and the different nuances.

And so this is like my excitement place where I get to bring both of you together and have those conversations. So I feel like maybe a good place to start might just be — both of you have a go on it, whenever there’s more than one person on the show we just kind of have to jump in where we fit in — but maybe share a little bit about the difference, or maybe even just get into some of the conventional ways that HA is often addressed. I think around the food and the eating pieces of it. And maybe Dani, you can share a little bit about how your program is a little bit different, but help us to understand how this is usually addressed. And Holly, I feel like you can jump in also to kind of share how it’s often addressed and why some of those things can be problematic.

Dani: Yeah, I’m so excited to talk about this and hear Holly’s perspective on it too. But I think the answer to that does tie a little bit into what we do and why it’s different, and it’s almost why I do what I do — was realizing there’s a gap.

When I had HA and I discovered that in my research, the advice was this concept of “all in,” which was developed by Nicola Rinaldi based on research. Like, it makes perfect sense — it’s a refeeding process where you stop all energy expenditure through exercise and you eat everything and anything, especially if you’ve ever restricted it in the past, with actually a strong emphasis on calorically dense, nutrient-poor food.

This is for a variety of reasons. Mostly, that it’s super high calorie — which, hypothalamic amenorrhea is an energy deficit. It is a lack of calories coming in. So it makes sense that you would just eat a ton of calories — you know, junk food, candy, soda, things like that — that honestly a lot of people with HA have just cut out completely of their diet. Orthorexic tendencies are super common — only eating super clean foods, quote unquote, and just like, “I don’t eat sugar” is like a statement.

So bringing all of that in as a way to get your cycle back as fast as possible, gain weight probably as fast as possible, and that’s it. Like, it’s super simple. And the challenge though — we say this all the time — is like, getting your period back is actually really easy if you look at it from that perspective. So why is it so hard? And that’s because doing those things is just — some of us, it’s absolutely impossible. Like, I have had multiple conversations with people who will attest to like, there is absolutely no way you will get me to make that complete 180 in my habits and beliefs and mindsets around food, for so many different reasons that we could get into.

But at the end of the day, the conventional advice right now and what seems to be the most acceptable thing to do is to promote: sit down, don’t move, and eat as much food as you can from poor food sources. And any advice around getting your calories from a place that’s serving you nutritionally and nourishing you — I wouldn’t say people get upset about it, but it would be considered coming from a place of diet culture still. So the area can be quite touchy. But I think that’s my perspective.

Lisa: So interesting. Yeah, so Holly, maybe share your perspective. You said you shared something also really interesting before we hit record.

Holly: Yeah, I mean, I very much can relate to what Dani’s talking about — the all-in perspective. And I think the addition that I can add to that is from the eating disorder perspective, of having been really pretty ill and pretty severely underweight.

The first time that I went into residential treatment, I remember that they have a very similar perspective in conventional eating disorder treatment, of just like, everybody eats the same thing. It’s a lot of processed foods, kind of crappy quality meat and dairy products, just like whatever’s affordable, I guess, and not really paying attention to nutrient quality at all. And there’s a very strong emphasis on weight gain — like, part of what you’re doing there, they give you weight goals in increments of ten. And it probably depends on the program, like exactly how they structure that and how much they emphasize it, but I know that it was pretty strongly emphasized in all of the programs that I went to.

So there’s this “gain weight at whatever cost,” and there actually really isn’t that strong of an emphasis on the period part of it. I think that was a personal interest to me because I was already an acupuncturist the first time that I went, and I knew about this fifth vital sign — it’s a big part of Chinese medicine for women’s health. So that was something that was important to me, but there was never an emphasis on optimizing your cycle. Of course, we didn’t talk about that at all.

So it is just sort of the same perspective of this “all in” — sit down. I remember I would sit with my feet together like with my legs kind of spread out because I’ve been a yoga person forever, and they would not let me even do that because they didn’t want me doing an exercise or whatever. You couldn’t stand for long periods of time, and then it was just like, fill your body, gain weight, eat all the food, eat the things that you’re afraid of.

And then the other part of it that I was talking about before we started recording is the refeeding process. Which, for anybody — and I was saying before that it’s sort of a spectrum of eating disorder, disordered eating, where people fall exactly — I don’t know where it starts to matter, but I know for me, if I had just said, “Okay, I’m going to go all in and I’m going to start eating the 2,500 calories” which they recommend, I could have really damaged myself.

I don’t know if it’s exactly the same thing as with alcoholism, but there’s a certain point where if you just stop cold turkey, it’s not good for you — you have to titrate. In the context of food, I needed to slowly start incorporating foods, because if I did just kind of start eating everything in sight and following the all-in guidelines, I could have suffered with refeeding syndrome. And I actually had to go and get blood work — I think I was going weekly for a couple of months to check my liver enzymes to make sure that I wasn’t going into refeeding syndrome, because of how severely I had been restricting.

So for somebody with an eating disorder who’s in the HA space and they’re like, “Yeah, I don’t have a period and that’s a problem,” and they’re reading about this stuff and they’re like, “I have to just go all in and start eating 2,500 calories and I can’t move my body” — that could potentially be dangerous. So I just kind of wanted to highlight that. It’s not something I’ve really heard people talk about in the HA space so far.

Dani: And I’ll second it. We see elevated liver enzymes on labs in people in recovery a lot, which can be concerning for people. And I think one of the things that — to put the cherry on top for the challenges that this issue brings up — is there’s no forward-moving skills that are developed, and tools that are developed, for reintegration. Like, if you do get your period back by eating a metric ton of calories every single day, well, okay, that’s great, but now how do you get out of that situation? Because that’s a lot of work and it’s not sustainable.

Lisa: So this is really interesting for me. I feel like when I think about what this approach represents, it’s kind of more of the stereotypical allopathic medical model, or just the way that we boil things down to the simplest parts. So, “Oh, this is just a calorie problem — we just need more calories.” It’s very much like a math equation — like, “Okay, so she’s not getting enough calories, let’s just get her a bunch of calories. She’s exercised too much — obviously we need to get this whole situation organized, so we’re just going to say no exercise.”

I feel like that’s interesting because it’s a very simplistic approach. So I guess the question that I want to ask out of that — because regardless of whether the person in question who’s lost their period for six months or more, regardless of whether that person has an eating disorder, like an actual diagnosable eating disorder, or there’s disordered eating patterns happening, usually there’s some sort of issue there.

So one of the arguments I’ve heard for an approach like this is that, well, you can’t really restrict anything, because if you restrict things, then you’re just enforcing and supporting that eating disorder or disordered eating pattern. I’m not saying I necessarily agree with that, but I think that’s a fair point. If we’re still restricting a whole bunch of stuff and saying that there’s good food and bad or whatever, are we enforcing that?

But ironically, Dani, what you said hit pretty significantly — which is, well, what skills are we helping to foster if we’re just endlessly eating everything, knowing full well that this is not a sustainable way to live? So maybe you can each comment on what your thoughts are on that, because it seems like a nuanced topic.

Dani: Yeah, I think relearning or re-establishing your relationship with food is actually the cornerstone of the work that we have to do. For some people, it might be re-establishing their relationship with exercise or something else, but for the most part, it’s people who have developed fears and rules and guidelines and deep, deep structure. And it’s not necessarily that on their own those individual rules that they’ve brought in are a problem, but collectively they’re all adding up and they’re all sort of bringing you towards not eating anything.

Whether it be you lost your cycle because you have had really bad gut issues and you just eliminated and eliminated until there were three foods that you could eat, or you really wanted to lose a bunch of weight and really want to maintain a certain body — and nine times out of ten, it’s that at its core. And it might even be hidden beneath — some people, it’s beliefs that, “It’s actually my digestion” or “This is actually how I feel better.” But at the end of the day, it does mostly seem to be about body image.

So what’s fascinating is having to have a lot of conversations and unpick or pick apart more of why these rules exist and what the meaning behind them is. So it’s not so much that eating too many carbs is bad or eating too much fat is bad, but for someone, it’s often about what it means if you eat too much of those things — that it should be linked to science and facts and reality, but it’s usually just coming from a place of fear about my worth and how I’m going to be seen and how I’m going to be valued based on my body.

I don’t know if this might not be the answer that you were expecting, but that’s sort of what comes to mind when I think about it. You have to approach it from the mindset and the beliefs and what people’s goal was with the restriction in the first place, and actually unpack that. Once that’s done, it’s actually quite easy to build a healthier relationship with food back in, without ever having to say something is inherently good or bad. Does that make sense?

Lisa: Yeah. So I mean, I’ll paraphrase then. It sounds like what you’re saying is that women who have developed these habits of restricting food — they’re obviously doing it for a reason. We all know that. And you’re saying that oftentimes it’s to do with body image, which is what I found as well. It’s often to do with wanting to maintain or achieve a certain body type. Obviously there’s nuances in there, but that’s kind of a common thread. And so what you’re saying is, if you kind of unpack the why this is happening and work through some of those things, then we can start working on improving the relationship with food.

Dani: Yeah, I feel like you’ve helped me kind of sum it up a little better. You’re not really afraid of fat, you’re not afraid of carbs — you’re afraid of what you think they will do or what you think the outcome will be. So stuffing yourself with Oreos is probably not going to resolve that part. And so what are you going to do when you get your period back and now you believe you’re recovered?

Holly: Yeah. I mean, that is totally my experience. And mine was in the context of a treatment center, but it’s kind of irrelevant that it was — it could be anywhere. But it feels like the same thing.

And yeah, I left there feeling terrible in my body. It wasn’t just about body image — I just felt unhealthy. I didn’t feel strong and vital and good. And my period was really painful, and it did come pretty regularly, but I wasn’t tracking to the extent that I track and chart now. So it’s hard to know exactly how optimal the parameters were of my cycle.

But I think that is a big piece that’s missing — that it’s just weight gain at whatever cost. And I do think that outside of the weight part of it, it is kind of like exposure therapy of just like, “Oh, you’re scared of pizza — you have to eat pizza in order to face that.” And I think, like you’re saying Lisa, there’s a certain amount of that that’s kind of true. It really is good to be able to incorporate a variety of foods and not make decisions based on fear. I even remember saying something to you about like, people inviting me to things and there’s not food that I’m comfortable with, or like a kid’s birthday party — it’s always pizza and cake. That is still something that’s uncomfortable for me.

And I think that in ultimate HA recovery — or eating disorder recovery — a person would be able to incorporate all different kinds of foods when it sort of makes sense and it’s appropriate. But I don’t think that it’s an all-day, every-day, just stuffing your face full of Oreos and not being able to go for walks that make your body feel really good.

So yeah, I think that’s a big part of it — that it’s not sustainable in a lot of ways for long-term health. But also, for me, it wasn’t sustainable for me to continue doing that. I went home and immediately started restricting again and fell flat on my face in my eating disorder, even harder than I ever have before, because I had been pushed so far in the other direction and felt so awful that I was just like, “I’ve gotta reel this back in” — and went even deeper into restriction and controlling my body.

I think I’ve been through that a bunch of times — these kind of extremes on either side. And what I did this time — which this is the first time I’ve ever been able to get my period back outside of the context of a treatment center — was applying what we learned in FAM. And for me, that was a really strong emphasis on protein that I didn’t even realize.

They’ll talk about vegetarian diets, like, “Oh, nuts are a good source of protein and beans are a good source of protein” — all these things that vegetarians learn about why it’s okay to be a vegetarian and you don’t need to eat animal protein. What was really so helpful for me in the FAM program — which I share with everybody that I work with too, and then leave the decision up to them — is how many nutrients are missing if that is primarily what you’re using for your protein source, and how hard it is to get up to the 80 to 100 or 125 grams that really is needed for women of reproductive age. That was obviously not something that was emphasized in the HA recovery space that I’ve seen so far.

Lisa: Yeah. I mean, this conversation is so interesting. I feel like what I’m hearing is that within that HA recovery space, the goal is just to make her bleed, essentially. The goal is to get the period back and that’s it. What’s different and more nuanced in the work that we do within the context of FAM is that we have broader goals. My goal with the client — sure, to get the period back, for sure — but what really is the goal?

Like Holly, when we were working on this postpartum — the goal isn’t just to make you bleed. The goal is to set you up so that you can sustain a healthy cycle. We’re looking broader than that. We are aware that if you have no period for an extended period of time, that also puts you at a greater risk of developing osteoporosis and other health issues, and the progesterone issue and those kinds of things. Knowing that you’re postpartum and also knowing your multi-year history of disordered eating patterns, we also know that you may have some nutrient deficiencies that have piled up that need to be addressed.

So it’s interesting to think about how having a nuanced conversation like this pulls it away from just doing whatever we can to get the period back as soon as possible, and moves into how do we set up these women to come into a more sustainable pattern. And I mean, Dani, I know that all of your clients aren’t trying to conceive, but maybe you could share a little bit — a lot of women who are in that space of really trying hard to get their period back are doing it so they can get pregnant, right? So what’s the point of forcing this calorically dense, nutrient-poor situation? We need to be focused on both things.

Dani: Well, yeah. I mean, if you’re trying to get your period back just to get pregnant, you’re definitely missing a majority of the picture, and the focus is very narrow. But sometimes that’s how people need to find out that there’s a problem at all, and I understand that.

And it’s like, there’s this side of the spectrum — I loved everything you were saying, Holly — where I’ve actually never had a client who’s gotten a beautiful, textbook-looking cycle operating on the all-in method. Or the other option, which is getting your period back on super nutrient-dense, super calorically dense food — meaning it’s Instagram perfect, all of their meals are colorful and beautiful and filling, and you’re like, “Yeah, they’re checking all the boxes.” Their cycles are also not optimal.

And it’s those who can go to the party and eat the pizza that seem to have the balance that is necessary. Which is interesting to me, because it says that there’s some information that we don’t quite have — that we’re very science-based in this calories-in approach, but there’s something about mindset and the restriction in your head that’s still happening. Even if you have the calories coming in, there’s a level of restriction and stress and panic and rules and rigidity around food that is stopping you from getting typically the ovulation or the luteal phase that you’re looking for.

Which, you know, to your protein point — I’m so annoying with protein. Sometimes I worry everyone’s going to find out that protein is all I’m telling people, and I’m going to get outed as the protein girl. But it’s true — it’s just like, how many times do you look at someone’s food log and you’re just like, “Well, here we go, let’s try some protein — see what happens.” It’s like magical.

Lisa: Yeah, it’s so interesting. So maybe share then, from both of your perspectives — Danny, basically what we’ve done so far in many ways is talk a little bit about how HA is traditionally handled, which is basically this forced feeding thing, which I feel again does make sense theoretically. If we look at this as a math equation — she’s not eating enough, let’s just get her to eat more, right? However, there’s so much nuance.

And another thing that came to mind as well is I mentioned the goals, but from my perspective, a part of that goal is to have a healthy menstrual cycle and have hormonal balance. And so it’s very ironic — there’s no other type of client who you would literally tell to eat pizza and ice cream all day. Like, there’s no other situation where this would be the advice.

I do understand — I feel like there should be — it should be okay to eat pizza and have ice cream. It should be okay to do that, and it should be something where you don’t feel like you can never do that. And that gets into the complicated issues of the restriction and the rules and that kind of thing. But for that to be the sole strategy — like chips, pizza, ice cream, Coca-Cola, pop, or whatever — I mean, anyone can see that that’s problematic and not sustainable for the long run, especially when you have a population of women who specifically were restricting for body image.

So yeah, I would love to hear your perspective on that and the sustainability of it, and also what do we do instead?

Dani: The sustainability piece — yeah, I think it’s obvious. It might sound exciting in the beginning to go and eat pizza for every meal, but you’re going to get over that fast. And I’m having a lot of conversations like, “I don’t want to eat anymore. I don’t want to eat anymore.” And when that happens, we try and find a way — we’ll dive in and look at, “Okay, well, why are you feeling so uncomfortable? What are you eating a lot of?” And if we do find it’s because it’s a lot of pizza, chips, and burgers and stuff, it’s like, “Oh, now I see why you’re feeling bloated, having stomach pains, and feel like you can’t stomach anymore.”

So from a practicality standpoint, you will burn out on food. From a nutrient standpoint, you will cap out on diverse nutrients that you need. But I think one of the things that is most important is that aspect of — do you want to get your period back, or do you want to ovulate and have a beautiful cycle and have low to no period pain every month? I think that’s really, really valuable, because I don’t want these people to get their period back and then be like, “You know what? I changed my mind.”

And when we think about hormones, it starts with blood sugar. It starts with cortisol, starts with insulin. And how do we manage that through diet? So I love bringing it down to like, “Well, the reason you’re coming to me — you have HA, but you also report perfectionistic tendencies, you report anxiety, you’re very stressed, you report fatigue, you report your hair is falling out, you report a lot of these things.” When I’m going through the paperwork, I’m just like, ticks boxes for all — for all, often.

And if we want to address those symptoms at the same time — let’s just balance blood sugar, because that is what’s going to allow cortisol to get on track, which is kind of going to let the body do the rest when it comes to getting all of the other hormones, the reproductive hormones, into gear. So it’s like, we could just try and see if the body figures it out, or we could give it exactly what we know it needs to do the job itself to its maximum capability.

So it feels logical to me from every aspect to actually just re-educate people on what a healthy meal looks like. It has protein, carbs, and fat. Does it always have to be healthy? No. But it should be substantial, it should probably vary, and it should include animal proteins. And those are the basics. And oftentimes we can get amazing results.

And I honestly never seem to have clients who are like, “Okay, I’ve got my period back and I have extreme period pain.” They always come — because sometimes I work with people who have recovered but the cycle is still finicky, and they just want to work with me because I get the history. And I’ll notice they took that sort of all-in approach prior. We change where the food is coming from, we see improvements in period pain and in the cycle parameters. So that’s the approach that I take almost every time. I mean, unless you’re missing your gallbladder — I’ve had clients who haven’t had stomachs, things like that, where things get more nuanced. But other than that, that’s the approach I take, and that’s why.

Lisa: Well, Holly, you shared a little bit about your experience of that exact thing, where you added in all the stuff and then you didn’t feel good at all in your body. And you also mentioned that your periods were painful and those kinds of things. So yeah, feel free to chime in and share a little bit about it.

What’s interesting in your case is that you had the experience of being in a treatment center and doing exactly what they said to get your period, and it worked — you did get your period back. Versus last year postpartum, we worked together for quite some time. And the interesting thing that I kind of pieced out of what you both had talked about is that, theoretically, you could get your period back a lot quicker if you did do something like that — like this kind of all-in approach. And Holly, when your period came back last year, it was not this thing that happened right away. It was not this fast thing that you just changed up for a month or whatever. So maybe share a little bit about, from your perspective, what approach kind of makes sense to you now after everything that you’ve been through.

Holly: Yeah, I’ve actually gone through maybe four or five separate times that I’ve had to get my period back. And I was recalling my most recent period before I got pregnant with my daughter — I remember being up in the middle of the night burning moxa, which is an herb that acupuncturists use, over my belly. I could not sleep because I was in excruciating pain. And this was from, really, I think just because I wasn’t prioritizing protein. I was vegetarian at the time. And even the cycle that I got pregnant with my daughter, I ovulated day 40-something. So before I got pregnant, I really still hadn’t gotten fully out of the HA spectrum, really.

So then when I started the FAM program in January of 2022, I think I was kind of a little slow to start. I can’t remember exactly when I started really trying to go for getting 100 grams of protein every day and eating animal protein multiple times a day, stopping caffeine, taking the liver capsules — there were so many different things that I changed. And I didn’t get my first cycle until September. So it took a really long time.

And even when I could see that I ovulated, my ovulation was sort of pathetic-looking — the progesterone levels just really didn’t get too high. And when my period came, I was sort of couldn’t believe it because it was so uneventful. It was just fresh red bleeding, a little heaviness, but it was not painful, no symptoms. I got a little emotional, but it felt good — like I’m connected to my emotion, and I felt sort of sad and introspective and quiet, but it was awesome. It was exactly what I was hoping for when I started bleeding again.

And then I had a few more, and none of my cycles have been optimal so far. And I think the missing part for me is what Dani was sharing about — that I do have these sort of “Instagram meals” of wanting everything to be really perfect and healthy and exactly balanced. And I think that can get you to a period, but I think that having — and there’s so many people that don’t track their cycles to the extent that we do in the context of FAM that would never know that their luteal phase — like my last luteal phase was ten days. They wouldn’t know that that’s a problem. They would just think, “Oh, I had a 32-day cycle” or whatever. But I know that I ovulated pretty late — I don’t think it was 32, I think it’s been like 40 days. I ovulated late and I had a short luteal phase. So that’s still happening for me.

So I’m still sort of in this discovery zone of what exactly is going to be the thing for me. And I think stress is another thing. I saw you post something, Dani, that I really loved on Instagram — it was something like, “Could it just be stress? Like maybe I don’t have to eat more” — or something like that.

Holly: Because I told my husband that I wanted a divorce in September and he moved out, and I immediately ovulated. So I do think that stress is a part of it — that I just had this overarching stress in my life sort of every single day. And I think that for anybody that has HA, it’s usually a combination of over-exercise, under-eating, lack of nutrient density, and then also stress in a variety of forms. And it’s sort of just this mixed bag of what is going to be the thing that makes a difference for you.

But I think that my system is so sensitive — because, and we’ve talked about this Lisa — I’m like teetering on the edge of just being enough to get a cycle. And so I think for women with HA, if they’re just sort of like, “Okay, I got my period back, hooray” — it is kind of, you’re in it for the long haul. You have to keep at it every single day. And I don’t mean to make it sound like it’s bad — it’s pretty much everybody has to do that in order to live a healthy, happy, vital life, to prioritize taking care of themselves. But I think for people with HA, you have this tendency for this specific alarm to indicate to you that something’s wrong.

Dani: Yeah, the first period is really just the start. And people kind of think it’s the finish line. And they realize, “I’m more stressed about getting the second cycle.” And there’s something interesting that happens in your brain where, as soon as I have that first bleed, “I no longer have HA.” So now there’s not something objectively wrong with me that gives me the permission that I need to eat this food. And now I must run back in the other direction because that’s all I know. It’s tricky.

And that thing of being sensitive — this is such a good point. We will have a different allostatic load — our body’s individual ability to handle stress and then maintain homeostasis. You don’t just have that back after your first cycle. Of course, it is definitely a gift from your body to be like, “All right, we’re going to dip our toe out, we’re going to peek and see, we’re going to say hi — but if stuff goes south, we’re out.”

And it takes you a year, you know, of straight intentional eating in order to then be able to not think about it so much. Because that’s definitely what happens — we’re coming into this with the tendency to run back the other way, and we have to be on top of it. And this is why we’re always asking about the stress thing. Yeah, it can be stress, but it’s usually not — because you could handle that situation better, often, with a better relationship with food at a higher body weight.

We have found that your ability to tolerate stress — it’s like a sliding scale. If you’re a lower weight, less ability to tolerate stress. Higher body weight, higher ability to tolerate stress. So we can say stress is an indicator, but it’s like we’re allowing ourselves to do the bare minimum needed to recover — to keep this super healthy lifestyle or this super lean body or whatever it is — that we’re not really recovered. We just got a period.

Lisa: Totally. Exactly. Well, and there’s language that you’ve both heard me use quite a bit in the FAM program, which is women who don’t have HA, but I would say they’re on the HA spectrum. I say that a lot. And what I mean by that — if it’s not a thing, I just made it a thing — but what I mean is women who have not lost their periods but do essentially the same types of behaviors that women with full-blown HA do. So over-exercise, under-nutrition — eating not enough to cover their expenditures — and possibly the stress piece as well. Often for the same reasons: to maintain a certain body image, to either lose weight or maintain a certain body weight.

So it’s not enough — they haven’t done it enough to lose their periods. But when we’re tracking in the way that we track in the FAM program and the way that I work with clients, we can see the signs. We can see disrupted ovulation, sometimes it’s low mucus patterns, sometimes it’s a short luteal phase or issues in the luteal phase — all that kind of stuff.

And so it’s really interesting, because Holly, as you were talking about your experience, first thing that should be really clear, hopefully, to everyone who’s listening, is that you have come just so far. I think you had commented to me that this was the first time that you were able to bring your period back without being in a recovery center. And this is not something that you dealt with on a Tuesday afternoon. This is something you’ve been dealing with your whole adult life.

If I remember correctly, before we first worked together, you had just got your period back after like three years of not having one.

Holly: No, I think it was more like ten.

Lisa: Okay, yeah. That’s huge. So actually, what it was is that I went into treatment in 2015 for the first time, I got one period, and then — but before that, I hadn’t had it for ten years. But then I started getting it regularly when I met you for the first time in the Fertility Awareness Mastery program.

Lisa: Yes, that’s so interesting. So if we put that into perspective — I mean, I’ve often heard people say, if you have a chronic health issue and you start addressing it, if it took you five years to get to this point, give yourself at least five months. And so from that perspective, it actually makes perfect logical sense that you wouldn’t just be able to out-eat this problem and just eat a bunch of crap and get your period back and then you’re fixed — because this is more than that.

And Dani, it was something that you said — like, what do you do now? Right? Like, now you’ve got your period back, where do you go from here? It is completely new territory. And I found that it’s very, very triggering.

This thing with the period — so I always love the period, anyone who’s listened to this podcast for a while knows, because it gives, in my opinion, an objective, individualized marker for each woman. Because there’s certain things that you or I would need to do to get our cycle to this place where it hits those parameters. It doesn’t mean our cycles are perfect — it means that they fall within normal parameters.

And so now one of the great things, Holly, that you’ve been able to do is now you are in this relationship with your cycle and you can see. And I think there’s a lot of reassuring pieces in that — you actually don’t have to have it all figured out or do everything perfect to have a period. So I think that’s reassuring. And as you’re going through this journey, you are learning so much, you’re seeing how far you can push it. And this is what real life looks like.

I don’t know if you want to comment on that, Holly, but I feel like there’s so much value in this kind of imperfect, cycle-to-cycle relearning of how to eat.

Holly: And I think — yeah, I’m trying to be concise about the way I say this, but I just have so many thoughts. I feel like a lot of my life, I’ve given my power away to practitioners or providers, of like, “Tell me how much I need to eat, tell me how much weight I need to gain — like, what do I need to do?” And the period has been sort of like a central piece for me because of this Chinese medicine background.

But it has always been this sort of outsourcing of my power — of wanting somebody to tell me what to do. And I think, I don’t remember exactly which session I had with you, but at a certain point — maybe it’s just having been exposed to your work for so long — but the chart doesn’t lie. My chart isn’t giving me a short luteal phase because it’s trying to trick me into eating pizza. My chart is an objective measure of: what you’re doing is moving you in the right direction and it’s still not quite enough yet.

And that is why I feel so passionate now about teaching other women fertility awareness, because there is so much missing if the only thing that you’re looking at is when you get your period and when you get your next one. There is so much information in looking at all of the parameters of the cycle that I would really — like I said before — I would be missing all of that.

I can even remember when I conceived my daughter at that time, because I had had like five periods in a row or something, I was like, “I’m awesome. I’m totally recovered from my eating disorder, no problem. I’m absolutely eating enough.” But I would have like 60 or 80-day-long cycles. And just the fact that I was bleeding more than once in five years or whatever was a really big deal for me.

But I think it’s coming from this background of it just not being a part of my life. So it never really felt to me like it would be possible to have a monthly cycle. And now that I can see — I’ve seen it over the years — so pretty much since 2018, I’ve been really charting wholeheartedly, and I can see what I’m doing with exercise and with food completely impacts what shows up in my cycle. 100%. There’s no — nobody can convince me otherwise because I know, I can see the objective measure. So I hope I’m not repeating myself, but yeah, I mean, it’s been a lot to me to have that reflected back over the years.

Dani: I think what’s so helpful about using FAM with HA is because they do — we do identify — we do like to say, you know, what we feel or think or what our ED voice is saying is true. And you need to be able to always bring it back. It’s like, “Well, the chart — do you have a period?” A lot of like, “I think I already ate enough. I’m definitely weight restored. There’s another girl and she’s in the same running club as me and she’s my height and she runs just as much as me — she has periods.” So like, every reason to not have to do the thing, and unable to find reasons why.

And it’s always nice to be able to just bring it back to like, “Well, your luteal phase was only eight days, so I don’t know.”

Holly: Yeah. And I mean — even now, there will be days when I’m like, “You know, my daughter just woke up, I kind of don’t want to eat anymore. I’m just going to go and do this other thing, I don’t need to prioritize it.” And then I go back to the cycle and I’m like, I know my body is telling me for sure that what I’m doing isn’t enough. So I cannot cut corners right now.

Dani: Yeah, it stops you from BSing yourself.

Holly: Absolutely.

Lisa: Yeah. Well, and this is the beauty of the fifth vital sign piece. This is the heart of why I do what I do, because I feel like I’ve been privy all these years to have that for my own self, because I’ve been charting in that way for so long. And this is really what I strive to bring to women all over the place, because it really does — it kicks the BS right out the door.

And I’m pretty sure, Holly — I mean, we’ve known each other for quite some time now, and I can remember having conversations kind of along those lines, because you really made huge shifts. You added in so much. And I know at some point you said, “I’m eating more now than I ever have” — consistently, too. And we looked at the cycle, and I’m like, “Well, you still don’t have a period though.” So even though you’re eating more than you ever have in your whole life, it’s still not enough. And it’s not me saying it — it’s literally your body saying it and us just paying attention to what’s happening in your cycle.

So I think it’s so interesting, this conversation, because it kind of brings together the traditional approach, the nuanced approaches — like Dani, the nuanced approach that you’ve developed in your program — and marries it with the cycle. And the cycle, from my perspective, gives you this tailored thing, because everyone isn’t the same. And you can’t compare yourself to what someone else is doing.

It’s an interesting conversation that I often have with clients and practitioners as well — it’s not fair, because we know that there’s that woman out there who can eat what she wants. And I would throw in, of course, well, you don’t know what her cycle looks like.

Dani: Yeah, absolutely.

Lisa: But we look at other people and say, “Well, she exercises five to seven days a week and she still gets her period, so why do I have to cut down my exercise?” But the cycle kind of gets rid of all that chatter, because at the end of the day, I’m looking at you and we’re looking at your chart, and it’s like — if what you’re doing is working, then your cycle is going to fall into those normal parameters. Again, we’re not looking for a perfect cycle. We’re just looking for it to fall into those parameters, and there obviously is wiggle room in there. And yeah, it’s just so fascinating.

Well, as we start wrapping — I mean, I could have this conversation all day. I really enjoyed this conversation. I feel like we’ve really hit some important points and I’m really glad that we were able to get together and do it. But as we kind of start wrapping, I’d love to hear just any last thoughts that you have. Maybe Dani, we could start with you. If you have any thoughts around this, or after all these years working with so many HA clients — I feel like you put it real succinctly — but for the woman who’s listening, who kind of stumbled on this episode and she’s in that limbo phase, either waiting for her period to come back or maybe she’s had a period or two, what would you want her to know?

Dani: Yeah. Why not you? So usually it’s an issue of like, “Well, I’m weight restored, yada yada” — there’s all of these reasons that you have for why you don’t need to take this route, like you don’t need to put in this work, and you don’t maybe need to gain weight, and you don’t maybe need to eat more food. It’s a worth issue, often, and you’re just like, “It’s not me, I don’t deserve to do that.”

And if you have that conversation, if that’s a story in your head — you absolutely are the person to do it. It’s a story. You absolutely have to go down this route if you have a single excuse not to do it.

Lisa: Well, and I’m going to ask Holly the same question, but before that, I wanted to ask you a question, Dani, because remember we had a conversation around your own experience postpartum. And this — I don’t know, you can share as much or as little as you want. I just thought it was interesting because you’ve been in the field for so long, you’ve supported so many women, you’ve also gone through your own personal experience. But when — I think your daughter was a year or maybe more and you were still kind of waiting for it to come back — refresh my memory if I’m remembering things incorrectly — and we had a conversation about what that looked like for you. Which makes me think that it’s an ongoing thing for people. This is not something that we just fix and now we’re all perfect and we’re on the podcast and everything’s great. We never have to worry about it again, right? It’s not a thing. We’re all always having to work on our stuff. So anyways, I would love to hear your comment on that — I thought it was really interesting, just your own process there.

Dani: Yeah, I was fully weaned at ten months. My baby was ten months old, and I hadn’t gotten my period back. At six weeks I gave myself six weeks of making no changes — like, I’m okay with six weeks, no changes. But I didn’t even have any cervical mucus. I didn’t even have a change in sensation, you know — it was dry. So I kind of knew.

I know how to look at what I’m doing objectively at this point. It’s like, okay, maybe I’m doing this and doing that. And I brought it to the mentorship call and spoke with you guys about it as well. But it was no mystery — I just had a kid and wasn’t having a proper breakfast. I was just eating some of her leftover scraps. She’s got tubes now, but it was a whole thing — she was really, really difficult. And so I was just having coffee. I was just doing the things that are easy and comfortable.

And was there a part of me that was like, “I feel a little bit uncomfortable with some recent weight gain”? Yeah, there was. So therefore I was okay with essentially skipping breakfast. That belief reinforced the behavior.

And after the six weeks, I started kind of like, removed a cup of coffee, introduced a bit more food, things like that — wasn’t working. And then I called myself out on my BS, which just has to happen. And sometimes it’s slow, and that’s okay. But I did it. And then reintroduced the full breakfast, haven’t had a cup of coffee until way after breakfast since, and had like two months straight of cervical mucus. Every day was peak. Every day was peak. I was like, “What is happening?” And then I got my period.

But I can look back and see — I know exactly everything that was holding it back. I do have a level of sensitivity. I’m just not robust enough to skip breakfast and do those things. And sometimes I have to prove it to myself. But I always say, as long as you’re willing to look at it, you could try whatever you want — but you have to be willing to look at it and put a time limit on how long you’re going to give your approach to try before you say, “Okay, well, maybe I’ll do it the right way.”

Lisa: Well, and thank you for sharing. I mean, I think again it just goes back to how much I love the menstrual cycle and just how, when you’re attuned to it — what I love about it too is, when we had that conversation, it wasn’t really us saying anything. You already knew. And so we were just having a conversation about it. And obviously, your cycle responds.

So, in Holly’s words — the cycle doesn’t lie.

So same question posed to you, Holly, that I initially posed to Dani. For someone who’s kind of on that fence — whether they’re waiting to see if their periods come back, or whether it started to come back, or kind of somewhere in there, like it’s come back, they had to gain a little bit of weight to get it back, and now they’re really uncomfortable with that and wanting to run in the other direction.

Holly: Yeah. I mean, I will say that I think one of the things we haven’t really talked about that has been really important for me personally in being more comfortable in my body is actually inhabiting it. So it’s a little hard for me to describe, but essentially it’s embodiment practices.

We can be really caught up in our head and not even sense or feel what’s happening in our body. And this has been a long journey for me, starting with yoga. I mean, that’s also the exercise part to consider. But yoga — yoni steaming has been really, really profound for me in connecting with my womb, my deep inner knowing of like, I don’t have to look any certain way or be anything. I am feminine. I’m a woman. And I’m supposed to have curves. That has been really, really helpful for me.

The Beauty Myth I can highly recommend, too. And just looking deeper at why do you feel that your body has to be a certain way or look a certain way. So part of it, I guess, is being able to feel comfortable in your body.

Acupuncture too, I should mention — that has been a big part for me. It sounds kind of silly, like putting these needles on your body, why would that be helpful? But it has been really helpful for me. Even something like massage — just having somebody care for your body in a really loving, nourishing way can be helpful in learning how to respect your body for what it can do.

And I have a teacher that says, “Your body as an experience rather than as an image.” And that gives me chills all over my body every time I say it. It’s like — what would it be like to not think about what your body would look like in a picture or in the mirror, but just experiencing all of the sensations that are inside of your body? That is such a more pleasant experience for me. So I would just say, anything that you can do to get back in touch with what your body feels like — outside of what it looks like.

Dani: Can I be annoying and add to it, because I love it so much? Just — can you please get clothes that fit? So much of this process is like, “I feel uncomfortable in my clothes,” and that is a triggering event that makes this extremely hard. This is so important. It took me so long to learn — this is so important that in our coaching packages now, we have a personal stylist. And one of your calls is she helps you figure out your body shape, your style, and what to wear that works within your style. Because it’s so crucial. If there’s this embodiment — so important — and then respect it by putting clothes on it that fit and that work for you, it’s going to make the process so much easier. I can’t believe how long it took us to figure out that that needed to happen.

Holly: I love that. And actually, as part of eating disorder treatment, a lot of the therapists will go shopping with you. That is a big part of it — if you’re wearing pants, even if they still technically fit, if they’re pinching you in a weird way, it just makes you even more aware and builds distress about your body.

And I have gone through experiences of visualizing my body getting bigger and thinking of it as a good thing — expanding into my clothing, just as growth, as children grow. And it’s not a bad thing. You’re just a growing woman. You’re growing into your feminine, womanly form. And I think if you’re trying to wear these tight, skinny jeans, it’s not really so possible.

Lisa: I love that so much. I feel like that was really profound. I’m really glad that you jumped in, Dani, with that, because I don’t know that I would have thought of that. But I’ll just share something, hopefully it’s helpful. My daughter is seven months today, actually, when we’re recording. And with the third baby, my body definitely shifted from what it was before. And a lot of the clothes that I had before don’t fit the same. I don’t have hangups around buying clothes, so I naturally did buy a few different things, things that are comfortable, things that I feel good in. So when I put them on, I feel really good.

But I can really relate to how that makes you feel — like, if you have clothes that don’t fit and you try to put them on, and every time you put them on you’re reminded that you’re not the same size. That’s a whole thing that happens every single time you put on clothes. Like, that’s not going to work.

Dani: Yeah, well, you’re always very level-headed like that. You’re always very logical. But I love that, because you wouldn’t have thought about it, but it makes sense. Because you want to hang on to — it’s the end of the world to buy different size pants. But it’s not actually, and you can still look good in whatever size. But that’s like a whole other tangent.

Lisa: So before we jump into a whole other tangent, I just want to thank both of you so much for coming on the show. I can’t tell you how much I loved this conversation. So I really appreciate both of you coming on and hashing out basically all of this great stuff about HA. I know this episode is going to be really helpful for a lot of women who listen to it. I feel like we really talked about it in a different way than what I’ve heard in other places.

So before we run — Dani and Holly, maybe share again just details where people can find you. Website, Instagram, all the places, and if you have any fun things that we need to know about, let us know.

Dani: The Hypothalamic Amenorrhea Podcast — that’s me, my co-host Ashley. The HA Society is our practice and community, and The HA Society on Instagram.

Holly: So my business is Rosebud Wellness — rosebudwellness.com — and I’m at Rosebud underscore Wellness on Instagram. And I also have a podcast called Womb Wisdom. And I do have a holistic fertility awareness mentorship that I’m now offering after completing the FAM program, which is part teaching fertility awareness and using it as the fifth vital sign, and then I also weave in all of my acupuncture, yoni steaming, Chinese herb information in there too.

Lisa: Awesome. Well, I will make sure to link both of those resources and all of your details on the show notes page. Thank you again for being here.

Dani: Thank you.

Lisa: I hope that you enjoyed today’s episode. I just loved this conversation, and it was such a treat to be able to interview both Holly and Dani, getting their unique perspectives and experiences.

If you’re a long-time listener of the show, you’ll know that one of the things that I love to do is share the experiences of real women so that we really get a sense of what’s happening in real life — so that we don’t just spend all of our time in the theoretical realm talking about research and studies, which I also really enjoy, but so that we really get into the nitty-gritty of what’s going on in the day-to-day lives of women who are struggling with these issues.

And so I feel like today’s episode really shed some light on some of the different pieces of this conversation that we don’t always hear about — that real women are struggling with when they’re trying to overcome HA. And just the gravity of the situation, because HA is unlike many of the common health challenges related to menstrual cycle issues. It’s not an underlying condition that you have a genetic predisposition to, necessarily. It’s something that is induced by behavior — it’s induced by the combination of under-eating, over-exercise, and stress.

So for some women, it may be more related to under-eating, like in Holly’s case, although there’s a combination of exercise there. And in other women, it may be more related to over-exercise, as is Dani’s experience. However, there was a combination of both situations in each of their stories, as well as the stress component.

I think one of the key takeaways, at least from my perspective, for today’s episode is that when it comes to HA, it’s not just this quick, easy recovery. You just eat more — like a math equation — and magically it’s over and you never have to think about it again. It’s a process, it’s a journey, and it takes a while for women who are dealing with this challenge to really get a hold of it, to identify what the problem is, to face how much they really have to eat, how much exercise they have to let go, as well as their body shape. So there’s a lot of pieces to this that can be really difficult, and it’s often a process that takes quite a bit of time — even after the period is returned, because that stage is certainly not the end of the process. That’s merely the beginning. And then the journey continues to normalize menstrual cycle health.

And it comes as no surprise that the menstrual cycle is one of the tools I feel can be just so powerful. From my perspective, I feel like it’s essential for women who are really, truly dedicated to overcoming their HA, because as Holly puts it, she was always able to see what she was up to by tracking her cycles. She could see if she was going back into the under-eating behaviors — she could see it. She could see delayed ovulation. She could see luteal phase issues. And when she would tighten that back up, she would see those issues subside.

So again, the menstrual cycle does act as a real-time biomarker of your overall health. It is truly the fifth vital sign. And it can really cut through all of your thought processes around, “Well, I know how much I need to eat” and “That’s just ridiculous,” or whatever the case is. Your cycle really tells you if what you’re doing is working or not. And so I hope that that’s one of your big takeaways from today’s episode.

So with that said, 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!